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How ADHD therapy can help manage stress and work performance in Singapore.

Have you met Michael recently? He’s the bright, young, dynamic person at our office… I always thought of him as the person who’s the life of the party, and he genuinely seems to care for his colleagues… Aah, yes, the same person who unfortunately missed out a promotion this year… I heard his boss say that he definitely had the potential,  but it wasn’t showing up in his work. He would initiate tasks with enthusiasm but would lose interest quickly; turned up late for meetings, or even forgot about them, and frequently misplaced important files as his table was often cluttered.

Does this seem familiar? Do you recognise similar signs in yourself or someone else you know? These issues might be due to something known as Executive functioning deficits or disorder (EFD). Though symptoms start in early childhood,  the challenges might have been seen as the individual’s behaviour problems and not as a syndrome. Even as adults, many of those with EFD aren’t aware they have it — they just know that even everyday tasks can be challenging.

What is EFD?

Executive functions are the set of higher-order mental skills that allow us to analyse, plan, organise,  make suitable decisions, manage time, focus attention and execute the plan. No matter how smart or talented one is, not much will get done well without these key capabilities. The human brain comprises of two systems: the automatic and the executive.  While the automatic system guides 80 to 90% of our activities every single day, the executive system guides the remaining 10 to 20% and requires purposeful, regulatory effort.1

What causes EFD? 

Experts don’t know exactly what causes this and a 2008 study found that differences in these skills are “almost entirely genetic in origin due to differences in brain chemicals” 2

People who have executive functioning deficits might have problems with many of these functions:

  • starting, organising, planning, or completing tasks on deadline.
  • multitasking
  • listening  or paying attention
  • remembering tasks or details
  • problem-solving
  • time management
  • decision making
  • controlling emotions or impulses
  • prioritising

But it is important to note that EFD is not associated with low IQ.

Almost everyone has some symptoms similar to EFD at some point in their lives but It isn’t EFD if the difficulties being faced are recent or occurred only occasionally or intermittently in the past. If you’re curious to know if you do have EFD, you could take the test given below.

https://www.additudemag.com/executive-function-deficit-adhd-symptoms-test-for-adults/

Even if you’re not sure if EFD is indeed the cause of the problems experienced, or, if you do not want to give it a label, you could still use the tips/ strategies given below to enhance your general skills and productivity at work.

One surprising way found to improve executive function in adults is aerobic exercise. Many research journals have published that regular aerobic exercise in older adults can boost the executive functions that typically deteriorate with age, including the ability to pay focused attention, to switch among tasks, and to hold multiple items in working memory.3

If you think that the feeling of the constant deluge at the office is largely the result of so many things clamouring for attention at once, a tool like Stephen Covey’s Quadrants can be used. Each quadrant (Q) has a different property and is designed to help prioritise tasks and responsibilities. These  are:

  • Q 1 – Urgent and important
  • Q 2 –  Not urgent but important
  • Q 3 – Urgent but not important
  • Q 4 – Not urgent and not important

Another useful technique is the Pomodoro technique of time management developed by Francesco Cirillo in the late 1980s. It uses a timer to break down work into 25-minute intervals, separated by 5-minute breaks. This method not only helps you remove distractions and enhance focus on your task, but it also factors in time to take a short breather.

Those who are tech-savvy can find these as smartphone apps. Other technology tools that can help are File-sharing software like Dropbox to keep notes handy,  digital sticky notes or reminders, and password manager software to keep track of passwords. Those who are not  comfortable with technology can compensate for working memory deficits by making information external — using cards, signs, symbols, sticky notes, lists, journals, clocks and timers.4

Other simple  workable strategies are:

  •  Break large tasks into smaller individual tasks and put them into a linear order or flow chart. This helps provide clarity and allows you to monitor your progress
  • Keep a routine
  • Know yourself and get your best work done according to your own biorhythms
  • Give it a positive twist – make the activity a ‘want to do’ instead of ‘should do’.

Games can help to improve executive function skills. Games like Checkers, Monopoly, and Clue use planning, sustained attention, response inhibition, working memory and metacognition. Games like Zelda and SimCity help with problem-solving and goal-directed persistence. Managing  fantasy sports teams also use executive skills like task initiation and time management while having fun.4

Positive emotions reduce the impact of stressful events on the self and help build resilience. They make us more flexible, allowing us to be more open to options of problem-solving. Studies show that people feel and do their best when they have at least three times as many positive emotions as negative emotions.5 It is, therefore, most important that you periodically reward yourself when you have met the goals you have set.  Equally important is positive self-talk which is a powerful tool for increasing your self-confidence and strengthening your resolve to make these healthy new habits a part of your personal and working life.

 When to seek help?

Diagnosis of EFD can be difficult because certain symptoms are similar to those caused by other conditions, such as ADHD, LD, depression, anxiety, mood disorders or OCD. If any of the symptoms listed above continually disrupt your life, talk to a mental health professional. There is a variety of strategies recommended by experts to help strengthen the areas of weakness that EFD creates. Treatment options could be medications and therapy such as occupational or speech therapy, Cognitive behavioural therapy (CBT).

References:

1 https://www.additudemag.com/working-memory-powers-executive-function/

2 https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/executive-functioning-issues/executive-functioning-issues-possible-causes

3https://www.pbs.org/wgbh/nova/article/the-science-of-smart-surprising-way-to-improve-executive-function/

4https://www.additudemag.com/executive-function-treatment/?src=embed_link

5 https://kidshealth.org/en/teens/power-positive.html

https://www.medicalnewstoday.com/articles/325402#summary

https://www.additudemag.com/executive-function-disorder-adhd-explained/?src=test

Photo by You X Ventures on Unsplash

Discover how family counselling can foster lasting love and strengthen bonds between family members

Many years ago, whilst I was a trainee, I used to work in the Institute of Mental Health. One night, while I was on duty in the emergency room, an old lady in her 90s brought her 60-year-old daughter to the clinic. With a calm and friendly smile, she told me that her daughter had relapsed. It turned out that her daughter had been suffering from schizophrenia for many years, with frequent relapses that required innumerable hospitalizations. At the age of 16, she started to suffer from hallucinations and paranoid delusions. She became suspicious of others, and her temper became extremely volatile. In the early days, she resisted taking medication, resulting in a rapid deterioration in her condition. Within a few months, she was forced to drop out of school. Subsequently, she did try to work, but was unable to hold on to a job. Without a stable income, she was unable to support herself and was unable to lead an independent life. Moreover, her psychotic symptoms worsened, impacting on her self-care. She had to stay at home near-daily, relying on her mother to care for her.

The old lady was a senior nursing officer in our country before her retirement. She made many important contributions to our country’s healthcare system and she was a pioneering leader in the nursing profession. Unfortunately, her husband passed away early on, and she had to raise all their three children by herself. Her eldest son went abroad to start a business and now has a successful trading company in the United States. Her second child also did well in her studies. After getting her master’s degree, she taught at the university for several years but decided to become a housewife after getting married. The third child was originally the smartest and most sensible amongst the three children. She studied hard since young, and did well academically, with excellent grades every year. She was a filial child, who would always help her mother with housework. In short, she was never a trouble to her parents.

Unfortunately, she fell ill during the first year of junior college, resulting in a dramatic change in her personality and behaviour. Formerly a cheerful, vivacious and enthusiastic young lady, she became irritable and impulsive. Her paranoia resulted in her isolating herself from her friends and loved ones. The old lady took care of her with infinite love and silently accepted this difficult mission. But the eldest brother and the second sister refused to associate with her, and did not welcome their visits even during the Lunar New Year.

The years gradually passed. The old lady is now retired and the frailties of age took a toll on her physical health. In her twilight years, she sincerely begged her two elder children to take care of their sister. But they both adamantly refused to accept this burden. After asking several times, and after having the door literally closed on them on the 2 older children, the old lady finally understood. She courageously continued her lifelong mission and patiently looked after her daughter. By then, she was in her early 90s, and her daughter was in her 60s. That night, she quietly told me: “I’m actually tired, but I cannot die. Because she still needs me.”

That night, I truly understood the greatness and self-sacrificing nature of a mother’s love.

Schizophrenia is a serious, long-term disease. The support of family members is very important to the patient’s recovery. Without the help of family members, even if you take the best medicine and see the best doctor, it will be to no avail.

How to emotionally recover from relationships with narcissistic individuals.

Happily-ever-after is an ideal that many believe and pursue and numerous studies have suggested that the key to happiness lies in a thriving marriage. I am also convinced that when couples come together and decide to get married, they do not have the thought of a divorce on the horizon.

To many, marriage is not a frivolous decision but one where he or she has deliberated and decided to entrust oneself to the other legally. Imagine the horror when shortly after the wedding bells, you discover that your spouse turned out to be someone that you don’t recognise and ends up hurting you so deeply that you wonder how you even got to this point: being romanced to being discarded. This is what it is like to be in a relationship with a narcissist.

Let’s explore the traits of a narcissist.

The following are the 9 official criteria for Narcissistic Personality Disorder (NPD):

  • grandiose sense of self-importance
  • preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • believes they’re special, unique and can only be understood by, or should associate with, other special or high-status people or institutions
  • need for excessive admiration
  • sense of entitlement
  • interpersonally exploitative behaviour
  • lack of empathy
  • envy of others or a belief that others are envious of them
  • demonstration of arrogant and haughty behaviours or attitudes

In essence, a narcissist has an excessive sense of self-importance over and above the needs of others. There is a sense of grandiosity and arrogance; and a lack of ability to empathise and experience reciprocity within intimate relationships. They are typically charming and charismatic. The early stages of the relationship are almost always exhilarating, romantic, powerful and intense. Love-bombing is a tactic where NPD makes you feel so special and loved that you can’t help but fall deeper in love with him or her. Most narcissists only reveal their true colours when they are in conflict. And when you no longer serve their needs, they discard you from their lives or make it a living hell for you.

Imagine the adverse and trauma that one experiences when you wake up one day and realises that the love you’ve received is not real and permanent.

The following are the lasting psychological and emotional impact of being in a relationship with a person with NPD:

  1. “I don’t know what is real anymore.”
    Survivors of persons with NPD have the inability to trust their own judgment. Because gaslighting is a key feature in this toxic relationship, they lose touch with what is the reality. Gaslighting is defined as a form of manipulation, emotional and psychological abuse that results in a slow dismantling of a victim’s self-trust and judgment.
  2. “It is all my fault. Everything I do is wrong. I trigger him/her. I deserve his/her anger.”
    Because a person with NPD will never assume responsibility for anything (they believe they do no wrong), they turn it around and project their emotions on the survivor. The survivor is the one who is over-sensitive and would ask irritating questions that trigger them to react. The consequence of this is that the survivors feel powerless and start to blame themselves for not being good enough for their partner.
  3. “I am worthless and deserve nothing
    From the constant criticizing and undermining from a person with NPD, the survivors begin to accept the narrative that they are the problem and suffer from low self-esteem. They may start to withdraw from their family and friends who are concerned and question the relationship. They also hide their partner’s behaviour and lie about it.
  4. “I am going crazy”
    This is related to point #1. Because a person with NPD constantly lie and intentionally say things that make the survivors question their reality, they start to think that they are crazy for having those questions. They feel confused and lost all the time.
  5. “I don’t know. I can’t decide. It will be wrong anyway.”
    They have great difficulty in making decisions because they start to believe that they can’t do anything right. This is the message that is drummed into them persistently and this could extend into other aspects of life, such as in their work.

One of the common frustrations that my clients, who have survived persons with NPD, have often expressed: ‘how is it possible that they missed the warning signs’. Because of the suffering that they have been through, they have asked for the warning signs to be shared so that more can be aware and watch out for them in their relationships.

  1. Self-centeredness
    They believe that the world revolves around them. They are not able to empathise and therefore can only see from their point of view. When things do not go their way, they get very upset and may threaten to end the relationship. Everything is on their terms. For example, my client shared that when they were dating, the partner dictated when to meet according to his schedule. Not knowing better, she accommodated. That is a red flag. Also, when they no longer have use of the partner, they have no qualms to simply discard them by being emotionally unavailable, refusing to communicate and abandoning the partner.
  2. Frequent threats and emotional blackmail
    If you feel like you are perpetually walking on eggshells not knowing when your partner will explode on you, chances are he/she has NPD. Threats and emotional blackmail are their tools to control and get you to submit to their wants. E.g., Go ahead and leave, I never needed you anyway. I’ll tell everyone what a mean person you are.”
  3. They act entitled and rules don’t apply to them.
    They believe that their needs are more important than their partner’s. There will be no reciprocal gestures unless there is an ulterior motive to get what he or she wants. Because of the self-importance and arrogance, they believe that they can do as they please as long as they don’t get caught. They deserve special treatments.
  4. Obsessive focus on the external
    This applies to how they dress and carry themselves. Typically they are attractive, have material possessions and are of certain social status. They appear to be an excellent “catch”. They will go all out to inflate their status and standing. Another client told me that her husband, a covert narcissist, was charming and social. His real self only surfaced when they were on their own and when he felt threatened by her. This creates problems as people may not believe her when she tells her challenges.
  5. They are master manipulators and schemers.
    The key emotions that you feel when you’re with a narcissist are guilt, shame and confusion. The hallmark of a person with NPD is the inability and unwillingness to take responsibility for any action and word. Consequently, they project their emotions onto the survivors and make them feel guilty and responsible. They can also be verbally abusive and are good liars. They scheme and twist the words of the survivors to their advantage. They have no issue in making their partners the bad guy and spread rumours that paint themselves as the victim. The bottom line is this: they need to make themselves feel good at the expense of everything and everyone. When they don’t get what they want, they will withdraw either physically and /or emotionally from the partner. They may give the silent treatment, be passive-aggressive, stonewall and/or ignore the partner. At the end of it, the partner will accept the blame and promise to not upset them next time.
  6. They are hot, then cold.
    When they want something, they will go all out to get it. As such, in the early stages of the relationship or when they are on a mission to keep you under their control. They will pull out all the stops to make you feel wanted, admired and loved. One moment, you could be the most important person in their lives and in the next, when you don’t agree with them on something, it could be a trivial matter, you would become a worthless person that is undeserving of his/her respect and love. The switch from hot to cold is unnerving and they will make the survivors think that the problem lies with them.

In spite of the detrimental impacts of being in a relationship with a narcissist, the good news is that it is possible to heal from it. I have supported and seen my clients live a meaningful and flourishing life following the breakup with a narcissist. Though the journey may not be easy, if one is willing to work with a professional to go deeper and understand the pattern of relationships in their lives, they can find healing and freedom.

What are the steps to heal?

  1. Educate yourself on NPD and accept that it is a disorder. Know that you are not alone and you are not the problem. Raise awareness for it. The World Narcissistic Abuse Awareness Day is on 1 June. Get involved and when you are ready, share your story. You can empower and help others by sharing your experience courageously.
  2. Get professional help as dealing with trauma can be complicated. Learn to connect the past to the present; typically, the dynamics between the person with NPD and the survivor is one that the latter is familiar with. It is not uncommon that upon the realization that the partner has NPD, the survivor can see that a family member could be one as well. Those who persist in such toxic relationships are usually accustomed to such dynamics from childhood.
  3. Practice boundaries – physical and emotional. Have zero contact or keep it to a minimum should you share the care of the children. The survivors are usually empathic and attuned to the feelings of others. Be mindful not to take on feelings that are not yours. Have clarity on what is your responsibility and discard those that are not yours.
  4. Build a strong foundation – focus on one’s strengths and resilience, in ending the relationship and working through the issues. Find meaning in it by rewriting the narrative.
  5. Forgive and work on self-love. Self-compassion is a critical component in recovering. Learn to take good care of yourself – physical, emotional, psychological, spiritual, social.
  6. Pay attention to your body as trauma is stored in your body. Practice mindfulness to bring yourself to the present moment when you’re triggered by difficult memories. The triggers will still be there, and the healing process will be imperfect and a work-in-progress.

  7. Focus on the good – that is in you; the work that you have put in to heal and maintain your well-being by learning new skills and maintaining good habits. Celebrate quick wins when you are able to enforce boundaries or not take on responsibility for how others are feeling.
  8. Embrace a healthy relationship. After being in a toxic relationship for a long time, being in a healthy relationship can feel weird and scary. You aren’t sure what to make of it. The lure to get back to what is familiar albeit negative for you is high. Be aware of it and put measures in place so that you can recalibrate when you feel threatened.

Let’s remember that significant relationships in our lives will impact our mental well-being. Even as we focus on the benefits of positive relationships and promote it, we also need to provide support for those who have been through traumatic and toxic relationships. The key is to remember that relationships should enhance your lives and motivate you to be a better version of yourself. When there are disempowerment and manipulation in the relationship, it is not healthy, and you can make the decision to get out of it.

Healing comes with returning your focus to yourself, acknowledging your feelings and emotional experience and taking responsibility for yourself. Through the right help and therapy, you can learn new skills, to regulate your emotions, have better communication and understanding, and help yourself break the cycle of unhealthy patterns. Your resilience can be enhanced, and a flourishing life is once again within your reach. 

1  DSM-IV and DSM-5 Criteria for the Personality Disorders

Evolving Trends of Social Media and How It Impacts Youth in Singapore

Social media trends.
Social media trends are constantly evolving in today’s information age.
Generation Z (individuals who are born between 1997 and 2012) are considered to be digital natives where they are surrounded by vast technological advances since birth (Seymour, 2019). In contrast to other generations like the Millennials (those born between 1981 to 1996) and Generation X (those born between 1965 to 1980), Generation Z grew up with social media, smartphones and rapid information sharing (Seymour, 2019).
There are many different types of social media and some examples include social networking sites, dating apps, gaming apps, blogging or vlogging platforms. Globally, the top ten most used social media platforms are Facebook, YouTube, Facebook Messenger, Instagram, WhatsApp, Twitter, LinkedIn, Pinterest, Snapchat and Skype (Global Web Index, 2020). One of the latest additions includes TikTok, an app that comprises short entertaining videos created and enjoyed by younger users.

Impacts on youths

Given the increasing popularity of social media in recent years, it is undeniable that social media plays an important role in our society today. Social media provides a new lens for people to exchange information and interact with others. As youths enjoy their social connections with peers on social media platforms, the increased use of social media will likely pose a risk to their mental health and well being where they will feel anxious, depressed, lonely and the fear of missing out (FOMO) (Robinson & Smith, 2020). Youths also tend to compare their realities with other people’s best moments in which depicts an inaccurate representation of a person’s overall life (Robinson & Smith, 2020). Besides, youth may experience cyberbullying from others on social media platforms. As a result, youths will likely experience low self-esteem and psychological distress, anxiety or depressive symptoms.

Helping youths

Parents and teachers can assist youths by emphasising their youths’ values and strengths in relation to the different aspects of their lives in order to help them navigate the labyrinth of social media platforms. In addition, parents and teachers can focus on recognising signs which youths may exhibit when they are victims of cyberbullying such as social withdrawal, changes in mood and avoidance towards discussing their online interactions with others. Youths can also be encouraged by parents and teachers to seek counselling support if they find it difficult to manage unpleasant feelings related to their social media use. Please make an appointment to speak with one of our health professionals (a psychologist or counsellor) should youths require counselling support. 
Reference
Seymour, E. (2019, August 25). Gen Z: Born to be digital. VOA News, Retrived from: https://www.voanews.com/student-union/gen-z-born-be-digital
Robinson, L., & Smith, M. (2020, September). Social media and mental health. Help Guide, Retrieved from https://www.helpguide.org/articles/mental-health/social-media-and-mental-health.htm
Global Web Index (2020). Report: social media marketing trends. Global Web Index, Retrieved from: https://www.globalwebindex.com/reports/social

Managing Anxiety and Depression: During Christmas

Christmas is a time of giving, peace and joy. It is also a time to celebrate traditions where family and friends gather, feasting on Christmas goodies and exchanging presents. There are scents, sights and sounds that are familiar to Christmas time where individuals can form a strong attachment with. Therefore, such festivities may likely trigger strong memories and feelings within some of us. The feelings of loss, people being away from us, losing contact with others are examples of bittersweet memories that one can have during festivities like Christmas.

A past memory can also trigger different memories and they can become potentially difficult to process. Some may experience sadness when remembering a lost loved one, while others may feel anxious to attend social gatherings.

Living in a pandemic, things have slowed down considerably, and feelings of loneliness have intensified because of a lack of stimulation in our environments as well as physical interactions with others. In sum, we have been inside our own cocoons. A quieter Christmas this year may also mean a heightened sense of loneliness, anxiety and depression. Here are some ways to cope with some of these unpleasant feelings you may experience during this festive season.

Legitimising those feelings

Recognise and acknowledge that you may experience some unpleasant feelings such as anxiety and sadness this Christmas. Take the time and show some kindness to yourself. Take your time to feel some of these things that are missing in your life. You can write those thoughts and feelings down in a journal or confide in a trustworthy family member or a close friend. If you find it difficult to cope with these feelings and feel overwhelmed, please make an appointment and talk to a health professional (e.g. psychologist or counsellor) about what you are going through.

Reflecting on your values

Connecting with your values can help you to achieve some meaning and purpose in life. Think about what makes your life worthwhile and the values that matter most to you. Some questions to ponder: how do we want to be as a person, what do we want to stand for, and how do we want to connect to the environment around us. For some, feeling positive emotions and being optimistic are important, while for others, engaging in enjoyable and pleasurable activities (e.g. playing the guitar) are meaningful to them. Other individuals may also focus on social relationships with others and some may derive their sense of satisfaction by celebrating their personal accomplishments. When you navigate through life with your values, you will not only experience great inner strength and joy, but you will also have a meaning and purpose which will help you to tide through life’s challenges.

Maintaining a healthy lifestyle

Looking after yourself physically also helps you to look after yourself mentally which will benefit your overall wellbeing. A good night’s sleep and keeping a balanced diet are both equally important. Having at least eight hours of sleep every night and consuming a diet filled with fruits and vegetables can be helpful for your body. Additionally, exercising at least thirty minutes a day also helps to keep your mind active, leading to a healthier body. Do also, keep yourself hydrated with plenty of water. All these help maintain a healthy lifestyle.

In closing, try not to dwell on things that have not worked out. As we live in unprecedented times, things can easily interrupt our daily routines. Focus on smaller and more manageable tasks and when you do achieve them, remember to celebrate your small victories! Here is an anonymous quote that I saw at a doctor’s clinic waiting area: “Life is too short to wake up with regrets – so love the people who treat you right, forget about those who don’t believe everything happens for a reason. If you get a chance, take it. If it changes your life, let it. Nobody said life would be easy. They just promised it would most likely be worth it.”

Harris, R (2008). The happiness trap: How to stop struggling and start living. Boston, United States of America: Trumpeter.

Mok, Y.M. (2018, December 26). Commentary: The festive season brings loneliness, sorrow and anxiety for some. Channel News Asia, Retrieved from: https://www.channelnewsasia.com/news/commentary/christmas-festive-season-depression-ocd-lonely-sad-grief-stress-11059260?fbclid=IwAR2DisPAYSAB3aB2-K1HIyfWywQfGZNQHVsHsyY-TKSRG-f1h75J14G8k2s

Pascha, M. (2020). The PERMA model: Your scientific theory of happiness. Retrieved from: https://positivepsychology.com/perma-model/?fbclid=IwAR1B_Zuan1aYIkFIowe6aEUIrqnNyjwfVv0x4Hp5GFXOCRYJ4a1ecMF3a-M

Photo by Andy Holmes on Unsplash

Learn to identify warning signs of a failing marriage and seek support.

In Singapore, the law states that there is only one reason for divorce to be granted – the irretrievable breakdown of marriage. Currently, this must be proven by one or more of five facts: adultery, unreasonable behaviour, desertion, separation of three years with consent, or separation of four years without consent.

A sixth fact was recently introduced as a proposed amendment to the Women’s Charter, divorce by mutual agreement of the irretrievable breakdown of the marriage.

This amendment enables couples to take joint responsibility for the breakdown of their marriage. Mr Ivan Cheong, a partner in family and divorce law at Withers Khattarwong, notes that the changes would benefit more couples who wish to go their separate ways amicably, and do not want to have to find fault with the other party’s behaviour to obtain a divorce.

“Often, the act of having to list out the faults of the other party as a means of seeking dissolution of the marriage increases animosity, and may result in each party trying to pin fault on the other,” says Mr Cheong.

Currently, grounds for divorce must be proven by one or more of five facts: – adultery, unreasonable behaviour, desertion, separation of three years with consent, or separation of four years without consent. (Photo source: Canva)

While Mr Cheong welcomes the development, he adds that he doesn’t think divorce rates would increase simply because of the introduction of the option. “This option does not make it easier for parties to get a divorce, or render divorce as the default option simply because parties have minor disagreements in their marriages”, he says, pointing out that certain safeguards will be put in place.

So, how do you know when it is worth fighting for your marriage, or when it is truly time to think about splitting up?

Red flags in a marriage

The late American author and journalist Mignon McLaughlin once said, “A successful marriage requires falling in love many times, always with the same person”.

But what if that fails to happen?

Dr Edmund Wong, principal family life educator, and Ms Chang Mun Lan, senior family life educator at TOUCH Integrated Family Group, says that some common problems that married couples go through include unrealistic and unmet expectations, unmanaged conflicts, relationships with in-laws, financial matters, and personality or cultural differences.

These recurring problems could even get worse, if left unacknowledged.  Here are some warning signs to look out for.

Common problems for a breakdown of marriage including infidelity, feelings of neglect and abandonment, and disagreements over parenting styles and finances. (Photo source: Canva)

1. Total breakdown of communication

Arguments happen in all marriages, even healthy ones. But there may be situations where the couple can no longer spend time together without constantly getting into arguments and would rather be physically apart from each other as much as possible, says Mr Cheong.

“It’s a major red flag where couples refuse or are unable to talk civilly with each other, preferring to spend as much time away from the other spouse as possible and where they start keeping separate households, either by living physically apart or in separate bedrooms.”

2. Lack of physical closeness and companionship

A lack of physical intimacy and physical affection, including hugging, kissing and holding hands, can be signs of greater problems to come. It could start off with reasons such as busy work schedules, being preoccupied with the children or household matters, or even a major event such as the loss of a close family member.

However, these could easily lead to spouses getting habituated to the momentary dry spell, and start feeling increasingly distant from one another. Over time, either spouse may begin to experience abandonment issues.

3. Being emotionally checked out

Another major red flag is a lack of awareness, interest and knowledge in what your spouse is doing. Ms Winifred Ling, a couples therapist and relationship coach with Winslow Clinic, Promises Healthcare, says that when you have checked out emotionally, you are “living a parallel life and see nothing wrong with it”. The person may feel alone in the marriage and yearn to regain independence by cutting off emotional connection with his or her spouse. “You stop making the effort to take the initiative to be kind. Instead, you engage in a ‘waiting and comparison’ game where you refuse to be the one to reach out to your partner but you want your partner to make the first move’.”

In such cases, Ms Ling adds, the couple has forgotten why they share a life together – and they engage in negative communications such as criticisms, contempt, defensiveness and stonewalling.

If issues in a marriage are left unchecked, the marriage may eventually suffer from emotional distancing, poorer communication, increasing conflict and dissatisfaction. (Photo source: Canva)

4. Violence or abuse

Abuse does not necessarily have to be a slap or a kick in the stomach. Besides physical abuse, there may be instances where a spouse controls, bullies, or even threatens the other party. Some signs include blaming the other for everything that goes wrong, throwing things when angry, constantly yelling at the other to make him or her feel small, threatening loved ones, or controlling the other party’s expenses, as well as who he or she goes out with.

5. Presence of a third party

Infidelity is a clear warning sign that the marriage is on the rocks. But third parties can come in other forms. Addiction – be it social media, alcohol, gambling, video games and so on, can easily become a third party in the marriage. You may find that your scrolling through Facebook and Instagram is putting a dent in your couple-time and relationship, or that you are constantly sneaking or making excuses to get a drink. If these actions make you feel guilty and make you feel like you are cheating on your spouse, it’s a huge red flag and a sign that your relationship needs help.

Research shows that couples wait an average of six years of being unhappy before getting help. (Photo source: Canva)

Is it time to say goodbye?

There may be situations where staying in the marriage is more detrimental to the psychological and emotional health of both individuals. Ms Ling explains that it can be exhausting for the couple to be “living a fake life”. “The dishonesty and inauthenticity will take a toll on them emotionally,” she says.

In addition, it can also affect other members of the family. There may be cases where the couple fights so much that the mental well-being of the children is compromised and they grow up in a high-conflict environment. “Some parents may also feel guilty about giving the wrong impression to their children of what a marriage should be,” Ling adds.

It remains to be seen whether the introduction of the option for couples to mutually agree to divorce will have an impact on divorce rates. But experts seem to agree that the change would be beneficial in that a long-drawn, acrimonious divorce process could be avoided. With the new option, the two parties would file as applicant and respondent, compared to the current proceedings where they would file as plaintiff and defendant.

Mr Cheong says he had previously received feedback from parties and other family lawyers that “having to recount past conflicts and play the ‘blame game’ by finding fault with the other party’s behaviour as a reason for the breakdown of the marriage causes further animosity between the parties.

Even more importantly, NUS sociologist Tan Ern Ser is of the view that a simplified track would surface what could have ended up hidden. He says, “It reduces the acrimony or the prospect of having to put up with a broken, through apparently intact marriage.”

He also adds one could argue that a broken marriage would lead to a divorce in any case, the only difference is not in the “divorce statistics, but in causing further hurt and pain”.

Recognise when you need help

But it doesn’t necessarily mean that your marriage is doomed, even if you have ticked off one, or more, of the above warning signs.

Research has shown that marital relationships can be repaired if both parties are willing to put in the effort to make things work, by addressing the hurt and pain, understanding each other’s perspectives and taking active steps to hear each other out.

Relationship coaches and marriage therapists can help assess the health of your relationship and help you develop better relational skills. (Photo source: Canva)

Dr Wong and Ms Chan add that marriages need consistent effort and nurturing. They recommend a marital health check on a regular basis, for instance, once every two years, or in preparation for transitions in life, such as parenthood or career changes. It could highlight the areas of growth in the relationship and guide couples towards areas that may be causing tensions, and help nip any potential issues in the bud.

Research shows that couples wait an average of six years of being unhappy before getting help – by which time a lot of hurt and resentment has built up. Ms Ling urges couples to seek help at the first sign of trouble. “This can be as early as the first year of marriage when you notice that there are perpetual issues that keep surfacing and you simply can’t find ways to resolve them.”

If you think a divorce is the best option for you, seek professional help in guiding you through the process. Look at the motivation and reasons for the split and assess if the situation is salvageable or not, she says.

“Divorce doesn’t just affect the couple, it affects the extended family as well”.

*This article was first published on thehomeground.asia

What is a relationship tune-up?

Everyone who owns a car knows that it needs servicing periodically. We don’t wait till the car has broken down before we send it to the workshop. We do regular tune-up for the car so that we can ensure its smooth running and lifespan.

What does it mean when we apply the analogy to a relationship?

Relationships are just like cars, and they experience wear and tear. If we ignore the little things that go wrong, we may end up dealing with a major breakdown. Whilst relationship tune-up is not therapy, per se, it is a session with a relationship coach to evaluate your relationship and the intent is preventive.

Some questions that we look at are:
• How satisfied are you with your marriage?
• Where are the gaps that you’ll like to close?
• What’s the legacy that we are creating together?
• What’s the dream within the conflicts that we have?

Many are familiar with pre-marital counseling and we are also aware of marital counseling, which is usually assumed to be for troubled marriages. Relationship tune up is the in-between where most relationship lies and yes, you can seek help to enhance your marital life.

Contact Promises healthcare today if you are looking to tune up your relationship.

Written by: Winifred Ling – Psychologist, Couples Therapist and Relationship Coach, Promises Healthcare

An interview about Children with ADHD on Vasantham’s En Ullae S2 with S C Anbasaru

Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Clinical Psychologist, S C Anbarasu, in the name of bringing greater mental health awareness to the Indian community in Singapore.

In En Ullae S2 episode 9, we are introduced to an exuberant boy, who upon closer inspection is revealed to suffer from Attention Deficit Hyperactivity Disorder (ADHD). Is he beset by developmental issues, or is there a more benign explanation? Senior Clinical Psychologist S.C. Anbarasu opens the episode with a parsimonious explanation of ADHD – simply, people with ADHD are distinguished by a lack of ability to pay attention, and appear to have vast amounts of energy, hence, ‘hyperactivity’.

In a dramatisation, the boy’s mother wears an expression of bemused exasperation – the problems began even before his birth. Prolonged labour (which occurs after 18 –  24 hours), and a possible Caesarean section heralded the coming of a “problem child”. Anusha Venkat then recalls how, at the age of 2 or 3, she came to the realisation that her son’s inability to focus was far more prevalent than what she observed in other children. Even a couple of seconds of concentration seemed to be a hard ask. He couldn’t remain placated long enough to complete any task. At the childcare, teachers baulked at how he pinged from corner to corner of the room.

Anusha reveals how a serendipitous discovery that Carnatic music could calm him down enough to remain in one spot for more than 10 minutes. A breakthrough! Anbarasu explains that while a child suffering from ADHD can disrupt classroom proceedings, it is pointless to use force to discipline them. ADHD can make someone feel like they are “constrained within a container” if they are impelled to do a task in which they have no interest. Instead, they expend their energy reserves by indulging in some other activity – like running around and being a little menace. For parents who are unaware of ADHD as a mental health condition, seeing their child act out can be scary. In fact, Seelan (the boy protagonist) went undiagnosed at age 3 – doctors merely offered that most children are, well, rambunctious tots at that age. It takes a diligent parent to make a reasoned conclusion that their child may suffer from ADHD. Seelan was given assorted tasks to complete, with his attention span closely watched, even who he liked or disliked in class was logged.

(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep9/958092)

However, Anbarasu recommends that care must be taken to conduct a diagnosis per the Diagnostic Statistical Manual (DSM-5). First, the test must be conducted on children below the age of 12. While school-going children come with a larger raft of observable behaviours due to differences in environment (home, school, etc), Anbarasu admits that is is not easy to chalk up roughhousing or rowdiness to ADHD when those are developmentally appropriate behaviours for a child. Apparently, six or seven are ages when an accurate diagnosis is reached easiest.

Aside from Carnatic music, Seelan’s attention span was helped by repetitive menial tasks like peeling potatoes, chopping ladies’ fingers and carrots. Anbarasu acknowledges that dealing with ADHD in children is a time-consuming task because they aren’t able to complete tasks as quickly as their peers. He calls on parents to pick up the slack – strategising holistic ways to help their child, both at home and in school. It’s a collaborative effort between teachers and parents to then carry out an agreed-upon strategy.

All is not doom and gloom, however. Seelan is observed to play with Lego building blocks for hours on end, despite not performing in the classroom. Anbarasu calls this ‘hyper-focus’. It is a state of mind wherein the mind eliminates noise that potentially distracts them from the task at hand, a sort of “perk” if you will. We are cautioned that encroaching upon this state of hyper-focus can exacerbate emotional issues and precipitate anger. People with ADHD are victim to ‘emotional dysregulation’, which may manifest from frustration in perceived inability to complete tasks satisfactorily. Seelan was unable to appreciate the benefits of delayed gratification, getting restless and upset if things didn’t go his way. Anbarasu explains that this results from emotional dysregulation as well.

At some point, Seelan faces potential expulsion from his class due to the complaints of other children’s parents. Especially in Singapore, where grades are paramount, a poor academic performance which results from an inability to work with a child’s ADHD can be distressing to parents. The teeth-gnashing frustration can make parents feel helpless, and Anbarasu suggests that these situations call for a consultation with a professional therapist who will elucidate the behavioural issues at hand. This gives parents more information to plan future steps. Parents of children with ADHD also attract stinging criticism from other parents. They might feel inadequate in their roles as nurturers and mentors. Anusha has accepted this to be a part of life, chortling as she muses that “you can’t change people”. Whatever the case, it isn’t fair to fault parents for a child’s ADHD. Or the child. Anbarasu clarifies that ADHD is a neuro-developmental disorder – in other words, that’s just how the cookie crumbles. Blame should not be apportioned. Anusha recalls how Seelan used to behave like an attention hog – in its absence, tantrums would be the order of the day. According to Anusha, dealing with instances of emotional dysregulation like this is challenging, especially if you have to deal with the needs of your child while observing social propriety.

Every child’s circumstances are different, so Anbarasu recommends that care be taken to evaluate if danger is imminent. Shouting for a little is perfectly OK. Deal with them after they have thrown their fits because anger is not conducive to receptiveness to advice. Anbarasu is careful to eschew the notion of a “cure” for ADHD. Rather, he says that it is “treatable”. Whether with medication or psychotherapy, or a combination of the two.

Children with ‘combined-type’ ADHD are challenged in a triune of areas – attention, hyperactivity and impulsivity. For these cases, neuropharmacological support is required, to aid concentration and retention of information in class. If the ADHD is not as pronounced, therapy alone could manage the condition. For parents who are especially harrowed by their child’s condition, they should know that there is ample evidence in favour of managing ADHD through the concurrent administration of medication and therapy. On top of psychiatric interventions, there are support groups inside and outside the classroom for parents who are overly stressed.

The episode closes with the narrator speaking over clips of Seelan looking positively cherubic. The viewer is called on to spare the snide remarks, replacing them with positivity, understanding, and “plenty of support”.

Anxiety and anxiety disorders in children: Time to talk about it

Anxiety is a common feeling for many of us. It’s that uneasy feeling of nervousness, worry, dread, and fear that we experience in certain situations. You might have felt it before a job interview, while you’re in the labour room (even if you’re not the birthing parent!) and probably on your child’s first day of school. The occasional anxious feeling isn’t exactly a bad thing – in fact, it’s perfectly normal and beneficial to a certain extent. Healthy levels of anxiety function as a warning signal during dangerous situations, prompting us to react or flee to protect ourselves.

However, some people may experience overwhelming levels of anxiety to the point where it interferes with their daily life and relationship with others. In this case, professional help is highly recommended as intense and prolonged feelings of distress aren’t great for anyone and may be attributed to an anxiety disorder. And we’re not just talking adults – anxiety disorders may also develop in children.

Senior Clinical Psychologist, S C Anbarasu & Senior Psychologist Jane Low, share their thoughts about this with Honeykids Asia. Follow the link to read on:

https://honeykidsasia.com/anxiety-in-children/