Senior Clinical Psychologist, Henny Tan, was interviewed by the popular YA YouTube channel, LadiesFirstTv (Titan Digital Media) about the stigma a person might face when being identified as having a mental illness.
Click on the red play button to watch this 13min 24 sec video.
Written by: Andrew da Roza
Deciding to see a therapist is a big step – and staying in therapy requires a commitment to effect real change.
It is not surprising that many hesitate before starting therapy.
Some may be wondering how talking to a stranger can change their lives for the better.
They may not know which therapist they ought to approach – and what they should be looking for in a therapist.
Others may hesitate because they are anxiously thinking ahead: “what happens if I don’t like the therapist?”; “what if the therapist doesn’t understand my struggle?”; “what if I don’t think that enough progress is being made?”.
They may also be wondering if they can change their therapist and if they can have more than one therapist.
If you are struggling with these questions, thankfully, there may be some answers that put your mind at rest and give you the confidence to seek a therapist and engage in the healing process.
Most clients can articulate why they wish to seek therapy – and have clear ideas about what is causing them distress or difficulty.
Clients with clinically diagnosable mental illnesses may have already sought help from a family member, friend, doctor, psychiatrist or religious leader. They may have even “Googled” their symptoms.
If specialist help is needed, choosing a therapist with the relevant qualifications and experience will be the first step.
In addition, you may wish to choose a therapist you are more likely to be comfortable with based on the therapist’s language ability, gender, culture and so on.
Research has shown that the positive connection a client makes with their therapist accounts for 36%-50% of the changes clients experience as a result of treatment. (1)(2)
Sometimes called the “therapeutic alliance”, this is experienced by clients as liking and trusting their therapist.
Some will bond strongly with therapists if they demonstrate empathy, warmth, unconditional regard and respect. They would like their therapist to be open, non-judgmental and curious about the clients’ struggles – to have a strong desire to “walk in the clients’ shoes”.
Such clients make good progress in therapy when they feel understood and heard – as well as valued.
Others may seek therapists who are good communicators and are well informed about the issues the clients are facing. They tend to bond with therapists who are able to impart and discuss information; offer practical suggestions; articulate action plans, goals and timelines; and support the clients in their motivation to take action to effect positive change.
Many also seek insights into themselves, their emotions, the ways they react to people or situations; and their perspectives and intrusive thought patterns.
By being more present with what arises in themselves, they seek to take more control over their own lives – to respond to people and situations instead of habitually reacting to them – and to accept and let go what they cannot control.
These clients appreciate therapists who can assist in self-discovery. Therapists who are able to help articulate their “inner worlds,” and to reframe them. Therapists who empower them to navigate this “world” with more ease and confidence by playing to their strengths, rather than dwelling on what they perceive as their weaknesses.
Interestingly, studies have repeatedly shown that the type of therapy used for individual therapy (such as cognitive behavioral therapy, psychoanalytic or psychodynamic therapy, dialectical behavioral therapy, person centered therapy and so on) has only a marginal effect on the outcomes of therapy (3)(4)(5).
So, the key to choosing a therapist involves articulating what you expect from therapy and your therapist, and what kind of person you think will best meet your emotional and other needs.
It would be helpful to articulate what you want the therapist to do (and not do); and what your end goal or “vision” for therapy is. You can do this by first asking yourself the question: “what changes am I seeking that will make a real positive difference in my life?”.
Many benefit from putting all this in writing and bringing it to the first therapy session to discuss it with the therapist.
On the first meeting with a therapist, some clients – though this may be rare – simply do not like or trust the therapist, or that they do not have the experience or knowledge to assist them.
It also sometimes happens that a client feels that the therapist is not present or really hearing the client’s narrative.
Worst still, they may see the therapist jumping to conclusions – or solutions. They may feel disrespected and “unheard” – and that they are being left behind, while the therapist is “racing” ahead of them.
Other clients may feel that the therapist is judging them or telling them what to do, think or feel – and not to do, think or feel. The clients may feel anxious, disempowered, dismissed, angry or offended.
If this happens to you, let your therapist know. If you don’t see any change in their approach, rest assured that changing therapists is likely to be helpful.
One situation that you may wish to avoid though, is changing therapists regularly. This is because continuity in therapy is one of the keys to progress.
Therapy is very much a journey.
Whether the goal is self-discovery, empowerment, executing action plans to change behaviour, building confidence, or managing anxiety or depression. The journey has stages, and keeping the same guide on this journey is likely to facilitate progress.
If you are in the middle of your therapeutic journey, and you wish to change therapists, it would be helpful to articulate clearly why you want to do this.
Is the therapeutic bond broken – and cannot be fixed? Is there little or no progress in your clearly articulated goals? Have you changed the goals and discussed them with your therapist – and it is clear that the therapist will not be able to assist?
Some clients simply feel that therapy has become “stale”; or they feel as though they are attending therapy to “tick the box” and to show others that they are willing and able to change.
Whatever the reasons, write them down. Discussing them openly and honestly with your therapist is likely to help.
If you wish to make a change, ask the therapist for a referral to another therapist, and give permission to the current therapist to brief the new therapist. You may wish to join in this discussion.
This is more likely to ensure that your therapeutic journey continues without disruption.
One situation you may wish to be conscious of, is changing therapists solely because the therapeutic work has become difficult. “Jumping ship” may not be the answer.
There is no doubt that therapy can be very challenging – perhaps the most challenging thing you have ever done.
The challenge could arise because the insights are uncomfortable (or even painful); the changes in behaviour require a lot of motivation to sustain; a change in perspective seems counterintuitive; or because the anxiety, intrusive rumination or low mood seem relentless.
Changing therapists may not be the answer – and may simply delay or disrupt the difficult therapeutic work ahead of you.
It is likely to be more helpful to articulate these challenges, write them down and discuss them with your therapist.
Some clients may need more than one therapist.
A client may have an individual therapist who assists the client on their own personal journey.
They may also have a couples’ therapist to address their relationship with their partner. In that event, the therapist treats the couplehood as “the client” – and provides equal support to both parties and works towards their joint goals.
Other clients may also have a family therapist to address the relationships within the family. Again, the therapist will see the family as “the client” and assist with the family goals.
Couples and family therapists tend to provide specific modes of therapy, which have proved effective for couples and families.
In the case of individual, couple and family therapy, in most cases, it is generally considered unethical and a conflict of interest for one therapist to play all three roles.
The therapist cannot best serve the client’s, couples’, and family’s interests while wearing all three “hats”.
Once a therapist tries to do this, they may (for example) feel obliged to keep secrets from one person in the couplehood or others in the family. This may reinforce the unhealthy dynamics of secrets and deceit that brought the clients to therapy in the first place.
Conflicts of interest create confusion, anxiety, anger and disappointment for clients.
Keeping to ethical boundaries is more likely to ensure that the therapeutic journey is not sabotaged.
Unethical conflicts of interest also arise if a client is seeing two different individual therapists.
Broadly, therapists are obliged to decline to see a client if they already have an individual therapist they are actively working with.
Having two therapists engaged in the same work exposes clients to confusion, anxiety and conflict, and is likely to disrupt a client’s progress in their therapeutic journey.
If you are considering seeing two therapists for individual therapy, it would be helpful to clearly articulate why you think this will assist – and to discuss this openly with the therapists.
Some clients may change therapists to “find the right answer”; the “best answer”; or the answer that fits their “view of the world”. That “view” may be the same “view” that has been causing them the trouble – and motivated them to seek therapy in the first place.
All this is worthy of open and honest discussion and exploration.
Another situation in which other therapists may be involved occurs when a client has an individual therapist and also attends group therapy. Group therapy can be a very effective way to continue the therapeutic journey, once progress has been made in individual therapy.
Again, therapists commonly use specific modes of therapy for groups.
If you are working with multiple therapists, it is helpful to let them know who else you are working with, and what goals you (e.g. as an individual, couple or a family member) have agreed to pursue with the other therapists.
From time to time, it will assist to share with your therapists what you took away from the other therapy sessions, how the sessions are progressing and what plans you have agreed with the therapists.
It is always open to you to ask the therapists to communicate with each other and to coordinate treatment.
It is also your right to maintain confidentiality and not to coordinate treatment – but “dovetailing” these different therapy sessions is more likely to help optimize your outcomes.
The Promises Healthcare website provides assistance to clients to identify their issues and provides photographs, names, languages, qualifications and experience of the specialists who can assist: https://promises.com.sg/about-us/our-team/
We hope that you will be able to find the right help from us.
Therapy is an indispensable tool to recovery, or in helping one gain deeper insights and achieve self-actualisation. In light of the ongoing COVID-19 pandemic, traditional face-to-face therapy has been forced to take on various forms, including sessions conducted via telephone or through video-calling platforms. Of course, therapy serves the same purpose, regardless of whether it is conducted in person or otherwise. However, there is definitely something restorative about being able to connect with a therapist physically. Humans are innately social creatures after-all, and sometimes when things get tough, a little more human interaction and comfort can go a long way.
Physical presence in therapy certainly provides a deeper sense of connection, in contrast with virtual therapy where one might feel more distant and detached. It may seem bearable at the very beginning, but as you progress through the sessions, having to interact with your therapist through a screen all the time can get frustrating. Similar to how students may have trouble coping with online school and home-based learning, virtual therapy has some form of hindrance when it comes to relationship-building with your therapist. For most psychotherapy methods, it is indeed possible to shift them online. However, for others such as psychodrama, it may not be entirely ideal. How expressive and comfortable can you get, when you’re struggling to follow your therapist’s directives through the small screen and having to deal with technological lags?
Seeing your therapist in person also allows for him/her to detect any subtle body language and somatic movements. These are all non-verbal cues that may be lost through telecommunication. Non-verbal cues are just as important as verbal ones, and can provide your therapist with greater insights. Non-verbal signals can serve to convey your feelings along with what is being said, and can either reinforce or contradict verbal messages. Ignoring them would be very much a failure to be fully engaged in a conversation. Moreover, seeing you in person provides therapists with the ease to identify any form of dissociation. During the session, clients may not necessarily attune well, and may not be fully present in the moment. The client may be engaging with the therapist, but seemingly thinking about something else that is going on in their life at the same time. This does not mean that the session is unhelpful or “boring”. While this could simply be attributed to the lack of presence, it could also point towards other concerns regarding the client’s state of mind. Fragmentation can occur especially when one is recovering from a past trauma and can be brought to the forefront, causing incomprehensive emotional reactions when triggered. Fragments of self are usually suppressed, often attributed to the lack of a sense of safety when it comes to expressing their inner needs or desires. When these feelings start to show during therapy, therapists can identify them through common tell-tale signs such as a switch into dissociation, noticeable body movements (twitching, scrunching of fingers or toes etc.). Body language is not definitive, but can offer clues about one’s thoughts and feelings. With telecommunication, it is more often than not impossible to see the client below shoulder-level, thus making it difficult for therapists to assess any somatic movements that may be occurring.
Another issue with telecommunication is the lack of control over the therapeutic environment. In a traditional face-to-face session, the clinician has considerable control over the environment, and is able to ensure a private, safe and quiet space for the entire duration of the session. This limits the number of distractions and allows for both the therapist and the client to concentrate on psychotherapy. Moreover, in a clinical setting, furniture is often set up in particular ways to facilitate clinician-patient interactions. For instance, seats may be arranged such that the clinician would be facing the client at an angle of 45 to 90 degrees, and approximately 2 to 3 feet away. Facing the client directly can feel somewhat threatening for some, and this angle allows for the client to feel more at ease. Additionally, it allows for both parties to break eye contact naturally (intermittently) without seeming antisocial or distracted by having to do so actively. In contrast, having a session online or through telephone allows for less control over interactions and the client may be more exposed to external distractions or undesirable interruptions. This also leads us to our next point, where teleconsultations also increase the risks of privacy breaches.
Due to the lack of environmental control, having a consultation via telecommunication methods can be a challenge especially for those who do not have access to their own private space. For individuals living with others, there could be situations that compromise client confidentiality, including potential eavesdropping or having others walk in on them. Not only does this make the session extremely disruptive, it can be a huge concern for many considering that mental health concerns are sensitive topics. Clients must make the extra effort to find a suitable place and time for them to speak with their therapists freely and with ease. As such, physical presence in a controlled clinical setting may have the upper hand.
Nevertheless, this article in no way aims at undermining the efficacy of tele-health, nor to allude that tele-therapy is ineffective or pointless. Considering the need for physical distancing during the pandemic, telecommunication is undeniably crucial in limiting the spread of the virus. Putting that aside, traditional in-person therapy can have its barriers too, limiting people from attaining the mental health support they need. Individuals with disabilities may find accessibility to be a significant problem at hand, and find it difficult to travel for therapy without having others to rely on. Others include parents who are unable to find suitable childcare options, all while juggling work and mental health care. For those struggling with social anxiety and agoraphobia, it can also be extremely intimidating and overwhelming for them to step out. In fact, some research has shown that virtual and in-person therapy, depending on the treatment goal, can be equally effective. In adults, cognitive behavioural therapy was shown to be similarly effective both in vivo and virtually (Khatri et al., 2014). There is also evidence that youth with anxiety disorders respond positively via telehealth (Khan et al., 2020). Traditional face-to-face therapy and tele-therapy both have their perks, and we acknowledge that it also boils down to individual preferences. If you’re unsure as to which treatment option to opt for, do feel free to contact us.
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For many people, when they hear the word ‘Psychiatrist’, it would instantly conjure up an image of a doctor prescribing medicine for someone with a mental health condition. This is true to the extent that a psychiatrist is a medical doctor who has undergone training to become a mental health specialist. While prescribing medications are indeed part of the treatment process, what really goes on in between – from the first session to the very end?
On your very first session, your psychiatrist will most likely spend 1-1.5 hours with you to gain a better understanding of what you’re coming in for. Mental health conditions can be a touchy subject for many, and it is understandable that you’d feel hesitant to open up to a complete stranger right away. However, trust that your psychiatrist has your best interests in mind, and will do his/her best to provide optimal treatment. Don’t be afraid of being judged for your symptoms, rest assured that the psychiatrist’s office is a safe and non-judgemental space. The psychiatrist will want to know as much as you’re willing to share, and being honest with your psychiatrist will be extremely helpful for an accurate diagnosis and the development of an effective treatment plan. Just as what you’d expect when you seek a General Practitioner for physical conditions, your psychiatrist would start off by asking broader questions such as, “What brings you here today,” or “How can I help you?” For some individuals, especially if it’s their first time at a psychiatrist’s, open-ended questions like these may be nerve-wracking. You may feel a little overwhelmed, not knowing how to start or where to begin. However, there are no hard and fast rules as to how the session should flow. Simply communicating your symptoms and your concerns would be a great start, and your psychiatrist will guide you through the interview.
Your psychiatrist will also run through a history-taking process, paying special attention to your medical history, family history, your current lifestyle habits and general patterns of sleep. It is important to let your psychiatrist know if you’re on certain medications, as some may have side effects that may fuel certain mental health conditions. Avoid downplaying or dismissing any information related to your physical or mental wellbeing, the clue to an accurate diagnosis may very well lie in the details. As such, going for your first session prepared with a complete list of medications, dosages, and your compliance with them can be very beneficial. Many studies have also shown that genetics play a role in mental health disorders. If you have a family member who suffers from a psychiatric issue, be sure to let your psychiatrist know for him to have a clearer idea of the situation. If need be, your psychiatrist may also ask permission to speak with other family members.
Depending on the patient’s circumstance, the psychiatrist may conduct a physical check-up if necessary, or possibly laboratory tests to exclude other possible causes for your condition. These are done to confirm that what you’re experiencing are not due to other medical conditions which may give rise to similar symptoms. Hence, if your psychiatrist asks for these procedures to be carried out, don’t feel too worried! Questionnaires to further assess your symptoms may also be given, so do make sure to answer them as truthfully as possible.
Depending on the complexities of your condition, medication options or other forms of treatment may be prescribed. If you are given medications, the psychiatrist would counsel you on how you can tell if the medications are working. Over the course of your recovery journey, take note of how subtle changes to the medications made by your psychiatrist affects you. Do they stabilise or improve your condition, or do they seem to send you on a downward spiral? How have you been feeling since you started taking them? Whatever the outcome, keep your psychiatrist in the know of how you’re coping. In the same vein, it is very important that you do not adjust your medications on your own without seeking professional advice! Patients may get impatient if they’re not seeing the desired change after a while, but constant and unregulated changes can cause undesirable fluctuations, potentially worsening the situation. We need to understand that there could be catastrophic, life-threatening consequences if we do not take them seriously.
In general, psychiatrists usually work closely with psychologists and therapists, as some mental health conditions are best treated with both neuropharmacological support and psychotherapy. Thus, your psychiatrist may also refer you for psychotherapy if deemed fit. Depending on the level of care required to address the patient’s symptoms, psychiatrists may recommend treatment programmes if more intensive care is needed.
It is natural to feel nervous or uncomfortable about seeing a psychiatrist, but don’t let these emotions hold you back from getting the help you need. We hope that giving you a better sense of what to expect will help alleviate your concerns, and give you the courage to seek professional help.
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Imposter Syndrome is a shockingly common psychological phenomenon experienced by an estimated 70% of the population. Chances are you’ve probably had such a mindset at least once, but perhaps you couldn’t pinpoint the exact words to describe the feelings you had. Imposter syndrome, as defined by the American Psychological Association (APA), is where “highly accomplished, successful individuals paradoxically believe they are frauds who ultimately will fail and be unmasked as incompetent”. In other words, it’s when you feel like you aren’t worthy of what you have accomplished, and are not good enough to be where you are. Successes and accomplishments are thought to be attributed to sheer luck, rather than one’s actual skills and capabilities. While this psychological pattern was initially thought to be applicable to women and women only, studies over the years have shown that men are equally as susceptible to the same psychological pitfall. This phenomenon is rarely spoken of – individuals with imposter syndrome usually suffer in silence, and this is a likely case of them being afraid to be exposed as a “phoney”.
An expert on imposter syndrome and author of The Secret Thoughts of Successful Women: Why Capable People Suffer From the Imposter Syndrome and How to Thrive in Spite of It, Dr. Valerie Young categorises it into 5 main types:
1. The Perfectionist
The broader definition of an imposter syndrome may sound superficially applied to intelligence and achievements, but as we delve deeper, we can see that it has close links to perfectionism as well. Perfectionists tend to set extremely high expectations for themselves, and for some even unrealistic ones. You may have heard something along the lines of “the higher the expectation, the greater the disappointment”, and this can hold true for these perfectionists. When expectations are set too high, these individuals tend to feel like a failure when they are thrown off by even the smallest mistakes or setbacks. Waves of self-doubt and inferiority can overcome them, making them feel like they are unable to measure up to other accomplished people when they overly fixate on their flaws. This group of people are thus also prone to developing anxiety due to the great deal of pressure they impose on themselves.
2. The Superman / Superwoman
Individuals who fall under this category tend to overwork themselves (past the point of what’s really necessary) as they have convinced themselves deep down that they are phoneys. Fearing that they are unable to match up to real-deal colleagues, friends or family members, these people drown themselves in work in an attempt to achieve more. This can take the form of working extra long hours, feeling guilty and stressed whenever they’re not working, or feeling the need to sacrifice self-care for work. These are unfortunately merely false cover-ups for their insecurities, which may not even be a cause for concern. Needless to say, these individuals must take care not to over-exert themselves, as it can take a tremendous toll on their mental and physical health over time.
3. The Expert
Experts base their competency levels on how much they know, or how much they can do. In a sense, they try to quantify their capabilities in order to prove their worth. Constantly haunted by the idea of not knowing enough, or being exposed to be unintelligent or underqualified, these people often underrate their current level of expertise. As such, they may strive to seek out additional trainings, certifications continuously and excessively in order to upgrade themselves and to attain success. Of course, there is no fault in focusing on self-improvement, but hoarding knowledge for false comfort isn’t the way to go.
4. The Natural Genius
This group of individuals are somewhat similar to the Experts, yet there are still slight differences between them. Instead of measuring their successes by how much they can do or know, these people measure their level of competence by the ease and speed of which they can achieve their goals. As the categorical name implies, these people believe that they need to be “natural geniuses”. They pressure themselves to achieve their goals fast, and if possible, on their first try. When plans fall through and they end up taking longer to master certain things, they start feeling an overwhelming sense of shame and worthlessness.
5. The Soloist
These people are highly individualistic – to the point where they feel like a failure whenever they have to seek help or assistance from others. They equate their self-worth to their productivity and ability to achieve results on their own. Hence, asking for assistance can seem like a sign of incompetency or weakness for them.
For some, imposter syndrome can act as a motivational force for them to strive to achieve a better version of themselves. However, this can come at the cost of your mental wellbeing, developing into feelings of constant anxiety and even depression. A major issue with struggling with an imposter syndrome is that it deprives you of the ability to internalise your successes – you may very well be capable of achieving the goals you set, but the more you achieve, the more you feel like they were merely flukes. This brings us to our next point: how can we get past this imposter syndrome?
It is very important for us to first acknowledge our thoughts and put them in perspective. When you start feeling waves of insecurity, worthlessness and start downplaying your own abilities, try focusing on the facts. Focusing on the valid reasons and on your qualifications can help you see things in a different light, and realise that you’re truly deserving of your achievements. Let’s think this through – how many “flukes” will it take to convince you that you’re actually good at something?
Instead of fixating on your mistakes alone, remember to celebrate your successes! We need to acknowledge that while we may occasionally miss the target, there will be times when we’ll hit the bullseye. A great start would be to start embracing your successes and allowing yourself to receive praise and recognition for them. For example, picture a scenario where someone commends or compliments you for achieving certain targets. A person with imposter syndrome would likely have an urge to ignore it, reject it, or simply brush it off awkwardly. However, the next time you encounter situations like these, try something new. Say “thank you”, bask in these moments and accept the recognition you deserve.
Sharing your feelings with trusted friends and family members can be tremendously freeing too. Allow yourself to rely on your social network. Just as how others would approach you to share their feelings, rant, or to ask for assistance, don’t be afraid to seek them out when necessary. Bottling up your feelings can lead to further festering of negative, irrational beliefs that will ultimately do you more harm than good. Rest assured that seeking help isn’t a sign of weakness or incompetence. Alternatively, seek professional help from a mental health expert to help you break the cycle of imposter thinking, if you’re crippled by the fear of being found to be a phoney. Individual therapy can equip you with the tools to build on self-acceptance, confidence and to reframe your mindset to serve you better. At the end of the day, keep in mind that you’re not an imposter, you’re an original.
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