Musings from Clinical Notebook - Acorntherapy

“It’s unspeakable. I don’t know how to tell you about what happened” — would EMDR therapy still work?

Mon, 07 Nov 2022 05:36:23 +0000

Most of us are reluctant to revisit our unhappy past. Our instinct is to push these memories down and bury them deep.

But where such past cuts us deep, it will find ways to pop back into our life to torment us. We could be triggered by anything happening in our environment that echoes the past. Then in a flash, in the most unconscious and uncontrollable manner, we re-experience and relive the shudder and pain as though we are back there, back then. That in turn instantly affects our mood and behaviour.

Such flash back or reliving of the past could happen at a very inconvenient time, in the middle of a dinner party or a board meeting.

Repeated recurrence of such instances drives people to seek professional help for relief.

Clients in a bind

Most trauma-focused therapies require clients to verbalise details of the traumatic events as part of the activation of memories to facilitate processing or treating the traumatic experience.

However, when it comes to the specifics of a traumatic event, there are times clients just find it too hard to verbalise and retell. The incidents may be so clear in clients’ heads: the sight, the sound, the smell, the taste, the sensations in their bodies.

But to translate these into words and allow the narrative of the episodes to cross their lips could be so horrific, so demeaning, filling them with shame, disgust and guilt all over again.

Or they may be embarrassed by the contents, or fearful they may be judged for what happened.

All these places the clients in a bind, they desperately want relief, want to heal from the trauma, but petrified about talking through the details of the experience. The thought of having to retell may even drive some to opt out of therapy.

Clinicians: Do not harm

Clinicians, on the other hand, are obliged to observe the principle to do no harm, especially when working with psychological trauma. We seek ways to deliver therapy without retraumatizing our clients. We want the healing journey for our clients to be as comfortable as possible.

A variation of the EMDR Standard Protocol

A variation of the EMDR standard protocol to allow non-verbalising of the trauma target was first alluded to by Bessel van der Kolk in early 1990s and then Francine Shapiro around 2001. For various reasons these early ideas became obscure, until around 2018, when clinicians revived and experimented with this technique.

Its efficacy was studied and reported in a paper published in 2020.

The paper reports on a project where the participants were Yezidi survivors of gross human rights violation at the hands of ISIL [the Islamic State of Iraq & the Levant]. Amongst other abuses, they were captured and sold as sex slaves. These episodes were but the most recent of generations of persecution and trauma suffered by the Yezidi over the centuries because of their religion.

The study was a humanitarian project of several NGOs to build trauma capacity in Northern Iraq. At that time, ISIL was still active in Northern Iraq and the environment was considered a “theatre of conflicts”.

The context gives us a clue why the victims had great difficulty disclosing details of the abuse for reasons including shame, and fear of reprisal and retribution.

The group of survivors-participants was briefed on the resolution of their traumatic experience with EMDR therapy. It was repeatedly emphasized that they were under no obligation to divulge details. In brief, they were to just think of the episode and inform the therapists of the level of distress.

The study found that EMDR remains effective, safe and efficient in reducing the level of distress in these victims, notwithstanding that the details of the target episodes remained “blind” to the clinicians. This technique is also known as “Blind to Therapist”, or B2T.

B2T: there is no need to verbalise and retell details of trauma

Difficulty of verbalising details of a traumatic event is experienced by survivors of trauma, in civilian as well as war settings. B2T is therefore a useful tool in the EMDR tool box.

For that reason, B2T has gained adoption by EMDR clinicians. We now have a sensitive and compassionate way to help clients overcome the fear and pain of processing trauma.

Clinician only needs to know the general subject matter to guide client in the therapy. The client does not have to disclose the specifics of the incidents. EMDR will still work effectively without clients verbalising the details.

One explanation is this: when a client silently recalls the trauma incident and notes the related emotions and body sensations, the essential details of the memory are activated in his/her brain, ready for processing, without having to verbalise and retell the episode.

Oftentimes clients are visibly relieved when they are told they do not have to tell me the full details of the event we are working on. When they are ready, or when they are drawn to it, they may disclose it. Clients feel empowered with this approach.

Trauma-focused therapy works best when it is respectful and meets the needs of patients.

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What if war comes to our shores? — On being grounded, calm and centred

Mon, 07 Nov 2022 06:16:47 +0000

Images of high-rise buildings with their faces blown off, exposing half-eaten dinners on kitchen tables. Homesteads reduced to rubbles. These are distressing images to our generation of Singaporeans who have been so fortunate to enjoy uninterrupted peace and security all our life.

Nearer home, there have been spats and threats across the Taiwan Strait.

The thought of war coming to Singapore have flitted through many minds. For those of us who are more prone to panic and anxiety, we ruminate about the possibility of war coming to our shores.

In some cases, the Ukrainian war not only provoked anticipatory fears, it has resurrected ghosts of past family traumas. Stories heard as a child from old folks about invasion and occupation during World War II, about hiding in the jungle, sampan rides as refugees when enemy planes dropped bombs overhead, internment, tortures and rape by invaders.

What is to be done?

Government leaders have sounded alarm about the economic and political challenges we face. Some have termed the convergence of geopolitical tensions, international financial instability, and natural disasters the perfect storm.

People react differently to such messages and news. Some are upset with potential interference of the rhythm of life we are accustomed to. Others, worried and anxious about a string of “what ifs”.

If you find yourself reacting emotionally to international tensions, first take a step back, to recognise what is in your control and what is not within your control. Geopolitical struggles and its impact on Singapore are beyond the control of us individuals.

So instead focus on doing what you can control.

What is in our control?

Is there anything within our control?
Yes.

For a start, if we know of friends and family exhibiting distress and anxiety about the prospect of strife and war, or about trauma, as described above, encourage them to seek professional help. We want everyone to be in as best a state of emotional and mental wellbeing as possible to deal with potential negative events on the horizon.

For the rest of us, it is back to basic including:

Keep our bodies healthy: eat nutritiously, sleep well, exercise regularly
Acknowledge our negative emotions, and learn ways to manage them
Be judicious in our media consumption; if need be, go on an occasional media fast
Treasure our loved ones. Hug them often and say “I love you” right out loud. Do what we can to love and support each other.
Put our financial affairs in order. Political conflicts inevitably affect savings and investments. There are confusing and conflicting views, so take financial advice when necessary.

Seek helpful information such as this article.

Toxic noises, disinformation

As the tension between big powers rises, propaganda on all sides becomes shrill. It is therefore important we learn how to approach news and information with a calm and clear mind.

The propaganda machinery wants you to take a simplistic black-and-white position: you are either for us, or you are against us. But the issues at hand are multi-layered, oftentimes opaque, and too complex to be squeezed into a binary approach.

Be aware that the contest of narratives and opinions is dividing family, friends, and setting citizens against citizens. Take care not to trade family bond and friendship for political stance. Above all, do not sacrifice your humanity for the sake of politics.

Refrain from impulsive and reactive response.
Take a step back.
Evaluate and verify information.
Be aware that conspiracy theories and misrepresentations are in abundance.

Factcheck.
Date check, because a favourite ploy is to replay old speeches and writings of well-known figures as though they are commenting on current conflicts.

Learn to think slow (see Kahneman: Thinking, Fast and Slow, a talk at Google).

Think consciously, deliberately.
Be contemplative and rational.
Consider different perspectives and ideas.

Cultivating mind, nourishing the heart, staying grounded

However, we also know that it is very hard for our mind to think slow without reining in the instantaneous and unconscious reactivity of fight, flight or freeze. We need to first soothe our emotions and calm our mind.

To achieve that, we look to contemplative practice to help us ground and centre: prayers, chanting, mindfulness, meditation, breath work.
Do what works for you. Start with baby steps.

Contemplative practice helps us to progressively cultivate clarity and wisdom in our minds, compassion and peace in our hearts. These qualities place us in a state of equanimity and balance, which are valuable in times of chaos.

We can then observe the happenings around us with detachment and clarity, helping us to make better judgment and decisions.

If you are so inclined, read your holy scriptures and texts for comfort, direction and inspiration.
Or you may wish to revisit the Desiderata to experience a sense of serenity and perspective.

Above all, count our blessings.
At the fundamental level: we still have our loved ones, a roof over our heads, food on the table, comfortable beds to rest our heads at night……

May you journey well.
May peace and security always be with you.

If you or your loved ones are experiencing anxiety or suffering from any traumatic memories mentioned in this article, do connect with us today.

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— On being grounded, calm and centred appeared first on Acorntherapy.

Desiderata by Max Ehrmann

Fri, 02 Dec 2022 02:22:40 +0000

Go placidly amid the noise and haste,
and remember what peace there may be in silence.
As far as possible without surrender
be on good terms with all persons.
Speak your truth quietly and clearly;
and listen to others,
even the dull and the ignorant;
they too have their story.

Avoid loud and aggressive persons,
they are vexations to the spirit.
If you compare yourself with others,
you may become vain and bitter;
for always there will be greater and lesser persons than yourself.
Enjoy your achievements as well as your plans.

Keep interested in your own career, however humble;
it is a real possession in the changing fortunes of time.
Exercise caution in your business affairs;
for the world is full of trickery.
But let this not blind you to what virtue there is;
many persons strive for high ideals;
and everywhere life is full of heroism.

Be yourself.
Especially, do not feign affection.
Neither be cynical about love;
for in the face of all aridity and disenchantment
it is as perennial as the grass.

Take kindly the counsel of the years,
gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.
Beyond a wholesome discipline,
be gentle with yourself.

You are a child of the universe,
no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you,
no doubt the universe is unfolding as it should.

Therefore be at peace with God,
whatever you conceive Him to be,
and whatever your labours and aspirations,
in the noisy confusion of life keep peace with your soul.

With all its sham, drudgery, and broken dreams,
it is still a beautiful world.
Be cheerful.
Strive to be happy.

— Max Ehrmann, 1927

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Gaslighting 1: How do you know?

Fri, 02 Dec 2022 02:48:02 +0000

Gaslighting has entered into our common parlance in recent years. Sometimes the term is uttered out of frustration, anger or dissatisfaction in difficult relationships, whether at home or at work. Sometimes, women after long struggles to understand their intimate relationship, began to query whether they are a victim of gaslighting.

So, what exactly is gaslighting?
How can you tell?

In this series of Musings on gaslighting, I address gaslighting only in the context of adult intimate relationship. Notwithstanding that, it is important to note that gaslighting occurs in any situation where there is power imbalance. So gaslighting can occur in the context of family relationships, between bosses or managers and employees, by politicians or cult leaders.

I also refer to the victim as “she” not because women are incapable of being the perpetrators, but only because women are the victims in a majority of gaslighting cases in adult intimate relationships.

Origin of the term Gaslighting

The term originated from a 1938 play which later evolved into a 1944 film, “Gaslight”. It is a story about how a husband manipulated the wife into doubting her sanity so he could send her to a psychiatric hospital and steal her assets.

What is Gaslighting?

Gaslighting is a form of emotional abuse where the perpetrator repeatedly denies the reality of the victim. It is insidious, pernicious and manipulative. Over time, the victim feels confused, doubts her perception, her sense of reality, and her judgment. She fears the unreliability of her memory. She feels so invalidated that her sense of self, self-worth and confidence is battered.

For instance, if the victim raises any issue regarding the relationship or the behaviour of her partner, her comments may be met with rebuttals that query the validity of her observations, often laced with contempt, dismissal or ridicule:

No, I didn’t say that / I didn’t do that
I have no clue what you are blabbering on about
Oh it’s your bad memory again.
You are too sensitive / over suspicious
Stop acting like a drama queen
Why can’t you lighten up and take a joke
You never get things right
There’s something wrong with you, you are not thinking straight

Or the perpetrator may just turn the table to allege bad faith on the part of the victim:

You are just trying to make me feel guilty.

The perpetrator may also create a false narrative to malign the victim by lying about her to family and friends, for example, that she is not well, that there is something wrong with her. Over time such action could diminish the circle of support for the victim, isolating her.

Gaslighting can be ambiguous

Gaslighting is not black and white, especially in the initial stages. There are aspects that make it ambiguous and confusing. It may evolve over time.

A perpetrator may start by picking on the appearance of his partner, it could descend over time into insulting her intelligence.

He can also be very unpredictable. He may make devastatingly withering comments about the partner one moment, then become sweet and endearing later.

Gaslighting often is not a stand-alone signal of relationship failure.

He may behave in the following ways to exert his power over the victim:

Action to show he has power over her mood, that he can make her miserable, especially on occasions that she values, e.g., celebrations, festivities
Frequent demand for apologies
Meting out silent treatment.

The victim may also uncover acts of betrayal and infidelity.

Controlling and coercive behaviour

In some cases, gaslighting escalates to, or is accompanied by, controlling and coercive behaviour such as

Public humiliation
Monitoring or restricting social contacts and activities, access to phone and social media
Controlling expenditure, finance
Manipulating or forcing unwanted sex

Through these tactics, the perpetrator intimidates and instils fear.

It is noteworthy that in England and Wales, controlling and coercive behaviour in intimate relationship is now an offence under the Serious Crime Act 2015.

Potential escalation into physical violence

There is a risk that emotional abuse may escalate into abusive power and control, and physical violence. If a perpetrator perceives any act of the victim as defiance, he may resort to physical force to suppress and control the victim.

Do not under-estimate such risks.

Psychological impact of gaslighting on the victim

The impact is deep and devastating.

The victim begins to doubt herself, feels that she could not trust her senses and judgment about anything. She believes there is really something wrong with her, she may blame herself as being too suspicious, too sensitive, poor memory or otherwise. That it is her fault that she upsets the perpetrator, or provokes his retaliation with tighter control.

Generally, she may feel she is just not good enough in so many ways.

As her sense of self withers, she withdraws into a state of low mood, despondency, anxiety. She may even feel that she needs to rely on the perpetrator’s interpretation of reality, because hers is faulty.

When her trust in herself is destroyed, she also could not trust others.

How can you tell whether you are a victim of the abuse of gaslighting?

It is not an easy task to decipher that in an ongoing relationship. Women want the best for their relationships and families. They don’t want to lightly allege abuse or gaslighting. They want to give their partners the benefit of doubt, even if it is at the expense of the women’s own wellbeing.

The situation can be very confusing, “very foggy” as one of my clients described it. Unlike physical abuse, emotional abuse leaves no mark. And there is so much self-doubt amongst these women that impedes their ability to clearly analyse the situation.

The following are some indicators that you may be a victim of gaslighting:

For a while now, you have a deep uneasy feeling that something does not jell in your relationship, something is not right,
You sense that what you feel and perceive to be true is constantly denied and rebutted by your partner
You begin to feel you can’t trust your judgment, your memory
You are always querying yourself: did I imagine that? did I cause that? is it my fault?
You feel insecure and anxious about your partner and your relationship
You feel isolated, don’t know who to turn to, who to trust
You feel the ground under your feet is shaky
You are frequently forced to apologise for things that you know you are not in the wrong
You feel obliged to placate and pacify your partner for fear that worse thing could happen to you or the relationship
You recognise what’s described here as common behaviour and tactics in gaslighting.

Is the perpetrator of gaslighting always malevolent, intentional to cause harm?

To add to the confusion, it is possible that the perpetrator of gaslighting may not have acted intentionally, or is conscious of his intent to cause psychological injury.

It is also possible that he could be a product of family dynamics where the powerful members are emotionally abusive, and gaslighting is par for the course. In other words, it is possible that it is a learnt behaviour, and the perpetrator does not think there is any wrong in such behaviour.

That said, whatever is the root cause of the perpetrator’s behaviour, it cannot justify the behaviour of gaslighting. Gaslighting erodes trust, destroys the foundation of a secure and safe partnership, and causes psychological trauma and damage to the victim.

Do not accept gaslighting. It must be stopped.

Check out in Musings from Clinical Notebook:

Gaslighting 2: What can you do?
Why do you believe me Yi Shing?
Gaslighting 3: Recovery from Gaslighting
Resources & Support

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Gaslighting 2: What can you do?

Fri, 02 Dec 2022 03:02:48 +0000

In the last article “Gaslighting 1: How do you know?”, I wrote about Gaslighting, its nature, and adverse impact on the victims.

In this instalment, I will address

what you can do if you suspect your partner is gaslighting you; and
on the flip side, if your partner alleges you are gaslighting her, how you should respond if you care about your partner and your family.

Please also note that there is a list of Resources & Support in “Musings from Clinical Notebook”.

Gaslighting is confounding

As I have shown in my first article, gaslighting can be very ambiguous and confusing. Sometimes you may feel like you are struggling with shadows.

Women in an ongoing relationship also feel the need to give their partners a chance, and to salvage their relationship.

Further, victims often blame themselves as the cause. Sometimes they labour under the illusion, for instance, if I control myself, if I never get upset and if I become “really really good”, I can turn him around, and maybe he will be kinder to me.

If you suspect you may be a victim of gaslighting, what can you do?

What you can do depends on your situation.

Your options need not be binary, limited to either staying or leaving the relationship. It can be a combination of steps.

You can start with baby steps to clear your mind by say, journaling, seeking support and information, as mentioned in Plan A below.

Or you can combine different steps, for instance, if you feel that is warranted to give the relationship/your partner another chance through counselling and therapy.

But if your situation requires you to take more drastic and assertive action to protect you and your children, you may have to consider Plan B to set up safety plan and exit the relationship to save your sanity.

Use the information and resources as appropriate to your circumstances.

2 Routes: Plan A and Plan B

I set out 2 routes below: Plan A and Plan B.

Plan A is appropriate where you suspect gaslighting, but coercive and controlling behaviour has not surfaced.

Plan B is relevant where you are more certain that your partner is engaged in gaslighting, and you are fearful of his coercive behaviour. You may also be anxious about the potential escalation to physical abuse, or your partner’s behaviour has deteriorated from verbal abuse to physical violence.

Whichever route you take below, there are two things you should guard jealously:

Your self-worth, you core
Do all you can to protect and preserve your self-worth through the steps suggested here. Safeguarding your sense of self will give you the clarity and confidence you will need to assess your relationship, and decide how you want to move forward.
Your financial independence
Where possible, do your utmost to attain and maintain financial independence. Keep your job, invest in your skill set. It is a critical pillar to your self-esteem, and a major lifeline to help you exit the relationship, should you so decide one day.
Look for groups in Resources & Support that could help you to become financially independent.

Plan A: Where you suspect gaslighting, but there is no coercive and controlling behaviour, you could

Journal to clear your mind, reinforce your sense of reality, track relational development. Please however keep your journal safe and out of reach of the perpetrator.
Seek support from trusted friends and family, or support group, for emotional and psychological support and a second opinion.
Seek help from a psychotherapist or psychologist experienced in the field of abuse recovery, to help you get a clearer view of your circumstances.
Suggest to your partner that you both attend couples therapy to understand the relationship dynamics and to repair your relationship.
If you have not tried this, have a calm and open discussion with your partner about how you feel and what you sense. Maintaining calm in such conversations can be difficult. If so, seek the help of a neutral forum and facilitator by engaging a couples therapist.
Without risking physical retaliation, you may, for instance, learn to break the cycle of unproductive conversations and escalating emotions with the following words suggested by Dr Robin Stern:
- “Let’s agree to disagree”
- “You’re distorting what I said. Let’s take a break and talk later”.
You can also consult the agencies in Resources & Support for more information and help. Join their support group for survivors of marital abuse.

It would be a good idea to set a deadline for these attempts. So that should the situation not improve, or if it deteriorates, or your partner insists there is nothing wrong with him, you may have to look to Plan B.

If the relationship is very tense, and you feel you have passed the stage of engagement and hope for repair, it would be advisable to contain the situation to prevent escalation to physical violence, by

Minimising confrontation and argument about what’s the truth or who is right,
Minimising engagement with the perpetrator.

Plan B: Where you know there is gaslighting, realise the perpetrator is coercive and controlling, and you fear potential violence, or have experienced actual physical abuse to you and/or your kids:

you need to seek help urgently to set up a safety plan for you and your children by contacting any of the agencies in the Resources & Support;
you may also need their guidance to apply for a Personal Protection Order;
it would be a good idea to continue with the self-help measures mentioned in Plan A.

Do not compromise on mental wellbeing and physical safety of you and your children.
Staying in abusive relationship will hurt your children’s wellbeing.

On the flip side: If your partner alleges you are gaslighting, what should you do?

If you care about your partner and your relationship, this is an alarm bell for your deep reflection and to take remedial corrections.

Put aside your ego, park your defence at the door, and think sincerely: is there any merit in what my partner said?

If upon reflection, you have searched your conscience, and in all honesty, you did not intend to and do not want to harm or instil fear or insecurity in your partner, or

if you feel you may have unknowingly behaved in a way that unsettled and hurt your partner,
you can take the following steps:

Individual Psychotherapy: through individual therapy, you will:
- uncover your blind spots, uncover aspects of yourself you did not know
- gain self-awareness
- realise what and who in your growing up years influenced such mindset and behaviour.

Did you also suffer?
Were you also psychologically hurt or brutalised in the process?

Sincere and authentic conversation with your partner: You will need to start having open, authentic and honest exploratory conversations with your partner. Instead of feeling maligned and defensive, learn to be curious:
- Why does my partner keep raising certain issue?
- Am I missing something?
Couples therapy: It is challenging to conduct a calm and open conversation with your partner about a tricky subject like gaslighting. It may therefore be a good idea to seek help from a couples therapist to manage this process and to resolve the relational crisis.

But if you know you have deliberately caused psychological harm to your partner, but you don’t want to lose your partner and your family, you should also seek professional help suggested above, so you can rein in your action that hurt your partner and your children.

If you choose to take your partner’s allegation positively as an opportunity to change course, you stand a chance to make amends, and rebuild the relationship and your family.

Otherwise, there is only one certain outcome: your abusive behaviour will continue or deteriorate, your domestic relationship will unravel, your partner and children will be alienated and estranged from you, and the mental health and wellbeing of your family will suffer.

That is a grim prospect nobody wants.
You can take the steps mentioned above to prevent that from becoming your reality.

Check out in Musings from Clinical Notebook:

Gaslighting 1: How do you know?
Why do you believe me Yi Shing?
Gaslighting 3: Recovery from Gaslighting
Resources & Support

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Why do you believe me Yi Shing?Gaslighting 3: Recovery from Gaslighting

Fri, 02 Dec 2022 03:45:04 +0000

Why do you believe me Yi Shing?

Mel [not her real name] asked, when she first told me what happened in her marriage.
I can still recall that scene: she was in tears, her face contorted with so many emotions, her body hunched over.

She struggled to tell her story, double guessing herself at the same time, fearing she might be making it up.

When she sensed that I was there listening, there with her, and for her, a part of her was surprised and relieved that a professional did not doubt the authenticity of her narrative. That I understood her words and her pain, and affirmed her reality.

Mel would repeat that question several more times in the early days of our work together.

Such expressions in different iterations are common amongst victims of marital emotional abuse. These questions demonstrate the deep anguish and suffering of victims of gaslighting [1][2]. Their reality has been ridiculed and denied by their partners for so long that their sense of self has been mangled through sustained psychological abuse. They are riddled with self-doubt.

Many of these clients of mine were professional women with proven career track records, and were well regarded in their respective fields. At times, such characteristic exacerbates their sense of shame and self-blame, making their traumatic relational experience all the more poignant.

Where the victims have exited the toxic relationship, daily relational distress with their partners would be more contained. They would have more bandwidth to attend to the next phase of their life: healing and recovering from relationship trauma, building and reclaiming their life.

In this 3^rd instalment on Gaslighting, I write about

setting the stage for rehabilitation and recovery, and
the therapy journey to overcome emotional and psychological turmoil resulting from relational abuse, to heal the wounds.

Enlisting professional help to stay on course and to heal

The psychological injury caused by gaslighting varies according to the individuals and their circumstances. At the more dire end of the spectrum, the wounding can be grievous and debilitating. Where harassment by the perpetrator continues or where the victim has little family support, the time required to recover can be prolong, and the road to recovery can be bumpy.

Leaving a toxic relationship is challenging. Sometimes the survivors regress, return to the perpetrator, and then struggle to restart the process of extricating themselves all over again, with untold misery.

Because this can be a difficult journey, it is best you have the support of a psychotherapist or a psychologist experienced in the field of abuse recovery to help you focus on your resolve to move on, and navigate the way forward.

Alternatively, you may seek such help from the groups listed in the Resources & Support.

That said, do have faith that you can recover from the damage of gaslighting.
You can reclaim your life.

Setting the stage for rehabilitation and recovery

1. Prioritise yourself: Care for yourself first

Oftentimes, women prioritise their children first, neglecting their own needs. It is important to remind them that unless they are healthy and strong in body and mind, they have little capacity to support their children through this turbulent passage.

Keep your body healthy and strong, so you can heal your mind. You will then find the strength to deal with everything else: children, job, money etc.

Do what you can to put these fundamentals in place

Eat nutritiously, exercise regularly, sleep well.
Learn to appreciate quiet time by yourself. It may be a new experience. You will find that you could recharge through
- Reflection
- Journaling
- Reading to understand your experience.
Pick up meditation or mindfulness to experience inner calm and clarity
Stay very focused on your recovery, wellbeing of you and your kids, your job, your future.

2. Create stability

Help yourself and your kids to settle into new accommodation,
Arrange for childcare, new schools and routine for your kids,
Keep your job, invest in your career and your knowledge: it is a leverage and enabler to build your new life.

3. Restrict your contact with the perpetrator

It may be hard, but you have to keep reminding yourself why you left. Seek the help of therapy or support group to sustain your resolve, and to keep moving forward.

It is important for survivors to know that perpetrators of gaslighting may try various means to get you back into their orbit.

Acknowledge your inner conflicts: that you may feel tempted to go back, you may chide ourself for being so hard and so harsh, after all there were some good times in the past, that living and parenting alone is tough.

You need to remind yourself of the fear and misery that forced you out of the relationship in the first place. Weigh the pros and cons and the consequences of reversing your steps. Seek the support and advice of those who had stood by you and supported you.

If you need to keep contact with the perpetrator for reasons of child support or co-parenting, set clear boundary. Limit such communication to only one platform, and do not engage in subject matters other than essential tasks.

4. Set clear boundary with family and friends

You need friends and family you can trust, and who can support and nurture you.

You may distance yourself from people who are only interested in fodder for their idle gossips. You would also realise that conversation with naysayers who criticise your decision to leave will only cause you grief and confusion. You don’t need additional pain right now.

Journey of recovery through psychotherapy

Survivors have taken the mammoth step to leave their toxic relationship. But the wound is still raw, and they continue to experience emotional and psychological turmoil.

Psychotherapy will support and meet different psychological needs of the survivor on this path.

Issues arising from new living arrangements

From time to time, we have to tackle “practical issues of living”. They range from issues of single-parenting, finance, to managing retributions and blame from family and perpetrator. These are often presented with underlying psychological obstacles arising from her recent trauma.

Building psychological resources and coping skills

Survivor often suffers from poor sleep or have nightmares about the past or the future.
She may experience crying spells, irritability, body aches and pain. Her work performance and her social relationship may suffer as a result.

Learning the skills of self-soothing through breath work, mindfulness and relaxation practice, skills of emotional regulations, is the first steps towards calming her frayed nerves.

It is also helpful to learn self-acceptance and self-compassion.

Accept and embrace who she is. Accept that she had done her best, and is doing her best on a daily basis. Accept that abuse happened to her in her relationship, and learn to tell herself she did not cause it and did not deserve it. Exercise compassion for herself, and affirm herself for her efforts to survive and keep safe.

Together, these will begin to stabilise her emotions, and in turn introduce greater serenity to her relationship with her children.

Collectively these will place the survivor in a steadier frame of mind to undergo trauma therapy.

Trauma-focused therapy

The therapy required varies according to each individual’s conditions and circumstances. Whatever are the symptoms, the focus is on repairing and healing her sense of self, nurturing her confidence and self-worth, reclaiming her power, so that she could move forth and grow in her new life.

Major attention is devoted to resolving the trauma origins of symptoms such as the survivor’s exaggerated negative views of the self, intrusive thoughts, emotional dysregulations.

Some common negative self-beliefs of the survivors include:

self-doubt
- maybe I am really a liar
self-blame
- it’s my fault
- I caused it
- I am responsible for what happened
- I am a failure
- I am not good enough
- I should have known better
- I have let down my parents and children
shame
- how can I be so weak and stupid to let him ride roughshod all over me
- my clients and my fellow professionals would be shocked by how pathetic I am
- my subordinates and staff would not believe how useless I am.

The survivor may grieve over the loss of marriage, the marital status, the “normal or ideal nuclear family”. They worry about the impact on their children.

She may experience many emotions including anger, anxiety, fear, loneliness. She may also struggle with the stigma of divorce, whether real or imaginary.

In addition, the survivor may re-experience (“flashback”) episodes of marital conflicts and confrontations; moments of fear, distress and anguish; images or thoughts about the past popping into her mind, upsetting her balance.

In some cases, a survivor may find her distress so intolerable that she resorts to numbing her pain through alcohol or substance abuse, or the distraction of over-spending, for instance.

These symptoms are mostly trauma-related. Whether or not the symptoms are sufficiently serious to warrant a diagnosis as PTSD [posttrauamatic stress disorder], resolving the root cause of the distressing symptoms is the key to rehabilitation and recovery.

Outcome of trauma resolution

When trauma memories are progressively processed, the survivor will experience a strengthening of her sense of self and agency. Positive view of herself will emerge to replace her erstwhile negative beliefs. These are sure signs of recovery in progress.

However terrible had been your experience, the trauma can be resolved through appropriate therapy (What is EMDR + Emotional wellbeing with EMDR).

The wound will heal.

You will regain your sense of self.

You will reclaim your life, and go on to live a healthier, happier and more productive life.

If you are, or someone you know is, suffering from ramifications of relationship abuse, please contact us.

Check out in Musings from Clinical Notebook:

Gaslighting 1: How do you know?
Gaslighting 2: What can you do?
Resources & Support

The post Why do you believe me Yi Shing?
Gaslighting 3: Recovery from Gaslighting appeared first on Acorntherapy.

Resources & Support

Fri, 02 Dec 2022 05:48:19 +0000

Please also refer to the excellent list on Channel News Asia.

I. Support for victims of relationship/domestic abuse

National Anti-violence helpline

1800-777-0000

SMS 71999

Call 999

Association of Women for Action and Research [AWARE]

1800-777-5555 [Mon-Fri, 10am-6pm]

sacc@aware.org.sg

Visit their website

Care Corner Project StART

6476 1482

projectstart@carecorner.org.sg

Visit their website

Family Service Centre Hotline

1800-222-0000

Or go to this link to find a FSC nearest to you

PPIS (Persatuan Pemudi Islam Singapura) Family Service Centre

6848 4661

fsceast@ppis.sg

Visit their website

PAVE (Centre for Promoting Alternatives to Violence)

6555 0390

admin@pave.org.sg

Star Shelter

It provides a safe space for women and children who are victims of domestic violence.

Call these numbers during office hours on Mon-Fri:

6571 – 0191 / – 0192 / – 0193

II. Support for women to become financially independent

Employment and Employability Institute

Provides career counselling and coaching, and helps people seeking a fresh start.

Visit their website

Daughters of Tomorrow

Through various programs, it helps women to become financially independent, seek job opportunities and arrange child-minding for working women.

empower@daughtersoftomorrow.org

@daughtersoftomorrow

Mums@Work Singapore

Helps women to return to workforce whether as full-time, part-time, flexi-hours employees, or as home-based business owners.

Visit their website

@mumsatwork.sg

The post Resources & Support appeared first on Acorntherapy.

Is there life after an affair?

Mon, 07 Nov 2022 04:23:58 +0000

This is a Cry in Despair from many suffering the aftermath of an affair, whether you are the one who has been betrayed, or your act of betrayal has been discovered.
But the short answer to that question is YES, a resounding YES.

There is life after an Affair – for you individually, and for your relationship / marriage – should you choose to work at it.

However, the path to get there is not a walk in the park.

It calls for great determination, patience, persistent effort and time.

Therefore, it is best to engage an experienced therapist to help you navigate this tricky journey in your relationship.

Let me start from the beginning.

What happens when you uncover an act of Betrayal

If you have suffered an incident of cheating by your partner, you could be on a roller-coaster racing through emotions such as anger, disgust, heartbreak, shock.

It is like someone has just punched you in your guts; the ground shaking beneath your feet.

You might blame yourself: I should have done xyz; how can I be so blind/stupid/trusting; I am not good/clever/attractive enough that’s why he/she did this etc.

Images of what your partner were doing with the other person keep running through your mind – you just can’t keep them out.

You may be hypervigilant, checking on and tracking your partner all hours of the day.

You don’t know what to feel or think, how can I get through this?

You don’t know what to do next: leave? stay?

If you are the person who had been cheating and found out: you too are going through various emotions.

You could panic, find yourself suddenly staring at an abyss: the end of your marriage/relationship, a breakup of your family.

You could feel shame, guilty at causing such hurt to your partner.

Or you may push back: defending yourself you did this because your partner ignored you, was cold to you etc

You will find your partner repeatedly asking: why-why-why did you do this?
what exactly did you do with him/her etc

You feel whatever answer you give to your partner’s pressing questions – you just can’t extinguish his/her anguish.

You begin to feel frustrated: this punishment will go on forever – there’s no end to it.

Both of you are in chaos and confusion.

What can I / we do next?

This relationship is in tailspin and needs emergency aid.

For couples who want to save this relationship, this is how I would work with you.

Through the process of Atone-Attune-Attach, I will first help you to address and contain the pain. I will guide you both through the stage of Atonement, and give you skills to survive this phase.

Do not rush this stage – however painful or uncomfortable this may be for you

Because whether your relationship will survive this catastrophe – and whether you individually will be able to move on having learnt the necessary lessons – depends on how well you work this stage.

When relative calm settles in, the therapy will move into the next stage of Attune and Attach, when I will support you to repair and rebuild the relationship.

You will stand to learn more about yourself, about your partner, about your relationship, and learn skills to build a “relationship/marriage 2.0”.

Infidelity: Character Defect? Relationship Dissatisfaction?

Infidelity could happen for a myriad of reasons, and a combination of factors.

Oftentimes, it occurs when the relationship has gone cold, filled with tension and distance.

That, however, should NEVER excuse any acts that destroy the trust in the relationship, nor acts that hurt and injure one’s partner.

Cheating strikes a lethal blow at the foundation of the relationship. It is a devastating breach of trust between partners.

When couples experience relationship difficulties, the responsible approach is NOT to seek excitement or comfort elsewhere.

The responsible approach – when we realise we are not getting well together, we are fighting or ignoring each other too often – is to seek professional help to deal with the problems.

It is the JOINT responsibility of a couple to learn through therapy what difficult emotions belie our repeated conflicts, learn relationship and conflict management skills.

So that we could bring back, or cultivate anew, respect, trust, warmth, delight, curiosity, joy and, of course, fantasy.

Infidelity may also happen due to issues of an individual, arising from childhood or life experience, addiction to substance, behaviour, sex or social media.

In such cases, in order to reduce the long-term suffering in this relationship, that partner needs additionally to seek individual therapy to overcome such difficulties.

What if I just want to up and go?

You may have good reasons to reach this conclusion.

But there again, you may be doing this because you want the pain to stop. Now.

I would just say: hold it for a bit, come in and have a chat first.

Ending the relationship is not necessarily a bad thing. Just don’t do this out of an impulse to avoid the pain, to run away, or because of the constant stabbing in your heart.

Allow yourself the time and space for calmer deliberation:

Do I want to hear how he/she would Atone – then I decide?
Do I want to grapple with what caused this – because I don’t want anything like this to ever happen to me again?

See an experienced therapist to help you get to clarity.

Where ending the relationship could be good

Sometimes a calamity like an affair serves to shake us out of the inertia of a relationship that has been too hurtful for too long and is beyond repair. Leaving, in that case, may be a good thing.

Life is meant to be productive, healthy and joyful.

Not full of pain and resentment.

If that fits your situation, then in order to live well in the future, I would suggest that you spend some time looking back to review what lessons you could takeaway with you. So that these painful teachings could guide and enrich your vision for your new life.

Is there life after an Affair?

So again, the answer is YES, there is plenty of life after an Affair.

However, how good a life that will be depends on whether you deal with Infidelity with all the attention you and your partner deserve.

So DO NOT turn a blind eye to the pain, DO NOT sweep it under the carpet. The wound will just fester unabated, and send your relationship down a slippery slope.

Whatever happens from this point onwards: you will have to grapple with your personal and inner issues first – understand the past, so you can live well in the future, whether in this relationship or alone.

Only when you are whole and at peace with yourself, could you be effective in repairing this relationship, and/or rebuilding your life.

Act to heal yourself and your relationship.

And you will live better.

The post Is there life after an affair? appeared first on Acorntherapy.

Telehealth

Thu, 04 May 2023 06:44:32 +0000

With the adoption of Telehealth (also known as online counselling or online therapy) since the start of the pandemic, our services have become accessible to

people who prefer the convenience of seeing me from their homes, and
people who need psychological therapy outside Singapore.

What is Telehealth, Online Counselling, or Online Therapy?

Telehealth, Telepsychology, Online Counselling or Online Therapy has been used by providers of mental health counselling and psychotherapy for many years, and is common especially in countries with huge land mass such as USA and Canada.

Since the pandemic, Telehealth has proliferated throughout the world. Many mental health professionals adopted it to continue to serve their clients.

Studies conducted on the efficacy of Telehealth have found the clinical outcome is just as good as in-person therapy. In fact, in some cases, the outcome can be better than face-to-face therapy where clients suffer from a high degree of fear and phobia, and they feel safer in their own homes. The distance afforded by Telehealth is an added assurance to such clients.

Telehealth@acorntherapy.sg

Just before the Covid-19 Circuit Breaker in Singapore in 2020, I moved my in-person service to online video platform to pre-empt a disruption to therapy. Telehealth or Online Counselling and Therapy has allowed me to work with my clients without interruptions.

We may have weathered the worst of the pandemic, mutations and surges to emerge into more relaxed measures. However, no one knows if there will be further waves, or other infections or emergencies, that could prevent in-person contact in the clinic.

The pandemic was a watershed global event that has radically changed our lives, our societies, and in particular, how psychotherapy and mental health service is delivered.

One thing is certain: Telehealth is here to stay.

It will make mental health services accessible to many, beyond the constraints of physical barriers and geographical borders.

Encrypted and secure platform

I use an online video-based platform that is popular with the medical professionals and clinics in the USA. It is encrypted, secure and HIPAA compliant. [HIPAA is a USA law, the Health Insurance Portability and Accountability Act of 1996, which protects and ensures the lawful use of online health information of individuals.]

How do you access Telehealth?

The platform I use is simple and does not require you to download any software or maintain any account.

All you need to do is to scroll down to “Contact Us” and send me a message. I will get in touch with you to provide you with further information on seeing me through Telehealth.

Many of my clients are not “tech savvy”, yet they found it easy to connect with me via the platform I used.

What my clients like about Telehealth?

My clients have grown to appreciate Telehealth, not least because it saves them commuting time, avoids the hassle of crowded public transport, and does away with expenses of petrol and parking!

Some have found it particularly helpful because they are not able to travel for reasons of illness or immobility.

Others have found that with Telehealth, they are able to have their pets nestling besides them during the therapy sessions, giving them additional comfort.

Further, clients in Asia and beyond have been able to access my service through Telehealth.

What if you are not sure of Telehealth?

You are most welcome to ask me questions. I will be more than happy to address your doubts and concerns. Please send me a message via “Contact Us” so I can get in touch with you.

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