A million little things – how we build great friendships and protect against loneliness.

In a recent article in the Financial Times newspaper [1], data insights reporter Federica Cocco warns of a growing epidemic of loneliness for people in the world. Citing ongoing research from the American Time Use Survey, Cocco highlights that people in the US are appear to be decreasing their experience of friends and family who they can count on for support.

In particular older people are more affected than other age groups. Over half the people over 65 years of age spend more than 8 hours of their awake time alone. Cocco also highlights that young women are a growing group at risk of experiencing loneliness, as the percentage has doubled of women spending reporting protracted periods alone (2011-2021: 7-14%). 

Loneliness has been associated with objective social isolation, depression, introversion, or poor social skills. It is a threat to physical and mental health.  Income, education, sex, and ethnicity are not protective against loneliness. Rather than trivialised, ignored or blamed in those who experience this condition, we need to consider how we can protect ourselves and others.[2]

We see the expansion of loneliness in our clinical practice as well. In Hong Kong many people who come for counselling report the lost of friends and increased experience of social isolation as part of their current life experiences. We are social beings. We thrive on being emotionally connected to others and function well when we are involved in rewarding relationships. {3, 4]

Although many of us still have friends that we can spend time with, we may also being lack of intimacy in the friendships that we have [3]. It is important to have support, people who you can share your worries and concerns with, and provide us with key support that we need and protect us against social isolation and loneliness.

Developing new valuable friends is a skill that we have to learn as children, but often we need to relearn and revisit friendship making skills repeatedly over our lifespan. – We need to go into friendship making mode when we experience an intimacy gap among our friendships, we have lost many friends, we change our life circumstances (living location, having children, marital breakdown, leaving employment).

Not only are friendships vital, they fulfill and number of key roles in our lives from championing for our health, connecting us others and helping to challenge your mindset [4].

If you acknowledge that your friendships are not as you would like them to be, in terms of numbers of friends and also depth of friendships we have some recommendations that can help you reboot the Intimacy in your friendships  – frientimacy (Nelson, 2016)

Friendships are the result of combining a number of action/ingredients: consistency of effort, personal positivity, your ability and willingness to be vulnerable, understanding and respecting other people’s preferences, having patience, and reflecting mindfully on what is working/not working in order to determine a future for each friendship. 

Consistency

Consistency is a priority in creating a new friendship. The act of building new, and better friendships, is the accumulation of a million little things rather than a few big events. If you want to build a new acquaintance into a friendship you need to create consistency into the relationship – hence why we become friends with people that we see that they same class or activity each week.[3]  

So, if you are looking to meet and make new friends you will be best placed to attend a regular event instead of a one-off workshop. For example, if you want to make new friends you might consider joining a choir group, sports club, bridge or mah-jong club, or regular support group.

You also play a role in creating consistency in your friendships. If you are invited to lunch and decline, ensure that you protect the consistency of the relationship by offering an alternative catch up opportunity immediately. People drift apart because of lack of sustained effort.

Admittedly relationships still require give and take. If you are constantly offering meet ups, and the other party is not reciprocating, consistency will become difficult to achieve. This highlights the value of the other ingredients needed to create meaningful friendships.

Positivity.

We have all had one friend who has been stuck in a negativity rut and one time or another. Depending on the history, and future aspirations of that friendship, you may need to resist a desire to pull away from such a person. That is because it is very difficult to be around negative people.

“Healthy people aren’t looking for needy, whining, drama-filled, complaining, negative people with whom to spend time” Nelson, 2016, Frientimacy [4]

Conversely, people are drawn to fun or positive people who help lift the mood at a gathering, or help others feel good.

This doesn’t mean that you need to be over-the-top. People who appear happy all the time appear inauthentic. There is a long range of acceptable emotionality between happy people and negative.

In your relationships with people, you might like to consider how positive and negative you are towards your friends. The Gottmans, the leading marital therapists in the US, state that friendship is the key component of romantic partnerships, and within those that they classify as masters of relationship they share positive action (comments or gestures) to their partner 20 times more than negative comments.

These positive components are not necessarily major investments of time or money, for example nodding when you are listening to a friend’s story is a ‘positive’. Certainly, thanking them for a gift, or their time, or sharing a compliment will spread a feeling of positivity. You could aim for the magic proportion of 5:1 positive to negative action as a starting point. This is be basic ratio that the Gottman’s advise to build positive sentiment in a relationship. [5]

What is a negative element? Obvious verbal criticism, unkind mocking or being caught gossiping will hurt your friends. But it is often small actions that can bring negative element into a friendship such scrolling through your phone when your friend is talking to you, ignoring their texts, rolling your eyes when they tell you a story [again], repeatedly being unavailable to meet up.  

It’s not enough to spend time, and be positive, you also have to be vulnerable. For some people this is difficult.

Vulnerability

When we share vulnerability we are expressing that we are not perfect, we are real humans with feelings, dreams, aspirations and disappointments.  Some individuals find it extremely difficult to share vulnerability, challenges or hurts with another person, possibly because of past trauma or broken trust. By avoiding vulnerability, they keep people at arm’s length. This messages to the receiver that I will spend time with you, but not intimate details of my life. If you want deep friendships rather than acquaintances, you need to let people in.

When we share our vulnerability with another person, we are giving them the opportunity to demonstrate empathy and support for us. Empathy and support within a friendship are the glue that hold it together. After all everyone will have encounter challenges in their life – when changing jobs, experiencing a break up, dealing with difficult co-workers. Friendships are extremely valuable during periods of personal challenge.

I warn you against too much vulnerability too soon. Sharing too much, too soon, and too often can be overwhelming to your audience. Vulnerability as an ingredient needs to be timed and measured carefully. Share vulnerable content only after you have meet with a person 4-5 times and watch their reaction. If they demonstrate empathy, your sharing has helped to deepen the relationship. If they don’t show caring, then it might be that you have overshared or that they are not able/willing to have vulnerability as part of your friendship.

Understanding, and appreciating, differences

We are all have different values and priorities. Understanding the world of your friend as well as their communication preferences will help you to build better relationships. Intimacy can be built when people feel understood.  Don’t just focus on being interesting, be interested.

In order to better understand your friends’ build and understanding of their world you can engage in activities that expand your understanding of their world. The Gottmans use love maps to help build back understanding, appreciation and trust into relationships. We have expanded some of their questions to create a friendship love map starter list of questions.

See our picture of  a few questions you might like to know the answers to. Having conversations with your friends about what matters to them indicates that you are interested in their lives. Give it a try.

A set of questionnaires that we use  in couples therapy that are also applicable to building good friendships include understanding your friend’s love language and their apology language (see https://5lovelanguages.com). When we respect our friends’ love languages we better connect with them. Understanding that your friend values acts of service means that you will build a stronger relationship helping them with a house move, rather than buying them a box of chocolates to celebrate the mo

Building better friendships requires expanding our ability to mend fractures in the relationship that can possibly lead to breaks.Friends have disagreements. Apologising to your friend in their preferred apology language, also helps mend the relationship when disconnections. We have a tendency to communicate in our own preferred language rather than the preferred language of our recipient. If your friends’ preferred apology style is different from yours, your apology may feel insincere or incomplete. To learn more about your, and your friends’ apology preferences visit  https://5lovelanguages.com.

Most people have more than one preferred apology language so you might consider combining the language around your friends preferences – for example if your friend prefers restitution and repenting you might apologise by saying to them, “I promise I won’t do that again, and ask can you tell me how I can make things right with you.”

Patience

In studying how long does it take for college students to make and secure friendships Hall (2018) [6] suggests the following. The chance of classifying a person as a casual friend rather than simply acquaintance occurs for most students after they have spent over 43 hours together. Casual friends transition to “friends:’ after at least 57 hours together within a 3-week period. Best friends, or good friends take longer. Over a 3-month period an investment of over 200 hours is required.

What can we learn from Hall’s analysis. Basically, it supports the prediction that value of time spent together is a predictor of friendship and friendship closeness. Taking this investment approach to friendships can help us decide if we have really put in enough effort to secure a friendship. Are your expectations realistic? When we desire new deep relationships it can be uncomfortable to understand that friendships take time.

Reflect what is working, and what isn’t before you audit.

New friendships, and building deeper friendships, take time, consistency, vulnerability, understanding, and positivity. Even then you may feel that the relationship is not working for you.  It is quite possible that you become impatient with potential friendship candidates converting to becoming friends.

Ambiguous loss is the term used to describe the grief you have for someone who is still alive, including a relationship which seems to be fading or not delivering as it uses to. It is healthy to audit your relationships to consider if reinvestment could save them, or a mismatch in timing or values is now so considerate that perhaps you would be best to invest your time in another friendship instead – ie audit.

Before you cast a new, or even and old friendship, aside – reflect on the following considerations.

Reflections:

  • People have a bias to overestimate what they give to a relationship, and underestimate the efforts of others. Could you be operating under such a bias way of evaluating your friendship?
  • Do you know what you want from this friendship, and have you made this clear(er) to your potential friend?
  • Am I over-giving and not receiving enough back from this friendship? If so, is this you offering too much or them not offering enough? Could this be changed?
  • What traits do I admire about this person? Do I want to still have access to those traits or offerings. Consider exploring what type of friend they are according to the Rath “Types of friends” graphic. Do you have other people in your life who provide this trait/skill?
  • Is your friend going through a tough period in their life when they can not be a great friend to you? Can you consider to have a more “one-sided” relationship for a specific period, but make it clear that, this is not a permanent status.
  • Am I willing to break out of my comfort zone and usual way of operating in order to make this friendship better? If you are not, are you willing to accept the consequences of “doing what you have always done?”

If you acknowledge that your friendships are not as you would like them to be, in terms of numbers of friends and also depth of friendships the recommendations we have included here could help you make new connections, rebuild old connections, and reinvigorate your friendship base. You don’t need to be alone if you don’t want to be –invest in your connected future.  

References.

[1] Federica Cocco Are we ready for the approaching loneliness epidemic? FT.com 25 November 2022. https://www.ft.com/content/c3aef690-b5a5-4f0d-9da5-2bf4c560c4f4

[2] Gerst-Emerson, K;, and Jayawardhana, J (2015) Loneliness as a public health issue: The impact of loneliness on health care utilization among older adults. American Journal of Public Health, May . 

[3] Nelson, S (2016) Frientimacy: How to deepen friendships for lifelong health and happiness. Seal press.

[4] Rath, (2006) T. Vistal Friends- the people who can’t afford to live without. Gallup Press.

[5] Gottman J and Silver, N (2013) What Makes Love Last?: How to Build Trust and Avoid Betrayal. Simon and Schuster

[6] Hall, JA. (2018) How many hours does it take to make a friend? Journal of Social and Personal Relationships. Volume 36(4) page 12788-1296.

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Allow yourself time to grieve

The Western world has a lot to apologize for when it comes to bereavement. Many people have lost friends and family during the COVID pandemic, and the stress around it. Because of restrictions in travel our usual rituals and rights-of-passage have been interrupted. The traditional Western approach to accepting death is not particularly emotionally realistic. This has, possibly been exacerbated, by the way we have had to deal with death during the pandemic.

Our approach to dealing with death can makes dealing with bereavement harder for some people.

Western approaches to Death and Grieving almost expect those left behind to have a moment, and then “get over it”. Getting over our grief, or achieving “closure” seems to be positioned as the objective.

This is not healthy.

As counsellors we see clients come to us trapped in their grief over the passing of loved ones, angry at their own impatience that they just can’t get past these feelings.

Each person’s grief is unique and depends on their personality, the relationship with the deceased, the quality of death (sudden, long, quiet, violent), the emotional style of the bereaved, their mental health, and the social and cultural perspectives on death and the afterlife. In short, your path of bereavement is your path. Its OK to not feel OK. It is OK to continue to miss someone. Of course, we may need to also be functional whilst we grieve, but rushing “recovery” is not only unhealthy, it is unrealistic

Make the most of deathly rituals

The use of rituals at the time of death may help or hinder the experience of grief. The formal funeral common in the western world is a far cry from the Maori Tangihanga – a three-day grieving ritual with gathering, storytelling, beer and tears-a-plenty. The same could be said of the Irish tradition of a merry wake. These highly emotive celebrations lament death and mourning as a rite of passage, normalising the expression of pain. It is not sombre, quiet and with restraint. All emotions are explored and experienced. Giving ourselves sufficient time to acknowledge a death has occurred helps us better process the impact of that person’s passing

 The Mexican celebration, the Day of the Dead invites the departed to revisit the earth and join their families. The Chinese traditionally improve the afterlives for their loved ones by burning paper objects such as iPads, new clothes and even cars so that their ancestors are nice and comfortable. These rituals keep the departed loved, remembered and, most importantly connected to the living.

Because of the covid pandemic many individuals did not even have our usual, even inadequate, rituals to help us start the grieving process. We say goodbye to loved ones via the internet, or not at all. We have witnessed an onslaught of death as a consequence of COVID, each body representing the broken hearts of many who were robbed of a final, loving and respectful “goodbye”. We do not have a measure of the collective impact of this grief. In counselling, we face each case, one by one, or occasionally in workshops.

Connect to the echo of your loved one.

Staying connected to those who have passed helps people to continue to grieve. You don’t have a specified period to complete grief, like it is a quest within a game.

In her wonderful book for children, “The Invisible String”, Patrice Karst reminds us that we remain connected to the dead through our shared love and remembrances. Rituals and celebrations are a great way to maintaining connectivity.

Staying connected to the memory of a departed loved one, can provide comfort. For example, celebrate a loved one’s birthday with their favourite food or wine, or enjoying one of their activities, continues to keep you connected to those who have died.

In counselling we can use a utilize a variety of ACT and psychodynamic therapy techniques to help you accept, repair or resolve the features of your relationship with your departed loved one. If you find your grief more than you can take, it is OK to talk to a qualified professional. If you think it would help, seek out a bereavement workshop, or support group*

Remember dead does not mean forgotten.

In the poem Death is Nothing At All by Henry Scott Holland, reminds us that whilst our loved ones have left our physical world, we need not forget them, or ignore them.

Death is nothing at all.
I have only slipped away into the next room.
I am I and you are you.
Whatever we were to each other,
that we still are.

Call me by my old familiar name.
Speak to me in the easy way
which you always used.
Put no difference in your tone.
Wear no forced air of solemnity or sorrow.

Laugh as we always laughed
at the little jokes we enjoyed together.
Play, smile, think of me, pray for me.
Let my name be ever the household word
that it always was.
Let it be spoken without affect,
without the trace of a shadow on it.

Life means all that it ever meant.
It is the same that it ever was.
There is absolutely unbroken continuity.
Why should I be out of mind
because I am out of sight?

I am waiting for you,
for an interval,
somewhere very near,
just around the corner.

#Bereavement

#CopingwithDeath

__________________________________________________________________

Angela Watkins is a psychologist and counsellor at RED DOOR Counselling in Hong Kong. Her current clinical work focuses on all aspects of family life – including bereavement. Angela has been listed as HK’s best therapist by LIV magazine (2022)

  • * Angela will be running bereavement workshops every few months at RED DOOR starting from Jan 2023.

The Best Books to improve your love connections.

As a therapist of individuals and couples, I have read copius books about relationships, and how individuals act within them. In this blog I highlight my 5 favourite books I recommend to deepen the relationship of couples and my current 5 most endorsed references to help individuals better understand their role in their relationships (past and present).

We often spend more time ensuring that we are good employees, than good partners. Take some time to invest in improving your connection to your partner, and your own responsibility, motivations and agency within relationships.

5 Books that will help you strengthen the bond in your romantic relationship.

Whilst some of these books are primarily aimed at married couples, they will also be of help for any couple who are in a serious relationship. Most of these books are written with hetrosexual couples as their examples, but many outtakes will  also be helpful for same-sex couples.

The Seven Principles for Making Marriage Work – John Gottman.

The Gottmans – John and Julie – are the landmark marriage counselling trainers and theorists (see www.Gottman.com). Their fourty years of relationship counselling experience has culminated in their Sound Relationship House model of what makes love last. This model aims to help couples build the positive attributes in marriage (shared meaning, admiration, friendship, understanding) and minimise those activities that compromise and rob the marriage of joy and contentment, which are often on full display when lovers are in conflict.

.There is a plethora of books written by the Gottmans, particularly scholar John Gottman. Most of these books are based on the Gottman model and activities within it. The reason that I recommend this book is that I believe it is the best written of (many) books, and easier to understand. There are helpful exercises to help build mutual understanding, express yourself and your needs, fight fair and repair hurts.

Other great Gottman books to consider – 8 Dates, The Relationship Cure, What makes love last, and, And Baby makes three.

Marriage Rules: A manual for the married and the coupled up. Harriet Lerner

Clinical Psychologist Harriet Lerner is a prolific writer. This book is different from the rest of her publications (see Dance of Intimacy below) in that it is a practical guide for couples. Delivered in the voice of a good friend, a lot of what Dr. Lerner has to say, just makes good sense.

Since the book is presented as a list of “rules”, you can simply skip over those which aren’t applicable to your current relationship situation.

Mating in Captivity – Ester Perel

Esther Perel takes on the questions that couples that have been together for a while frequently avoid – how do we navigate the union of domesticity and sexual desire.

Many couples in therapy express the loss of physical intimacy as a reason for their relationship dissatisfaction. This book takes on bedroom dynamics and promises to liberate and energize your sexual connection.

201 Relationship Questions – Barrie Davenport.

Barrie Davenport is a coach rather than a marriage therapist – something you need to know before you buy and use this book. As such he has created a book that asks many provoking questions that therapists may prefer to ask in session, rather than in the real world. If your relationship is in crisis this is NOT the book for you. Sometimes topics such as how we feel about extended family, and previous relationships are best handled in a supportive, mediated environment.

However, if you feel your relationship is on pretty solid ground, these questions are a great way to see where you and your partner connect – and potentially clash. Understanding and appreciating your partners’ world view is essential to building a long term, satisfactory relationship.

If you are looking for a more mild safe set of questions the Gottmans (above) have question packs available on their website.

The Dance of Intimacy – Harriet Lerner

Fixing a relationship is an act of teamwork. However, one person’s willingness to model their intimacy may well inspire the other to embrace authentic change as well. Harriet Lerner has produced a litany of “Dance of ___ ” books, all of which I recommend. Whilst the intimacy book is an oldie, it’s still great and packed with several commendale and well considered recommendations.

See also the Dance of Anger, the Dance of Fear.

5 Books that will help you better understand yourself in romantic relationships

Some people have the same, or strikingly similar relationships, with the same painful outcome, again and again. The following 5 books may be of help to highlight your thinking patterns, your needs and preferences so that, should you wish for a romantic relationship again, the experience could be different.

Attached. Amir Levine and Rachel Heller

Talking about attachment theory in relationships is quite the popular psychology topic these days. Recognizing your attachment style is one way to understand and predict your behaviours within a romantic relationship.

We know that attachment styles influence a variety of interpersonal relationship behaviours including- feeling constantly anxious about the commitment of your partner, jealousy, avoiding closeness, and punishing your partner with silence.
This book is a great one on this topic – very interesting with practical insights.

The 5 love languages – Gary Chapman.

The 5 love languages has become part of our popular culture. It will serve you well to understand the love you want and the love you give. If you have been giving friends gifts that don’t seem appreciated, if you have ever received the complaint, “you just don’t make time for us”, then this book is for you.

Essentially people give and receive love differently. Chapman identifies the 5 landmark manners that people like to receive “love”. These languages are physical touch, verbal affirmations, gift giving, acts of service and quality time. Whilst other authors have tried to add more love languages, I still mainly recommend the OG version of the hypothesis because Chapman’s explanation makes the most sense, and has associated online tools to easily help identify your style.

A lot of communication intended to be kind within relationships present missed opportunities. Because we perfer to give love in OUR love language, we are often talking past our partner rather than communicating to them. It is also extremely helpful for us to discuss love languages to our partners – tell them if small gifts go a long way to helping you feel special.

Understanding love languages is not just for romantic relationships – it can be useful within friendships and families as well. For example, I have also assessed my children – one needs verbal affirmations – the other wants gifts.

Recently Gary Chapman has released the 5 apology languages. This is helpful to know about yourself and others and can help to repair relationships when there is conflict.

Getting past your breakup- Susan Elliot

Whilst this is primarily aimed at those suffering from the breakdown of a marriage, anyone who has been scared by a breakup can benefit from the lessons it covers. I love that it highlights that the loss that we feel when a relationship end can help be galvanized into a learning opportunity to shape our future.

The book tackles what to do about the feelings of loss, being stuck attached to old partners, self-compassion and self-reflective exercises, and inventory checks to get your mojo and your future relationship prospects back on track.

Daring Greatly – Brené Brown

Thought leader Brené Brown is another prolific self-help author. Daring Greatly may not be her greatest book, but it is the most focused on how we are in relationships. Essentially Brown suggests that we are restricted by our fear of being shamed to become the authentic, vulnerable and brave individuals that we need to be – in love, at work and in life. We hold ourselves back from saying what we want, asking for what we need, and asking others to reciprocate our affection. When we dare greatly, shed off our shame, we can achieve the deeper, richer relationships that we crave.

All about Love – Bell Hooks

This thought provoking philosophical book can be quite heavy reading. Its not the kind of book you read in a single sitting. Hook considers what it means to expect love, and what happens when we are denied love, in our familial and romantic relationships. She reviews how love is expressed – through duty, affection and acts of obligation.

We are raised to need love, but sometimes it slips past us. What happens when we are denied the love we need, and what can we do to recover the pain that remains.

The most important thing in life is to learn how to give out love, and to let it come in. I hope you take some time to invest time to better understand what has shaped your concepts of love, your practice of love, and how you deliver love.

Continuing education and vocational planning is essential for young adults with special educational needs.

When we look at options of services to extend the skill development of teens and adults after they finish school in HK is thankfully being expanded, but still has a long way to go. This is even more complicated as we rise and fall with the waves of COVID 19 outbreaks and responding restrictions.

Good people are doing good work, but the data on employment opportunities remains depression. Currently post school programmes are provided by Watchdog, and the Nesbitt Centre all of which do a great job, but there are still areas of need not covered.

In general, this period of time is hard to be young adult (disabled or otherwise)!

Exploring data from International Labour Organization (2017 data in the link below), global employment trends for growth 2017 suggests the global unemployment rate was 13.1%. The youth population (disabled or otherwise) represents more than 70 million people globally are experiencing unemployment – they are neither in employment or in further education. Young adults are 3 times were 3 times more likely to be unemployed than older adults. And this was BEFORE the global COVID epidemic.

Young people need to be prepared to be educated but still be unemployed. This applies to all young adults, and affects the disabled in a disproportionate format. The future of the world of work is the topic of many fantastic books at the moment and will have a major impact on those already in work, and the next generation of college and school graduates.

It’s even worse if you have a disability.

Exploring US data from the Bureau of Labour Statistics (link below) the disabled experience less employment than those who have no disability and are young.


There are often barriers for those with disability to gain access to suitable employment, including prejudice and misconceptions among employers, difficulty accommodating people’s physical or work schedule needs, the type of disability including the health implications, the ability to act a in socially expected manner, academic or task related competencies, and of course having the right skills. Part of the solution to this problem is adequate education of employers (thank you to the SENsational consultancy in Hong Kong www.senconsultancyltd.com)

• For those 16-19 years old and disabled only 17% are employed, and 26% are underemployed
• For those 20-24 years old and disabled only 37% of that population are employed, and 14.6% are underemployed.
• For those 20-25 years old and disabled only 43% of that population are employed, and 10.9 % are underemployed.


To better prepare the next generation of special educational adults, we as parents and educators need to provide ample services to those young adults as they launch from high school into the next stage of their careers. The majority of areas in which disabled individuals in Hong Kong find employment (hospitality, some retail, office work) are covered by certain centres in Hong Kong, but as these centres have become under greater financial pressure, their futures can also be fragile

Careers need to construct a future  around specific strengths of their SEN teens and young adults.

The gap exists for children who have different areas of strength and varying levels of motivation – perhaps they are great artists, mathematicians, photographers, early childhood teaching assistants, even have extremely good knowledge of music or ability to sing. For them, and many others they not only require a more customised style of vocational training not previously available in HK. What is also important, they may have finished school without their education being complete. They may need a basic entry level of English or Math in order to start their career in a suitable arena, and this needs to be made possible within a setting that also teaches the requisite social skills and independence skills. Private tutoring provides the content but not the context. Quite simply, these kids, need the continue a concept of school until they are more fully cooked.

A new hope for the future – worth considering.

One area of employment growth which I believe has enormous potential is the area of self-employment or entrepreneurship.  Self-employment for people with special educational needs may help build career success within the future world of work. Portfolio work – working on various projects, and different arenas – in a freelancing capacity might be suit them more. What parents and their young adults need is a customised plan to help create these opportunities. Particular psychologists, including myself, can help parents and young people create these customized plans.

Careers developed around the strengths of individuals – artists, mathematicians, photographers, artists, which may involve further training, further therapy, and personalised business development plans.

In collaboration with their families and their community, young adults with disability can start to build a strong plan to identify their strengths, and vocations which celebrate those strengths. I am not saying its going to be easy. I’m simply pointing out that its necessary and possible.

A word about continuing education.

Children with special educational needs often leave school before their education is finished. They have often not solidified basic knowledge of key math and English skills. I heavily encourage parents to continue to work with tutors or other programme providers to continue to develop key English receptive and communication skills, as well as understanding the world of money, basic maths, distance and time.  I will be exploring these key skills to help your child achieve in a future blog.

About the author

Angela Watkins is a counsellor and psychologist working with teens – typical and neurodiverse – to help them overcome various challenges including vocational planning, learning difficulties and emotional challenges such as anxiety, suicidal ideation, self-harm, abuse and violence, and troubles with schooling.

Can you forgive? Do you know how to?

When we talk about healing from a hurt – the healing process – the inevitable question arises if forgiveness is a possible component. Mental health advisers define forgiveness as a conscious, deliberate decision to release feelings of resentment or vengeance toward a person or group who has caused you harm.

You may have been hurt by a betrayal in business, in a friendship, within your family of origin, or in a marriage. You may have been bullied. You may have been physically harmed by another person. They may have caused you injury in an accident. They may have broken a sacred vow, of fidelity, or protection. There are so many ways that a person can cause offense against you and forgiveness can seem impossible to do.

Psychologists promote forgiveness as a component of healing, a cleansing that you do to lighten the burden that you live under. Forgiveness for yourself, not for anyone else. Even if you agree that forgiveness is possible, even desired, it may still seem impossible to do.

NOTE: You are not obligated to forgive in the a situation when a crime of violence has been committed against you, forgiveness of yourself might be your priority over forgiveness of others. In the case of sexual assault forgiveness could be discussed with your counsellor, but not an obligation.

In order to consider if you can forgive, if you should forgive, and if you can forgive, it is important to understand what forgiveness is NOT.

Forgiveness is NOT.

You do not need to ‘forgive and forget’. Forgiveness does not absolve a crime. Forgiveness does not mean forgetting, or excusing, or trusting the offender again. There are so many aspects to what forgiveness is NOT.

Forgiveness does not automatically imply reconciliation between you and your offender.

Forgiveness does not mean that something bad did not happen.

Forgiveness does not indicate that you were not hurt.

Forgiveness does not excuse another person’s bad behaviour.

Forgiveness does not imply that you are ‘okay’ with the offender.

Forgiveness does not need to be a religious experience.

Forgiveness does not mean that you trust the offender again.

Forgiveness does not mean you are weak.

Forgiveness does not mean that the offender WINs and you lose.

Why would you forgive?

In general, holding onto a grievance actually costs you mental peace of mind.

Think of forgiveness as a gift that you will give to yourself. When we create a grievance story, we are empowering our offender to determine how we feel, how we see ourselves and our future, and can keep ourselves stuck in our suffering. It is helpful to remember that, holding people accountable for their actions is not the same as blaming them for how you feel.

By releasing any bitterness and past resentments you are not longer bound or enslaved to the negative and destructive thoughts and emotions attached to those resentments. Acknowledge that you are the master of how you choose to feel about a particular problem.

If you now agree that you think forgiveness could be possible, let’s explore my step-by-step remedy as to HOW it can be achieved.

The process of forgiveness.

In this process of forgiveness there are 4 steps. Forgiveness doesn’t happen all at once, it is a process with steps that take time, and require you to spend time thinking about your situation, your reactions, and who you want to be.

Step one – Detail your narrative.

Write down the story of your grievance. This record will be a great starting point to not only detail what happened at the time, but also detail when it happened, what you think the offender was thinking and doing during the insult, and afterwards. Take as long as you like to write your story. Writing your story down can be cathartic.


If you need some prompts:

What happened – including dates whenever possible.

How has this made you feel? How have you felt since the events?

How did it change your expectations of the offender, and others?

What has made this situation particularly difficult for you to forgive?


Step 2 – Identify your barrier to forgiveness.

When we clearly identify our barrier to forgiveness we can start to consider a path forward. Below are a list of many reasons people express as barriers to forgiveness. Is your reason on this list?

Keep a note of your reason not to forgive together with your narrative. Now you have all you need to start this process. Consider your narrative, and your barrier, whilst you reflect upon the following 8 questions for forgiveness.

Step 3: Reflections: questions for forgiveness.

When we ask you to reflect on your narrative, remember that this is not taking away that you have been harmed and may feel entitled to being hurt. What we want to explore, only within your own private thoughts, is if you are ready to reconsider your pain, are you ready to move beyond it, especially if it is holding you back.

The following 8 reflections can be tackled in any order, and as slowly as you like. To rephrase the famous quote of Chinese philosopher, Lao Zi , “When I let go of what I am, {when I think about how I am being}, I become what I might be”.

Questions for forgiveness: Are you taking the issue too personally?

To the victim of an insult, the offender is seen as intending harm. At the same time an offender is likely to tell the story differently – indicating that any hurt caused was ‘accidental’. I want you to consider if you are taking this issue too personally and may be influenced by the cognitive bias, called the fundamental attribution error,

The fundamental attribution error  is the tendency for people to over-emphasize dispositional, or personality-based explanations for behaviors observed in others while under-emphasizing situational explanations. At the same time, explaining their own behaviour one may have a tendency to allow a greater emphasis on situational elements.

For example – You may see that you had no choice but to act in a particular way in a situation because you were forced to by circumstances (situational factors) But under the influence of the fundamental attribution error you are likely to say that your offender did the things they did because they are always jealous, or are a horrible and unkind person.

There is really no objective account of an incident.

Many crimes are performed without consideration for the impact on the victim. If your parents neglected you – their actions were not undertaken in order to make you feel bad, but rather because of their shortcomings, their failing coping mechanisms, and their problems operating in the world. These words are not written in order to trivialize your hurt. The hurt happened. It is legitimate, but may not have been as personal as you thought it was.

Imagine that you can write your narrative of your hurt from the perspective of the offender. Would they say that they deliberately intended to hurt you. Would it be that they were acting careless and selfishly, or were incapable of doing better in the circumstances. Try to remember, all of us have had our moments, or performed actions which we later regretted. Could you start to look at your narrative differently thinking about this consideration?

Questions for forgiveness: Is it time to forgive?

Forgiveness doesn’t happen all at once. You can forgive an insult piece by piece. You can also take your time. Forgiveness in a time when you are ready and you have allowed yourself to feel yourself to feel your strongest emotions.

Holding on too long. Has this grievance ended? If you are in the middle of deal with an insult, forgiveness may be something to contemplate later, for now focus on coping and surviving. Sometimes we hold onto the hurt of an insult for too long. Did the offence happen more than a few years ago? Just because somebody hurt you, does not mean that you have to suffer indefinitely. Forgiveness is a process when you determine that the grievance you have held, is long longer sanctioned to dominate your mental space. Is holding onto your hurt helping or harming you? If you refuse to forgive, you run the risk of remaining bitter and unable to let go, and feel differently.

To soon. Has the grievance hurt ended or is it ongoing. Forgiveness belongs with an event that has ended, rather than is ongoing. For insults that are ongoing, you may better focus on coping.

Some of us have been trained, since childhood, to forgive too easily and too quickly. If you forgive too soon, you may find yourself open to being hurt again, perhaps even by the same person. This type of expectation can be a feature of co-dependency.

No one but you should decide if the timing is right for you to forgive besides you. Even your offender. When you have been hurt and someone then apologizes – it is okay to say, “give me some time”. We may need some time for inner healing and emotional recovery to occur.

When thinking about this reflection ask yourself it is time for you to try some forgiveness. Its okay if you feel it is too soon. In order to take responsibility for your recovery, consider when might be a suitable time to start this process, and ask yourself again at that time.

Questions for forgiveness: What price do you pay?

When you decide to forgive, you have decided that your healing is more important than your hurt. Continuing to feel the hurt is price that you pay. Maintaining a grievance is exhausting. You need to decide weather to hold on to this hurt, or work through the hurt actively. Part of this process may be to work on what parts you perceive objectively, and what elements hold you back. You may have a reason to be angry, but try to distinguish the helpful from the harmful aspects of your anger.

Another person’s bad behaviour may have contributed to your difficulties, but blaming all of this on the offender can take away your power to solve the problem because you remain stuck inside the unfairness of the situation. When all of the cause of your pain lies outside of us, we will continue to look outside of ourselves for a solution.

Ask yourself are you paying a price for not forgiving a person. Perhaps not forgiving means that you don’t have to deliver some of the hard work which will lead to your eventual success in your career. Reflect on this question for a while. Be open to the answers that your mind offers.

Questions for forgiveness: What benefits could you gain?

Ask yourself is you are missing an opportunity to transform your hurt or angry feelings into an experience that helps you grow. Forgiveness allows you to let go of your obsessions and anger, you benefit. Think about what could be different if you forgave the situation and offender. Could you finally start a project that could make your life better. Unleash your potential.

Questions for forgiveness: Who needs to be forgiven?

It is quite possible that you need to first forgive yourself in a situation. You may be unfairly blaming yourself for what has occurred.

Forgiving yourself is empowering. Once you have forgiven yourself, any manipulative members of your family can no longer use guilt to control you. Forgiveness will free you.

It is not necessary to forgive the offender in certain cases. Particularly in the case of child abuse, the only person that you have to forgive is yourself. It is often the case that victims of abuse feel ashamed of what has happened, what they may have done to cope with a situation, for enjoying any part of a situation and the rules that you feel you now have to live by. It is not your fault and you deserve the love you can give yourself to help you heal.

Questions for forgiveness: How do you perceive forgiveness?

Think of how you perceive and value the concept of forgiveness. Perhaps you see people who forgive others as weak? Perhaps you perceive that if you forgive you have “lost” a battle. Perhaps you feel that complete forgiveness is not possible.


How you see the act of forgiveness – for yourself and when performed by others – is an important aspect of deciding if you can forgive. Take a look at the rules you may hold about forgiveness and ask yourself if things could be different from those perceptions. For example, you may believe that Forgiveness has to be complete and forever. Could you consider that maybe not 100% of forgiveness is required. Perhaps you can only forgive a percentage of what has occurred, and the rest will need to remain, “What it is”. If you decide this then think about the cost of “What it is”, will remain?

Questions for forgiveness: What does winning in this situation look like for you?

Just because bad things happen does not mean that you have to be stuck or dwell on it. Instead, why don’t you focus on your good fortune in the past, and think about what that good fortune might look like in the future.

Sometimes the offender in your situation doesn’t have to loose in order for you to win. Simply think about what winning in a situation would look like. Would it mean having a relationship with someone that has been lost to you, that you believe the offender has taken from you? If a business partner betrayed you, what would it take for you to win. Does the offender even need to be involved? Imagine what winning would look like, and see if you can write a plan to make that win possible.

Questions for forgiveness: What is within your power?

Ask yourself, “Am I giving the power of my thoughts and feelings, and the ultimate outcome of this situation, to someone else”? Forgiveness allows you to take back your power.

Ask yourself if your anger is helping you heal or holding you back? What would it mean for you to be the best version of yourself that you can be? Is the pathway to your best self something that you can achieve? Is your anger holding you back from achieving your goal.
You have the power to determine what an outcome from a situation can look like for you? You can’t control another person, but you can determine how you feel and what you can do. Take back your power. Forgiveness allows you to do this.

Step 4: Re-write your narrative.

Now that you have thought about all the angles around the insult, and the offender, can you rewrite your original narrative into a new narrative. Can you empower yourself to take charge of what happens next? Can you see that the actions of your offender are most likely selfish and inept, rather than evil and deliberate? Review the list of what forgiveness is NOT. If you decide to look at a situation differently you don’t need tell the other party, forget what happened, reconcile with the offender.

The only obligation to you have is to yourself and what will help you feel better about yourself and the outcome. If you have trouble moving towards forgiveness, talk to a counsellor, it can really help.

Give the forgiveness process a try. You can try it with multiple offences. You may find the freedom you seek from the heaviness that holding a grievance is weighing on you.

About the author

Angela Watkins is a counsellor and psychologist working out of RED DOOR Counselling in HOng Kong. Angela helps teens and adults overcome trauma, anxiety, learning and relationships challenges. To contact Angela email her at Angelaw@reddoor.hk

Does living in COVID times lead to PTSD?

As restrictions start to be reintroduced in Hong Kong do your find yourself feeling disproportionately anxious to these regulations? It may be possible that you are reacting due to Post Traumatic Stress responses created by the COVID-19 pandemic.

The COVID-19 epidemic began to spread around the world in the early months of 2020. To date (June 2022), the pandemic has wreaked havoc on population growth, people’s health, the economy and our ability to function. It is suggested that people are suffering psychological challenges including anxiety, depression, and PTSD (Post Traumatic Stress Disorder).

Population Impact. COVID:19 has had a significant impact on the global population with over 6 million people having been lost to the disease, and the epidemic increasing building to a growth in the death rate in the world. [1]. In Hong Kong, we are encountering the highest death rate in the past decade [2]. Over 540million people worldwide are recorded as having contracted COVID, whilst the current figure of cases in Hong Kong is 1.2 million.

Ongoing Physiological Impact: Whilst most people recover from COVID, especially if they have been vaccinated, some people do not recover well. The prevalence and impact of Long-COVID are still being researched and many questions remain unanswered, with inconsistency in numbers in a lot of the research. Current conservative estimates [3] indicate that about 13% of those who contract COVID-19 are still experiencing symptoms after 28 days. Some people – about 2.6% – still experience symptoms 90 days after initially contracting COVID19. This would represent about 1.5 million people worldwide at this time. The most prevalent long-term symptoms include fatigue, headache, attention difficulties, hair loss and shortness of breath.

Psychological Impact from COVID-19: COVID-19 impacts the lives of those who contract it, and the greater population. People fear the consequences of catching COVID and also the impact of particular government regulations and health practices

Anyone who lived in Hong Kong during the period February 2022 and April 2022 may have experienced anxiety during the fifth wave [4].

In Hong Kong we are coming out of our fifth wave, our worst experience of COVID-19 so far. The fifth wave appears to be dissipating, from a height of over 78,000 new cases a day in early March 2022, to an average of 740 cases a day by mid-June 2022, and a death rate of close to 300 deaths a day in March 2022, to zero deaths so far in June 2022. In the wake of the fifth wake, we note an explosion in cases in Hong Kong. At the end of January 2022, less than 1% of the Hong Kong population had contracted COVID, by the time the fifth wave started receding, the rate was 16% [10].

Whilst HK did not experience an official “lockdown”, there was still a significant impact on ‘regular life. Schools had to, repeatedly, move online, working remotely became standard, businesses were closed (and reopened, and re-closed), and various isolation facilities for cases, and close contacts, have been utilised. Flights into and out of Hong Kong have been cancelled, travel has become unpredictable, and quarantine rules continue to be revised (and not yet, removed), and the health system, and those working within it, collapsed. The Hong Kong government’s interdependent approach with mainland China, to supporting the concept of Zero-Covid maintains a sense uncertainty. And the fifth wave will not be the last.

A recent piece of academic research produced by the Hong Kong Polytechnic University [4] revealed a prevalence of over 12% of PTSD (Post Traumatic Stress Disorder) symptomology among Hong Kong adults recorded after the fourth wave of COVID-19 in Hong Kong.

It is suggested that there are particular people who appear to have psychological vulnerability [6] particularly those of lower social socioeconomic status, younger people, and women. The Hong Kong research [4] also suggest that those with lower socio-economic status in Hong Kong, may also have a heighten vulnerability to experiencing PTSD symptomology.

What is PTSD?
PTSD is a psychiatric disorder featuring distress and disruption to daily functioning in response to a traumatic event. Not all people exposed to a trauma develop PTSD. Any particular individual may be exposed to more than one traumatic event in their lifetime, with over 30% being exposed to multiple traumatic events [5].

The characteristic elements of PTSD include a distressing rotation of intrusion and avoidance compulsions together with hyper vigilance. The intrusion elements include experiencing nightmares, visual flashbacks of the trauma, and having intrusive thoughts about yourself, the events and the outcome of those events. Avoidance is demonstrated through deliberate efforts to avoid thinking about or talking about the events, as well as places and people the remind you about the event. Hyper vigilance is demonstrated through being easily startled, and feeling wary and unsafe, and therefore agitated, when the trauma is over [7]

The likelihood that PTSD will develop after a trauma is, in some part, influenced by the type of trauma. More personal and violent traumatic events being more likely to produce a PTSD response [5].

The question now is if the type of stress experienced by actions around the COVID-19 pandemic cause PTSD. This type of trauma has not been studied extensively, given the rareness of this event. So, the HKPoly U [4] finding of a 12% prevalence (from wave 4) is revealing. That study explores the presence of this stress response in the general public, not just those who have contracted COVID-19.

Disasters are a trauma that can produce PTSD. Although there is no consistent definition of disasters in the literature, researchers generally agree that disasters share three key characteristics of large-scale traumatic events. Firstly, disasters threaten harm or death to a large group of people, regardless of the actual extent of lives lost. Secondly, they affect regular process, causing disruption of services and social networks and communal loss of resources such as economic impact. Thirdly, they involve secondary consequences, namely identifiable mental and physical health outcomes, such as anxiety and depression. [8] It appears that the COVID-19 pandemic could fit the criteria of being a global disaster trauma.  

In therapy, people often dismiss their stress responses in response to the COVID-19 pandemic because, “everybody is experiencing this”, thereby invalidating their individual experience because there seems to be a societal expectation to “just get through this”. As with other disasters, it would be a mistake to dismiss that people do not develop PTSD simply because everybody has been exposed to the traumatic event.

When people become influenced by PTSD their nervous system becomes agitated by trauma and people then try to ‘regulate’ this traumatic response. Unfortunately, self-treatment can include an attraction to some destructive practices to soothe those agitations including performing self-injury, drastically controlling food consumption, using alcohol or drugs to create numbness, or distraction through hyperactivity. [9]

Despite the debilitating nature of PTSD, many people do not seek treatment, or only seek appropriate treatment after extended period of suffering from these symptoms, or experiencing multiple traumas [8]. Sometimes PTSD is even used a reason to avoid therapy as people fear facing and exploring their symptoms. How do you know if you have PTSD?

Diagnosis of PTSD.

You can assess if you are suffering from PTSD yourself. You can use the same measure used by team at Hong Kong Polytechnic University [4]. They used a slightly adapted Cantonese version of the Impact of Events Scale – Revised [7]. This questionnaire can be self-administered. A copy of this survey is pictured to the right. You can look up copies online..

This measure corresponds to many of the items from the Diagnostic and Statistical manual (DSM) that psychologists utilize in their decisions about diagnoses.

There are two ways you can use this measure once you have completed it. The questionnaire asks you to rate your experience from 0-4 relating to how frequently you experience a particular symptom. As you are completing the survey consider if you feel this symptom specifically in relation to the COVID pandemic. Once completed, add up your total score. A normal, non-PTSD score, would be less than 12. A score of over 33 merits further attention and may indicate that you are experiencing PTSD symptoms to an extent that requires support.

You can also explore your performance as to which sub scale presents the most problems for you. The three sub scales of the questionnaire are are Intrusion, Avoidance, and Hyper vigilance. The sub scale items are highlighted the bottom right hand courner of the Weiss survey pictured above. Average your score for those sub scales so you can compare them. The sub scale that has your highest score (somewhere between 0 and 4) is the most problematic, and any average score over 2 is warrants further attention.

The treatment for PTSD.

The treatment you can consider for your PTSD depends on the type of trauma you have experienced (see Note). The following information applies to PTSD resulting from your experience of the COVID pandemic. PTSD deserves to be treated properly, through therapy [4,7].

What would you cover in therapy?

In therapy wish to reduce the negative impact related symptoms have on your individual functioning. Ideally our goal would be for a client to no longer experience or be troubled by event recollections, avoidance of event reminders, hyper arousal and disinterest in relationship or activities. in the interim, involve an evolution to becoming comfortable with being uncomfortable rather than seeking numbing through self-medication and other behaviours.

The sub scales that you explored in the survey will tell us what we could focus on first – for example, building self soothing thought processes to reduce hyper vigilance, using CBT (Cognitive Behavioral Therapy) activities to help overcome avoidance demands, and ACT (Acceptance and Commitment therapy) or CBT to overcome intrusive thought processes.

Treatment using these types of tools have great track records in the treatment of PTSD [8,9]. These tools need to be customised to each clients triggers, circumstances, soothing mechanisms, feelings of shame and advocacy, so that, eventually, a new style of calm can be achieved. Therapy can help. Recovery is possible.

NOTE IF YOU have PTSD attached to another trauma – particularly sexual violence – please only visit a therapist who has a solid track record (years) of treating such trauma.

About the author – Angela Watkins is a counsellor and psychologist working out of RED DOOR in Hong Kong. She is experienced in treating anxiety – such as that resulting from the COVID pandemic, loss and abuse. For more information contact Angela at AngelaW@reddoor.hk

References

1 Centre of disease and control and prevention – National Center for Health Statistics: Excess deaths associated with Covid19

2 Macrotrends – HK death rate 1950-2022.

3 Halvalkele, B. D.; and Parham, J (2022). Long Covid: A review of long-term consequences of Covid-19. Journal of Mississippi State Medical Association. Volume 63(6).

4. Cao, Y., Siu J. Y-M.; Shek, D. T. L; and Shum, D. H. K. (2022). Covid-19 one year on: identification of at-risk groups for psychological trauma and poor health-protective behaviour using a telephone survey. BMC Psychiatry. 22:252.

5.Benjet, C et al. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological Medicine (2016), 46, 327–343.

6. Kessler, R. C et al. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psycho traumatology , Volume 8.

7. Weiss, D. S. (2007). The impact of event scale revised. In JP Wilson and TM Keane (Eds). Assessing psychological trauma and PTSD: A practitioner’s handbook. 2nd Edition. Guildford Press.

8  Goldmann, E.; and Galea, S. (2014) Mental health consequences of disasters. Annual review of Public Health. Vol 35.

9. Fisher, J. (2021).Transforming the living legacy of trauma: A workbook for survivors and therapists. PESI Publishing.

10. Using Worldometer figures as at 16 June 2022.

Changes to your romantic relationship after you have a child

Becoming a parent changes your romantic relationship. The landmark relationship advisors, the Gottman Institute, assessed satisfaction among new parents. Their research reveals that two-thirds (67%) of the couples that they interviewed expressed dissatisfaction in their romantic relationship within the first two years of having a baby. The pattern of lower martial satisfaction when comparing parents with non-parents is supported by other academic research as well.

There are many paths to parenthood. New parents often feel stressed and exhausted. It can feel as if the distance created by small differences that existed between you and your partner when you first got together, have become a chasm once you are parents.

What drives this unhappiness? And, what can you do to protect, or improve your relationship after bringing home baby?

Perception of roles

Part of these differences are due to how you see your new role as parents and how this redefines to your perceived role as a person, worker, friend, partner, and a representative of your community. Suddenly you aren’t just a man, who is romantically involved with this other person, and a worker, and a member of the sporting community. You are now a “Father” – with all that word conveys to others, and expectations that it holds for you.

How we see our roles, and that of our partner, are the result of our research, and created through an osmotic process of being the child of the parents in our family of origin. The father figure featured in your family of origin taught you what you admire, and don’t admire , about the role of being a “Dad”,  The same applies for Mum.

What do new parents fight about?

The Gottman Institute suggest that for each new child, an additional 33 hours of household work is required to look after their needs on a weekly basis. Suddenly time becomes a precious commodity, and you may be exhausted all of it. Given the pressure of child care, and the changes to roles and personal lives that parenting can require, what do new parents mostly fight about?

In our ounselling practice, we see similar trends to those seen by the Gottman Institute. The main issues that we encounter with new parents include are stresses over family finances, the division of labour in the household, the  (unwelcome) influence of family and friends, changes (or not) to social and recreational activities, and mood and affect challenges resulting from the physical changes of child rearing.

When couples enter the counselling environment, they are ready for the counsellor to highlight up how wrong their partners’ perceptions, behaviours, and viewpoints are. In essence, they often want the counsellor to be the judge and tell them who is “right”. But the counselling process is not about who is right and who is wrong. Rather the focus is about establishing those practices that make love last.

So, what makes love last?

The answer to this question is so simple, and so complicated, at the same time. In studying successful relationships, famous relationship researcher John Gottman, suggests that the friendship with the romantic relationship which is the greatest predictor of relationship satisfaction. Quite simply, people who like each other are happier together. It’s deceptively simple.

Unfortunately, our romantic partner often receives the worst of us, not the best of us. Sometimes the way we act towards our partner is, quite frankly, unlikeable. Over time those small jabs, and missed connections, create a canyon that feels hard to transverse.

With re-establishing your friendship as a goal, there are a few actions that you can take to help build back that positive affect in your relationship. Whilst all couples have conflict, partners who prioritise friendship are more likely to create homes where conflict is not feared, destructive to the relationship, or negatively impactful on their children.

How do you get back the friendship when all you do is fight? Sometimes a safe zone, such as a counselling environment can help. There are some activities you can try for yourselves:

1.Affirm each other.

Firstly, when you can, try a brief affirmation exercise. This exercise is suggested to help couples appreciate what attributes their partner appreciates and recognises about them. When you have a young child, sharing appreciative or affirming comments, becomes a rare activity. Take a moment to reverse this trend.

Sit together. Pick three positive attributes about your partner. If you have trouble identifying those attributes, I’ve included some suggested by the Gottman Institute for your ease. You don’t have to pick items from the list. You can identify your own.

from the Gottman Institute website.

Take turns sharing an attribute and the story behind your perception of that attribute. For example, “I was so impressed by how resourceful you are. When we were lost in Italy, it didn’t take you long to sort out new bookings and get our holiday plans back on track.”

After you have each shared three attributes stories, take a moment to think about how it feels to listen to these recollections and compliments from your partner. Do not dismiss your good work with the temptation to share what “bothers” you at this time. Enjoy the positive atmosphere created.

2. Love Maps.
Another great Gottman Institute idea is to rebuild your Love Maps of each other. A Love Map is the personal knowledge you have of your partner. Sometimes we assume that we know everything about our partner. Often, we don’t, or our perceptions are out of date.

Do you know who is their best friend? Do you know who is the relative they like least, and why? Do you know what their favourite song to listen to is at this time? Who do they talk to most at work? What would they do if they could retire today? What countries are on their bucket list of places to visit? What activity helps them calm down? What things make them smile? What is their favourite meal of all time? What would a dream weekend involve? Who do they wish that they had a better relationship with in their family of origin?

Take some time to really get to know your partner again. You can undertake building love maps as a date-night activity, or you can break it into a series of daily connection moments. Build a path back to understanding, and appreciating, each other’s worlds.

3. Fight well.

The most constructive thing you can learn to do to support your relationship is to learn to have constructive rather than destructive conflict. It is normal to disagree, and have some form of conflict in a relationship. The style of how you express yourselves during the conflict can, determine if their relationships can last, or remain satisfying. Relationships where conflict discussions include contempt, criticism, excessive defensiveness, and avoidance, are unsatisfying.  When these destructive elements exist, are likely to remain so. They will not go away without activity to change.

Think about at the last time you and your partner had a  disagreement. Did you say hurtful comments that you regret? Did they? Did it feel like things just “exploded”. Did you feel out of control? Did you feel neglected or invalidated? Did you storm off and then refuse to reengage in any future discussion?

Learning to fight well involves developing a series of skills around communication – being a good listener, a responsible speaker, choosing your timing well, using gentle introductions to conflict topics, being respectful of your partner’s world, owing your emotional reactions, avoid blaming and contemptuous language. Think about if you are ready to start adjusting your behaviour. Even one person changing their behaviour can have an impact on style of conflict within a couple. Quite simply, if you do what you’ve always done, you will get what you’ve traditionally got. So, make a change, so that change is possible

In the reference section of this article there are some great books, by the Gottman Institute that suggest activities to help you improve your communication conflict style regarding the specific behaviours that destroy relationships.  Couples’ counsellors are trained to help couples adjust those behaviours. They can help you understand your conflict style, and help practice new habits to help change the disagreements, and dissatisfaction in your relationship. You can seek out couples counselling for conflict, or to make a stronger connections. It is a wise investment in the future of your relationship.

Notes:

  • Red Door Counselling offers couples counselling through the conjoint-counsellor model. This model involves 2 counsellors with 2 clients. This model is superior in avoiding perceived favouritism and situational objectivity.
  • Red Door offers couple connection courses from time to time – for groups – to help teach those skills that make love last. Our next couples’ connection course will run in August 2022.

References

Gottman books you might enjoy

Gottman, J and Gottman, JS (2007)

And baby makes three: The six-item plan for preserving marital intimacy and rekindling romance.

Gottman, J and Gottman, JS (2008)

Ten lessons to transform your marriage.

Other good references.

Twenge, J.M.; Campbell, W.K.; and  Foster, C.A. (2004). Parenthood and marital satisfaction: A meta-analytical review. Journal of Marriage and Family. Vol 65(3), page 574-583.

Nagaraja, A.; Rajama, N. M.; and Reddy V. V. (2017). Effects of parents’ marital satisfaction, marital life period and type of family on their Children Mental Health Status. Journal of Psychology, p 65-70.

Mental Health First Aid during the Pandemic

Note: this article was written during the 5th wave of the Covid-19 pandemic in Hong Kong

During this very stressful time in Hong Kong it sometimes feels like we are waiting to exhale, holding our breath, waiting to be able to feel that final relief when we know things will be ok . Whew.

But the pandemic continues and every week there seems to be a new event or policy that can bring on a new wave of anxiety. School holiday rearrangements. War in Ukraine. New covid-19 isolation centres. Vulnerable individuals hospitalised, and dying. People leaving. It seems never-ending. The solution is that we need to learn to live with anxiety, not escape it.

First aid treatments of anxiety during the Pandemic

As when we apply first aid to a physical injury we can apply clear steps to provide first aid to the mental health issue of anxiety. Firstly, we need to assess and monitor the experience of anxiety. Secondly, we need to have immediate solutions to treat anxiety in its most threatening form – when we experience anxiety attacks. Lastly, we need to have an organised treatment plan which reduces the chance of anxiety attacks in future (prevention) and builds the ability to better respond should we encounter an attack in the future.

Monitor and record your anxiety score 2-3 times a day

Step one – measure and monitoring anxiety.

It is important that you gain the ability to monitor your anxiety. It is normal to feel anxious in a time of such uncertainty. Changes in policy, the status of the pandemic, interfere with our feelings of being able to control the outcome of this situation. It is normal to experience some anxiety, some frustration, some sadness when life is disrupted. Whilst it is normal, it still requires a healthy response to protect yourself psychologically. Knowing how you are doing is the first step in figuring out how to respond.

Monitoring your anxiety regularly allows you to recognise if your anxiety is becoming more than you can take on a regular basis. Take three moments during the day to rate your anxiety on a scale of 0 to 10. A score of zero indicates no anxiety. A score of 10 would indicate severe anxiety, with heart palpitations and breathlessness, perhaps requiring hospitalization. A score under five would indicate that you still feel that you can function in performing your daily tasks – being study or work. A score over five would indicate that your anxiety is starting to affect your ability to function.

Record your score a few times a day. Make a record of the maximum score you experienced during the day. Record what you were doing just before, or when that maximum score occurred. We want to use this data to create your personlised diagnostic – noting when and under what conditions you experience the strongest feelings of anxiety, so that we can build a treatment plan just for you.

Step 2 – techniques to provide immediate relief from anxiety.

If you are experiencing anxiety at a level of 7-10 you might like to use some immediate first aid techniques to treat the anxiety in your body. Essentially you want to sooth your body back into a normal automatic breathing pattern. I recommend deep breathing exercises and distraction techniques using the senses, colour or physical activity. These techniques, and others are covered in our blog on emergency responses to anxiety attacks below.

These techniques are sometimes call grounding or self- soothing techniques. They can also be helpful when you are flooded with other strong emotions including sadness and anger.

Anxiety Attacks – Emergency responses

Step 3: Build a personalised treatment plan to build better responses and prevent anxiety in the future. Every person’s experience of anxiety is unique, but there are many common elements that we can include, or exclude in a treatment plan for your anxiety. You are in the best position to monitor your anxiety. You can use the following information to decide what elements might be best for you to include in a treatment plan. Utilising an external expert, such as a counsellor, will also help you to capture information about historical triggers, and help clarifying activities that help, heal from those which may actually harm you in your recovery from anxiety.

3a) Identifying amplifiers and reducers of anxiety

By monitoring your anxiety, and reviewing your anxiety responses from the past, you can explore some of the activities which amplify your experience of anxiety. RED DOOR recently set up anxiety workshops in response to anxiety people report during the current Covid pandemic (Wave 5). Some of the things that amplify people’s experience of anxiety include excessive scrolling of news, consumption of social media and even (careless) conversations with friends and colleagues. Watch how you feel after reading the news, is your anxiety experience rating increasing or decreasing.

Think about your response to stress and anxiety. What do you do when you see that there are increasing cases, or new restrictions. Do you pass on your anxiety to others – post the bad news on the internet?. Do you want to help? What is your response? Is your response improving your feeling of anxiety, or making it worse? Being mindful of your anxiety will help you identify what escalates those anxious feelings.

It may be tempting to blame your feelings on the actions of others. “My husband makes me anxious”. Own your own feelings. People’s actions are their own. Your feelings are your own.  Whilst people’s actions can be careless, sometimes even hurtful, often our perception and interpretation of those behaviours is what hurts, rather than the actions themselves. Take a look at the section on perspectives later in this document to learn more about cognitive distortions.

Take note of those external triggers that amplify your anxiety and consider to limit them. In our anxiety workshops during the covid pandemic, actively reducing news and social media consumption has helped our participants better manage their anxiety at this time.

In addition to amplifiers, take a moment to think about those moments in the day that you feel most at peace. We are well trained to note when we feel anxious, it takes specific focus to capture yourself feeling calm. It is important to understand what people or activities that are associated with your sense of calmness or reduction of anxiety. For many people a moment in the sunshine, or a brief walk, might bring them some sense of calm. For you it may be when you take hold of a good cup of tea. Make note of these reducing activities. We need to build them into your self-care treatment plan which I will detail later in this article.

Many people respond to crises in various ways. We know about the fight/ flight response, Outflows of families from Hong Kong has been a clear demonstration of a, very natural, desire to flee from perceived danger. Some people choose to stand and fight, either in person or online. We can see that behaviour as well. Others choose to help – look at how they can add support to less fortunate. Others choose to cheer others – inserting humor or other entertainment. All of these responses can exacerbate or decrease your anxiety. Fleeing in response to perceived, rather than real danger, can solidify the anxiety-flee response. Sometimes you need to stand your ground and deal with your anxiety rather than move away. These situations are best discussed with a professional.

Choosing to help is actually a great way to achieve some sense of control at a time of uncertainty. Helping others, and volunteering, is a great for building gratitude, which is one aspect of a healthy anxiety management plan.

3b) Build a checklist.

In the longer term having a list of activities that HELP and HARM you will help you build better protection and prevent anxiety in the future.

Take the amplifiers that you identified from the exercise above, and the activities that reduce your anxiety. Put them into a checklist under the items of HELP and HARM your anxiety.  You want to build a checklist of activities that HELP you and HARM you so that you know what you need to do a daily or weekly basis.

The activities that are detailed below can be added, if you believe they might help you. Once you have a list of HELPing activities, I want you to commit to trying each one once a day or one a week, whichever frequency seems more sensible.

For those behaviours you consider potentially harmful I would recommend that you place a limit on them. For example, you can set limits on social media scrolling, you can manage the amount of times you check the news a day.

There are a set of behaviours which may seem like HELPing behaviours but may, when done to excess, become a HARM. For example, you may want to monitor your consumption of alcohol, recreational drugs, and any form of self-medication. People sometimes things that these activities help them to cope with anxiety, but actually when observed, they may notice that that they actually maintaining anxiety over time, not dissipating it.

You can build a number of items into your checklist. Have a look at our sample, read through the rest of this document, and decide what items you want to utilise to HELP you, and those items you want to start monitoring and limiting which HARM you.

3c) Check your perspective

Accepting your circumstances is, in part, a matter of perspective. Those whom are content are more likely to be able to respond positively to change when it is required, accept that some events are beyond their control and allow situations to be different than their expectations. This is because they can approach challenges with a perspective that is mindful of the extra thoughts that they may have within a situation, or in response to a stimulus, to check what is real from their “interpretation” of events.

Famous psychologist, Albert Ellis, identified a plethora of irrational beliefs that we develop as part of the way we are raised, see the world, and believe about ourselves and other people. These beliefs are filters that, like a pair of glasses, interfere with the way that we see situations. Wearing faulty filters may cause people to engage in self-defeating behaviours such as experiencing self-hatred, jealousy, self-harm, accepting abusive relationships, procrastinating, and anger.

The good news is that it is possible to change your thinking and be happier.

You can stop help yourself and remove some ineffective thinking filters by creating a constructive dispute with yourself. Experiencing faulty filters is quite common, if you discover you have been experiencing faulty filters, you can change the view. By disabling these filters, you are will start responding to what is, not simply your processed interpretation.

An article on many of the cognitive filters we can be susceptible to is attached below. I recommend you take some time to look through all the thinking filters that people often experience and then consider the type of discourse and dispute that you can create within yourself to stop some of the reactions you have.

Change the View. Challenging your thinking filters.

It is important however to pay attention to three filters which cause particular concern during this time – Catastrophising, Comparing, and Mindreading/Blaming.

Catastrophising.

Catastrophising refers to the faulty thinking filter which we can apply when exploring the future of situations in regard to negative outcomes. This is very common during a pandemic because we don’t know what the outcome will be.

Whilst it is typical to occasionally feel a negative outcome, when we go for medical checks and such, excessive worry is of no help. During the pandemic you don’t need to look much further than social media to see evidence of catastrophic thoughts.

Catastrophic thinking increases your experience of anxiety

If you tend to catastrophise regularly you cause yourself immense distress. Imagining that all situations will end in disaster is exhausting. Worrying that people will die or leave you will not make those situations any easier when they do happen, it just makes you experience the situation, virtually, again and again.

People who catastrophise need to challenge their thinking with more ‘realistic’ thoughts, and remind themselves how many times in the past situations have turned out OK. Often the worry caused by catastrophising may move people to seek out reassurance from others, and this in itself can become a problem. Try to do nothing for a while first. Whilst the anxiety you feel is unpleasant you can work to distract yourself from that experience with anxiety relieving activities. Try to create a disputing dialogue.

Use the “At least” exercise to break catastrophic thought patterns

One specific cure to reset your catastrophic thinking will be to engage the perspective taking exercise of “At least”. Some individuals can become hardwired with a pessimism bias. The pessimism bias refers to the tendency to overestimate the likelihood of negative events while underestimating the likelihood of positive events. This attitude of expecting the worst is a prominently associated with the experience of depression and anxiety and can have considerable ramifications for recovery from these conditions.

If you find you naturally comment on the negative aspects of a situation, consider changing your choice of expressions, if only for a little while. We sometimes forget that when we speak, we are feeding ourselves. This negativity loop can be hard to break. In therapy one way we start to break the process is to encourage clients to start to use the phrase, “At least” when they speak, either attached to their pessimistic dialogue or to help build some sense of gratitude.

Every cloud has a silver lining. Help yourself, and your kids, find it.

This approach may seem like chasing rainbows rather than dealing with the real issues. I would challenge you to consider if your negative viewpoints are honest, comprehensive and useful. Almost every challenge has both difficult and beneficial elements. For example, I work with teens and when it became obvious that school would be online for a protracted period of time, I asked them what they liked about online school They came up with the following things they liked. I did not ask them if they like online school more than in person school. I cannot provide them with in person school when it is not possible. Rather I am helping them see the positive aspects of a situation that can feel beyond their control.

Practicing gratitude to stop catastrophic thought patterns.

Over the longer term, practicing gratitude will help develop a more positive mindset which will help be more practiced in seeking the pleasing elements of your life, leading to a greater sense of satisfaction in general.

Practicing gratitude is associated with a stronger immune system, as well as more positive emotions and happiness. Its easy to be grateful over the big things, a bonus, the birth of a child, and a promotion. The real benefit for individuals in practicing gratitude over the smaller things – a sunny day, a successful cake, a kind gesture from a friend, technology that works without trouble. That is where the magic happens.

Practicing gratitude regularly, either through journaling or keeping a gratitude jar, helps to develop the habit of gratitude. When we practice gratitude regularly, we start to mentally contrast negative news stories and voices around us, looking for the positive element rather than amplifying the negative.

Exercise- the gratitude jar. I particularly like this exercise because both adults and children can use it Take a jar and label it your gratitude jar. If you have children, you might like to decorate this jar with stickers and plastic gemstones. Once the jar is “complete” you can start to fill it. Using small note paper – such a post-it type or note paper write one or two things that you are grateful for.

Other thinking filters to overcome – the combination of mind reading and blaming.

Mind reading occurs when we assumptions about people in the absence of all the evidence, because we are convinced, that at some level, we know what they are thinking. Whilst on some occasions we may guess this right, we may also get this wrong. For example, I often talk with clients who assume work colleagues talk about them negatively or think a particular way about them. In my experience we tend to overestimate how much people talk about us, and how judgmental of us they may be. Most people are usually worrying about their own performance, and what they need to do, rather than the role we play.

Occasionally people let us down, even hurt us with their actions. Sometimes these actions are intentional. Many times, they are not.  It is good to be able to accept disappointment and the imperfections of others. If you find that you become stuck and the process of blaming others for your position in life, or in a situation you give away some of the power to fix that situation. Accepting someone’s behaviour is not an endorsement of that behaviour, it is simply acknowledging that bad realities exist, and that life can be unfair.

During a pandemic people can combine both these mind reading and blaming filters, especially when regarding the decisions of governments or health authorities. A pandemic such as Covid has not been experienced during most expert’s lifetime, even if they studied previous case studies. So, governments and health authorities can make decisions that, sometimes, look like mistakes. We make ourselves additionally anxious when we assume that they are making those decisions because they don’t care about the outcome for us as individuals, or that they want us to suffer. I don’t agree with many governments’ approaches to managing the pandemic, but I find it helpful to remember an adaption of Hanlon’s Razor, “Never attribute to malice that which is adequately explained by incompetence”.

When society is responding to a pandemic there will be setbacks. Overcoming mistakes or setbacks is a part of life and allows us to build resilience. Ask yourself, what actions by the government, or your company, or building management is really aimed to cause you harm? Are these people intentionally trying to hurt you, or is it possible they are doing the best with the information that they have, and the fears that they hold? We don’t have to give in to policy that we find unacceptable, but it will help you’re experience of anxiety to better try to understand that those making decisions are not personally trying to upset you.

The final filter to eliminate – Comparison.

It is common to consider our own attractiveness, status, success, and personal worth relative to others. During a pandemic regularly comparing yourself and your circumstances to those of others can increase your anxiety. Feeling jealous because friends left Hong Kong to live, temporarily, overseas, will not help your need to stay here. It increases your sense of worry – there must be a reason that people needed to flee. Ask yourself if that is really accurate.

Comparison is a guaranteed path to misery.

When you compare you tend to look at the world through a lens of “winners and losers” you will always find others who have achieved more than you. This is disorienting, and artificially casts you in the role of loser.

Additionally, comparisons are often driven by inaccurate information. . We often compare snapshots and these are often superficial and incomplete. For example, you might feel jealous of people sitting by the pool in Singapore whilst you have to work from home. That is nice for them. They have a pool. They can have dinner at a restaurant. You can’t, right now. That doesn’t mean things will always be that way. This doesn’t mean that everything is going well, or will go well for those people.

Comparing yourself with others will only echo the feeling that life is unfair. Some people are born with more advantages such as social connections, wealth and looks. The world is an uneven playing field. When we focus on comparisons we brood on this unfairness rather than focusing on what we have the power to achieve.

3d) Add calming activities to your daily diet

Specific activities which help to calm the body can help, not only in times of a crisis, but also to build a regular routine of self-soothing and calming.

Activities that help introduce a sense of calm in your life:

Try meditation

Meditation is a good way to bring about, a sense of peace, and help you better manage stress. These benefits do not end when the meditation exercise ends, they can be carried into the rest of your day and employed at times when you encounter something that makes you feel anxious.

Meditation is an umbrella term for the many ways to a relaxed state of being. There are many types of meditation. Committing to even a few minutes of meditation a day can help. Anyone can practice, and benefit from meditation.

During meditation, you focus your attention and eliminate the stream of thoughts that may be crowding your mind and creating a state of stress.

Some of the types of meditation you might like to try include:

Guided meditation. Sometimes called guided imagery or visualization, with this method of meditation you form mental images of places or situations you find relaxing. These meditations often ask you to engage your senses and therefore act as good distraction to calm your breath and stop trails of intrusive thoughts. You can find guided meditations on YouTube or Spotify.

Breath focused meditations. This type of meditation is based on being mindful, or having an increased awareness and acceptance of living in the present moment, all whilst focusing on your breathing patterns. Mantra focused meditations. In this type of meditation, you silently repeat a calming word, thought or phrase to prevent distracting thoughts and to create a sense of calm.

Colouring books – colouring activities create a sense of calm. Colouring books are extremely popular as a result of the positive effect possible from regular colouring. Colouring is not just for children. Teen and adults benefit from colouring activities as well. Doodling is also a great way to create a sense of calm if you would rather create your own artwork.

Other calming activities.

Going for a walk, especially in nature, is one way to bring calm into your day. Some people find making art projects – sewing, knitting, woodwork a great way to achieve calm. During the pandemic many people have taken to baking as a relaxation technique. You can experiment to find out what works for you.

3e) Healthy habits

Practicing healthy habits, especially getting enough sleep, will help you better manage your anxiety. It doesn’t take more than a few nights of poor sleep for frayed tempers and foggy minds to impact your ability to cope with challenging circumstances.

Adults require 7-9 hours of sleep a night. Teens and children require more. Sleep is required to recover from the day, including processing the psychological toll that living in pandemic conditions creates. If you have trouble getting to sleep, or staying asleep, try employing many common sleep enhancing activities such as creating a calm bedtime routine, having a shower and a bath, banning technology an hour before bedtime and from the bedroom. The following article focuses on improving your sleep habit. You can consider medications such as melatonin, if your doctor agrees.

In addition to sleep other eating habits such as diet and exercise can help to better manage your experience of anxiety. The opposite is also true -being overweight and possibly hypertensive, consuming too much alcohol, sugar, smoking, or medications, can actually increase your experience of anxiety and anxiety symptomology.

A special point I’d like to offer is to please watch your consumption on alcohol in response to anxiety. Many jokes are made about “wine o’clock” as a stress response. If you find that you can not limit your consumption to one drink a day, then start to reflect on your relationship to alcohol. Many people find that they need to consider if their alcohol consumption is helping or harming them. There is no shame in taking a break if you need it. If you would like to read more on this topic our article below may help. #

Sleep training for adults.

3f) Utilise your social supports

Friends are important. In times of crisis, good friends are critical. Unfortunately responses to the Covid pandemic often break down social support systems and individuals can feel isolated. You may need to actively build new support mechanisms and networks to ensure that you have good people to talk to during periods of stress.

It is important to talk to people who actively help you to reduce your experience of anxiety. They may simply be the people who listen to you, and say that times are tough right now. If you follow the guidelines of monitoring your anxiety regularly, you may like to record how you feel after interactions with various friends. Talking to some friends may may you feel better, and others the opposite.

Some people seem determined to offload their anxiety onto others. If you have friends like this, perhaps ask if you can change the topic of conversation as it makes you uncomfortable. A good friend will heed such a request. If a friend can not “change the channel” , you may choose to spend less time with that person.

Times of crisis are, often and unfortunately, a time when we learn how strong and helpful our bonds with other people really can be. During the pandemic some of your friends may let you down. If this happens you will probably feel abandoned and upset. People can disappoint us sometimes. I also suspect, that if you look around you, you will notice that other friends have been more supportive and helpful than you originally anticipated. These revelations can be unsettling. Forgive yourself for expecting more of some friends than they could provide, but also be thankful for those people who show up, and offer support.

3g) Mindful Communications

Winston Churchill once commented, “We are masters of the unsaid words, but slaves to those we let slip out”. He was referring to sharing secrets, but this saying can also apply to how we communicate with others during a time of heightened stress.

This is particularly applicable to our communications on social media. Whilst we may have read an article which alerts us to a perceived risk, think if you really want to share it with others online. Ask yourself – is this communication helpful? Is is accurate? Is it factual rather than sensational in its content? Is it necessary for people to know this information? Is it kind for me to share this information? If you answer no to those questions consider holding off on sharing that information online.

This has been particularly true in continuing news or headlines which have been proven to be suspect or written for sensational purposes. For example, media feverishly published that Hong Kong has/had the highest death rate in the world, based on the deaths per capita calculations of the data site Our World in Data. Whilst it terrible that so many people have died, the context of the data always needs to be considered – i) this is at a certain point in time looking backward, not forward, ii) this is a per capita calculation so a relatively small population like Hong Kong with 7.4 million people looks worse than the US and iii) this number does not project any particular individuals chance of dying. If you are vaccinated and generally healthy in Hong Kong, you have a very good chance of surviving Covid. It is tragic that much of this would have been avoidable if more people, particularly older people, had received full vaccination.

So why do media publish such headlines? Because it is sensational and sells papers. Even long after this number subsides they will write that Hong Kong had the world’s worst death rate because it sells. It was these same publications which circulated horror stories of reactions to vaccines which, many have driven, resistance among the older population to agree to vaccination ahead of the fifth wave. It does not help. The news isn’t always accurate or helpful, and whilst its important to stay informed, we need to, unfortunately, be mindful of that.

You may often feel overwhelmed and anxious, and it is appropriate to talk to someone about those feelings. Friends who you know well will be a good first point of call. Consider the recipient if you post about your anxiety on line, and if you do, own your feelings. For example, write “I feel worried how my kids will be affected by interruptions in their schooling” rather than “Kids have been completely ruined by online school”. The later style of statement is may cross the line between simple venting and trauma dumping. When in doubt, keep the shares on your personal life within your private circle of friends.

3h) Pack away your baggage

At times when you are under great stress you want to reserve the energy that you have, and will need, to fight the battle you need to fight. In a pandemic, it is the worry about infection, treatment options inside an environment of miscommunication. You need to utilise your energy to keep yourself as balanced and focused as you can be.

In order to do this it may be similar for you to call a halt to any other fights that are ongoing in your life, with your inlaws or other family members, or with your neighbour or child’s school. Those fights can wait.

Unresolved trauma from the past has a way of becoming unpacked when we are presented with a new threat. For example seeing the government struggle to cope with the current wave of infections and severely sick people may remind you of your own feelings of abandonment. It may be time to put the weight of those traumas behind you with some professional help.

3i) Ask for help if you need it

If your anxiety is crippling, is persistent, or requires you to perform organised routines or practices please consider to seek additional support. You may be advised to visit a counsellor, a psychologist or a psychiatrist in order to help build a different treatment plan. Medications for anxiety are nothing to be ashamed of. We are living through a time of great uncertainty and if your doctor recommends a little extra help, perhaps consider taking it.

Putting it all together

You now know the elements of a treatment plan and you can put it together for yourself to help frame a checklist of practices that should help you during times of heightened anxiety. For some of these activities it may help to join a class to create a dedicated time to perform such activities. I recommend online art therapy and yoga classes for this time.

Even if you want to put everything into practice you may feel trapped trying to navigate your negative thought patterns or overcoming pain from the past. That is when a professional counsellor or psychologist might help. There is no shame in visiting a counsellor.

The question is not why to consider counselling, rather it could be, “why not”.

The scientific benefits of counselling are extensive, and include:

  • Improved wellbeing and health
  • Improving your relationships (friendships, professional relationships, romantic relationships and relationships with family members)
  • Decreased feelings of depression and anxiety
  • Help you get through tough times (pandemic, illness, breakups, disappointments)
  • Accept yourself and improve your self-esteem
  • Build resilience
  • Overcome past challenges and hurts
  • Help to remove roadblocks in your life which make you feel stuck
  • Feel supported and feel seen
  • Better express yourself
  • Improve your ability to manage your emotions
  • Help you feel more hopeful
  • Improve your motivation
  • Better understand yourself and discover more about yourself
  • Find your purpose in life

Counselling is for everyone. It is not just for those who are feeling anxious or depressed. Everyone benefits from receiving counselling. Wouldn’t you like to have improved relationships, better understand yourself, and feel more motivated. Give counselling a chance to help you feel stronger and do better. Certainly in times of heightened anxiety, talking to a qualified counsellor will help.

About the author

Angela Watkins is the Head Counsellor at RED DOOR Counselling in HOng Kong. Angela is an experienced counsellor and trains and teaches counselling in Hong Kong. For more information about how counselling might of benefit to you, you can send her an email at angelaw@reddoor.hk

This article reflects the professional opinion of Angela Watkins. If you are unwell from Covid please seek the advice of a doctor or hospital. If you are feeling regularly overwhelmed by anxiety you should consider counselling in person or online.

#mentalhealthmatters #covid19 #anxiety #meditation #arttherapy #counselling #friendship #cognitivefilters #immunity

How we can build great girls

As women, and mothers’ of girls, we are constantly reminded that the women’s rights movement still has some way to go, and we can all play a role.

While I am delighted that my generation has experienced a broader remit of occupations they were allowed or encouraged to apply to  than our mothers, it begs the question, what attributes should we be encouraging in young girls to break the glass ceiling, end gender bias, and redefine what it means to be a woman.

Essential skills  for Young Women

Personal strengths – Identifying and celebrating what strengths you have, regularly, is investigated and encouraged. Believing you can face challenges is extremely important. Celebrating overcoming difficulties is particularly important. Young girls often to have an abundance of confidence, but by the time girls are 16-17 this confidence is harder to find. That loss of confidence can be undone.

Believe you CAN– As women we have a responsibility to expose our female teens to all kinds of achieving women so that they can better appreciate that women’s careers are being redefined, daily and hopefully, forever.

Teaching self-acceptance and healthy thinking patterns – Self acceptance is not only recognizing your strengths, but also accepting that you will make mistakes, you will experience failure, and that this is part of life. We need to teach girls to avoid thinking traps such as comparing, personalizing, labeling themselves negatively and catastrophizing. By adulthood many of us are limited by negative thinking patterns – building habitual thinking patterns that challenge these negative thoughts helps to raise teens who accept their mistakes, avoid self-punishing behaviours, and get themselves ready for the next big challenge.

Negotiating with confidence – We can teach girls confidence to negotiate in life, for job promotions, and for salaries. This starts from learning and using negotiation skills as early as the teen years. Negotiating for independence, pocket money, activities, and also performing chores as part of those negotiations, teaches girls that they can determine their future through their efforts, and that they have the right to challenge what is a fair wage for fair work.

You are not your body – You are not defined by your body, and loving your body will help you have a fuller life.  We need to teach girls that women come in all shapes and sizes, and none is better or worse than another. You are not your “fat thighs” or your “boring hair”. Speaking negatively about your body and yourself can be challenged, and need not be part of your self-talk dialogue.  You are more than your body, your healthy body gets you from A to B, and if you look after your body, it will look after you.

Relationships and boundaries – The teen years can include episodes of being bullied, feeling unpopular, wanting to be unique (while being just like everyone else), and wanting to please others for a multitude of reasons. We need to teach our teen girls to reflect on the decisions they make in friendships and if those decisions are to their benefit or cost in the long run. If teens fear being cut off from a group, we can teach them ways to stand their ground, be themselves, and be comfortable with the consequences. Having a broad range of friendships helps protects girls from this vulnerability.

Cyber security – With the proliferation of the internet, young children have access to a wealth of sites, information sources, and social media channels. A teenager can receive a thorough education (and mis-education) simply from spending a few hours a day on YouTube. Recently I discovered that our 15-year old girl had been talking to people overseas on the WWE (World Wrestling Entertainment) website forums! Some of the people were adults. She had sincere difficulty understanding why her parents responded to this with such horror. To her it seemed very innocent. We reiterated our cyber safety rules in the house:  Mum and Dad have access to your online profiles and may check them,  you can use your computer only in public areas of the house, never share personal information about yourself, and never agree to meet in real life (without adult supervision). This is a large topic and deserves a blog all of its own.

Physical safety – I believe that all girls should be prepared to protect themselves physically. This preparation may simply involve them being able to respond to unwanted physical attention in a manner beyond embarrassment. Helping girls become comfortable responding to negative attention may seem like shifting the blame for abuse onto them. This is quite the opposite. We want girls to know that they have the right to protect themselves, to be prepared to respond to a perceived threat, and, particularly, not to freeze in fear. And of course, teach boys to understand that traditional power patterns not only disadvantage girls, the limit them as well. 

We rise and fall together. Don’t harass other girls. – For example: girls who wear big hoop earrings or short skirts are not “hoes” or “sluts”. When girls degrade other girls in these superficial ways, they bring us all down. When we defend all girls, we all rise together.  We need to stop this gender depreciating madness.

The Safety Card – I am a keen proponent of the safety card – setting up a “what if” system to help teens imagine themselves in difficult situations and then determine an acceptable response. A safety card helps teens negotiate highly charged situations when they feel calm, helping prepare them for situations that may feel more out of control. For example, if you feel very depressed and even suicidal, what can you do?  If you found a friend was self-harming by cutting what could you do? If you found one of your friends had drunk too much alcohol at a concert, what could you do? Talking to teens when they are calm in hypothetical situations helps to acknowledge two important aspects of life in Hong Kong.  First, as adults we know that these behaviours do occur, we are not lecturing but helping them negotiate a potential situation. Second, we are enabling them when they are calm to set out set of steps that they can follow if they ever find themselves in difficult situations.

Let’s build a next generation of girls that are stronger, less impeded, and even more liberated than the generation that came before them.

#Internationalwomensday #feminism #teens

About the author- Angela Watkins is a counsellor and psychologist who works with many teens, helping them become stronger, more resilient individuals.

Anxiety Attacks – Emergency responses

Living with anxiety feels as if you are inhabited by a monster constantly whispering about your fears, insecurities and your worthlessness, your inevitable failures and the catastrophes which you can’t avoid and are probably creating. It is estimated that 13-14% of people in Europe [1] live with anxiety. One symptom is anxiety attacks. Some people only realise that they have been suffering from anxiety when they experience such an attack.

An anxiety attack differs from a panic attack. It is usually a response to a stressor – often a thought or feeling or specific dread. People feel apprehensive and full of fear. Their hearts may race and they may feel short of breath. Often people feel out of control and may become extremely tearful. A panic attack may include some of these symptoms, but usually occurs without a clear stressor. Both can be terribly frightening. If you experience anxiety attacks it is important that you are prepared with an emergency response.

Here are my favourite techniques to respond when anxiety attacks.

Try this exercise when you feel anxious.

Breathing exercises – Listen to the pattern of your breath when you are anxious. It can give you a clue as to how best to respond to your anxiety. If you are hyperventilating – taking fast, shallow breaths, feeling faint, and fearing that you can’t catch your breath, try to breath into a paper bag. Breathing in and out using a paper bag will recycle air, returning carbon dioxide to the body, which will naturally make the breath deeper and slower. Do this for a minute. If you don’t feel better, try again for another minute.

If you are not hyperventilating, you can use the calming breath technique. Breathing exercises such as those used in yoga classes are effective in reducing anxiety. One simple exercise I use with clients uses counting inward and outward breaths to calm the mind. Simply breathe slowly in through your nose for a count of 4, then breathe out of your mouth for a count of 4. Repeat. Then breathe in through your nose for a count of 4, and out of your mouth for a count of 6. Repeat. Then breathe in through your nose for a count of 4, then breathe out of your mouth for a count of 8. Repeat. Check to see if you feel better. If you don’t, repeat the exercise again, concentrating on the sensation of your breath.

Distraction exercises. Distraction exercises help your parasympathetic nervous system override an anxious reaction. By simply refocusing your energy to elements of your environment and allowing your underlying operating system to return to homeostatic (ie regular) breathing.

Use your senses to help calm your breathing

The most commonly used therapeutic technique asks the client to engage their senses to distract their busy minds. Identifying a number of items you can see, smell, hear, touch and taste can help you reset your body. Imagine 5 things you can see, then 4 things you can hear, then 3 things you can smell, then 2 things you can touch, and 1 thing you can taste. Then monitor your breathing again. Has it become less panicked?

Since we work with a number of teens and children at RED DOOR we also use the RAINBOW technique, often with our proprietary rainbow fidget toy, to help teens achieve quick calm. One can perform this technique without the fidget toy. Simply you count objects in your near vicinity which are specific colours. You can count the number of objects, or a specified number of objects that are red, orange, yellow, green, blue and black.

Distraction and can also be created with some physical “reset” activities such as repeatedly snapping an elastic band against the wrist or performing sets of 10 jumping jacks.

Meditation/Relaxation – Mediation, when practiced regularly, can help people reach a relaxed state more easily. Practice makes progress when it comes to mediation. If you are experiencing an anxiety attack, try to find somewhere to sit quietly or lie down. Then try progressive relaxation, also known as a body scan, which can be especially helpful. Progressive relaxation soothes as you tense and relax muscles – isolating and focusing exclusively on one group of muscles at a time. Begin with your toes, and work up through your muscles to your head, where you may focus on relaxing the muscles around your chin and eyes.  Guided progressive relaxations are available on Spotify, YouTube, and on CD.

Imagery – In the throes of an anxiety attack use your active imagination to help your de-stress. First, isolate the location within your body where you feel the greatest sensation of anxiety. Use imagery to help unwind and relax that spot. Cute, warm, and amusing imagery will be of the greatest help. If you feel tension in your shoulders imagine a collective of kittens massaging the knots away. If you feel butterflies in your stomach – imagine yourself in your stomach with them, asking each to settle on your arms and flutter no more. One client recently expressed her fear of butterflies, so, using imagery, we collected the butterflies and they turned into Golden Retriever puppies, ready for a cuddle.

This mantra might help with your negative self-concept

Mantras – Anxiety attacks are created by dreadful thoughts running through your mind. One way to settle these thoughts is to repeat a mantra. While there are mantras on the internet, you may benefit from one that you write specifically for yourself. The mantra should be full of words of kindness, understanding and love. The words “should” or “must” cannot be part of any mantra.

Centre yourself with art therapy techniques

While avoidance is not a long-term technique for managing anxiety, if you are ruminating or feeling a panic attack, distracting yourself with a change of scene or activity can help. Go for a walk, particularly in nature, to reset yourself. Try colouring, which I have detailed in a previous blog [https://reddoor.hk/2017/03/06/reasons-to-colour/ ], which involves both sides of the brain, stimulates creativity, and can help to calm the mind.   Even listening to some upbeat tunes at this time, get up and dance, just break the pattern of your anxiety for a moment to reset your emotional clock.

Talk to your anxiety – The long-term cognitive approach to anxiety is to create an internal dispute. Disputing your anxiety helps you reframe situations, see hope, and utilise self-compassion. If you experience anxiety ask yourself to challenge your view of the stressful situation – have you been overgeneralising, personalising, or catastrophizing? Is there an alternative way of looking at this issue? Sarah Wilson[2] , in her compendium of suggestions to utilise in one’s challenge with anxiety suggests an ancient adage, “ First make the beast beautiful”, meaning accept that your anxiety – it is something that originally may have been created to help you, but overtime has started to inappropriately misfire. When you make the anxiety beast beautiful you may say to yourself, “Thank you brain for alerting me to potential danger, but I know I am safe right now, you can go back to your guarding post”.  Developing the process of dispute is an area of action where a therapist can be of significant help. If you cannot create this dispute for yourself, utilise the resources of a counsellor. For more information see our post on this topic https://reddoor.hk/2020/09/07/talk-to-your-anxiety/

Prolonged anxiety is extremely challenging to your health. If you have been struggling with anxiety for a while please seek the help of a counsellor or a doctor. They may recommend a combination of therapy and even medication to help lessen your anxiety. There is no shame in needing help. Take charge of your future. Everyday is a new day for you to thrive. Start gently now.

 #mentalhealth #mantra #mindfulness #anxiety #reddoor #selfhelp #anxietyattack #treatmentanxiety

Sources

1: Prevalence –

2004: The ESEMeD/MHEDEA 2000 Investigators,2004, Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

2011: https://www.theguardian.com/society/2011/sep/05/third-europeans-mental-disorder

2: Sarah Wilson, 2018, First we make the beast beautiful: A new journal through anxiety. Dey Street Books

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Angela Watkins is a psychologist and counsellor at RED DOOR Counselling in Hong Kong. Her current clinical work focuses on parenting. relationships, anxiety, OCD, career change, stress management and divorce.