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Psychology

Stigma of mental illness preventing Asian immigrants in seeking help – what it takes to overcome the stigma and find the help they need

Stigma of mental illness preventing Asian immigrants in seeking help – what it takes to overcome the stigma and find the help they need

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Imagine living in a world in which everyone feels free to talk about their therapy sessions openly without judgement, as they do about dentist or physiotherapy appointments. Although psychotherapy is a common practice in some cultures, this scenario is unheard of in the Asian immigrant community in which discussions of mental health are hushed, therapy is shunned, and seeking help takes tremendous courage. Not only is heavy stigma associated with mental illnesses, feeling shame and guilt for having a mental health issue also makes Asian immigrants reluctant to get help. Additional cultural challenges, such as the desire to “keep it in the family” or “not washing dirty linens in public” (to prevent outsiders from discovering one’s mental health issues), fear of being ostracized by their communities, seeking help as being seen as a “weakness”, concerns of confidentiality, and the possibility of losing “face” or bringing shame to their families can further prevent them from even acknowledging/admitting that they are experiencing mental health problems (Chen, Kazanjian, & Wong, 2009; Thomson et al., 2018; CBC/Radio Canada; 2018).

Back in their countries of origin, their main supportive networks may consist of close family members, friends, and co-workers. Immigration to a new country can significantly reduce the accessibility of social support networks in their home countries, which can greatly increase their vulnerability to mental health problems. It can be difficult to find new sources of support in a foreign country, yet many are still resistant to getting help. It has been shown that Canadians of Asian ethnicities are the least likely to utilize mental health services in their communities (Durbin et al., 2015; Li & Browne, 2009; Tiwani & Wang, 2008).

Due to possible linguistic barriers, strong feelings of shame, guilt and denial deeply rooted in cultural values, visiting a psychologist is usually seen as a last resort in Asian immigrant communities. Receiving professional help is often seen as taboo and people who experience mental health problems live in fear of being labeled as “crazy” or “insane”. Refusing to seek help or dropping out prematurely during psychological treatment is common. Symptoms of those who make it to the psychologist’s office are often more severe and more difficult to treat than Canadians of other origins (Fang, 2010). In addition, Asian immigrants may mistake psychosomatic symptoms for physical illness due to the importance and attention they give to physical health, yet they lack awareness of, or perhaps avoid, issues related to mental health.

Furthermore, there may be numerous misconceptions in the Asian community of what a clinical psychologist does and the services that he/she can offer, possibly due to media and/or cultural beliefs. For many Asian immigrants, psychology comes across as a western subject matter, with treatment values and perspectives developed in western individualistic cultures that focus on improving the life of the individual. This may be in direct contrast to collectivistic cultural values, which are more typical of Asian cultures, in which focusing on self-improvement may be viewed as selfish and even induce guilt.

Finally, the role of psychologists can be drastically different in their home countries compared to that in Canada. In some countries where the profession of psychology is young and not as well regulated, immigrants may have experienced different and perhaps ineffective psychological treatment, which misconstrues the potential benefits of psychological services. In Canada, psychologists must be licensed with their provincial regulation boards (e.g., Order of Psychologists in Quebec) and must have strict academic and clinical credentials to be eligible to do so. If you are looking for a psychologist who fits your patient’s needs, visit the official website of the Order of Psychologists of Quebec to find a suitable match: http://www.ordrepsy.qc.ca/.

So what can we do as health practitioners to help immigrants overcome stigma and find the help that they need?

1) Normalize seeking help from psychological services in Canada and encourage them to look for a psychologist within their provincial regulation board (e.g., the Order of Psychologists of Quebec)

2) Reduce the stigma by encouraging them to think of psychological problems as getting a “cold” psychologically. Encourage them to seek help instead of letting symptoms drag on until the issue becomes a psychological “fever” (more severe)

3) Encourage immigrant populations to seek out community support – e.g., at their local community and cultural centres that offer support services in their language of preference

4) Assist them in utilizing community and online resources to educate themselves about issues related to immigration and mental health.

5) Address “the elephant in the room” – racism and discrimination issues that immigrants often face

6) Practice cultural sensitivity when seeing clients of a different cultural background. Be curious and willing to learn about your clients’ issues and try to understand their cultural context

7) Provide psychoeducation regarding the close association between one’s physical and mental health

8) Utilize cultural consultation services such as: https://www.mcgill.ca/tcpsych/clinical/ccs


Zhen Xu is a Ph.D. candidate in clinical psychology at McGill University and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram, or like us on Facebook.


References

CBC/Radio Canada. (2018, March 1). 'The unspoken ones': How race and culture complicate Asian-Canadians' access to mental health care [News Release]. Retrieved from https://www.cbc.ca/radio/thecurrent/facing-race-the-current-s-town-hall-event-in-vancouver-1.4558134/the-unspoken-ones-how-race-and-culture-complicate-asian-canadians-access-to-mental-health-care-1.4558354.

Chen, A. W., Kazanjian, A., & Wong, H. (2009). Why do Chinese Canadians not consult mental health services: health status, language or culture?. Transcultural psychiatry, 46(4), 623-641.

Durbin, A., Moineddin, R., Lin, E., Steele, L. S., & Glazier, R. H. (2015). Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study. BMC health services research, 15(1), 336.

Fang, L. (2010). Mental health service utilization by Chinese immigrants: Barriers and opportunities. Canadian Issues, 70.

Li, H. Z., & Browne, A. J. (2009). Defining mental illness and accessing mental health services: Perspectives of Asian Canadians. Canadian Journal of Community Mental Health, 19(1), 143-159.

Thomson, M. S., Chaze, F., George, U., & Guruge, S. (2015). Improving immigrant populations’ access to mental health services in Canada: a review of barriers and recommendations. Journal of immigrant and minority health, 17(6), 1895-1905.

Tiwari, S. K., & Wang, J. (2008). Ethnic differences in mental health service use among White, Chinese, South Asian and South East Asian populations living in Canada. Social psychiatry and psychiatric epidemiology, 43(11), 866.

 Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

In my July Blog post, I referred to what happens when certain personality traits are too high or too low, causing life difficulties. Borderline Personality Disorder (BPD) is one psychological diagnosis or label that mental health care professionals and clinicians use to describe a specific pattern of problems. Typically, this pattern involves intense, chaotic relationships with both the self and others. Even though some of the traits involved are amplified versions of normal personality traits, many people with BPD will experience problems that are serious, and that most people never experience (Paris, 2017). Although there are some commonalities and a general pattern, individuals with BPD do not all have the same problems or experiences.

Let’s think of Jessica for example. She was recently diagnosed with BPD. She’s always felt something was “off”. She suspected early in life that she wasn’t feeling the way others around her felt: her emotions have always been so intense, it was as though she was walking around with no skin. She’s noticed she reacts impulsively to these intense feelings, which change from one moment to another. One moment she can be thrilled, the next, filled with sadness or rage. Along with these strong emotions is also an emptiness inside that she’s not sure how to describe to others.

Sometimes she feels her life is not real and asks herself “what’s the point?”. She often thinks of suicide, wondering if it’s the only way to stop her suffering. She’s even attempted to end her life a few times by taking pills, with mixed feelings when hospitalized and treated for these overdoses. She questions who she is, often feeling like a bad person who isn’t worthy of love. When she gets into a relationship, she’s afraid the person will leave and looks for ways to prevent this, or to have her partner reassure her that they won’t. Eventually, the ups and downs and efforts to avoid being broken up with cause a lot of stress in the relationship and it ends.

Jessica has received many diagnoses by health professionals in the past, including Generalized Anxiety, Depression, Attention Deficit and Hyperactivity Disorder, and Bipolar Disorder. She has tried therapy numerous times and felt frustrated because nothing seemed to “stick”. Recently, a new psychiatrist she was seeing diagnosed her with BPD.

Receiving a BPD diagnosis

It’s important to remember that a diagnosis, especially one of BPD, is not an identity: it describes a cluster of problems in someone’s life—what’s not working for them. Receiving the BPD diagnosis can be the key to getting the right help. When Jessica first got diagnosed, she went home and looked it up online. She was angered to find that much of what she was reading suggested there is something wrong with her personality and that she would be “difficult to treat”. She felt ashamed and angry with her psychiatrist, who she had no intention to return to see. She felt as though another health professional had let her down.

Despite this, she also felt some relief that she could make sense of what’s been going on, and eventually decided she would go for another visit to ask a few questions. Although she was hesitant, she told her psychiatrist how angry she was and was surprised that this led to a conversation during which she felt understood and even hopeful about the future.

Jessica learned that this diagnosis would allow her to get more specialized help, and together she and her psychiatrist came up with a plan. With treatment that fits (and some patience), Jessica can go from being diagnosed with BPD to no longer meeting any of the criteria and leading a more satisfying life. It’s also important to remember that when the label no longer describes someone’s current problems, it no longer applies.

Unfortunately, because of stigma around BPD, many people are reluctant to accept or disclose their diagnosis, which can get in the way of receiving appropriate help.

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

Why the stigma?

Compared to other disorders, BPD is a fairly new diagnosis, with treatments having only been developed in recent decades. There are times individuals with BPD feel like their experience is unbearable. Their symptoms often reflect the intensity of their distress; When Jessica went to see the psychiatrist, she had cut herself badly and said she wanted to give up on life. Although her psychiatrist identified her diagnosis, some health care professionals may not recognize BPD or know how to help, leaving all parties feeling frustrated. In fact, people with BPD are often not diagnosed or treated at all. Sometimes, they are offered treatments that do not fit their problems. Since intense emotions are part of the experience, speaking about what’s most painful with a health care professional, who is often a stranger, can be quite challenging.

It is not surprising that there would be friction between someone consulting for a situation that feels urgent and impossible, and a health care professional who isn’t sure how to help. Sometimes, the clinician may themselves react unfavourably when feeling unsure or helpless. As you can imagine, these reactions would not be well-received by someone in distress who already feels let down.

In fact, it is likely that someone seeking help for these symptoms has already had many frustrating experiences in the health care system. As a result, they might express anger (even rage) or withdraw from treatment, which in turn might lead to the clinician distancing themselves even more. This can become a continuous self-fulfilling cycle and can help explain some of the frustrations that people with BPD as well as clinicians face (Aviram, Brodsky & Stanley, 2006). Unfortunately, cycles like this one perpetuate the stigma and contribute to a reluctance toward both pursuing treatment (on the part of those seeking help) and providing treatment (on the part of clinicians).

Maybe you relate with parts of (or all of) Jessica’s experience, and you’ve experienced these frustrations yourself. If you’ve been feeling helpless, hopeless, and chaotic on the inside (and maybe outside too), or like no diagnosis has made sense so far: Remember there is the right kind of help out there—help you can use to help yourself.

What to do if you think you might have BPD and want to consult:

1- Take a deep breath. Remember these are words to describe problems you are experiencing, and that having these words means you can communicate to get the help you need.

2- Look for someone who is qualified to assess and work with personality in therapy, or ask for a referral to someone who does. You can look online, or ask your GP or most health care professionals.

3- Be prepared to speak with someone by taking note of what’s most important to share about what you are experiencing.

4- When meeting a health care professional, observe whether you are feeling intense emotions, and challenge yourself to be open—to stick around and share your experience as best as you can, even if lots of uncomfortable emotions rise to the surface. Ask yourself: how can I help this person help me? Sharing your difficulties and what you are looking to work on are some ways to collaborate.

5- Give the person time to get to know you and figure out how to help. They may not know right away.

Don’t give up on getting the help you’re looking for. Sometimes, it takes meeting with a few different professionals before you feel you’re on the right track.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006). Borderline personality disorder, stigma, and treatment implications. Harvard review of psychiatry, 14(5), 249-256.

Paris, J. (2017). Stepped care for borderline personality disorder: making treatment brief, effective, and accessible. Academic Press.

The Art of Not Knowing

The Art of Not Knowing

Having goals, dreams and desires implies looking forward and planning ahead. However, focus on the future is often accompanied by worries about hypothetical situations. Indeed, the things we care about the most are often ambiguous and unknowable. Because humans are hard-wired to prefer certainty to uncertainty, we experience this ambiguity as highly uncomfortable, even distressing. Considering that the future is uncertain and that being faced with the unknown is uncomfortable, we tend to develop strategies to avoid or reduce uncertainty. These may work in the short term. When intolerance to uncertainty becomes the rule, however, striving to eliminate it altogether paradoxically contributes to increased anxiety and suffering, and ultimately impedes our ability to reach our goals (Dugas, Gosselin & Ladouceur, 2001).

According to Kelly Wilson and Troy Dufrene, authors of Things May Go Horribly Terribly Wrong (a perfect title for a book on uncertainty), the first step to changing the way we relate to the unknown is to become aware of the myriad strategies we engage in to neutralize ambiguity (Wilson & Dufrene, 2010).

The list below may be helpful to begin thinking about which intolerance to uncertainty tactics we engage in the most and to prompt reflection on what uncertainty means to us.

1. Observe: How do I relate to uncertainty?

Approach Strategies:

  • Worrying to “solve” uncertainty. Worries are often plans, predictions and preparations for hypothetical situations that are ultimately ambiguous and unknown. It may feel “productive” to worry, but when the topic of worry is out of one’s control, such as for future events, worrying about it becomes an “intolerance to uncertainty strategy” and only leads to more worry.

  • Reassurance seeking. Asking for reassurance and seeking advice are also common ways to dispel uncertainty and to attempt to “feel certain”. Ex: Asking a loved one if they love you multiple times a day, asking multiple sources about an upcoming decision, getting second and third opinions…

  • Searching online. Digital and social media technology provides the luxury of quick and easy access to unlimited answers to our innumerable everyday questions. Through immediate and constant access to information, technology use in many contexts can take the form of reassurance seeking and, ultimately, reduces spontaneous daily exposure to uncertainty. Recent research actually shows that intolerance to uncertainty is a rising phenomenon that correlates with the rise of digital technology such as smartphones. Ex: Googling health questions as they occur, searching through someone’s or one’s own social media, excessive online-researching before making a decision (Carleton et. al, 2019).

  • Double checking. Double-checking may also easily become triple-checking or more. Ex: Repetitive checking of one’s bank account and email, repetitive-checking that the door is locked, double-checking the route to get to a destination.

  • Perfectionism, not delegating and overprotecting. To reduce uncertainty and to gain a sense of control, some may try to do everything themselves, over-prepare and not delegate to others. This may also take the form of perfectionistic tendencies relating to the idea that if everything is perfect, the outcome will be predictable and positive. People may also apply these strategies in the context of their relationships with significant others by being overprotective and doing things for them.

Avoidance Strategies

  • Procrastinating, choosing not to choose and indecisiveness. Putting off beginning a task that has uncertain outcomes. Will I be able to succeed? Am I good enough? Having trouble making decisions that have unclear outcomes and that include uncertain elements. These strategies may serve to minimize one’s experience of the discomfort of not knowing (Rassin & Murris, 2005).

  • Avoiding new opportunities. Avoidance of the experience of uncertainty may take the form of avoiding new experiences altogether. Ex: turning down a promotion for fear of not being good enough, not going to a party with new friends, not travelling to unknown places.

  • Cognitive avoidance. Efforts to not think about uncertain topics until it is absolutely necessary.

Beliefs about uncertainty

  • It feels irresponsible or dangerous for there to be uncertainty in life.

  • Uncertainty means that something bad will happen.

  • Belief that you cannot tolerate not knowing how things will go (“I will not be able to manage”).

  • Feeling that it is preferable to be certain that an outcome will be bad, than to not know the outcome.

As mentioned, everyone uses some of these strategies some of the time. Intolerance to uncertainty becomes most problematic when reliance on these types of strategies interferes with what’s most important to us.

2. Observe and notice: What are the costs?

The second step is to become aware of how regular use of these strategies interferes with one’s goals, relationships and general wellbeing. We may ask ourselves the following questions:

  • Are worries about the future getting in the way of my enjoyment of the present moment?

  • How much time am I spending trying to “solve” uncertainty? What else could I be doing?

  • What meaningful experiences am I avoiding or putting off due to intolerance to uncertainty?

  • Does my intolerance to uncertainty affect my relationships with loved ones?

3. Observe, notice and feel: Sitting with it. The final step implies doing the opposite of efforts to move away from uncertainty. In fact, it involves leaning into it and requires the willingness to experience its discomfort. If the only thing that is certain in life is that life is fundamentally uncertain, then acceptance of uncertainty, in all its discomfort, is necessary. Allowing oneself to simply experience ambiguity is not to love it, but to learn that it is both uncomfortable and tolerable.

  • How to sit with uncertainty? When resisting the urge to engage in strategies to reduce uncertainty, take a moment to explore your internal experience. Identify what you are feeling. Observe the sensations in your body, notice the feeling of your breath. Notice your thoughts. Remember, no matter how intense your thoughts and emotions become, they are temporary and they will pass. It may be helpful to remind yourself of the following coping statements: “This too shall pass”, “I do not know and it is okay”, “It is uncomfortable and I can feel it”, “It is uncertain, I do not need to solve it”.

  • For more information on sitting with difficult emotions, see this blog post.

4. Be flexible. The objective of these steps is not to eliminate our response of discomfort towards uncertainty. It is alright and normal to worry and feel anxiety at times. Rather, the objective is to become aware of how consistent efforts to not feel discomfort get in the way of engaging in experiences that are unknowable and likely to also be highly meaningful such as connecting with others and moving towards goals (Wilson & Dufrene, 2010).

Building tolerance to uncertainty is like strengthening a muscle. The more you work it out, the stronger it becomes!


Rhea Marshall-Denton is a Ph.D. candidate in clinical psychology at the Université du Québec à Montréal, and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram, or like us on Facebook.


References

Carleton, R. N., Desgagné, G., Krakauer, R., & Hong, R. Y. (2019). Increasing intolerance of uncertainty over time: the potential influence of increasing connectivity. Cognitive behaviour therapy, 48(2), 121-136.

Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive therapy and Research, 25(5), 551-558.

Rassin, E., & Muris, P. (2005). Indecisiveness and the interpretation of ambiguous situations. Personality and Individual Differences, 39(7), 1285-1291.

Wilson, K. G., & Dufrene, T. (2010). Things might go terribly, horribly wrong: A guide to life liberated from anxiety. Oakland, California: New Harbinger Publications, Inc.

Emotional avoidance: Make it go away!

Emotional avoidance: Make it go away!

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Lately I’ve been thinking about the various ways that people try to avoid their emotions. And it’s understandable. Emotions can feel pretty scary, especially when they get intense. Intense anxiety can elicit a sense of impending doom, the physical symptoms that accompany panic can generate a sense that one is having a heart attack, and individuals overcome with anger can feel like they are going to explode. So it makes sense that we would want to avoid negative emotions. In fact, it’s not uncommon for people to cite getting rid of an emotion like anxiety as their initial goal for therapy.

Problems with wanting to eliminate negative emotions

Although it’s understandable to want to avoid negative emotions, either by numbing ourselves when they arise, or wishing we could eliminate them altogether, there are several reasons why this isn’t actually a good idea.

1. Our emotions are useful signals. A helpful analogy here is to think of physical pain – although many people wish they could avoid or prevent physical pain, pain signals give us useful information that we need to protect ourselves (indeed, people who do not get these pain signals often develop serious injuries; see link). In a similar way, our emotions are there to tell us something. For example, when we feel threatened in some way, anxiety alerts us to the possibility that we may need to protect or prepare ourselves. Without any anxiety, we might take risks that put us in physical danger, or we might shirk our responsibilities altogether.

2. It’s often not possible. When we suppress an emotion, it doesn’t typically go away.

a. The emotion might actually intensify over time (have you ever tried to push away feelings of frustration about something only to blow up about it later on?). In this way, our emotions are not all that different from children asking their parent for something – what do they do if they don’t feel heard? They raise the volume (sometimes very, very loudly!).

a. Or the emotion might come out in a different form, which can be hard for those around you to understand (e.g. if you become passive aggressive) or in ways that might confuse even you (e.g. you might be unsure of why you feel tense, irritable or drained).

3. The ways that some people try to avoid negative emotions, including drugs or self-harm, can lead to more suffering. Sometimes people avoid thinking about negative emotions by throwing themselves into projects or focusing on the world outside of their inner experiences (e.g. with to-do lists, focusing on other people’s problems); this can be a hard one to detect because we might trick ourselves into thinking that we are being productive when we might also be avoiding (the motivation behind our action is the important distinction here).

So, you want me to just…what? Sit with my emotion?

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Although this might seem crazy at first, allowing ourselves to sit with a negative emotion provides us the opportunity to see that our emotional wave (although very uncomfortable) will decline in intensity over time and will not destroy us. Also, by not trying to “do something” to get rid of the emotion at the peak of its intensity, we might avoid doing something impulsively which we might later regret (McKay, Wood, & Brantley, 2007).

Rather than telling ourselves that our emotions do not make sense, that we should not be feeling that way, that our emotions are dangerous, or that we should try to get rid of them, we can try to identify what emotions we are experiencing in that moment (e.g. I feel angry), validate for ourselves that our feelings are understandable in light of the situation or context (e.g. it’s understandable that I’m angry because this situation is unfair), provide ourselves with words of compassion (e.g. I know this is really hard right now, and I know I will get through this), and ask ourselves what it is that we might need - not what we need to get rid of the emotion, but what we need to take care of ourselves (e.g. restorative activities like a nap, working toward boundary setting)…and if we’re really up for challenging ourselves, we can even thank our emotion for drawing our attention to this need and for giving us the opportunity to take care of ourselves in a more compassionate and present way (Neff & Germer, 2018).


Simcha Samuel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

1. https://ghr.nlm.nih.gov/condition/congenital-insensitivity-to-pain

2. McKay, M., Wood, J.C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation & distress tolerance. Oakland, CA: New Harbinger Publications.

3. Neff, K. & Germer, C. (2018). The mindful self-compassion workbook: A proven way to accept yourself, build inner strength, and thrive. New York, NY: The Guilford Press.

“Holding Space” for Others’ Distress: How to Be There for your Loved One Without Trying to Fix Their Problems

“Holding Space” for Others’ Distress: How to Be There for your Loved One Without Trying to Fix Their Problems

Photo by  rawpixel  on  Unsplash

Photo by rawpixel on Unsplash

Have you ever been with a friend, partner, your kid, etc. and they’re extremely upset about something going on in their lives? For example, they failed a class, lost a parent, lost their job, or are struggling with a health issue? What is your first reaction? My first reaction is often to try to do or say whatever I can to make their suffering go away as fast as possible. If the person experiencing the distress is a young kid, I might have the urge to distract them; for example, by saying, “Check out this cool toy!” If it’s an adult, I might go into problem-solving or advice-giving mode, and say something like, “Maybe it’s time to discuss with your boss the possibility of moving to another department?”. While these approaches can be helpful, there are some ways in which they are potentially problematic.

What is wrong with trying to advice-give or problem-solve our loved ones’ suffering away, or distract them from their negative emotion? I’ve listed a few of the potential problems with this approach below.

1. You might be invalidating their feelings.

By trying to advice-give/problem-solve/distract our loved ones’ suffering away, we could inadvertently be giving them the message that they “shouldn’t” feel this way or that their feelings are “wrong” or inappropriate. In other words, we may, without even realizing it, be invalidating their feelings. Examples of invalidating responses include, “It’s not that bad”, “Big girls don’t cry”, or “You’re probably just over-tired”. We could also invalidate a loved one’s emotions through what we do, not just what we say. For example, when we distract a child who’s crying by showing him a shiny new toy.

2. You might be giving them the message that “negative emotions are bad.”

By trying to help our loved ones get rid of their negative emotion as fast as possible, we could be feeding into the false idea that negative emotions are bad. Although negative emotions can be extremely unpleasant, they do serve an important function.

For example, sadness could be telling us that we’ve lost something important, and therefore help us prioritize for the future the things we really care about. Anger, on the other hand, could be telling us that we’re being treated unfairly, and if we don’t take the time to acknowledge the anger and reflect on it, we may not be motivated to make changes to an unhealthy situation.

So, if we quickly try to change our loved ones’ negative emotions, they may not have the opportunity to get the information that the emotion is trying to tell them, and we may be adding to the belief that negative emotions are simply bad and should be shut down ASAP.

3. You might be implying that they can’t handle negative emotions.

Our quick attempts to problem-solve or advice-give could also be inadvertently telling our loved one that they can’t handle their emotions. To be fair, negative emotions are tough to handle. But, if we are able to sit with our emotions, perhaps using some self-soothing strategies while doing so, like deep breathing and imagery, we may find the emotion will run its course without us having to bottle it up or push it away. Being mindful of negative emotions in this way is beneficial because it allows us to process the emotion (see Point 5) and recognize what the emotion is trying to communicate to us (see Point 2). Additionally, sometimes the strategies we use to bottle up or push away emotions cause more suffering, such as numbing through sleep or alcohol, avoiding situations or people, and keeping ourselves excessively busy.

4. It may be more about us than them.

Our attempts to problem-solve the emotion away may be more about our own discomfort than about our loved one’s suffering. In this way, we might not be providing our loved one with the type of support they’re looking for. They may, for example, simply want a listening ear.

5. They may not have the opportunity to process their emotion.

By helping our loved one push away or bottle up their emotion, they might not have the opportunity to process the emotion. Why is processing our emotions important? As mentioned in Point 2, If we push emotions away, or “bottle them up”, we may not be aware of the important information they’re trying to communicate to us (Greenberg, 2002). Also, emotions that get pushed into the background don’t necessarily go away, but might continue to exist as “unfinished business.” The more unfinished emotional business we have, the greater the likelihood these emotions will build up until they essentially “overflow”, resulting in us feeling, for example, an overwhelming amount of emotional pain (Greenberg, 2002). In these types of situations, when we’re overwhelmed with emotion, we may end up lashing out with rage, or falling into deep self-loathing or despair.

6. You may be feeding into their self-critical thoughts.

Blocking negative emotions can make us feel worse about ourselves. To block our negative emotions, we have to tell ourselves things like, “Stop feeling this way!”, “You’re being ridiculous!” “Get over it already!”. Talking to ourselves and judging our emotions in this way can lead to a bunch of other negative emotions (like shame, anger toward ourselves, etc.). So, if you’re helping your loved one block their negative emotion, you could be facilitating their beating themselves up over their emotions

What can we do to “hold space” for our loved one’s difficult emotions, instead of trying to problem-solve, advice-give, or distract them away? What is commonly known as active listening is a great way to simply “hold space” for your loved one’s distress (Weger, Castle Bell, Minei, & Robinson, 2014).

Check out these tips for active listening:

1. Tolerate your own discomfort.

If someone you care about is really distressed and you just want it to stop, take a few long, deep breaths; remind yourself that this will pass and you can still be there for your loved one without making the emotion go away; and remember that, although it’s really difficult, experiencing negative emotions is a necessary part of learning and growing.

2. Communicate attentiveness through your body language.

Make eye contact, nod your head, and use an open, relaxed body posture.

3. Communicate attentiveness through your words.

Use phrases like, “Uh-huh”, “I see”, and “I hear you” to let the person know you’re listening. Reflect back to them what they’re saying (e.g., “It sounds like what you’re saying is you really weren’t expecting this and that makes it even more difficult.”). This will help your loved one feel heard and understood, and will build trust between the two of you.

4. Be a sounding board and reflect back.

Allow your loved one to bounce ideas and feelings off you while assuming a nonjudgmental, non-critical stance. Summarize their experience, what they’re saying and reflect it back to them. This will allow them to feel heard, understood, and will also correct your perception if you’re misunderstanding them.

5. Avoid advice-giving or “teaching” and interrupting.

Advice-giving and “teaching” can potentially lead to the problems discussed above (e.g., invalidation of feelings, not allowing emotions to be processed). If you sense that your loved one is really looking for advice, and you feel it might be helpful, you could always check in with them first before giving advice: “I can help you problem-solve, I can give you some advice, but I’m also happy to just listen.”

6. Invite the person to say more.

For example, "Tell me about it", or "I'd like to hear more about that if you’re comfortable."

7. Be authentic.

If it’s hard for you to relate to what the person is going through, don’t pretend. Instead, you might say something like, “I can’t even imagine what you’re going through right now, but I want you to know I love you and I’m here for you.”

8. Don’t make it about you.

Try not to relate it to your own experience, unless you ask first. It’s natural to want to share a similar experience, as it can allow us to feel more connected to our loved one, and they may even feel less alone. The problem with this is that it could make it more about you than them, and take away from their unique experience, not really allowing them to feel heard. Instead, you might say something like, “I went through something that I think is similar. I can tell you about it if you like.”

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I think one of our greatest abilities as humans is our capacity to problem-solve our way out of and “fix” difficult situations. We have probably survived so long because of this skill, which is one reason why we might default to this mode so quickly when someone we care about is struggling. However, as outlined above, there are also plenty of advantages to simply “being with” someone in their distress. I hope you found these tips helpful and can practice them next time someone you care about is sharing their difficulties with you.


Lisa Linardatos is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram, or like us on Facebook.


References

Greenberg, L. S. (2002). Greenberg Emotion-focused therapy: coaching clients to work through feelings. American Psychological Association Press, Washingoton, DC.

Linehan, M. M. (2014). DBT® skills training manual, second edition. Guilford Publications.

Weger Jr, H., Castle Bell, G., Minei, E. M., & Robinson, M. C. (2014). The relative effectiveness of active listening in initial interactions. International Journal of Listening, 28(1), 13-31.