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对精神疾病的偏见阻止了亚洲移民寻求帮助 – 怎样才能克服障碍并寻求他们所需要的帮助呢?

对精神疾病的偏见阻止了亚洲移民寻求帮助 – 怎样才能克服障碍并寻求他们所需要的帮助呢?

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试想一下,要是我们生活在那样一个世界,每个人都可以公开而无顾虑地谈论他们的心理治疗过程,就像他们谈论看牙医或理疗一样(那该多好啊!)。虽然心理治疗在某些文化中非常常见,但这些在亚洲移民社区是闻所未闻的,对他们来说,讨论心理健康是很忌讳的,他们回避治聊,寻求帮助那是需要巨大的勇气的!严重的障碍不仅与精神疾病有关,而且因为精神疾病使人感到羞愧和负罪感,使得亚洲移民不愿意寻求帮助。此外,文化方面的挑战,例如“家丑不外扬”或“丑事不出门”的观念(以防止外人发现自己的心理健康问题),害怕受到社区的排斥,寻求帮助被视为一个人的“弱点”,对隐私的担忧,以及失去“面子”或给家人带来耻辱的可能性,可以进一步阻止他们承认/认可他们正在经历心理健康问题 (Chen, Kazanjian, & Wong, 2009; Thomson et al., 2018; CBC/Radio Canada; 2018)。

说起他们的原籍国,他们的主要支持网络由亲密的家庭成员,朋友和同事构成。移民到新的国度,原籍国的支持网络可望而不可及,这可能大大增加他们出现精神健康问题的可能性。本来在新的国度寻找新的支持来源就很困难,更何况许多人却不愿意获取帮助。已经有科研证据表明,亚洲种族的加拿大人最不愿意在他们的社区中使用心理健康服务 (Durbin et al., 2015; Li & Browne, 2009; Tiwani & Wang, 2008)。

由于可能存在语言障碍,强烈的羞耻感,内疚感和他们文化价值观中根深蒂固的抵触感,寻诊心理医生通常对亚洲移民族群来说,实在是不得已而为之。在他们看来,接受专业帮助通常被视为禁忌,经历心理健康问题的人,害怕被贴上“疯狂”或“不正常”的标签,因而常常有人讳疾忌医,或者擅停前期的心理治疗。那些亚裔移民,一旦寻诊心理医生,病情症状就要比其它族裔的加拿大人要严重的多, 因而治疗起来更加困难 (Fang, 2010)。此外,亚洲移民可能会把心理疾病病症误认为是身体疾病,那是他们更为重视、关注身体疾病,而忽视心理健康(或可能是因为羞耻而回避)。更为糟糕的是,由于媒体或文化观念的原因,亚洲族群可能存在许多误区,他们不知道临床心理学家所做的治疗,以及他/她可以提供的心理治疗服务。对于许多亚洲移民来说,心理学是西方人崇尚的东西,治疗的价值和效用是源自西方个人主义文化,都是以改善个人生活为重点的。这可能与集体主义文化价值形成鲜明对比,后者是更典型的亚洲文化,其中关注自我改善可能被视为自私,甚至使人感觉内疚。

最后,与加拿大相比,他们原籍国心理医生所起的作用可能大相径庭。在有些国家,心理学专业年轻, 且行业规范化管理也不是太好。来自这些国家的移民可能经历过不同的,也许是不怎么有效的心理治疗,这些会误导他们,使他们不理解接受心理服务的益处。其实,在加拿大,临床心理学家必须获得其省级监管委员会的许可(例如,魁北克的Order  of Psychologists),并且必须具备严格的学术资质和临床资质才有资格获得。如果您正在寻找符合您需求的心理治疗师,请访问魁北克 Order of Psychologists of Quebec / Ordre des Psychologues du Québec (O.P.Q.)的官方网站寻找你中意的临床心理治疗师: http://www.ordrepsy.qc.ca/.

那么,作为健康职业从业者,为了帮助移民们克服障碍,帮其所需,我们应该做些什么呢?

1)规范如何从加拿大心理服务寻求帮助,并鼓励他们在省级监管委员会内寻找心理治疗师(例如,魁北克Order of Psychologists)

2)鼓励他们克服障碍,看待心理问题就像心理得了“感冒”一样。鼓励他们寻求帮助,而不是让症状拖延,直到问题变成心理“发烧”(更严重的症状)

3)鼓励移民人群寻求社区支持 – 例如,在当地社区和文化中心,用他们的语言提供支持服务

4)协助他们利用社区和在线资源来教育他们,如何处置那些与移民和心理健康有关的问题。

5)解决人们避而不谈的,移民经常面临的种族歧视,种族隔离的问题

6)遇到不同文化背景的患者时,要有文化敏感性。 好奇并愿意了解患者的问题,并尝试了解他们的文化背景

7)提供有关身、心健康之间密切关联的心理教育

8)利用文化咨询服务,例如: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.


参考资料

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.

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.

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.

“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.

Less What, More Why

Less What, More Why

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In sessions, clients often contemplate important decisions, such as whether to quit a job or whether to end a friendship. We sometimes go into problem-solving mode and consider practical factors, like the pros and cons of their different options. But over time, I have found myself focusing less on the ‘what’ and more on the ‘why’. That is, why they would be making that decision. So often, I don’t think that either of the options they are contemplating is inherently right or wrong, good or bad; but the reasoning behind it can vary in how healthy or constructive it is for them.

Let me give you a couple of examples to illustrate what I mean:

1. Imagine that you want to stay home and cancel plans to go out with friends over the week end. Again, there is nothing inherently right or wrong about this decision. But the reasoning is important.

a. You might be doing this because you have had a busy week and you find alone-time nourishing, especially when you spend it resting and engaging in hobbies that you enjoy.

b. However, you might also be making this decision because social situations make you nervous and you’d rather not put yourself through that. Indeed, anxiety often elicits the urge to avoid. People struggling with social anxiety often find themselves avoiding social situations which make them anxious (American Psychiatric Association, 2013). Importantly, avoiding something that makes us nervous can lead us to feel relieved in the short-term, but may actually serve to reinforce our fear over time (see Barlow & Craske, 2007).

In this example, the same behavior can be performed in the service of self-care in the former instance, and as an act of avoidance in the latter.

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2. Imagine that you often find yourself doing more than your fair share in a relationship. Over time, you might find yourself feeling hurt or resentful. You may be tempted to dial back how much effort you’re putting in for a while. There is no clear good or bad choice here, and this is where I would suggest that you pause and ask yourself why; what would be your goal in reducing your efforts?

a. You might be driven by a desire to make things more equitable in order to avoid feeling resentful toward your partner in the future. Indeed, some research suggests that relationship partners are more satisfied when they view the relationship as equitable (Stafford & Canary, 2006).

b. However, you might also be doing this to test your partner, that is, hoping that they’ll notice the change in your behavior, detect your underlying dissatisfaction, and adjust their behavior accordingly (e.g. by expressing more appreciation or doing their fair share). This can be risky for multiple reasons, including that your partner may not recognize the message you are trying to send and/or that they might not appreciate being tested in this way.

As you can see, the same behavior can aim to prevent resentment in one case, or to test the relationship in another case.

The practice of pausing and asking ourselves why may help us to get in touch with our underlying motivations, so that we can make more informed decisions. In so doing, it brings us one step closer to purposeful and thoughtful responding - rather than simply reacting.


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 and Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Barlow, D.H. & Craske, M.G. (2007). Treatments that work: Mastery of your anxiety and panic (4th ed.). New York, NY: Oxford University Press.

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.

Stafford, L. & Canary, D.J. (2006). Equity and interdependence as predictors of relational maintenance strategies. The Journal of Family Communication, 6, 227-254.