Tuesday, September 29, 2020

Psychoeducation on introversion and extroversion can be helpful for patients


In counseling, providing psychoeducation around introversion and extroversion can be helpful. 

In our human experience, we are able to focus our attention outwardly or inwardly. 

1 We are able to focus outwardly through our five senses i.e. sight, hear, smell, touch, and taste. When we are focusing “outward”, we are in the “here and now”. We give this “outward focus” a number of terms e.g. extroversion, 5sense experience, being present, or mindfulness. 

2 The other way in which we can focus is inwardly i.e. in our minds through memory of the past, and imagination or projection of the future. We can call this the “inside head” experience.

Introverts have a bias or tendency towards the inward direction, and extroverts have a bias or tendency towards the outer direction. We all have both of course, but we do have a preference, like left and right handedness. Each has its pros and cons. If imbalanced, it can lead to number of emotional problems. 

If one is too much outer focused, then one requires more reflective work. If one is too much inner focused, then one requires more mindfulness and outside head experiences perhaps. 

Which one is your tendency?


Friday, September 25, 2020

Lack of time being a barrier to counseling and how to shift that


When dealing with “lack of time” issues around mental health consultations, this is one of my approaches.

Firstly, we address safety. Once safe and other supports are in place, we now have some “luxury” around time. 

There’s often a strong belief in General Practice, that we don’t have enough time with our patients. It is true, and at the same time, there is an alternative perspective. In General Practice, we do have a whole lifetime with them as opposed to Doctors in Emergency Departments or other hospital settings. The end of a consultation is not the end.  It’s simply a pause. The “total” time we have is just not in one session, but it’s over many.  

We can see them for 20mins here and 15mins there, and at times, 40mins here and a 5mins phone check up there. Sometimes, we can choose to see them for shorter appointments but very regularly, rather than longer appointments but then further spaced apart. 

Looking after our patients in primary care is more like a marathon than a sprint. We don’t always have to do everything, all in the one go.


Wednesday, September 23, 2020

Counseling tips for couple counseling


I often have to remind couples that the “end of the relationship” is not “the end” but more of a change in that relationship especially if kids are involved. 

Couple counseling is about facilitating for a different, more adjusted relationship, whatever that may look like.  Hopefully, it’s going to be together but not always.  So together or apart, but “more adjusted” than the present situation perhaps.

Couples who struggle are ones that are very critical of each other, defensive in their reactions to each other, and are avoidant of conflict. These are innate fight/flight/freeze responses. 

Ones that succeed are more accepting, acknowledging of each other, and more assertive in their actions, as opposed to being more aggressive or avoidant. 

It’s not easy to achieve the above shift, so we are going to have to accept some failures “for now”. 

If they don’t succeed “right now”, we may have planted the seed for success next time. 


Monday, September 21, 2020

Are you and your patients in the right element?


When we are not in our right element or environment, we get stressed. Think “fish out of water”. 

When stuck in this situation, some of us may have a tendency to 

1 blame our environment for the stress OR

2 blame ourselves 

Both can lead to a lot of problems, physically, emotionally, and socially. 

Like a fish out of water, we need to be in the right environment.  But to be in the right environment, we need to know who we are first.  

A significant part of counseling is to help people understand self, and to fully accept self.  To know one’s values and way of thinking, and those of others, and from there, find or create a life congruent with oneself and complementary to oneself. 

When one is in one’s element, we can help many others. When one’s needs are fully met, we can help many others. Similarly, we need to put on our oxygen mask first so that we can help many others.

The question is, are you in your right element, and are your patients in their right element?

Saturday, September 19, 2020

Adopting the compassionate detachment mindset in counseling


In counseling work, or when helping our patients particularly around emotional issues, one needs to consider a compassionate detachment mindset in order to minimize compassion fatigue or being “emotionally drained”. 

Not so fused and “attached” that you will get compassion fatigue, but not too detached that we stop caring. 

The danger is to swing between these “2 polar opposites”. Fusing/caring too much, or detaching/letting go completely is easier than navigating somewhere in between. Like slamming on the brakes or the gas pedal. It is easier than maintaining the car at particular speed intentionally.

Be more defused, slightly detached, firm with our boundaries, but still caring and compassionate. A little bit like parenting work.  It will certainly help with our parenting skills as an added bonus. 


Friday, September 18, 2020

When counseling, adopt a curiosity mindset


A large part of counseling is more about unlocking, rather than “fixing”, to get our patients to the other side. 

It’s more about exploring possibilities rather than ruminating on limiting beliefs. 

It’s more about hope rather than despair. 

It’s more about creating new stories rather than repeating history. 

So start with curiosity. 

Start the conversation with “I wonder”, or “I am curious” can be helpful to get into this space. 

Have you tried that? 

Thursday, September 17, 2020

GP and counseling go hand in hand to address biopsychosocial health


I think that GPs and counseling go hand in hand  because who else can address the bio-psycho-social all at the same time?

We can ask our patients to rate their current bio-psycho-social health out of 10. 

1 Bio/physical health out of 10

2 Psycho/emotional health out of 10

3 Social/connection with their tribe out of 10

Then we can get them to reflect on a great time in their life, and rate the bio-psycho-social out of 10 during that time. 

We then set out to close the gap. 

Maybe we can do this for ourselves too as part of self care. For our health and our patients’ health to be optimal, all of our bio-psycho-social health have to be optimal, because each domain impacts one.


Tuesday, September 15, 2020

Counseling to help our patients navigate loss


Often counseling involves helping folks navigate through a “loss of something”. 

A loss of a love or relationship 

A loss of security and certainty

A loss of job, business or finance

A loss of a friend or connection 

A loss of freedom and autonomy 

A loss of meaning and purpose 

A loss of reputation

A loss of hope 

A loss of a family 

A loss of good health to name a few

When faced with a loss, we all go through various identifiable stages of loss. It may not be completely linear, but can fluctuate from one stage to another. 

1 Stage 1:  A sense of disbelief 

2 Stage 2:  The truth sets in, and we experience stress with fight, flight, or both. 

3 Stage 3:  We find “emotional acceptance” (not just “intellectual acceptance”)

4 Stage 4:  We adapt and grow from the experience. 

From experience, people often get stuck in stage 2, or fluctuate between stage 2 and 3. Being chronically stuck in fight/flight/freeze mode will cause a lot of psychosocial problems in people’s lives. I am sure we all see those in our practice. 

Counseling is to assist folks to move from stage 1 and 2 to stage 3 and 4, with emotional acceptance often being the rate limiting step.