IamA (Clinical Psychologist) AMA!

Who is this guy Rorschach and why does he keep drawing pictures of my parents fighting?

I know right? He was a psychiatrist in the early 1900s. The idea is that people can project all their fears, thoughts, ideas, feelings onto these ambiguous images. It's a form of tabula rasa (a blank slate).

A friend of mine is going through some pretty rough stuff in their personal life (relationship breakdown, finances etc.) and it has really shaken them. They're really angry and hurt and it is affecting their ability to focus on work and enjoy everything around them. They are really struggling to see the positives in anything and constantly want to discuss how bad everything is. I'm trying to be supportive but they aren't keen to talk to someone (counsellor or psychologist or anyone) and everything I say gets shut down, which sometimes makes me want to say nothing. How do you best suggest I support them?

The unfortunate thing is that help can't be imposed. There is research showing that invisible support is very helpful. So you don't need to be in their face about it, but the knowledge that you are there is in itself helpful. Forcing someone to get help is usually quite unhelpful. It's like forcing someone to be healthy usually leads the person to be unhealthy. People don't like to be forced. The problem with free will! *Of course there are situations where that is necessary - the person is a danger to him/herself or to others. *But if that's not the case yet, let your friend know that you are there and be prepared to wait. The difficulty is to continue caring when you are being shut down. The very fact that you won't give up on them means that when they are ready for help, they'll come to you.

what is the most fascinating disorder you've come across or have read about?

Good question. I think I was fascinated by psychopathy which isn't in the DSM-V. Probably the closest you get to it is antisocial personality disorder. I think it's fascinating because that world is so different from mine. I still don't really understand their world TBH.

I'm also quite interested in eating disorders which is more common than psychopathy. Anorexia is one of the only disorders where people "want" the symptoms. For most other disorders: Distress is one of the diagnostic criterions.

Very interesting. I'm one year recovered from anorexia. "Wanting" the symptoms of the eating disorder isn't something I've personally struggled with (mine began as an attempt to lose weight but snowballed into fears around foods making me physically ill), but it's absolutely maddening for me to watch in my friends. One of my motivations for recovery is being symptom free because otherwise my anorexia will literally kill me... yet I see deeply intelligent and wonderful people willing to let their lives slip away and live in misery to be thin. I'm going to school to become an eating disorder therapist as a result of my recovery experience. Do you have any insights or suggestions for working with this population?

Hi littlesoubrette, I'm really glad to hear that you are doing much better. It is a hard disorder to struggle with so every success story should be celebrated! You are right, it is maddening to see people go down the road and to see their fixation on a certain weight. 1. I think one of the challenges is to not be mad about their desire. We can't take it personally and we can't be emotionally involved with their struggle (as much as possible). 2. Pushing people to change somehow creates a reaction where people push back. I find Motivational Interviewing very helpful as well with a population that is reluctant to change. There is some new research that shows giving ED patients the choice whether they eat or not is helpful. I am personally not completely sold on that line of research and want to see more evidence. But my take home message from that study is that people need to feel some sense of control. Depriving them of all sense of control even if its for their own good is not helpful. All the best!

Can pedophilia be classified as a mental disorder?

Yes. In the Diagnostic Statistical Manual 5 (the book of mental disorders published by APA), it is a mental disorder.

Diagnostic Criteria 302.2 (F65.4) Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A.

Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.

Specify whether: Exclusive type (attracted only to children)

Nonexclusive type

Specify if: Sexually attracted to males

Sexually attracted to females

Sexually attracted to both

Specify if: Limited to incest

Can affected individuals be cured of it?

Since the cause is unknown, we don't have cures for it. I think that therapy is helpful to examine if there is any discernable contributing factors, to work through the individual's feelings about having these sexual desires, to help the individual to develop ways to cope with his/her feelings and not to act on them.

Do you think a dimensional scalar system of mental illness would be better than what the DSM-V uses? I recall hearing noise about professionals wanting one but not getting their way last year when it came out.

TBH, I think the DSM-5 upset many mental health professionals. They made some big changes in the DSM, some of which were not even backed by research. I think people use a categorical system to make things easier. I don't know if a dimensional scalar system would complicate matters and therefore make diagnosis much more difficult. Not to mention everything that comes with it - treatment, insurance claims etc. Having said that, I think that a label can be helpful for some people to get well, but not to be fixated on the label to the point that it becomes a justification for maladaptive behaviours.

is it true that people who work in the psychology field are more prone to developing mental illnesses themselves, due to the passion they have for their job?

That's an interesting question. You know, there is some research showing that people in mental health professions experience a lot of stress because they have to bear other people's emotions. So it can be quite taxing. I am of the opinion that therapists need personal therapy too. Therapy isn't for "crazy" people. It's just a safe place to talk, process what's going on and then to move forward.

Definitely, i agree that therapists need personal therapy too. How readily available would those resources be though, do they talk to their family and friends, or do they seek another colleague to talk to, or look up information online for self help?

Hey, personal therapy is set up like "regular" therapy i.e. Find a professional and start sessions. Self-help or friends/family while helpful and supportive does not take the place of a trained professional. You don't want your friends/family to be your therapist, you want them to remain your friends/family.

ah, that makes sense! Thank you for your insights and patience! (:

Pleasure!

I am a patient who has been seeing a psychologist/counsellor and a psychiatrist. Due to personal issues, I need to see a female mental health professional, although I am a male. Based on my finding, there are mostly female psychologists/counsellors and hardly any female psychiatrists. I notice this phenomenon. Why is that so? Is it a global phenomenon?

Hi Happy G8, the first psychiatrists/psychologists were male. Like most other fields, psychology and psychiatry were dominated by men. In some areas of psychology, it is more evenly split now with slight male majority e.g. Cognitive Psychology, Quantitative Psychology. Clinical Psychology does seem to be more female dominated. In my PhD class at McGill of 8 students, 7 were females (poor Dan!). I teach a MA class in counseling in Malaysia (15 students - 3 males). So it does seem to be a global phenomenon. Females have been found to be more relational and empathetic and thus I think they gravitate towards a field that provides opportunities for them to express these characteristics.

Relate's aim to de-stigmatise mental illness is a great one especially if our tendency is to try to hide the negative stuff away like abandoning kids in homes because they have learning difficulties/mental health issues. So I'm all for normalising mental illness and getting help for it, the same way you would address a broken leg ie: ask for help. Question 1: Sometimes those of us who don't have mental illness simply don't know what to say or do/react when their friend/family reports feeling low/sad/anxious/panic/worry. We might say "just snap out of it" or "don't be silly" or "why so negative all the time". It lacks empathy and understanding where the person is coming from. However, I think its important to highlight that if we say those things, it doesn't mean that we don't care and probably think we're doing what's best for them. So then, what are the ways that we can better support those with these symptoms, even if we're not trained psychologists/psychiatrists? Question 2: If I have a mental illness, or think I might do, what would you recommend I do or say to people around me (apart from seeing a professional) so that they don't get scared of me or avoid me? How can I as someone with a mental health issue, help to de-stigmatise this too?

Thanks Dr Chua!

Hi Jennsmer, thanks for your questions. Those are really good questions. I really like that you highlighted that you do care about them and that what you are doing comes from a good place. So a question that I always like to ask myself is: How can I best convey my care in a way that makes this person feel cared for? I don't think there is a one fit all cure. Each person feels loved differently. The first thing I would do is to ask the person: What is the best way I can care for you? More often then now, people have an idea of what is helpful and what is unhelpful. If they don't, give them permission to let you know when something you are doing is unhelpful (or helpful!). And this can shape your responses. Just by you asking for their direction and taking your lead from them will make them feel cared for.

I would also keep encouraging them to seek professional help.

And I would also make sure that I am supported myself. Being a caregiver is tiring. You have to receive to give. So have a support group. You know the saying - it takes a village to raise a child? It takes a support network to raise a friend. You get my drift. :)

Question 2. I think the best way is to be open about it. Your attitude can inform people how they should deal with it too. If you are embarrassed or ashamed, they probably will pick up on it and experience those emotions too. And the fact is some people won't know how to deal with it! That's ok too. We don't always know how to care for people, so revert back to Question 1 - help them help you by telling them what is helpful and what is not. And pass them information about whatever you are dealing with. There are many good sites out there with great resources/information.

Welcome! :)

Can we reprogram someone's psyche in the coming years? Wouldn't that be incredibly useful in the field of psychology? Schizophrenia, depression, anxiety and any of the disorders wouldn't exist. Victims of abuse, PTSD affected individuals could have a shot at a normal life. What sort of repercussions do you expect if it could be possible? What sort of positive results could come of it, according to you?

I think we all want a Utopia where nothing bad exists. Any sort of reprogramming would mean, to some extent, giving up free will and "free consequences". Who will be the one reprogramming? Who is in charge? Who do you reprogram? How much does one reprogram? I feel like there are many issues to work through.

I think the desire for no mental illness is a great one - so that would be the positive result! :) Is it likely? I suspect that most people wouldn't want it.

The psychiatrists I have seen do not have strong interest in my personal issues. They seem to be only interested in the symptoms. After I have described the symptoms briefly, they start talking about the dosage of the medication. Based on my experience, it is possible for psychiatrists prescribe effective medication with just the knowledge of symptoms without understanding of the personal issues. However, is this what you should expect from a psychiatrist - that is not too keen to listen to the patients' problems? Or have I been meeting the wrong psychiatrists? For example, the psychiatrist I have been seeing for nearly a year always speaks the wrong language to me (I cannot understand Chinese). He does not remember my preferred language!

I'm sorry to hear that this is your experience. Yes, there are psychiatrists focus primarily on medication. I would say majority of psychiatrists do focus on medication and so your experience, while not pleasant, is not uncommon. I don't think psychiatrists should treat without an understanding of psychological issues, but it happens. :/

Medication cannot address the psychological causes of the distress, but it can help with the symptoms. I find medication helpful particularly when the symptoms are severe and prevents the client from processing and addressing psychological issues. e.g. a client who is severely depressed may not be able to make it to therapy or is unable to focused during therapy.

how long does it take for one to enter psychology school? I've heard that you've to take up a lot of degrees to even major in psychology. Give or take, how many years is that?

Hi castleTerr. You can start majoring in Psychology once you start your BA/BSc. To be a clinical psychologist in Malaysia, you need a MA. So that's (4 (BA) +2 years (MA)). To be a clinical psychologist in the West, you need a PhD = 4 + 2 + 6 (PhD). Yikes! It's long but I really enjoyed my time as a graduate student!

To be a clinical psychologist in the West, you need a PhD = 4 + 2 + 6 (PhD). Yikes!

Quick note: most clinical psych PhD programs in the US do NOT require a Masters beforehand, so that extra 2 years you mentioned isn't necessary. It's 4 years of undergrad and then 5-7 years of PhD/internship, but admission is so competitive that you may have a 1-2 year gap between Undergrad and Grad school where you get experience to build a competitive application

Thanks for the note!

Ahh, thanks for the information! Would it be the same for Singapore though,do you know?

Yes - Singapore also requires a minimum of a MA. No worries. :)

How exactly can anxiety scientifically be a genetic trait?

Some people can have a tendency to be more anxious (nervous in disposition) but doesn't mean they will be diagnosed with anxiety. As of yet, there is no single gene responsible for most common mental health disorders.

Is there a specific mental illness that you are wondering about?

I have a mental illness (type 2 bipolar) and a degree in psychology/biology. I've been able to do some work in the mental health field, but am unable to last longer than 6 months before an episode hits. I've heard that some companies are attempting to instill mental health days. If so, I think a lot of people could benefit. Do you think that this is something needed? How can we go about making this a priority?

Hi, I'm sorry to hear that things have been tough for you. Yes! I think it is essential that we have better insurance coverage for mental health treatments and that employers recognize that there is no health without mental health. There are some EAP (Employee Assisted Programs) starting up, but these are usually time limited. I think that companies should provide support for individuals suffering with a mental illness the same way they support individuals suffering from physical illnesses. How do we go about that? It's about raising awareness and bringing it out into the open. Start and sustain the dialogue about it. Talk about it. In Malaysia, I think the fact that 1 in 3 suffer from a mental health disorder should compel us to rethink our attitude towards mental illness. It's not uncommon anymore. Ignoring it doesn't make it go away. Talking about it doesn't increase the prevalence (yes, some people actually think this).

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I think that you might be right and that your fantasies stem from your traumatic experience. It sounds like things were very very difficult for you. I'm sorry that you suffered the way you did. Even though there is an explanation for your fantasies, I would encourage you to get help for what you have gone through in the past.

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It does take time. You've been through a lot and it is difficult to talk about these thoughts and experiences. I'm glad to hear that you've been thinking about talking to someone though. Your therapist starts off as a stranger but ends up as a partner in your life journey. Whenever you're ready.. It's ok.. It's never too late to seek help. You may still find it difficult but walking alone is even harder.

I suffer from a myriad of psychological/psychiatric disorders- the major ones being bipolar, anxiety, ADD, and a touch of asperbergs. Is an actual 'cure' for any of these a relative possibility in the near future or will it continue to be a matter of treating symptoms as they occur?

Hey, I'm sorry to hear that. That's a good question. Some disorders are certainly more "curable" than others e.g. depression. An individual can suffer from just one depressive episode in their lifetime. The ones that you mentioned - Bipolar and Aspergers are "lifetime" disorders. Anxiety would depend on what kind of anxiety you have e.g. phobias which can be treated very successfully ("cure"). I suspect that the "lifetime" disorders would involve symptom management in the near future. E.g. You'll always need to be careful about your sleep and stressful negative life events to prevent an onset of a manic episode.
But in the far future? I'm certainly hoping that we will come up with better treatment! We are on track, but the complexities of these disorders require a lot of research.

Damn.... I'm screwed. Damn you depression!

In some ways, all of us are screwed. :) We are all vulnerable to having a mental illness...just like having a physical illness. Anyone can have an illness. That's why the stigma doesn't really make sense! Some physical illness leaves you with a limp (e.g. a broken leg that didn't set properly). You still function really well, but there are certain activities you need to be more careful about.

In what way does a psychiatrist differ to a psychologist? Can a psychologist make clinical diagnosis based on the patient's history and presentation as to a psychiatrist capable of?

Do you think somehow the treatment undergo by psychiatric patient's adequate as to the ideal setting in Malaysia? As an example, individual with General Anxiety Disorder would be prescribed with SSRI or SNRI without the assistance of CBD which study had showed better outcome rather than pharmacotherapy alone.

Hi! If you don't mind I'll copy and paste part of my answer. 1. A psychiatrist is a medical doctor and a psychologist has a PhD. When the field first started out, psychiatrists would actually conduct psychotherapy sessions (e.g. Freud), but this is much less common today. Psychiatrists are likely to focus on prescribing and monitoring the patient's medication. Psychologists focus on talk therapy/psychotherapy 2. A psychologist can make clinical diagnosis and are the ones who are trained to assess various illnesses such as ADHD and autism. However, having said that, the DSM-5 (Diagnostic Statistical Manual ) is published by American Psychiatric Association. So in the west (North America at least), the diagnosis had to be signed off by a psychiatrist. 3.I think that people don't always get the treatment that they should get. And some doctors and psychiatrists are too quick to prescribe medication without proper assessment and without recommending psychotherapy. I have worked with some great psychiatrists who have refused to prescribed medication but advocated for patients to have only psychotherapy. You are right, some people do just want the medication rather than psychotherapy. They believe it's a quick/easier fix to the problem. In general, relapse is much higher for medication than for psychotherapy but going through 3-6 months of weekly meetings with your psychotherapist is hard work vs. taking a pill. Also some people are ashamed that they are ill and that they have to see a psychotherapist. So it is easier to provide an explanation/cover story to others for medication vs. weekly absence for therapy. In Malaysia, psychotherapy is also quite expensive making it difficult option for people. It should be more affordable and there should be better insurance coverage for therapy. I am working with some researchers in the US to develop online interventions that are more accessible and affordable.

I was diagnosed with ADD (Attention Deficit Disorder) when I was a child. I was medicated through school and college. I stopped taking my medication for a while but recently started taking it again. I've noticed that my symptoms are worse on the days when I forget to take my medication. Is this normal, and how concerned should I be about depression and my ADD?

I am assuming you are referring to medication for ADD? Any medication prescribed for long-term chronic use can have this effect- i.e., you feel worsening symptoms when you stop the medication. This does not mean that you're addicted to the drug. Rather, from a pharmacological point of view, your body has adjusted itself to this "new normal". Hence, on days where you miss a dose, you may feel worse than before you started. Talk to your psychiatrist about your mood and other symptoms you are experiencing, make sure that the medication is at the right dosage, and seek psychotherapy. Psychologists can help you with your depression and also provide ways of coping better with ADD to help you function at your optimal level.

What's it mean when psychologists say "he's an IO" or he's "clinical?"

Hi! IO = Industrial-Organizational Psychology. It refers to the specific field/focus within Psychology. Clinical Psychologists focus on mental health (usually illness and treatment). IO Psychologists focus on behaviour in the workplace (how organizations work, leadership styles, motivation in the workplace etc.).

I'll be graduating with a BA in psych next winter; any advice for getting accepted into a clinical PhD program (in the US)?

Hi Simona, I would get some clinical and research experience. It is a competitive field so the more experience you have the better. Also, try to get an article published or in review. This is just the profile of most candidates. I would say that most of my friends took a year off to gain more experience and become a better candidate. If you have the opportunity, work in the lab of someone whom you are interested in pursuing a PhD with, or in a similar field. Reference letters also matter a great deal. So develop good working relationships with your professors/supervisors. All the best!

Thank you very much, I really appreciate it!

Pleasure!

Have you any experience with depersonalization? I have been through it and have had friends suffer from it. What's strange to me is that it can just disappear from ones life, while never leaving others. Are there a lot of cognitive disorders or conditions that are like this? What is your take

Hi SolelySean, I don't have any personal experience with depersonalization although I have treated clients who do. There is a disorder called Depersonalization disorder. But just because you experience depersonalization, does not mean you have the disorder. It could also be a symptom of something else (e.g. anxiety, prolonged drug use, trauma). You are right, it is strange. Another thing that we don't quite fully understand about the complex human mind.

Here is the diagnostic code for Depersonalization Disorder. Diagnostic Criteria 300.6 (F48.1) The presence of persistent or recurrent experiences of depersonalization, derealization, or both:

Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).

Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).

During the depersonalization or derealization experiences, reality testing remains intact.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures).

The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

What is one thing everyone should do to improve their mental health?

Hi, I am a fan of gratitude exercises. The research shows that these exercises are really helpful. 1. Write down 3 good things that happened you and why they happened. E.g. Event: My boyfriend bought me a chocolate cake. Because: he cared about me and was trying to cheer me up on a bad day. 2. Write a letter to someone to whom you are grateful to. Be very specific about what you are grateful about and thank the person.

Trauma can solve violence. Mindfulness class should be taught along side history class. I work with Great Hearts but I don't have any pull. How do we get meditation in to schools?

Hi Megamindbrian, You are right, mindfulness can be helpful. Like you, however, I don't have any pull as well! :) I think that you could start by talking to the board of education of your school and show them the research on mindfulness. I would suggest that it should not be tied to just history classes, but rather well-being. Parents may be cautious about mindfulness however, so it is not something that should be forced on students. Which is why pushing for it to be taught in schools may be a harder sell. Possible what's an easier sell is having after school mindfulness sessions offered to students, run by a therapist. All the best!

How do you change a person's ambitions?

Hi Megamindbrian, I don't usually aim to change a person's ambitions. By ambitions I mean something the person is striving towards? If I don't think the ambition is a good fit, I would encourage the person to go for career counselling, to find out more about the job, gain some internship experience, explore different options. However, if the person is adamant on it, I am unlikely to stand in the person's way (assuming that the ambition is legal and not harmful). I am not living the person's life, and so that person needs to figure out what he/she wants to do for him/herself. Ultimately the choice is theirs because the life is theirs to live and experience.

I should rephrase, how do you help people realize their ambitions faster? Communication is key!

Hi Megamindbrian, Sorry for the misunderstanding. I think I would talk to them first and assess what, if any, is holding them back from achieving their ambitions. Sometimes there are external factors that are at play, and sometimes that are internal factors. If the reasons are psychological in nature (such as anxiety), I would work through these issues with them. I think targeting just the ambition without a proper assessment of what are the causes for the slow goal progress would not work out in the long run. Thanks!

What's you're opinion on LSD ,do you think it can be used for good ?

Hi Sector9rider, I think many things have the potential to be used for good, but it'll have to be regulated. Also the potential for good has to be balanced against the potential for bad. 1. The effects/the drug induced psychosis is unpredictable. It is not possible to predict whether you'll have a bad trip or a good one. It has the potential to have long term negative psychological effects, or for some, none. 2. There is some initial research showing that a controlled amount of LSD given in combination with psychotherapy can be helpful for the treatment of anxiety (http://www.maps.org/research-archive/lsd/Gasser2014-JOP-LSD-assisted-psychotherapy-followup.pdf) There needs to be more research on this since this is just one paper. I would not advocate for uncontrolled use or the use of LSD as standalone therapy. 3. Although LSD is not highly addictive, people build a tolerance for the drug which lead to an increasingly higher dosage to achieve the same effect.

For me personally, I would stay away from it. I rather figure out ways to have positive experiences with my reality intact. :)

Are the requirements different than the US to become a psychologist?

Do you think suicide is a right?

Have you ever been injured or fear of being injured by a client?

1. Yes. Psychologist is not a protected term in Malaysia. You can, if you want, call yourself a psychologist with a BA. The training and educational requirements in Malaysia is not as stringent or as regulated as in the US.
2. I am hesitant to say it is a right because of the legal ramifications. I think that suicide is often the result of distress. 90% of suicides are committed by people who suffer from a mental health problem. Suicide is seen as (but not always) a way to stop the distress. Since I promote positive mental health, I would want to address the distress and look for ways to attain positive mental health, rather than to end a life. However, I do empathize with the difficulties faced by individuals who are feeling suicidal. It is not an easy road and probably feels like the end of the road for them.
3. I have never been injured or feared being injured. Majority of the people with mental health issues are not violent. Only about 3-5% of crimes are committed by individuals with mental health problems. Of the 3-5%, about 8% of those crimes are linked to their mental health problem (e.g. delusions, hallucinations). Crimes are more likely to be committed by individuals who are drunk or have taken drugs. Thanks!

"It is 10 percent what happens to us and 90 percent how we react to that"

How much of this meme is true? It seems that our personal reality is mostly constructed by our mind. This suggests perspectives we choose to take or train ourselves to take are very powerful. So, can we train ourselves into healthy / resilient beings?

Hey, I haven't seen that meme. I'll Google it now. First thought: I don't think it's a fixed percentage..:) I think that our reality is very much influenced by our perceptions. And we can certainly "train" ourselves to be healthy beings.

But 1. I don't want to psychopathologize every single thing. If someone we love passes away, and we grieve about it, that's perfectly fine and normal. We have normal negative human feelings. 2. I don't want to ignore "real" life. There is reality beyond our social construction. Someone passes away = reality. I'm sick = reality. These are objective events. And then there are the subjective events that are open to interpretation. "My best friend read my messaged (I saw the tick!) and did not reply" =>Multiple interpretations. E.g. She hates me, She's busy, She is at a meeting, my message isn't worth replying to.

So in those cases, then I think training to see things in a more adaptive way really helps. Adaptive means - choosing an explanation that will promote well-being. In an ambiguous situation, all of these explanations are probably equally likely. If I think she hates me, I am more likely to shy away from her, or even respond in a passive aggressive manner. If I think she is busy, I am better able to have a positive and friendly interaction with her, which is more likely to promote a good relationship than if I responded in a passive aggressive manner.

Well, this is helpful for me but it doesn't mean I would necessarily arrive at the truth. If it's a solitary incident, I'm inclined to go clarify with the person; if it happens many times, maybe there's an underlying feeling of insecurity that I need to address in myself, or a larger issue in the friendship it would also be helpful to work out?

Yes, that's a good point Jennsmer. If it is a solitary incident, do clarify. If it happens over and over again (reassurance seeking where you ask your friend: "Are you angry? Are you sure?"), then reassurance seeking behaviour will strain the relationship. In that case, training yourself to think the best of the person and choosing a more adaptive interpretation is very helpful!

When treating a depression, is there some kind of escalation of the means to hand to the patient?

(E.g. First some SSRI, then ssri + therapy, then meds + hospitalization)

Hi, 1. First you would want to rule out/check any physical illnesses (which may be the cause of the depression). For depression, a combination treatment of medication and psychotherapy has been found to be very helpful. I personally am not inclined to recommend medication without any psychotherapy. 2. Hospitalization is usually reserved for the severely depressed individuals who need monitoring or are a danger themselves (suicidal). So yes I agree with you.:) I think there is an escalation of care.

What is your view on the Kübler-Ross model (i.e. the 5 stages of grief) and it's use?

Should it's use be limited to the original setting (i.e. projection of terminally ill patient's mental state) as originally presented in the book "Kübler-Ross, E. (1969) On Death and Dying" or can the model's use be expanded (as it has been in popular culture) to include more mundane situations like a bad day at work or a stressful situation?

Hi! Well, I think it is useful for some individuals to identify what a relative "normal" process of grieving looks like. However, there is individual differences in the progression through the stages. So I may not go through depression after bargaining, but I might go through it straight before denial.

I also think that some might misunderstand the stages to mean that you can't be depressed (because there is a cause). Grief could be a cause for a depressive episode.

I actually did not know that some people use it in mundane situations. I am guessing that some people use it just because it's popular. Then again, I don't think it's fair to judge what a "real loss" is. If someone's pet died, they very well might experience these 5 emotions (or fewer) but still deeply and for a period of time. But perhaps just a bad day at work is a stretch! One could be stressed :) IMHO

what are some pieces of advice/tips you would give someone who wants to do psychology when they enter university?

Embrace all of it. My students are surprised by the fact that Psychology is a science. So there is research, statistics, and lots of reading! Psychology is not a subject you can cram for at all, IMHO. Get as much practical experience as you can - be it research or clinical.

Did you have a difficult time getting a job?

Hi writeandknow. No, fortunately I didn't have a difficult time getting a job. There is a clear need for psychologists in Malaysia - so there are plenty of opportunities for jobs (especially as a clinician). Also, having a PhD really helped in getting me a job at a university.

I have a few questions. Since your focus is in self-regulation and motivation, I assume it can be applied to many psychopathies.

What is your treatment approach for disorders like binge eating and for those who have trouble with impulse control? How is it different than the mainstay treatments of these disorders? Could you describe what a typical session of yours would look like with your clients?

Hey! I would use Cognitive Behavioural Therapy (CBT) to treat individuals with binge eating disorders and impulse control. I tend to take an eclectic approach to therapy. I take a client-centered approach and work with the client to come up with a treatment plan that he/she is comfortable with and agrees with. Having said that, I do believe in using treatments that are empirically based. So I wouldn't use hypotherapy to treat Binge Eating Disorder for example. I would probably use Cognitive Behavioural Therapy (CBT). A typical session looks like : My client and I discussing what happened over the week, going over homework (if there is any), and talking about whatever issues are relevant/important to my client.

Thank you for your response.

I'm also curious about the stigma toward mental disorders in Malaysia or in the east in general and when compared to the the views of the west?

How do Malaysian generally feel toward treating mental disorders as a physical real condition and diease?

Sorry about this. I didn't see your reply. I find that there is greater sigma in the East then in the West. There is no insurance coverage for treatment in the East vs. west. People are asked to declare if they hah or have a mental illness on their job applications which may very well affect their chances of the job. Therapy is seen as a last resort rather then something that is normal and helpful. Malaysians rather see mental illness as a physical illness. Taking a pill to make life " better". I suspect they want to see mental illness purely as physical rather than psychological because a psychological explanation makes them feel like they are "weaker" , or just " crazy". If it's a physical explanation then it's like having as flu or like cancer which they can understand. But this also means that underlying issues are not dealt with, only symptoms. The chances of relapse is higher with just meds vs. psychotherapy.

How useful is CBT?

Very useful! It's one of the most well researched psychotherapies that we have and has been shown to be effective in alleviating symptoms of depression, anxiety, eating disorders, schizophrenia, obsessive-compulsive disorders etc.

I work in MH in the states, I would love to hear how your practice is different in Malaysia. What's the access to treatment like for most people? How are people with SMI treated and viewed in society (I understand not very well). Thanks for your time!

Hey! We have 1 psychologist per 100000 people. So access is not great to say the least, unfortunately. Hence my resolve to start Relate. I think public awareness and education is low and that people fear what they don't understand. In addition, they don't know how to treat those with SMI, probably due to unfamiliarity. Thanks for your question. :)

1. Do psychologists ever just conclude that someone is stupid?
2. Psychology often seems like well-written rationalizations for poor behavior, is it?

Hi NedAkimbo, Thanks for the your questions. 1. Intelligence is measured using assessments which have been normed to the population. For instance the WAIS average score is 100. As a professional, psychologists may conclude that someone has low intelligence as measured by a certain assessment. 2. Psychology is just the study of mind and behavior. Its aim is to describe what people do and why people do the things they do. I can see how it may come across as a rationalization as in it provides an explanation. However, on its own, Psychology should be quite neutral. An explanation doesn't mean the action is good or bad, or helpful or unhelpful. Generally, clinical psychology tries to conceptualise behaviour as whether it helpful or not.

What is the most common mental illness Malaysia is suffering from?

One of the things that we don't have is good quality clinical psychology research. I would say that the prevalence rates with regards to the actual disorder probably mirrors what the prevalence rate in the West, but I can't confirm that because of the lack of research evidence. I'll go with depression and anxiety with being the most common mental illnesses.

1. How would you describe what differs you from a psychiatrist?

2. a) If you watch movies/TV series which one(s) are your favorite? b) Also which movie/TV series in your opinion represent certain mental health problem the best (e.g. depression,anxiety...)? I'm watching Mr. Robot now and it's very interesting to "see" into a mind of an antisocial/anxious person, given it's a correct representation. (Of course not everyone is the same). Sorry I made it a bit complicated, I'm trying to improve my writing skills.

Thanks!

Hi! 1. A psychiatrist is a medical doctor and a psychologist has a PhD. :D When the field first started out, psychiatrists would actually conduct psychotherapy sessions (e.g. Freud), but this is much less common today. Psychiatrists are likely to focus on prescribing and monitoring the patient's medication. Psychologists focus on talk therapy/psychotherapy. 2a. Gosh! I watch way too much TV! :) My favourite was the Good Wife, but since that ended.. ;( I also like Brooklyn Nine-Nine, Black-ish and Elementary. b. I loved Inside out for the portrayal of depression. Granted it's an animation, but it was really well-done. No worries, you were clear in your questions.

How did you motivate yourself to finish school? And also, what are some good study tips for a psychology major like myself? I'm currently questioning my major because of how much schooling it requires to get even get a chance at a decent paying job. The whole doctorate's degree is quite daunting to me, especially when I think about how I'm going to pay for it :'D.

With lots of chocolate! :) I really enjoyed my studies fortunately. But I knew that going into it that I wanted a PhD in Clinical Psychology - which meant completing my honours degree, getting research and clinical experience, having good experience. TBH I never did well in high school. I realized before I left for University that I was afraid of trying because I was afraid I would try and fail and find out that I'm stupid after all. But since my parents funded my education, I decided that the cost of not trying was too high. So I went all in and did my best. My parents' sacrifice and family support helped motivate me to finish my degree well. Good study tips: I hear the same complaint in Canada and in Malaysia. Psychology is very detailed and the exams are tough! I would say - know everything. :) I would go over chapter by chapter with a friend. We took turns explaining the chapter. When you "teach" someone, you realized what are the gaps in your knowledge/understanding. I tried to approach my textbook like each chapter was telling me a story on human behaviour, since the chapters are (let's be honest) so very long! I figured that if I allowed myself to think "this is so boring!" I'll never get through it. So I kept telling myself, "this is a story".

If you do a PhD in North America, these are usually funded. For UK and Australia, keep your eye out for announcements for graduate students. There are funded positions that you can apply for.

All the best!

In what ways are the public views on mental health different in Malaysia than they are in other countries like, for example, the US?

I think we are about 50 years behind the USA in terms of seeing mental health as part of health and normalizing mental illness. In my conversations, people still giggle about mental illness as being "crazy". The fact is the prevalence rate in the USA is 1 in 5 people have a mental health problem, in Malaysia it is 1 in 3 people! They are way ahead of us but we have a bigger problem. The prevalence rate has increased in the past decade from 1 in 10 to 1 in 3. Although people are coming to see mental health as important, they usually reserve help for others. In other words, everyone knows someone who needs help, but they themselves would "never" need it. There is also an idea that psychotherapy is only for the severely ill. We really need to challenge this idea and promote the idea that even stage 1 deserves treatment. Who waits till stage 4 to get help?