May 19

One of the lesser known aspects of psychotherapy is the rule of confidentiality. This rule (which by the way is not a binding part of Thai law yet, but handled very strictly in most Western countries) basically says that everything a client tells in the context of an ongoing psychotherapy has to remain between the therapist and the client/patient. In my home country Austria, psychotherapists are not even allowed to inform married partners about the diagnosis or whether the spouse or wife has been attending a therapy session or not. Clients can release the therapist from this constraint, but only to a certain extent. In court, psychotherapists are not allowed to reveal details of the therapeutic conversations as well. Exceptions to the rule of confidentiality are usually only allowed in cases where there is imminent danger.

While this regulation might sound awkward to some, it makes perfect sense. it guarantees a safe place for patients where they can trustfully express their deepest feelings and weakest points without having to fear that anyone else will ever hear about them. In times where more and more slices of our ‘privacy’ are taken away from us by governments and electronic means, and where society has developed some very tight models of ‘politically correct’ thinking, it can be very important to be able to have at least one place where you can express your thoughts, concerns, or your most delicate problems, being sure that they will remain inside the 4 walls of the therapist’s practice. It has happened more than just a few times, for instance, where men told me about pedophile or violent fantasies or where women told about certain sex-related issues or problems trying to find a partner; only if such thoughts can be expressed and openly talked about without having to fear being looked down upon it is possible to put these very delicate issues into perspective and to develop strategies on how to deal with them better than before, or maybe even to resolve the situation by applying new ideas and approaches.

The rule of confidentiality alone is a good reason why someone seeing a psychotherapist or counselor doesn’t have to consider thenselves as ‘weak’ or ‘mental’. Having an atmosphere where one can openly talk about their problems with someone who will take a neutral position and just tries to support as effectively as possible can be reason enough. If you are not sure how your therapist or counselor handles the rule of confidentiality, just ask. It’s a sign of professionalism if you receive a straight answer on it.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Sep 14

Many people enjoy gambling, whether betting on a horse or playing poker on their computer. Most of these people don’t have a problem, but some lose control over their gambling. They bet high amounts of money on card games, in casinos or playing slot machines. Today, people don’t even have to leave their homes to satisfy their drive to gamble anymore: the Internet allows one to spend unlimited hours playing games or placing bets without anyone interfering by asking uncomfortable questions – actually, many of the respective companies behind such websites try to keep people gambling as long and for as much money as possible. But once used to the rituals involved in a game, it is very hard for most to resist the urge of doing it again – if ‘only one more time’ in order to reverse their losses…

Typical signs of a serious gambling problem include:

  • Always thinking about gambling
  • Lying about gambling
  • Gambling during work
  • Spending family time gambling
  • Feeling bad after you gamble – but still not quitting
  • Gambling with money needed for other things – asking friends or family members for money or even breaking the law in order to obtain gambling money or recover gambling losses

The difference between a casual gambler and a compulsive gambler is that the latter one feels restless or irritated when they can’t gamble. They need the kick of betting money and will use gambling to relieve tension. While they may have tried to reduce gambling, they were not successful in the end. Effectively, they are losing not only money, but also valuable time from their lives, which are affected not only by the addiction itself but also by the long-term damage it causes them. An Australian study recently showed that 17% of suicidal people were problem gamblers.

Effective treatments for problem gambling involve a combination of counseling, step-based programs, self-help and peer-support. Sometimes medication is prescribed as well, however, only using one of these treatments alone is not considered to be sufficiently efficacious and no medications have been approved for the treatment of pathological gambling by the US Food and Drug Administration (FDA).

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Jul 31

Psychiatrist, Psychologist, Counselor, Trainer or Psychotherapist?
The maze of mental health-related job titles.

Most of the people looking for advice, having personal problems or problems in their relationrships inevitably have to ask themselves: who is the right person to adress my issues? 100 years ago it was usually a priest or a medical doctor. Today, however, thanks to the great progress in specialization and research, it makes sense to contact the most competent partner.

Psychiatrists and neurologists: they are trained medical doctors specializing in the diagnosis and predominantly pharmacological (drug) treatment of severe mental disorders such as personality disorders and psychosis (such as schizophrenia etc.) and neurological disorders (disorders of the nervous system).
Psychologists: are the experts on mental processes and structures. It’s clinical psychologists who usually specialize in diagnosis, counseling and training. Offering psychotherapy, however, requires additional qualifications in most countries.

Coaches, counselors, advisers: these titles are not protected, so a proliferation of vendors, mostly without any skills, or professionally based training exists. “Before use”, therefore, an opinion about the seriousness of the provider should be formed.
Psychotherapists: for their profession, the therapeutic treatment of mental disorders and psychological burden, they have to undergo several years of intense training. Psychotherapeutic applications include couples therapy and sex therapy. Psychotherapies usually involve sessions of about 50 minutes every 1-2 weeks.

For minor issues only recently beginning, counseling is usually sufficient. If these issues have lasted longer or occur again and again, it is recommended to visit a qualified psychotherapist and to follow through with the therapy for several months to achieve long-term improvement. With severe mental illness, consult a psychiatrist in order to get a correct diagnosis and medication support as complementary treatment – it is worldwide standard today to get supportive and stimulating psychotherapeutic treatment for psychiatric disorders as well. This approach however seems to only slowly gain footing in Thailand.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Jul 28

counseling: who needs such a thing?‘ This is about the view some veteran personalities express when the issue comes to psychotherapy or counseling. psychotherapy still has a dubious image – people who need it would have to be losers or people who don’t have control over their lives.

But a look outside the box shows that in progressive and self-critical, competitive societies, approaches such as psychotherapy, coaching or counseling are well accepted aids in difficult situations of life. Celebrities talk openly about how they learned more about themselves in psychotherapy, and managers report about achieving new momentum through coaching on a regular basis for their challenging job.

To see the potential of counseling, one has to understand that a person’s ability to help and ‘advise’ herself is actually quite limited. Each of us has a very personal way to deal with problems: again and again we apply pretty much the same strategies – and even if they fail, most of us tend to just try harder, even at the risk of a disaster. counseling and therapy however primarily bring in neutral and unbiased feedback from a professional not stuck in the dilemma – often, he can also introduce new perspectives and establish new and creative ways of dealing with the challenge to ease overcoming the obstacles for a solution.
In this sense, seeking counseling, coaching or psychotherapy is a sign of foresight and intelligence: that someone considers himself and his life so valuable that he no longer accepts feeling unhappy or wastes time by just relying on his own ways of thinking.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Nov 09

by Robert Preidt

new article illustration

THURSDAY, Nov. 6 (HealthDay News) — For children and teens who suffer violence at the hands of peers, immediate one-on-one mentoring on how to safely avoid conflict and diffuse threats reduces their risk of becoming victims again, a new study says.

The study included 10- to 15-year-olds treated for assault injuries — including gunshot, knife and fist-fight wounds — at emergency rooms at Johns Hopkins Children’s Center in Baltimore and Children’s National Medical Center in Washington, D.C., between 2001 and 2004.

Half of the 113 victims were treated and then referred by an ER doctor for at least six sessions of one-on-one counseling and three parent-home visits. The other half of the victims were referred to community resources and received two follow-up phone calls.

The counseling sessions included advice on how to identify and avoid triggers of anger, and role playing about conflict resolution and getting out of dangerous situations in appropriate ways.

The participants who received personalized counseling and formed a mentoring relationship with their counselors reported 25 percent fewer fights and 42 percent fewer fight injuries six months later, compared to those who received referrals only, the researchers said.

In addition, participants who received mentoring reported less aggression and fewer misdemeanors and were more likely to “think about the consequences,” take steps to avoid fighting, and “take a time out” when faced with a conflict.

The findings, published in the November issue of the journal Pediatrics, suggest that the emergency room is a critical point for initiating this type of intervention, which gives at-risk children and teens behavioral options that can prevent violence, the researchers said.

“There can be a cycle of violence fueled by fear and retaliatory feelings,” study lead investigator Dr. Tina Cheng, head of general pediatrics and adolescent medicine at Hopkins Children’s, said in a Hopkins news release. “When we see youth with assault injuries in the ER, we have a golden window of opportunity to step in and interrupt this cycle, and our findings suggest that pairing teens with mentors who teach them problem-solving skills can help decrease the risk of future violence,” she added.

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