In July, I was given a wonderful opportunity to be part of a meaningful venture taken on by The Media Pte Ltd for Mediacorp’sSuria channel. They produced a docu-drama series titled “Misteri Minda” (Mysteries of the Mind) which aims to educate viewers about various mental illness conditions. The series was recently aired on Suria and on the meWATCH platform.
I had a chance to contribute to this episode on Stress and Gen-Z. A big thank you to the creator of the series, Mr Mohd Ali for making me comfortable throughout the filming process, producer Nur Imani for inviting me to be part of the show, and to the rest of The Media film crew who made me feel very welcome at their studio.
For those of us old enough to recall the 1987 thriller Fatal Attraction, it is hard to forget Alex Forrest, the character that was, among other things, struggling with BPD. Glenn Close’s powerful portrayal of this character probably had quite a few men (and women) hoping they don’t know anyone like that. Oscar-worthy performance aside, the character of Alex Forrest, while perhaps meant to be terrifying to viewers on some level, was someone genuinely struggling with emotion dysregulation and a somewhat unstable and fractured sense of self.
Having said that, in recent times, while there may be more open discussions on mental health and mental illness, pop culture has also seen glamourizations of such mental conditions, not least of all, of personality disorders like BPD. Regardless of whether this was the intended effect, the messaging can be confusing, especially for those who are impressionable.
As I was drafting this particular piece, I figured that because so much has been written (and will continue to be written) about BPD, because as a subject of study it is fascinating, I figured I will take a slightly different spin on the discussion of BPD.
From the perspective of those with BPD or BPD traits (the latter refers to a person who displays some of the traits of the personality disorder), their fear of being abandoned is very real and very urgent, especially when they get into an intimate relationship. The fear of being abandoned by an intimate partner can ironically lead to the end of the relationship, because in trying to manage the fear, the person with BPD tends to cling to the partner and bombard them with demands of reassurance of their love and commitment to the person with BPD. As one can imagine, these demands become extremely draining for the partner, and over time the end of the relationship is inevitable. Sadly, the person with BPD then starts to believe that intimate partners will indeed abandon them and that therefore, they have good reason to insist on their assurance-seeking behaviours. This becomes a self-fulfilling prophecy.
Unfortunately, when such events transpire, the person with BPD is often unable to tolerate the distress and becomes very emotionally dysregulated. Self-harm may become their coping mechanism.
What I have described above is one scenario that is rather common amongst those who struggle with BPD and their loved ones. This is also usually the scenario that brings them to my clinic.
Over the years of being a therapist for my clients with BPD, one thing that always stood out for me was the response my clients had when they were diagnosed with BPD (and this can be self-diagnosis at times given the amount of information and questionnaires readily available online). For some, this was something to be ashamed of, something that they felt made them “abnormal”. There were others who wore the diagnosis proudly and felt that this was what made them unique. As you can see, both responses are arguably two sides of the same coin.
Whatever it is, what is interesting to me is how readily my clients started to identify themselves as BPD. I have had some clients who walked in for their first session with me, smiled and said, “So, I am BPD….” There is nothing wrong with that. Well, unless this identification is harming the client. And I do think that is the case with these clients who start to feel that they are BPD, rather than they have BPD. A subtle but pivotal difference. You can argue that this is a case of semantics. As a counselling psychologist, I would argue that how we speak about something affects how we think about it and what we do about it.
Whatever treatment modality a mental healthcare professional chooses to use in providing therapy for someone with BPD, I think one of the most effective techniques is establishing boundaries. Those who struggle with BPD may come across as being over-friendly with people, and this may sometimes border on inappropriate behaviour. They may also communicate with their family and/or friends in ways that may seem disrespectful of the other person’s personal space, i.e. that person’s boundaries. Incessant WhatsApp messaging in the middle of the night or asking overly personal questions in social or professional situations are examples of the difficulty in maintaining boundaries. When family and/or friends of those who struggle with BPD come to me, exhausted and at their wits’ end about managing the constant need for reassurance from the person with BPD, my suggestion is always to establish and maintain compassionate boundaries.
I like to use the analogy of a cushioned fence as a boundary. When we maintain a boundary by saying something like, “I am sorry you feel unloved, but I do care for you, and I do not want to keep talking about this same issue”, this is not an electric fence that is meant to burn the person who tries to get “in” to our personal space. Each time we maintain the boundary by calmly and firmly telling the person that the behaviour they are displaying is being triggered by the BPD and not what they would usually do, that is a cushion which helps them bounce off without getting hurt. Over time, they learn that this is a boundary that cannot be crossed at will and that they will retain the partner’s or friend’s love by respecting the boundary rather than pushing it.
This, in turn, also helps the person struggling with BPD to learn to establish boundaries for themselves. The lack of boundaries for themselves can be a reason for their fractured identity which usually does indicate a fragile self-esteem, and thus, a difficulty in practicing self-respect.
Perhaps equally importantly, the boundary is also a way I separate the condition from the person and therefore encourage the person with BPD to manage the condition rather than be managed by the condition. This again helps in nurturing a healthy self-esteem and a stable sense of identity. An identity which represents the whole person and not just one aspect which is the BPD.
In closing, I want to take this opportunity to dedicate this piece of writing to all my clients who have struggled (and are still struggling) with BPD and who are slowly, but surely, learning to manage it. You have truly taught me how to see BPD and to constantly find ways to help you and those like you, embrace their true selves. I will always be grateful to all of you for that invaluable lesson. And I hope you know that I always believe in you.
When we feel ill, we decide to see a doctor and get medication. Most would not argue with that logic and in fact, in these pandemic times, we really should adhere to this simple logic, to keep not just ourselves safe, but everyone else safe as well.
However, not everyone applies that same logic when it comes to seeking counselling. Too often have I had a client who would tell me, “You are my last resort. You have to help me figure this out now.” How did I become the “last resort”?
Sometimes, it becomes apparent that I am the “last resort”, not because my clients have gotten weary from trying to seek help from other mental health professionals, but because they hope to wait out the problem since it does not feel too bad all the time or, perhaps more optimistically, they simply wait for the problem to go away.
Why are people more willing to seek almost immediate medical attention for an upset tummy but tend to hesitate when their heart and/or mind does not feel too well? Perhaps it is our perception of requiring medical attention because we can feel the physical pain or see the physical symptoms of the physiological condition. Oddly enough, symptoms of mental health issues like depression, anxiety, or psychosis can be seen and felt (at least by the person experiencing it) but this does not always cause the person to seek immediate help from a mental health professional. Why is that? Perhaps it is our culture where some believe that mental health issues are not due to anything else but a lack of religious faith or a manifestation of a weak spirit which simply needs to “suck it up”.
Whatever the reason(s) may be, at least in Singapore, it is only recently that mental health issues have become more openly discussed and more people are willing to seek counselling to address their psychological and/or emotional concerns. As much as the pandemic has brought about much hardship and suffering around the world, it has also (finally) highlighted the need for us to pay attention to mental health.
So why did it take a pandemic for us to get to this realization? I think it could be because often times, when someone is feeling very distressed or extremely anxious, there is a tendency to dismiss it. We may hope that this will go away in time but at times, it does not and in fact it may get worse. By that time, it usually feels “desperate” for the clients. Usually that is manifested by ultimatums given by family members, intimate partners or the very real risk of losing a job or being expelled from school. And this is the point they usually come knocking on my door.
Unlike medical issues, seeking immediate help for mental health issues is a delicate balance between being overly paranoid about ‘having mental problems’ and waiting too long before it becomes too big a problem.
I like to use the example of a can of carbonated soda to perhaps illustrate finding this balance of when we should seek counselling. Life events will shake us up and like the carbonated soda, pressure builds up for us due to adverse life events like divorce, death, or a pandemic. At times, life has a way of showing us that we may need a little extra help in coping with some of these curveballs in life. When we ignore these “signals”, the pressure continues to build and will eventually need to be released. Waiting for this “release” or even close to this point of release may not be optimal when it comes to seeking counselling. In other words, you do not have to wait until you have every single symptom of the mental condition.
And this does not mean that every counselling relationship will last for months or years either. Just as we are taught that prevention is better than cure for medical issues, the same applies to mental health as well. The sooner we seek help, the earlier the counsellor may be able to help the client manage the issues that arise.
Having said that, I do not mean to belittle or minimize the challenges we all face in seeking help. I believe that it takes tremendous courage to seek help from a total stranger. And this can be especially difficult if the person is struggling with trauma or very complex emotional struggles.
All I am saying is that where possible, I hope we all can seek help for our mental health issues before our “soda cans” burst from all the pressure built within.
I hope that you are doing as best as you possibly can, given these trying times. Thank you for taking the time to get to know me through my website. If you have read about me, then you already know all about my diverse background. More of that in just a bit.
I am hoping to initially connect with you here (until if and when you decide to connect in person) where I will share my professional (and personal) insights and reflections through my experiences working with my clients. So please keep a lookout for these thoughts!
I was thinking about a suitable first ‘conversation’ topic, so to speak, and it made sense to start at the very beginning. What forms the core of my professional self? And in a lot of ways, the answer to that question also answers the question of what the core of my personal self is. I believe that any helping professional probably does their most optimal work when their personal and professional selves are congruent. That certainly rings true for me.
So, back to the question then, about my professional core. I suppose the answer was always obvious but it really became crystallized for me when I recall something I say very often, to all the undergraduates I teach. That the Rogerian approach (also known as Carl Rogers’ Person-Centred theory) is not just a theory but really the heart of counselling. The Rogerian theory is part of the humanistic approach in psychology, which celebrates the uniqueness of every person and seeks to understand the person as a whole being. There are three core conditions of the Rogerian approach – (1) the counsellor’s congruence with the client, (2) unconditional positive regard for the client, and (3) empathy towards the client. All these conditions are what I hope to consistently embody as a professional.
So here is where we revisit my diverse background. Anytime I tell someone my counselling psychologist journey, I am humbled, not so much by my accomplishments in terms of the diverse education I received, but by the myriad opportunities that I was fortunate to experience. Over the years, several clients have told me how intimidated they felt when considering seeing a counsellor because they feared being judged by someone who “seemed so perfect”.
I often reflect on why I wanted to become a counselling psychologist. It is not because I am perfect (far from it). And we are all works in progress and that is something to be embraced because knowing we always have another chance to grow, and evolve until our final breath, is something I feel immensely grateful for. I became a counselling psychologist because when I faced my darkest moments, I acknowledged them and learned how to heal from these setbacks. In other words, I want to be a helping professional precisely because I am as human as my clients and I aspire to help others heal and more importantly, make them feel that they are never alone in their time of need.
Along the way, I met individuals who demonstrated empathy and unconditional acceptance of who I was so that I could grow to become the person I am today. I feel that it is my calling to pay this forward, to help others the way I was helped.
It takes great courage to admit that we need help and to seek the help we need from a total stranger. If that is how you chanced upon my website, thank you for taking the time to consider me as your guide on your life’s journey at this point.