Mixed anxiety depressive disorder

In this journal, I’d like to talk to talk about mixed anxiety depressive disorder (MADD), one of the most common mental health problems in England. It’s a condition where a person experiences the symptoms of depression and anxiety. It’s described as a diagnosable illness when a person continually worry and feeling low in mood and is hard to enjoy life. It’s quite common to have this situation because of the stress of living in London, a highly competitive city of Europe. The pressure at work and living make people feels it’s hard to face daily challenges and hard to relief during the rest time or annual leave. People will gradually lost their interest in their interested activities and probably feel they’re hard to fall into sleep easily. If the situation continues, they may also tiredness all the time and feel other negative body symptoms such as muscle tension and quick heart rate. In fact, it’s very common in primary care system and it leads to numerous impact to the whole society. According to NHS England, it is estimated this health issue affecting approximately 16% of the population of England, and it leads to a decrease of England’s national income by around 4%, which is about £80 billion. This reduction is due to high turnover rate, temporary work and reduced productivity. Although the National Health Service and therapeutic organization are aware of the impact, not all of the public understand the impact of MADD and some patients were stigmatised since somatic disorders is easier to be accepted than psychiatric disorders. I think it’s essential that work should be done to educate the public regarding the details of MADD, how to deal with stress and anxiety in daily life and how to help friends and family members. I think that early interference will prevent an exacerbation to a more serious condition. 

In the next paragraph, I’d like to discuss how counselling can promote a positive mental health. For people that are living with high pressure, it’s hard for them to find a way out because they’ve already spent most of their time and effort to deal with the existing situation and thus they don’t have capacity to process their emotions and struggles, and those stress can’t be reduced in a proper way. I think counselling can contribute by assisting people to understand their situation and relief their stress via the talking therapy process. People can then find out possible ways to deal with their own situation with the assistance of the counsellor and start to plan their future. Counsellors are not acting as a person to teach clients what’s the best way. Instead, they’re guiding the people to understand their personality, what’s in their mind and how it can be achieved. In some cases, the situation may take a long period of time to improve. If people can find a way to deal with the stress in a proper way, then they can gradually realise their potential, find their own work-life balance and their own understanding of meaning of life. 

Self disclosure in a therapeutic relationship

In this journal, I’d like to talk about the case number five and discuss whether Michelle’s way of approaching is beneficial to the therapeutic relationship. Firstly, I agree that self disclosure is a good way to establish therapeutic relationship with the client. It’s useful when client experienced similar life moment. However, the disclosure must be within boundaries, so that both the counsellor and the client can have an appropriate relationship, like what’s mentioned in the BACK ethical framework. The case mentioned Michelle keep disclosing her own situation and turns out the focus of the session twisted to Michelle’s life story instead of dealing with client’s needs, I think that is a bad example of not putting client first. If possible, I think Michelle should consider how much she should disclosure at the beginning and make sure the purpose of disclosure is to demonstrate empathy to Paula’s situation instead of becoming a channel to express Michelle’s own feeling. Besides, it’s common that client is curious and wish to know more. When Michelle encounter that at first instance, she should deny the request and explain the reason gently, so that Paula understand it’s to protect interest of both sides. Michelle should also guide Paula to talk about her own experience that she wish to explore, so that she can apply the counselling skill and demonstrate good practise through the session.

2024 Review

自從2018年於南韓記下自己的人生軌跡及非正式遺囑之後，很久沒有花時間回顧自己的一生。是次預備遺囑不單挑戰我反思過往數年的各種人際關係、思考他日去世的安排，也迫使我面對這幾個月來我試圖置之不理的思念與感受。遺囑最特別之處在於我不是為數天後的處境作打算，而是在此時此刻為十年甚至是更久的日子決定我遺留在世上的人與事的處理方式。

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還記得小學時有監護人一欄，需要填上一位有資格為我們作出重大抉擇嘅人的名字。以前總覺得一切理所當然，因為在我之上尚有父母家人為我遮風擋雨。隨住時間過去，有資格成為監護人的人越來越少，也標誌着自己要為將來的決定附上全部責任。這件事既是人生的成長，同樣也是一種失落。

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遺囑上有一條預設問題，就是假如我倆過早回到天家，該如何處理後代。或許是因為近年經歷不少生命的消逝，這條問題為我帶來不少的苦惱，也令我思慮煩擾。如詩篇作者所說，我們一生的年日若是強壯或可到八十歲。但若主許可的話，或許我在意料不及的時間已可及早息了勞苦。耶穌在福音書曾經問「誰是我的母親？誰是我的弟兄？」。或許這個問題對於強調血緣與族群的人來說毫無意義，但對身處千里之外的我來說，這是一個貼身而又難以回答的問題。四減一，並不是簡單減數所得出的答案。在那一刻我深切感受到失去母親對我的影響是如斯沉重。不止是少了一個疼愛我的人，也有一種不知如何是好的迷茫。

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對於有信仰的人來說，與主相見實是好得無比的事情。那麼對於尚在地上等待主再來的其他人，我是否還有什麼該提早安排的事情？能夠成為他人放心交托身後事的一位，絕對是一種別人的認可。可是，這對於仍然在世的人來說會否是一份過重的托付？若事情已經脫離我的掌控，或許我根本不應如此多事，不必思考我所預備的要歸誰這個問題。

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有些決定既不理性，亦不合理，但目前我並沒有智慧去作出更佳的抉擇。

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當我記起當年往事 

我又會會如何
可會輕輕淒然歎喟
懷念你在我心中照耀過

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2024年我經歷了眾多的挑戰，也獲得了不少的成就。當然，也有一些慘痛無比的經歷。

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相比起在路面上以英文學車，突然覺得在駕駛學院學車的經歷是小巫見大巫。感恩遇到很好的教車師傅，不單止教我駕駛技術，也讓我更了解面對挫折時的情緒反應。你實在是一位很好的老師。

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一位好的上司除了以身作則之外，我覺得更難能可貴的是會因材施教，幫助下屬在各方面有所成長。尚記得那次你提到「三個月前我覺得你未ready, 但現在我覺得是時間了……今次不要讓我有理由不選你」。謝謝你幫助我找到自己的位置。

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課堂學習總是起伏不定，我想是因為我的心理狀態不佳吧。無論如何，課堂的時候也令我對於輔導、對於local 的生活有更深的認知，實是美事。

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曾經想過年月會否使自己被遺忘，不再被記住。慶幸這一切都沒有發生。每一聲親切的問候、每一個人提出的幫忙，在車上淚流滿面的互動，我都一一記在心裡。

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相比起別人如何定義事情，我更在意的是我如何因而作出新的決定。我曾經以為新環境可以萌生新的可能性。奈何江山易改……

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口裡表示自己有多痛恨某政治實體的做法，卻又使用一模一樣的技倆對付他人，實是一大諷刺。

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面對永遠不會犯錯的人，除了自己有錯之外，尚有何出路？

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那怕有上主的話，也不是改變油蒙了心，耳朵發沉，眼睛閉著的人

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相比起撒馬利亞人是否動了慈心，不作為的祭司及利未人才更值得被深入討論。因為那怕是不信神的人也懂得善待生命中遍到的人。


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"The best revenge is to be unlike him who performed the injury." - Marcus Aurelius

Understanding life event using CBT

In this journal, I’d like to apply concepts of Cognitive Behavioural Therapy to understand my life event. I was working at the supply chain team of an educational equipment company during the pandemic period. At that moment, the marine logistics is unstable and thus causing great pressure to myself. And the management announced bonus of six months’ salary will be given to staff a few months later. I was very struggle because I got severe eczema and backpain for the whole year, but I wish to have those money for the expense of upcoming wedding and emigration. When I look back to the history, the anxiety that’s affecting me is the uncertainty of future, and I jumped to the conclusion that having more money is the best way to deal with it. I did noticed my body situation at that moment and I thought I should carry on because that’s a huge money and I think I deserve it as a reward of working at the company for eight years. To deal with the cognitive distortion of ‘should’ statement and jumping to conclusions, I initiated self-talk and asked myself is it worth if I earn those extra money but forfeit my health. After a while, I realised that I still wish to have those money, but health is more important to myself and my partner. So I decided to quit the job and spend some time to rest and prepare for the future journey. 

In the next paragraph, I’m going to explore how I develop and maintain my relationship with my former colleague. I was promoted to a higher role to handle the development of new produces because of my performance. As a result, I have to work with colleague that I’m not used to deal with. The whole team promoted a 7/24 working style and expected the team member should work even they’re on annual leave. And they tried to justify this and asked me to follow. My new manager said that everyone else is doing it, so I as a new member must do the same thing. Since everyone were following that norm and agreed with that, I had no choice but to follow this irrational work style. At the beginning it’s fine and I justified this with the mindset that I should try my best to be part of the team. A few months later, I found that I’m exhausted and I no longer able to rationalize the work that occupy all of my time. I found that one of the greatest barriers that prohibit me to rebel was about the relationship with those colleague. I was taught that keeping good relationship with people is important and I always do whatever I can do maintain good relationships. I was worries about how the colleague would judge me, thus I pushed myself to stay in the role for a longer time. I decided to report that to the director when there’s a time that I couldn’t enjoy the time with my friends during weekend. I realized the cost of pleasing my colleague and that’s not healthy to my other relationships including family and friends. So I decided to abandon the idea of pleasing the others and strike a balance of work and my life. When I look back, I noticed the impact of “should” statements in my life. In my life, I was taught a lot of values and what I should follow. Now I have better understanding and that allows me to make correct decision to interact with different relationships. 

Personal blocks

Nowadays the society promotes the idea of diversity, equity and inclusion, many organisations and companies apply this in the recruitment as well. However, that doesn’t mean that discrimination doesn’t exist. It still exists in the workplace, but in a more hidden way. In my previous workplace, I belong to ethnic minority because there’re only two to three Asian staff. Most of the staff were friendly to me, but I can sense that some staff were quite hostile. When we’re working in a project jointly, I noticed that one colleague always criticises my language barrier. He’s aware that I’m not that familiar with popular slang or fashionable vocabularies, and he always explain the meaning to me exaggeratedly. It seems he tried to be friendly to a foreigner, but I though that’s a form of contempt. The tricky thing is that it’s hard to say it’s direct discrimination, but I can sense the unfriendly expression from his facial expression. The above experience enables me to understand the feeling of being treat unfavorably and I wish my client will never face this when we’re in a counselling relationship. It's inevitable that I will meet people that are from other background and they may have belief that completely different with mine. I will remind myself to demonstrate respect and congruence during the sessions, make sure they feel it’s comfortable to share their story and feeling with me. The key point is I don’t have to adopt their view in my own life, but I need to do what I can to listen and understand his ideas throughout the session.

In the next paragraph, I’d like to discuss what kind of personal blocks that will affect me to show empathy when developing a counselling relationship. The first one that I can think of is I’m hard to empathise with people that culturally promote machismo. I know that I should demonstrate underconditioned positive regard during the session, but I can foresee that I will feel very uncomfortable when I hear a male place woman into a lower standard and justify this in his own way. I grow up in a society that empathise gender equity and thus I own the value of treating the others fairly. If I have a chance to work with client that own different value, I guess I need very strong self-discipline to force myself not to argue during the session. Another type of people that I feel I’m hard to deal with are those with strong political views. I believe every people have their own frame of reference to see how the society operate, and people may have contrasting view because of their own experiences. I tried to understand my friend’s political view a few years ago. His sharing not only involved political beliefs, but also include strong negative emotions due to incidents happened in the society. I found that the conversation was very difficult because it’s a mixture of opinion and feeling, it’s difficult to differentiate them clearly during the conversation. When he mentioned some feeling due to a viewpoint that I disagree with, I found that I’m not able to show empathy, I was tempted to initiate the debate of that political point. Now I have more training and knowledge of counseling skills, but I still feel hesitate if I speak with a client with strong political belief. I’m not sure if I can focus on understanding his feeling instead of the political points. I think that’s still challenging to me at this moment.

Grief of an old widow

During the lesson, we spent some time to discuss a case regarding an old widow and her grief. During the discussion, some classmates suggested to find ways to assist the widow to regain interest to her hobbies and look forward to the future that without her husband. I understand their intention is to help the widow to get rid of the grief quickly, but I’m not sure if it’s too pushy. In the point of view of person-centred approach, I think the key is not to guide the widow to the direction we think is good to her, but to understand what she wish to deal with at the moment. I think what I should focus on is to demonstrate unconditional positive regard to her situation and try to understand what she wish to talk about. It’s understandable that she may not wish to talk too much because of the grief, counsellor have to try their best to demonstrate empathy via non-verbal communication as main channel. If she wish to share about her own situation, I will make sure enough time is spent, so that she have a space to talk whatever she wish to talk about, probably her feeling about the lost, what she thought regarding her children or other areas that she wish to share. Besides, the case mentioned Helen have signs of depression. I think it’s needed to consider referral if her situation is beyond the ability of a counsellor.




To conclude, I shared my understanding of the person-centred approach by sharing my comments about a case. I tried to apply the concepts of the approach and talk about what I think is appropriate to do when using the approach to the old widow.

Relationship with friends in an eye of person-centred theory

Today I’d like to use the person-centred theory to discuss my own relationship with my male friends. In my home country, good students are always expected to study science subject. And students learned to sort things by using scientific and rational way of thinking. I struggled with my future at that moment because of family financial situation and I’m not sure what I wish to study in university. So I tried to seek help from my friends. After a few conversations, I found that it’s difficult to continue the dialogue. My friends believed the best way to sort the emotions is to sort the problem itself, so they tried to offer various ways to solve my problem, such as inviting me to study and careers event and tuition class that can enhance my examination skills. learned the penson-centred theory, I understand more about my feeling at that time. The suggestions that my friends proposed were very useful, but I found that they never understand my underneath fear nor stress. I couldn’t feel their empathy and I felt I was a problem that to be solved and I was dehumanized. I’m not saying my friends didn’t care about me, but what they offered was focusing on solving the challenges that I faced but didn’t consider my emotional needs, and thus I didn’t feel their comfort. I think that might because we’re shaped by the logical way of thinking learned from the science subjects, thus it’s emphasis on finding solutions instead of demonstrating unconditional positive regard and empathy. 

Attachment theory and my childhood experience

In this paragraph, I’d like to use attachment theory as a foundation to discuss how my childhood experience affects my interpersonal relationship. I think this is a good starting point to understand how the interaction between a child and mother will affect the interaction with other people. I was diagnosed eczema when I was a kid. The red and scaly skin was annoying and that affected my daily life a lot. Apart from physically unwell, that also affected my appearance. But interestingly, the skin condition didn’t affect my self-esteem nor formed any obstacle for me to make friends with the others. I met some good friends during the key stage one and two, and I had an enjoyable primary school life and some wonderful friendships. When I looked back this history, I thought a possible reason why eczema didn’t affect me too much is because a secure attachment was developed when I interacted with my mother since the infant stage. My mother provided an environment that was full of love and acceptance and I had grown up with prompt response and sufficient physical touch. I remembered that I can always seek help and support from my mother when needed. And my request was never neglected. As a result, I was empowered to explore the world freely and try to interact with other kids in a friendly way. Even though the illness still exists, I still feel comfortable to build interpersonal relationships with the others.

In the second paragraph, I’d like to share what I heard from a helpee and discuss how the childhood experience formulates anxious-resistant insecure attachment. One of my helpees was grew up in a family that lack of love. Her mother spent most of her attention to take care of helpee’s elder brother and rarely spend time with the helpee. Unfortunately, helpee’s elder brother treated her badly because of his own emotional problem. As a result, helpee is grown up in an environment that didn’t offer sufficient care and love from other family members. And she established a mindset that close relationship can only obtained by ingratiate someone. When the helpee grown up, she wished to draw attention from friends and other males and tried to make them happy, so that she might able to build close friendships or love relationships. After a few helping sessions, she realized her way of building relationships is because of what she encountered during childhood and puberty. And the past hindered her to maintain proper and healthy relationships. Although we didn’t managed to find a possible way out during the sessions, she’s still delighted to understand herself a bit more and she wish to continue to explore possible ways to deal with the insecure attachment.

To conclude, I tried to use the attachment theory to understand my own history and what I heard from a helpee. And I found out that the childhood experience affect people a lot. The interaction between mother and children not only affects the childhood, and it’s highly likely that it will affect the rest of the life. However, I don’t think that the attachment type will remain unchanged for the whole life, I believe there’s possibility to change if people experience proper attachment with their partner or other intimate relationship throughout the life. Since I only have limited understanding about attachment at the moment, it worth more investigation and discussion regarding this before I make any conclusion.