Author Archives: Dr. Alex Kwee
Growing up, my family lived in a house in a cul-d-sac, in a suburb outside of Vancouver. It was the kind of place where you knew your neighbors, and they knew you. If you were standing outside on the deck behind my house, you could look straight back and see a big tall hedge – this made for nice shade during the day, and kept the neighbors behind from seeing into our home, which was mostly all glass doors on the back side. If you looked right, you’d see several medium sized fruit trees and a fence – about 6 feet tall- covered in ivy. If you were standing on the ground, you wouldn’t be able to see into the neighbor’s yard- the fence was a little bit too tall. If you were to look to your left, you would see a shorter fence, which allowed us to see over into our neighbors yard, and lent to the occasional conversation between the neighbor dad, and mine – their arms hanging over the wooden posts as they talked about summer plans.
When I started to learn about boundaries, the metaphor of the fence kept coming up for me. Like fences, boundaries are there to protect what is ‘ours’ and keep out what is ‘not ours’. Because of the fences in our yards, it didn’t mean we didn’t care about the other people in our neighborhood – it helped us know that whatever was inside our fence was ours to take care of. Rather simply, we would mow the lawn inside our fence, and the lawn on the other side of the fence, was someone else’s to mow.
Other than a fence, another way to understand a healthy boundary is to think of literal borders, like the US-Canada border. It is flexible, and rigid when needed. And when working well, it allows for a good relationship between the two parties. This is because the parties on both side have different identities (political values, restrictions on foods, taxes on purchases, etc). While neither is better, they are different, and the border defines where one ends, and the other begins. Boundaries are useful for defining, and also for protecting. Like security at the border, boundaries don’t just let anything, or anyone, in. They are designed to keep out what is harmful or hurtful, and keep in what is theirs. What I think is best about this border metaphor is that it reminds us that we can have boundaries, while still allowing flow between things inside and outside of the boundary. When the boundary is working well, and everything is in order, a boundary is unobtrusive. When necessary, boundaries can also become non-negotiable, and rigid. Think of the border between North and South Korea, where boundaries are keeping each entity as separate as possible. At times, borders, just like relational boundaries, preclude the ability for mutually constructive relationships. We always want the boundary to appropriately match the context and relationship.
In my work doing therapy with clients, it seems that as Christians we have a harder time with healthy boundaries than we would think. This difficulty, I believe, comes from the idea that as Christians we should give selflessly and sacrificially, as a way of showing that because of God’s love, we are different than ‘the world’ around us. But, how that can translate into boundary issues becomes more clear if we return to the metaphor of the fence: if I’m so busy mowing everyone else’s lawn, then I won’t have time to take care of what’s within ‘my fence’.
There is a book by Christian psychologists Dr. Henry Cloud and Dr. John Townsend, aptly called Boundaries, which gives lots of examples of common ways we can draw distinctions between what is ours, and what is ‘not ours’. Their first example is that of ‘skin’- the most obvious and basic of all lines that we draw, which defines who I am, and where ‘I’ end. Emotional and geographical distance, are two other types of boundaries. When we create geographical distance between ourselves and someone else, we can protect ourselves from their destructive or disrespectful behavior. Emotional distance does something similar, but is often less obvious on the outside. Think of the example often used at Christian weddings; “leave your mother and your father, and cleave to your wife” (Genesis 2:24). This is God’s way of instructing us that the marriage between two people draws a boundary between who is now responsible to whom – children have left their parents ‘yard’ and are now responsible for their own ‘yard’. This is not just a geographical leaving, but an emotional leaving – the husband is now bound to his wife in a way that reprioritizes who gets his whole heart – he has left his old family, to create a new family.
Another example of a boundary we use all the time is how we use our words. An example of a word boundary would be “stop”, or, “I don’t like it when you pinch me” – it tells people who you are, and what you like or don’t like. Cloud and Townsend say that words give us ‘edges’ so that people know what behaviors fit for us, and which don’t. Another word boundary is the word “no”. It lets others know they we don’t like something, or what is being asked of us doesn’t ‘fit’ with who we are. Saying “no” can be hard for some people, and is often one of the most difficult boundaries to put into practice. It is often difficult because we are afraid of what saying no to someone else will make them feel, and if we believe that we upset another person, then maybe we won’t be liked or respected by those around us. If someone asks for help, and we say ‘no’, it could also make us feel like we were doing a very poor job of ‘doing unto others, as we would have them do unto us’. Ouch. This can lead us to not put up boundaries because we feel guilty, as opposed to helping someone else out, from a place of love. Guilt with saying no, or fear of what others will think, are great concerns to discuss with your Christian psychologist or therapist, to explore more about what God really says about all of this.
Boundaries are not actually contradictory to what God asks of us as Christians. In fact, there are numerous examples of God drawing boundaries with us, or Jesus creating boundaries during his time on earth. An example of this is in Romans 13:12 (NASB) when Paul writes “the night is almost gone, and the day is near. Therefore let us lay aside the deeds of darkness and put on the armor of light”. Here, Paul is reminding us there is a distinction, a boundary, between what good is, and what bad is. Good, and God, is like the light, and bad, or night, is like the darkness of our sin. God is very clear with us in scripture that boundaries are appropriate as they differentiate what is Godly, and what is evil. Another example of a boundary in scripture comes from 1 Timothy 5:8 (NIV): “Anyone who does not provide for their relatives, and especially for their own household, has denied the faith and is worse than an unbeliever”. This verse reminds me of the fence analogy I introduced earlier – it can be tempting to say yes to everyone else, or hard to say no to others, but if it means we’re not taking care of what’s within our own fence, then we have a boundary issue. God requires of us, before mowing anyone else’s lawn, to make sure our own is mowed.
One of my favorite examples of boundaries is when Jesus retreats to pray. The story in Matthew 14, tells us that Jesus has just learned of the death of John the Baptist, and it tells us in verse 13 “when Jesus heard what had happened, he withdrew by boat privately to a solitary place”. When I think of this, it reminds me that it’s ok to take breaks, to say ‘no’, to listen to what we’re feeling and to rest. If you think about Jesus’ ministry at the time, it’s not like he had nothing to do. He probably had to make the choice to say no to opportunities for ministry, or caring or healing someone else, to make time to grieve the loss of his dear friend.
When I was spending time with my parents a few days ago, we were telling stories about growing up. As it turns out, I never knew this at the time, the neighbors to the right of our back yard (behind the taller fence) were not always the kindest or most respectful of our property. In fact, their son once egged our family home just for fun. On the other hand, the family on the other side was one that I babysat for, that we took daytrips with, and showed us trust and care on a daily basis. I don’t imagine that the height of the fences around our backyard were necessarily for those reasons, but when I look back, the metaphor still stands. The fences that needed to be higher to protect our safety and privacy as a family, were higher. And, the fences that separated our yard from the people who treated us well and showed us respect, were lower. We would never feel guilty spiritually about hurting another person’s feelings by putting up a hedge in our backyard to protect us from anyone looking in our bedroom window, and we also don’t need to feel guilty, or like we’re sinning, when we say ‘no’ to something in order to rest. God says a lot about boundaries, and scripture tells us that it’s ok to know who we are, who we are not, and what is, and isn’t, required of us as a result.
Written by Hillary McBride, with Alex Kwee
As a Christian psychologist and faculty member, I am often asked by students and interns to recommend a doctoral (Ph.D. or Psy.D.) training program at a Christian university in the United States, given that no such programs are offered within Canada at this time (since Canada lacks private Christian universities with exception of Trinity Western University, where I teach). There is a great desire among my students and interns to train within an accredited doctoral program that supports a Christian worldview, so I thought I’d list all the American Psychological Association (APA) accredited doctoral programs at Christian universities in the U.S. currently. But before doing so, just an additional word. It is important to seek out an APA-accredited program because accreditation reflects that the program meets the standards of education and clinical training rigour set by the APA. The parallel organization within Canada is of course the CPA, and there is significant reciprocity between the two organizations, with CPA recognizing APA’s standards and often following the APA’s lead in terms of setting its own standards for Canadian programs. When it comes to licensure and registration, graduating from an APA- or CPA-accredited program significantly reduces the hassle of proving that you have met educational and training standards to the regulatory bodies.
There are seven APA-accredited Christian psychology training programs in the U.S. currently, with the type of doctoral degree indicated parenthetically:
1. My alma mata, Wheaton College Graduate School in Wheaton, Illinois (Psy.D.)
2. Biola University in La Mirada, California (Ph.D./Psy.D.)
3. George Fox University in Newberg, Oregon (Psy.D.)
4. Seattle Pacific University in Seattle, Washington (Ph.D.)
5. Azusa Pacific University in Azusa, California (Psy.D.)
6. Regent University in Virginia Beach, Virginia (Psy.D.)
7. Fuller Theological Seminary in Pasadena, California (Ph.D./Psy.D.)
Remember learning about an oxy-moron in Grade 10 English class? It may not have been that year, exactly, but we all remember hearing the terms ‘hot ice’ or ‘jumbo shrimp’ to describe this literary phenomenon (in light of a recent trip, “British cuisine” is another one that comes to mind). I never thought I’d hear that same phrase thrown back at me when I use the term “Christian psychologist”. But as it turns out, there are people out there who think these two things couldn’t be more incompatible. You might be one of them, or you might be like me and think – it makes perfect sense for these two things to fit together.
So, what is a Christian Psychologist, and how could people think, or not think, that those two words fit hand in hand? As a psychologist who serves many people of the Christian faith, I am sometimes queried about whether there is a distinctive “Christian” psychology, and whether Christian psychologists are indeed using practices that are not antithetical to the Christian faith. I am often asked by some skeptical Christians, “Are your methods biblical?” – the assumptions being (1) there is a clear, biblically sanctioned way to do counselling and (2) secular psychology/counselling methods are inherently diametrically opposed to Christian principles. Granted the vast majority of Christians are quite balanced and do not believe this, and so I am addressing only those who hold a dogmatic view that psychology and counselling methods hold nothing for a mentally and emotionally suffering person, who needs only to have faith in God to be healed.
With all things, including the realm of psychology, we’re reminded from 1 John 4:1 that we must “test the spirits”. This is an exhortation for Christians in the world to possess a natural scepticism. In Elliot’s commentary of the English Bible, these “spirits” are our human tendencies towards good and evil, particularly as they pertain to thought or opinion. An example of a spirit might be a person’s religious fervour, that though seeming quite religious on the outside, could be opposing the will of God. Another example of a spirit could be a person’s opinion of counselling that feels really “right”, and sound like lots of other ideas popular in culture (i.e. what’s ok for you is ok for me, or there are no real consequences for your actions, it’s all relative), but again are antithetical to Scripture and God’s will for us. One question that comes out of the exhortation in 1 John 4:1 as it relates to psychology is: “Does this work I’m doing cause me to desire God more, to seek intimacy with my heavenly Father, and to better see myself as God sees me?” Another example of this is: “Is there anything happening in our work together that gets in the way of me being closer to God, and seeing myself as He sees me?” These are good questions to ask yourself as you think about engaging a Christian psychologist or mental health professional.
Many who stand opposed to psychology on Christian grounds assume a dualistic position that matters of the body and mind are separate; it is acceptable for relief for physical ailments to be sought through physicians (only the most fundamentalist of Christians would insist that such healing come exclusively by faith without medical intervention). But at the same time that medical treatment can be readily accepted, there can be deep reservations about receiving counselling or psychological treatment for emotional, mental or psychosomatic problems. The problem is rooted in a dualism of the physical and non-physical, with non-physical issues somehow being attributed to spiritual causes and the remediation, therefore, being a spiritual one – more prayer, more holiness, trusting God more. The implication is that if someone remains depressed or anxious, that person is somehow not measuring up spiritually because a person who is walking closely with God should not be depressed or anxious. Yet we wouldn’t presume that of someone whose cancer isn’t healed despite persistent prayer.
Let’s begin with the proposition that all truth is God’s truth. The bible doesn’t address, for instance, the current state of knowledge in healing infectious diseases or other knowledge in the vast plethora of truths that have been revealed through scientific inquiry, yet we do not dismiss such truths simply because they are absent from Scripture. The mind and works of a divine Creator are evidenced in the wonders of the natural order and the miracles of science, completely apart from Scriptural revelation. For as Romans 1:18 declares: “Since the creation of the world God’s invisible qualities—his eternal power and divine nature—have been clearly seen, being understood from what has been made.”
A second proposition is that all sicknesses, physical or mental, are attributed to humankind’s sinful, fallen condition. Here, however, we have to be careful to clarify what we mean. It is not necessarily individual sin that causes one to have a mental health condition, though sin (as in original sin, as in Adam and Eve and the spiritual fall of humankind) is always at the root of it. At the same time, individual choices, including moral ones, do play a role in shaping mental and physical health. Yes, someone with cancer is stricken because original sin caused the propensity for sickness to begin with, but lifestyle factors of diet, exercise, stress and relational health do play a role as well in the onset, progression and healing of cancer. We are complex, biopsychosocial phenomena – fearfully and wonderfully made as Scripture declares (Psalm 139:14). Simple, linear relationships cannot explain our complexity as humans. Although physical and mental illness are made possible by humankind’s spiritual fall, these are embedded in a complex web of individual choices, social environments, upbringing, economic opportunities and a plethora of other factors that reciprocally interact with and reinforce one another to shape our conditions.
If mental health issues are so complex in their cause, then the solution lies neither in overspiritualizing nor over-psychologizing (sorry for the made-up word) the remedy, but in intelligently and critically integrating faith with the revelation of psychological science to find our answers, while trusting that both are facets of God’s truth. There is no Christian psychology just as there is no “Christian medicine”. But there are theological frames of understanding of what cause mental illness and physical disease. And there are many practitioners of psychology who think “Christianly” in their practice of psychology. To me, this is what makes one a Christian psychologist (or physician, or educator or artist). To possess a Christian anthropology and a Christian epistemology of suffering and disease means practicing within the knowledge parameters of science yet seeing no incompatibility with belief, and seeking to critically and responsibly interact belief with the extra-biblical revelations of science. It is from such a knowledge framework that I practice psychology as a Christian, and think of myself hence as a Christian psychologist in the most un-oxymoronic and genuine way.
Dr. Alex Kwee, R.Psych. with Hilary McBride, RCC
Of all the ways to manage anxiety, they usually fall into three categories. The first, is to focus on cognitive strategies – that is, changing anxious thoughts and related behaviours. The second, is to focus on the body, for example to manipulate the body to intentionally de-stress. This might include taking deep breaths or working on muscle relaxation. The third approach is to practice mindfulness, and change the very relationship we have with the anxiety itself. Mindfulness has a very strong evidence base in the literature and completes a toolkit of evidence-based strategies.
Changing our relationship to anxiety entails practicing acceptance of anxiety. But why accept our anxiety? Typically the relationship we have with anxiety is antagonistic, we want to do everything we can to make it go away. When people get anxious, a part of them labels their anxiety as “bad” and wants to get rid of it. To get rid of anxiety, they may do counterproductive things such as worrying oneself out of a difficulty or becoming obsessive and over-controlling to micromanage a problem. This only makes anxiety worse, as it creates a “struggle-upon-struggle.” It is difficult enough to have something to worry about, but when you “hate” the feeling of worrying, you only compound your anxiety. The non-acceptance of anxiety in the moment, not the thing that originally caused your anxiety, is the majority of the suffering in anxiety.
To do this, we need to be able to separate what is causing our anxiety, from the anxiety itself. Most of the problems we have resolve themselves regardless of how much we fret about them. But if we continue to worry about them, the worry becomes a problem in and of itself. Often this can lead people to worry about their worry.
In order to accept, we need to take the position of a scientist, reflecting on our own lives with detachment, curiosity, interest, and inquiry. Just like a biologist observes and describes a new species of amphibians, or a geologist examines an interesting rock formation, scientists do not judge if the phenomena is ‘good’ or ‘bad’, they just are. The phenomena that scientists study are neutral. Anxiety, or any other psychological or physical problem, including pain, is just like that. But as soon as we label something ‘bad’ we create an inner struggle because we want to rid ourselves of bad things, and feel worse when we feel powerless to rid ourselves of these ‘bad’ things. If we remained neutral towards our anxiety, even though the experience is unpleasant, then we are more willing to experience it, and work with it, instead of fighting against it, creating struggle upon struggle. Something may feel uncomfortable, like pain or anxiety, but this does not make it bad. Bad is a moral transgression – like hurting people, stealing, or lying. Anxiety is not bad, it is a negative feeling, and feelings are only feelings.
Let us think about how this might work in an anxious moment. You can feel within yourself worry rising, with the familiar increase in heart rate and knot in your stomach. Instead of shaming yourself, simply notice the sensations. Describe them to yourself like a scientist studying a new interesting phenomenon. Ask yourself what it’s like to experience this, and what it feels like in your body, mind, and emotions. If it feels negative, what makes it that way?
The most common misconception about acceptance, is that if we accept something we must completely accept it forever. It is possible to do that, but it is also possible to do that for even just a short moment. We can accept even a great deal of pain for just a little bit of time, as long as for that time the acceptance is unconditional. This means saying ‘yes’ to it, not ‘yes, but’, as true acceptance must come with no qualification or condition. Try this: Imagine accepting something uncomfortable for even 30 seconds, then allowing yourself to go back to hating it. The next step is to expand the boundaries of your acceptance to 1 minute, then 5 minutes and so forth.
Noticing without judging essentially requires that you “see” your own anxiety, becoming an observer of your anxiety. When you can see something, by default it means there is distance between you and it, and you are less entangled in it. When you cannot see it, you are in trouble because you are caught up in it and you give it the power to control you. Research shows that people who meditate (and you can do this from any spiritual framework, including Christianity) are calmer because they can defuse from their negative experiences and accept them. When you learn to accept, these energies are now freed up to actually live your life with meaning and purpose without having to make all your problems and pain go away. Acceptance frees us up to align with our values to become the people we want to be.
Try doing this next time you’re at dinner with a family member who you find challenging, or you have a mosquito bite you want to scratch.
The research and clinical wisdom tell us that the happiest people on the planet are not necessarily pain-free but are value-rich. Avoiding pain or discomfort is not the most important thing to these people, living out their values is. Before the early 2000s, psychologists were trying to help people get rid of their psychological pain. But, they found that a person without psychological pain is not necessarily happy – happiness is not the absence of negatives (like anxiety) but the presence of positives, like faith, deep personal meaning, and hope. Through acceptance of anxiety, with the help of mindfulness, we can focus more on aligning ourselves with the positives in our life, instead of spending all of our energy trying to ward off discomfort and distress. This helps us create a life rich with meaning and purpose.
Written by Hillary McBride and Alex Kwee
“Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that” Martin Luther King Jr.
When an autopsy was performed on 39 year old Martin Luther King Jr after his assassination, autopsy revealed that King’s heart resembling that of a 60 year old. The biographer Taylor Branch concludes that this is due to the extreme stress of his 13 year dedication to the Civil Rights movement.
Although he had suffered unjustly in so many ways, at such great depth, for so long, King captured the universal response we have towards being wronged: to drive out darkness with darkness. This darkness, although sometimes enacted as revenge, is usually a darkness that resides within us. It is the hurt we continue to carry around with us, that ties us to how we have been hurt or wronged by someone else.
As King states, in order to win over the initial hurt, we need more than simply more hurt, within ourselves or towards others, to heal us. This is the concept of forgiveness; that although we have been wronged by someone, instead of wronging them back, we release them, and move forward. This is to fight darkness with light, or to fight hate with love.
Forgiveness exists in the vocabulary of most people, but it is a difficult concept to describe, and even more challenging to embody or apply. There are two metaphors that can help us understand and then practice forgiveness. The first metaphor is of debt. When someone has mistreated us, it is like they owe us a debt that we have the right to collect. When we forgive that person, it is like we are assuming the debt that we are owed—like we are cancelling the debt. This means that we accept the cost of what the other person has done, and don’t hold the debt over the other person, in spite of our right to do so.
If we continue with the monetary analogy of debt, we can understand how it may be easier to cancel the debt, if the debt is small. For example, I lent you a dollar, but you don’t pay me back, I can remind myself that in life, it is only one dollar, and this doesn’t have a significant effect on my bank account. Another possibility is that people try and forget the debt when it is impossible to repay. For example, a person has taken a million dollars and will not ever be able to pay you back. You might say “I have to forgive you, or cancel your debt, what other choice do I have?”, meanwhile burning with resentment because forgiveness, or debt-cancelling, seems like the only option to move forward. In this case, real forgiveness has not occurred, because there has been no choice or shift in the attitude of one’s heart. Since there has not been real cancelling of the debt through a true acceptance of the ‘cost’ of the wrong act, no real peace will result. Sue Monk Kidd describes forgiveness by saying it “is a painful and difficult process. It’s not something that happens overnight. It’s an evolution of the heart.” In this way, it is when we truly see the ‘cost’ of what we have lost, or what has occurred to us, and choose to accept and release the debt we are owed, that have we truly forgiven, and will feel real peace.
The second metaphor is that of a judge. When someone has wronged us, we are in a position of power over them, as we have the power to punish them, or make them pay back their debt. We see examples of this in the Old Testament style of justice. Examples of this include vengeance, like ‘an eye for an eye’, which aims to equalize the parties involved, to make the wrongdoer suffer in the way the victim suffered. After all, isn’t this the only way to equalize a situation in which there has been wrongdoing?
It may seem like a good idea, until we consider that there is another way – the way Jesus showed us to respond to wrongdoing through forgiveness. There is no less justice in forgiveness, even though it is not punitive. Because he is in the position of authority, and because we have wronged Him, He gets to choose what is a fair punishment for us. Unlike us, Jesus is a perfectly just and fair judge, and has decided that He will be merciful and compassionate towards our wrongdoing. As victims, because we are in a position of power over the wrongdoer, we also have the opportunity to be merciful and compassionate. Instead of inflicting punishment to even the score, we can wipe their record clean. It is difficult, when using this analogy, to remember that justice may not always fit with our logic. When a judge pronounces a sentence, whether it’s logical or not in our limited human concept of justice, it is still justice since the pronouncement came from the jurist’s bench.
We all regularly practice forgiveness, and this demonstrates that we know how to do it. When someone accidentally steps on our toe or spills water on us and apologizes, we can say ‘not a problem, it’s fine’. We do this while rubbing our sore toe, and cleaning up the water, and move on with the rest of our day. We don’t spend time looking for the perfect opportunity to step on his or her toe, or humiliate the person by telling everybody at the office how clumsy he or she is. In that moment, we ‘did’ forgiveness. Forgiveness is much more challenging when the hurt was on purpose, or the harm more significant. It seems then, much more difficult to ‘accept and let go’, and ‘move on’. But, the ‘how’ of forgiveness is essentially the same. This doesn’t mean that it is easy to ‘accept’ and ‘move on’ but the internal attitude and action needs to be the same. Kidd’s quote, after all, reminds us that true forgiveness can be painful, and more like a process. This is especially true when our wounds are deep, and the wrongs were so pervasive that they have shaped our identity, and the way we live in this world.
We don’t have to forgive. But we do have a choice to make when we have been wronged. We can choose to remain angry at the person who hurt us, or we can choose to cancel their debt to us. This doesn’t mean that we don’t hurt any more, or feel the weight of the debt; it means that we make a choice to release them from paying the debt back, because they will never be able to do so. It is not an easy choice, but forgiveness is the only path that leads to peace. It may seem like a path that is murky and unclear at first, but in time, commitment, and anchoring ourselves in the grace and mercy of Christ, we can continue to walk towards forgiveness.
No one was able to capture the oppression of African American people better than Martin Luther King Jr. And yet, in being able to understand experientially and intellectually that struggle, he chose to lead people in a non-violent movement, with forgiveness at its heart. He urged people to “develop and maintain the capacity to forgive” as being “devoid of the power to forgive [means being] devoid of the power to love”. In this statement, King captures a kind of love that we can only really understand when we look at Christ’s work for us on the cross. In knowing Christ, and His great love for us, we can then forgive others, as we have been forgiven.
Written by Hillary McBride and Alex Kwee
Driving a car, once a watershed event that symbolized newfound freedom when we were adolescents, eventually becomes a mundane experience when we get older. The freedom has lost its thrill, and a car becomes instrumental in getting us places that we don’t necessarily want to go. Then we start to bemoan the frustrating experiences of driving a car, among which is getting lost or detoured when we expect to arrive on time. When you’ve been lost before, what did you do? Did you sit in your car and cry? Or did you stop to ask for directions, or figure out your bearings and google the directions on your phone? Or did you perhaps dig through the glove compartment hoping there was an old map in there somewhere?
When people come in to counselling, it’s like they’ve gotten lost metaphorically. Clients even use the word “lost” as it has great poignancy in a season of despair or struggle. Some people had a plan that looked good but ended up taking them straight into a dead end. Others knew where they were going at first but got detoured by events beyond their control, ending up in places they now have difficulty leaving. We can all relate to these experiences through the seasons of fear, confusion and loneliness that we go through in life. “Getting back on track” becomes the apt metaphor of finding our way back to living a meaningful and purposeful life.
A counsellor may be the one you stop to ask for directions from. He or she may help you to find the tools to go forward when you’re stuck, but what is the existential “road map” that you use to find our way back to happiness, the one that you will consult time and again to figure out where you are in relation to where you want to go?
That road map is within us. All of us possess it but few have discovered it, let alone learned to read and follow it. Yet those who stop to learn and follow their map persistently will find themselves happy, even amidst the pain of life. The compass “directions” on the map—like north or south, east or west—are our values. The goals aligned with our values are like the “destinations” we arrive at, that let us know if we are moving in the right direction. At the risk of belabouring the metaphor, if your plan is to head east, you must arrive someplace east, which could be Toronto (which is east of Vancouver, where we live). But even if you arrived at Chilliwack, you would know that you are heading in the correct direction because Chilliwack is east of Vancouver and on the way to Toronto.
“Stuck” or “lost” may look like a bout of depression, anxiety, addiction or some other perplexing condition you may be struggling with. A counsellor or psychologist may give you the strategies to overcome these difficulties, but applied in a vacuum, these tools still would not necessarily result in a rich, full and meaningful life; a pain-free life is not the same as a happy life, after all. As psychologists and counsellors, we liken therapeutic strategies to tools that fix a vehicle but don’t actually help you to drive the vehicle forward in a purposeful direction. This is why we begin working with every client with an exploration of his or her values, so that the tools they learn can be applied in the service of living a life rich with meaning and self-directed purpose.
The study of subjective wellbeing—or happiness, as it is popularly called—has shown that the happiest people on this planet are those who find ways to manifest their values every day in small and big ways. They may still struggle with their issues—for example, chronic pain, stressed relationships, or a propensity to be anxious—but no matter what, they live in deep fidelity to their value system. In doing so, paradoxically, without focusing on eliminating their problems, they enter into a deeper state of fulfillment and happiness. And they find along the way that their problems become smaller, less central to who they are or how they function, receding into the backdrop to join everything else in the “landscape” of their lives while they journey purposefully towards becoming more authentic. It is our hope that every client we work with will discover the truth of this for themselves.
Imagine yourself on a rooftop patio downtown Vancouver, looking out at the horizon. Everything around you comes into view: the tall trees, the boats in the harbor, the bridges stretching out over the water, and all the buildings. In it all, you see beauty, especially as the sun hangs perfectly in the sky, illuminating the structures all around you. The view is perfect as it is; you’re not focusing on how that old building from the 70’s clutters the skyline, how that one barge sitting in the water takes away from the view, or even how there is some garbage on the street below. When you look at the view, you see the entire view as it is, and enjoy how all the individual parts come together to form the whole.
When a person struggles with self-esteem, it’s like they look at the landscape of their life, and just see the parts that need work. Like in the example mentioned, this would mean looking at the things that get in the way, that are unfinished or ‘ugly’. As a result, typically when people learn to work on their self-esteem, they’re taught to focus solely on best parts of themselves as a way of shifting focus away from the unsightly parts. This involves an intentional refocusing on the best parts of themselves, instead of fixating on the parts about themselves that they feel shame about. Sometimes this can look like choosing to focusing on 5 things every day that they like about themselves, and then repeating these things to themselves over and over, day after day. This process is often called ‘doing affirmations’, as a person begins to affirm themselves for their strengths and achievements.
It is a useful practice to be aware of one’s gifts. And, it is certainly unhealthy to only ever be considering the negative aspects of our character and behavior. However, both these approaches fall short when we consider how Jesus sees us as his children. He sees us as we are, and loves us anyway. While we were still broken and enemies of His, He died for us. In fact, He didn’t see just the good parts of us and then choose to die for us so we could be reconciled with Him, He saw all the parts of us, especially the bad parts. Knowing all the ways we have hurt him, and would continue to do so, he chose to take all of our suffering and pain, and conquer it. Because He died for us, He put a price on our lives: the price of His own life. This means we are not just priceless by human standards, but we have the value of Christ’s life: to God, we are of infinite worth.
For some people, this is easier to understand than others. Most Christians can say with confidence we are broken, and need Jesus, but they struggle to understand the other side of it: our infinite worth in Him. For those who have a hard time understanding we are priceless to God, it means trusting that who He says we are is who we actually are. Sometimes this means trusting His word, and our worth in Him, more than our feelings sometimes. When Jesus looks at us, he see all of us: the good and the bad. And, he loves us just the same. As Christians, this can change how we work on our self esteem. We don’t have to affirm ourselves by just focusing on just the good, we can look at ourselves and find that our worth comes not from what we do well, but because Jesus chose to die for us. We are precious to Him, even in our brokenness.
If we return to the image of looking at the Vancouver skyline, and remember that we see beauty in it all, not because it’s perfect. We can even see parts of the skyline that are less desirable, but together they make up the unique and special sight. This is how Jesus sees us, and how we can learn to see ourselves. We could easily look at our lives and say ‘I’m only going to focus on the good’ or ‘if I take out the bad, then I’ll finally be able to love myself’. But we can learn to look at our own lives by seeing ourselves as God sees us, and as we see the horizon: taking the entirety of what is seen, and loving it as it is.
Undiagnosed adult ADHD is understood to be a chronic condition that can lead to many problems of living and emotional difficulties. Among the problems my clients struggle with are academic failure, abandoned college and university programs, employment instability, and mental health issues that develop as secondary issues to untreated ADHD–including addiction, anxiety, and depression. On a day-to-day level, untreated ADHD leads to significant chaos in the home life–disorganization, inefficiency, financial problems (due to lack of planning and impulse spending), and poor emotional regulation are some of the issues that drive my clients into treatment. The prevailing feeling virtually every client reports is that he or she is expending a disproportionate amount of energy and effort just to barely keep their lives from falling apart, let alone be able to enjoy quality of life. Relationships and family life are hit especially hard. In marital therapy, one client’s wife tearfully expressed how tired she was of living in “damage control mode” because her husband was so unreliable and disorganized.
Many of my adult clients are coming to understand for the first time that they have ADHD. This is not surprising as the diagnosis did not exist when they were children, and so they spent their developing years struggling and underachieving without understanding why. As adults, they are left with a chronic deficit of self-worth on top of the ongoing difficulties created by untreated ADHD.
There is nevertheless significant hope for the adult with ADHD. Below I list the basic steps to remediate ADHD and get life back in order.
1. Obtain a formal ADHD assessment
This should be done with a Registered Psychologist who is familiar with ADHD diagnostic guidelines for adults and has access to research-based standardized assessment measures. It is important that the psychologist you choose understands the nuances of diagnosing adult ADHD versus childhood ADHD, because most ADHD screening instruments are based on DSM-IV-TR diagnostic thresholds which were developed on children. (The DSM-IV-TR is the definitive manual of diagnoses published by the American Psychiatric Association.)
The adult who suspects that he or she has ADHD should also be careful of “quick and dirty” diagnostic screens that are sometimes administered by their family doctors. It is disturbingly common to hear of diagnoses being rendered based on quick questionnaires (sometimes the very same self-diagnostic questionnaires widely available online) that do not capture the full picture of adult ADHD. A number of GPs I have advised are surprised that this is an invalid way of diagnosing ADHD. Best practices suggest that multiple components are needed in ADHD evaluation, including taking a careful developmental history, obtaining collateral information from different sources (including, ideally, a primary childhood caregiver), and conducting careful differential diagnosis. Differential diagnosis, the process of identifying whether the symptoms are attributed to ADHD or some other condition, is crucial because other conditions (such as anxiety, depression, or a learning disability) can resemble ADHD.
After the only provincially-funded adult ADHD clinic closed down in 2007 (with an ever-expanding waitlist reaching up to 14 months), diagnosing adult ADHD now falls to psychiatrists, GPs, and psychologists. Since these clinicians may or may not be knowledgeable about assessing adult ADHD, it is important to choose a clinician carefully. Typically, a psychologist who also conducts psychoeducational testing will have the background and tools for evaluating adult ADHD.
2. Work with a psychologist to learn ADHD self-management skills
Many clients find a course of psychotherapy to be extremely beneficial for better understanding ADHD and developing a set of self-management tools based on cognitive-behavioural therapy (CBT). Given that ADHD is a chronic condition, learning ways to self-monitor and manage the condition is essential to life success. Self-management requires a combination of internal and external resources. An internal resource is one that is self-generated–e.g., insight, meta-cognition (thinking about one’s thinking), time management, and self-motivation. External resources are “props” that help to keep life organized–a planner, automatic reminders for appointments, logical organization systems, etc. Noted ADHD expert Dr. Russell Barkley likens external resources to prosthetics that help the ADHD mind to do its job.
Psychotherapy can help adults with ADHD to develop better self-monitoring and heuristic (trial-and-error) learning strategies to work out and keep refining a personal set of self-management strategies. Some of these strategies can be quite idiosyncratic. For example, one client, a university student, learned that she needed to allow herself more time to study for tests. By experimenting with different strategies (the heuristic process), she learned that doing a quick second review just before her test allowed her to exploit her working memory and improve her recall on tests.
Finally, given that ADHD is associated with poorer emotional self-regulation, psychotherapy can assist clients in improving their emotional and stress management skills, as well as address the secondary psychological issues (e.g. anxiety and depression) that may have arisen because of untreated ADHD.
3. Seek a medication evaluation by your family doctor
The most common psychotropic medications for managing ADHD are psychostimulants–examples include Adderall, Concerta, and Focalin. Non-stimulants, e.g. Straterra or Wellbutrin, may be considered if stimulants are not well tolerated. I encourage clients to speak to their physicians about the potential for a course of medication to assist in symptom management. Physicians will often use my report as the basis of their diagnosis and treatment plan. Medication can have its place in a broad-based, holistic ADHD management strategy (see below). I encourage clients to use medication in the spirit of Dr. Russ Barkley’s metaphor of the “prosthetic” allowing the ADHD mind to do its job effectively. For many adult clients, the increase in focus that medication can bring is very empowering and predicts even greater success in psychotherapy (otherwise even remembering to come for the appointment, let alone remembering to implement recommendations, can be a struggle). However, medication is not always necessary if psychotherapeutic and other strategies can be employed successfully. Among my clients, if medication is essential, I work with their physicians to develop a treatment plan that includes ongoing symptom monitoring.
4. Address ADHD holistically
Clients should employ a toolkit approach, bringing to bear whatever resources are helpful in symptom management, including medication (if warranted), psychological and behavioural coping skills, lifestyle modification (including nutrition and exercise), and complementary alternatives such as yoga and meditation. Every client, if he or she is motivated and willing to experiment, eventually discovers a repertoire of strategies that is successful, allowing them to do more than they once thought possible.
“I’ve had it!” Every parent has experienced reaching the limit of patience and losing their cool with their ADHD child. Perhaps they may even cross the line and say words they end up regretting. The regret registers as quickly as the hurt look that comes over their child’s face, or the terrified look that acknowledges the power of a parent to carry out spirit-crushing threats. Many parents are familiar with the ensuing self-blame over damaging words that, once said, can never be taken back.
As a psychologist helping both kids with ADHD and their parents, I am familiar with the frustrations and feelings of inadequacy that loving parents can experience in their daily struggles of parenting an ADHD child. Because parents who have reached their limit may do and say detrimental things, I have summarized five coping strategies to help parents to keep their cool and love their kids through the tough moments:
1. Accurately attribute your child’s behaviour to ADHD, not a personal failing
A forgetful child is called irresponsible. A child with difficulty focusing and completing homework is called lazy. Another child who struggles to listen when spoken to directly is called rude or disrespectful. These words when spoken to a child convey personal failings that can damage their self-esteem and leave a lingering legacy of inadequacy and self-doubt. Remember that ADHD presents in ways easily mistaken for a moral or personal failing. Proper reattribution of the behaviour to ADHD can therefore help to reduce anger at the child and increase the capacity to parent lovingly through tough moments. Reattribution can take the form of consciously changing one’s self-talk from, “Johnny is so dumb for not being able to follow my instructions,” to “This is Johnny’s ADHD expressing itself.” Reattribution can also entail replacing charged or negative terms with more neutral ones, such as saying “inattentive” instead of “dumb.”
2. Focus on primary issues, not secondary ones
By the time parents come to me for help, there is often the sense that they are in crisis mode because the unmanaged ADHD has gotten so out of hand. Often I find that parents are overwhelmed because they are failing to distinguish between primary (or underlying) issues and secondary (or symptomatic) issues, and they are devoting scarce parenting energies to dealing with secondary behaviours that are driven by a more fundamental, underlying issue. Recently, one mother sought help to deal with a laundry list of problems with her son, “Tom.” Tom was oppositional, anxious, disorganized, failing in school, had low self-esteem, and there was significant tension in the family around Tom’s issues. After a couple of sessions with Tom, I found that most of his problems were driven by academic concerns – he was anxious and rebelled against studying because he lacked adequate organizational and study skills. Recognizing this helped Tom’s parents to focus on helping Tom improve his academic skills, pick their battles more wisely (e.g., they are no longer hell-bent on winning every argument), and feel less overwhelmed.
3. Forgive quickly
Let’s face it: Out kids can make us really mad sometimes. This is when the power of forgiveness can make a difference in how we cope. But what is forgiveness? It is easy to talk about forgiving but how do we actually do it? Forgiveness isn’t an attitude or a feeling. In a pragmatic sense, forgiveness is an act of giving up the right to stay angry at someone, with the understanding that you have every right to be angry and punish the wrong to obtain a “just” outcome. There is an implicit “justice seeking” mindset among parents who punish their children abusively – they carry out harmful punitive actions against their kids as “payback.” When parents forgive, i.e., give up their right to be angry and exact that payback, they will discipline with firmness and love but not punitiveness. A massive body of empirical and clinical evidence also indicates that they will feel calmer and cope better with their emotional stress.
4. Practice mindfulness
Mindfulness is a mental and emotional posture of neutrality and detachment. A central component of mindfulness is non-judgment. Mindfulness can reduce stress by helping parents to change their evaluation of stressors from “bad” to neutral. We naturally judge any negative situation as “bad” because it is unwanted. However, many of the stressors attendant to parenting a distracted and/or impulsive child are not bad in a moral evaluative sense. Stealing, hurting people and other moral transgressions are bad, but that same value judgment cannot be applied to your child’s ADHD traits. Moreover, stress itself is not bad – it is only stress (admittedly not good, but not bad either). The more we can see a trait or feeling as neither good nor bad but just is, the calmer we will be because we increase our acceptance of the experience and are more willing to work with it, rather than trying to get rid of the experience (after all, you would be more willing to have a neutral thing than a bad thing in your life). Take up yoga or meditation – these practices help to reduce stress by facilitating mindfulness.
5. Ask for support from your spouse or partner
In my clinical experience, the burden of dealing with the behavioural difficulties of kids with ADHD seems to fall on mothers. Typically, it is the mother who initiates the call, brings the child to my office, attends parenting sessions, reports ongoing issues and interacts with the feedback that I share. Many mothers that I work with report feeling stressed due to the lack of involvement of their husbands or partners. The burden of parenting behaviourally difficult kids needs to be shared. It is absolutely fair to ask for the support of your spouse or partner and convey an expectation of increased involvement. It is not hard to see that having added support will decrease your stress level in a number of ways, but sometimes asking for help is the difficult part as this can trigger conflict and bring up deeper marital issues. This is when a trained therapist can assist by helping couples to dialogue and agree on more reasonable parenting expectations. Asking for needed support and being able to count on that support is an important part of containing stress and preventing that scarce commodity of you from becoming depleted.