My initial contact with cancer patients was when I joined a group of psychologists in putting up the Cancer Support Program in a government hospital way back 1996.  For two years, we met with adult cancer patients and their caregivers to help them in their psychosocial care.  There, we listened to their stories as they dealt with the shocking disclosure, the decisions they had to make regarding their treatment, the sacrifices they and their families will have to endure, dreams that will have to die, the plans for a better life, however tentative, when going home.  Despite all these, in the program, we helped them celebrate what healing resources they have untouched by cancer and tap into them – their own bodies’ healing resources, remembering loving and good memories to uplift them, and sharing the love they have with their loved ones.

As the years passed, other cancer support groups were put up to meet the different needs of their members.  To mention two, there is the Cancer Warriors Foundation (CWF) founded by Mr. James Auste, himself a cancer survivor.  His foundation helps especially the poor children with cancer and their families emphasizing education, early detection, proper management and care.  You can know more about their foundation at  http://www.c-warriors.org/

Then there is the Carewell Community founded by Mr. Bobbit Suntay and his wife, Jackie, who passed away of cancer in 1995.  Their group “provides support, education, and hope to persons with cancer and their loved ones.” Again, you may check out their website at http://www.carewellcommunity.org/.

For me, the cancer patients are my teachers and I, their humble student.

In all the stories that they share, they only have one topic they talk about – their loved ones: people they love the most or who they are so angry at; the people who have hurt them or who they have hurt.  They talk about the valuable relationships they still have or have lost. They never talk about anything else—not money, not material things.  With their stories, they remind me that the only important thing in one’s life is our relationships that need to be nurtured and cherished.

Not later.

Not tomorrow.

But Now.

This post is written in honor of National Cancer Awareness Week, January 18-22,  2012

What is play therapy and why does my child need it? 

Play therapy is a form of psychotherapy for children conducted by trained psychologists/ therapists.  It is different from simply “playing” since the therapist utilizes different theory-based approaches to conduct the therapy.

How will play therapy benefit my child?

Your child can communicate and eventually “play out” his/her difficulties, overwhelming experiences or feelings through play in the safe and affirming environment established in the playroom.  Your child will have the opportunity to:

• Experience acceptance;
• Learn appropriate ways of relating and behaving;
• Express intense emotions and find relief from troubling feelings; and
• Feel affirmed and confident about himself/herself and his/her abilities.

Likewise, your child also learns to:

• Build self-esteem;
• Cope with fears and anxieties;
• Gain a sense of control over his/her world;
• Develop inherent competencies and talents;
• Identify and manage emotions appropriately; and
• Socialize and interact with peers in appropriate ways.

What is my role as a parent or guardian? 

As a parent or guardian, you play a very important role in your child’s progress in and outside therapy.  Your cooperation in bringing your child to weekly sessions is most valuable.  With the support and collaboration of the school and other professionals working with your child, you can be guided to ensure your child copes well with the difficulties he/she faces.

In addition, parenting sessions and conferences are conducted regularly to address your concerns, chart progress, and give tips on parenting.

How long should my child be in therapy? 

With your child’s developmental level and reasons for referral in mind, the therapist identifies specific goals your child needs to achieve while in therapy.  The child’s own pace to progress towards these goals will determine how long he/she will be in therapy.

Regular (usually weekly) individual and group play therapy sessions are usually offered.

In 2009, our consultant Ria wrote a post about how we can help one another find the rainbow after the storm. Here is a re-post of that article dated November 2009.

Over the weekend Typhoon Ondoy changed the lives of countless Filipinos. He spared no one. He knew no class, race or status. Hand in hand with Mother Nature, Ondoy showed us that we are not defined by what we have or who we are. Stories of loss and devastation are endless, as our stories of survival, gratitude, and yes, hope.

Today, we all begin the monumental task of rebuilding, not just homes, but lives. Many families are literally starting from scratch. As they pick up the pieces and start over, let us all offer up our prayers and support to them. Beyond prayers, let us also all get together and pitch in. There are countless ways in which we all can help. Many of us have taken on the challenge: donating, volunteering, spreading information. And yet, some still ask, how else can we help?

Over the next few days, psychosocial rehabilitation will be an increasing need.After the body is cared for, let us also find ways to help care for the souls of our countrymen. This is another way in which we can help.

If what we were witnessing unfold on television was heartbreaking, I can only imagine how terrifying and traumatizing being in that situation was and still is. When faced with such trauma, it is possible (and highly likely) that individuals undergo an emotional crisis or some form of post traumatic stress. We might never know the extent of their grief or bereavement. They may be overwhelmed by feelings of anxiety, depression, despair, frustration which may not necessarily be felt right now, but may escalate as the days go by. Post-traumatic stress can be like a devil in disguise. We may think our friends and family are okay and that they are coping with it but then symptoms and manifestations of PTSD may come like a theif in the night. Read more about PTSD here.

How can we help?
1. Lend a listening ear. Listen to their stories and help them process and grieve. You do not need to offer advice. A sympathetic ear and sincerely caring for what they have to say can go a long way.
2. Offer the right words of comfort. Many of us may think we are comforting with our words, but sometimes, we inadvertently downplay their feelings, thus leaving them even more grief-stricken or pained.
3. Find story books to help children cope with their feelings of loss and devastation. Also, allow them to ask questions and answer these as honestly as possible. This will help them feel safe and assured with what is going on around them.
4. Do not underestimate the small stuff. Picking up their mail, taking their kids out for the afternoon so they can have some time to themselves, or perhaps cooking them a home-cooked meal can be very helpful and comforting.
5. Lastly and most importantly,do not assume you know the answers. If your friend or family member is undergoing emotional problems or distress, consult a psychologist, grief counselor, psychiatrist, priest, and similarly trained professionals.

We are a group of Filipino Psychologists focused on promoting our clients’ psychological health and well-being. We work with individuals, groups, and families to be empowered and attain better emotional wellbeing to function as productive members of the community. Our goal is to assist in bringing out the best in people and improving their quality of life.

Since 2001, we have dedicated ourselves to provide quality clinical psychological services, consulting and addressing the needs of our clients. As one of the pioneers of group practice in the Philippines, our consultants have engaged in their own clinical work for a minimum of 6 years, to as long as 20 years, and have held various posts in the academe and hospital settings.

We also commit to train aspiring junior psychologists and fellow psychologists through our supervision program.

Read more about us here.

September 2010 marked my 7th year of service in Pangarap Shelter for Street Children. Just like that, seven years had already passed.Where did all that time go?

Looking back, I’d have to acknowledge that so many things have happened during those seven years.

I was initially hesitant to accept the part-time job working in an NGO.I just finished my Masters degree in Psychology, but I felt that I did not have enough experience. Was I ready to handle these street children? Was I good enough to fill the position? With these doubts and questions in mind, I took the job anyway, thinking that there is no better way to answer these questions than to plunge right in and give it a try.

I felt right at home in Pangarap Shelter. The staff members were warm and accommodating, while the administration was very approachable and supportive. Then you have the children!We had about 100 male adolescents in Pangarap Shelter, with their ages ranging from 12-20. Most of them are about 14-16 years old, who have experienced one or multiple forms of abuse – physical, sexual, and emotional abuse. In the streets, they were also exposed to various vices such as gambling and substance abuse (sniffing rugby or solvent, marijuana, shabu). I would say that most of the teenagers we had are smart, resilient, and ready to change and make their lives better. Well, some are more ready than others.

Working with street children is no walk in the park. I had my heart broken several times — when an adolescent I was working with suddenly decides to leave the shelter to stay on the streets, when a former resident of the shelter comes back to the shelter looking thin and malnourished, when an adolescent shoplifts from a convenience store. At times, when these adolescents misbehave, I can’t help but think if I’ve done everything I could to help them. Is there something I could have done better to help them make better decisions for them?

After having worked in Pangarap for 7 years, I realized that there is really just so much I can do for these teenagers. In the end, they themselves make the decisions about the course of their future. I’d like to think that during their stay in Pangarap, no matter how short it may have been, seeds of goodness and kindness have been sown. I may not see the fruits of my (or shall I say Pangarap Shelter’s) labor immediately, as the seeds need time to germinate, but I am hopeful that they make something out of their lives. While I’ve experienced sadness and frustration over certain teenagers, I’ve also experienced utter joy whenever they graduate from school, when I see changes and improvements in their behavior, when they finally have the courage to talk about their painful feelings, when they tell me they appreciate the work that I do with them, when I see them playing and laughing, as if they did not experience any trauma in their lives.

Working with street children has changed me.It made me realize how amazing and resilient the human soul truly is. I’ve been witness to having these children bounce back from adversity, forgiving those who have inflicted so much pain in their life and moving forward from this. They served as an inspiration to me when I had to undergo an agonizing time in my life when I was thrown one problem after another. At that time, I kept on telling myself that if these children were able to overcome life’s blows, so could I.

I never liked reciting in class when I was still in school. It just made me nervous doing so. But, I would still do it, because I understood that I had to, even if my heart sometimes pounded in my chest or I felt a little bit lightheaded.

I remember a girl in my class though, Maria* – she was a nice, quiet girl. Whenever teacher called on her, she would obediently stand up, but then would literally look like she was unable to move or speak; she would then turn red in the face, and shed copious amounts of tears, as the confused teacher looked on. Eventually, my classmates and I just came to expect that she would behave this way every single time.

We both dreaded recitation, but hers has gotten to an extent where it affected her ability to perform well academically. Rather than merely being afraid, Maria was anxious and most likely severely so at that.

Anxiety in children is quite common. In every stage of development, there is a new challenge to be tackled, and this brings with it a whole host of fears and anxieties. But what is the difference between fear and anxiety?

Fear is directed at something concrete, a “real and present” danger so to speak. Coming face to face with an angry dog or seeing strangers approaching for instance could have real consequences to a child’s sense of safety and stability. On the other hand, anxiety is often a generalized, vague sort of fear, a foreboding or dread that something bad is going to happen but not really being clear about what this is. It can be paralyzing and may not serve a real protective purpose, as is in Maria’s case.

Generally, fears and anxieties serve a purpose in children though. It prepares them to fight or “take flight” and in many ways protects them. Having a sense of danger alerts a child not to play with knives or matches, or climb an unstable structure. Moreover, our children’s fears and anxieties tells us that our children are developing normally. For instance, fear of strangers and the dark are typical fears in early childhood, because this is the time in their life when they are realizing that the world is larger and not so predictable as what they originally thought it was. It is normal to feel some trepidation.

What’s more, people in different life stages experience fears and anxieties because it helps them pull back a bit, assess their emerging skills, before proceeding to tackle new demands that life brings. Once the challenges are hurdled, the anxieties are then mastered and resolved. If you are a parent, you may probably recall your toddler’s scream of terror at seeing their first mascot at a birthday party. As they began to get exposed to more birthday parties (and more mascots) the terror may have eventually dwindled to a slight trepidation. Or you may remember your child’s first day at preschool when they clung to you and refused to let go. But once they got over that hurdle, after a few weeks, going to school on a daily basis became a breeze. As a teen ager, you probably recall receiving your first call from your crush or inviting your date to the prom, and worrying that you might get rejected in some way. Getting your first “yes” or finishing a successful conversation probably set you well on your way to entering the world of romantic relationships. All these are normal, typical fears that really come with the age and stage, and help us face more and more challenges that are appropriate for our age, with confidence.

However, there are 4 “D’s” that may indicate if anxiety has gotten out of hand:

• Disruption – When anxieties tend to interfere with your child’s daily routine, then, this may be beyond what is typically expected. Carina,* 13, has been refusing to attend school for almost a year. No amount of rewards, reinforcement, or punishments worked. She would promise to go to school the night before, but, once the day arrives, she would get dressed but struggled with her parents to get into the vehicle and take the ride to school. She went on like this for 2 more years, and subsequently fell far behind her peers. This presented additional problems because she also felt depressed at missing experiences that her classmates went through.
• Disproportion – When anxiety reactions are far beyond what the situation calls for, then, this may as well, pose a problem. Maria, my classmate, definitely demonstrated this. She froze, turned red, cried ceaselessly until attention was turned away from her. It did not matter that questions were benign or simple, or whether the teacher was gentle or strict, she still reacted with extreme anxiety this way.
• Distress – When the amount of distress also is beyond what the situation calls for and serves no purpose anymore, then this may be a cause for concern. Different children show their distress in different ways. *Shiela screamed and cried every morning, refusing to let her mother leave her in school. She was inconsolable for hours, and only calmed down when her mother picked her up. On the other hand, Jonathan* was unable to speak in other settings outside of his home, like in school, in malls, and even church. His parents and teachers could not believe he was anxious because his face was often impassive and he never cried. He just did not utter a single word or sound, even when someone was speaking to him, whenever he was out of the house.
• Duration – While typical anxiety lasts a short period of time and gets resolved on its own, a longer time frame may signal a red flag. For instance, Shiela was never able to hurdle the anxiety of separation. After 6 months, she still continued showing extreme distress and subsequently had to stop going to school for a year. Jonathan continued to remain silent for almost a year, until his teachers realized that his schoolwork was getting affected by his inability to speak, despite his good intelligence.

In typical situations where we think our child are more “wired to worry” some helpful behaviors may include showing acceptance and not blaming them for their behavior, listening to their anxieties and helping them find concrete and doable ways of solving their problems, helping them be aware of how they are feeling – awareness is the first step to finding solutions, being gentle and patient with them, and exhibiting confidence that they can hurdle their anxieties and fears. In more extreme cases where anxiety persists and fulfills the “4 D’s”, it may be helpful to seek professional help, from psychologists or psychiatrists who understand the phenomenon of anxiety in children; it may also be helpful to collaborate with all the other people in the child’s environment until the problem gets resolved.

I sometimes wonder about Maria, the rest of my memory of her somehow seems blurred – did she get transferred to another school? Did she eventually get to a point where she spoke comfortably after being called by a teacher? I do wonder how she has turned out now, I hope that she had enough support and encouragement from people around her, parents, teachers, maybe even friends and she has made it through. As for me, I still dread recitation – now why did I sign up to speak at that convention this August?…..

Many people first learn of Autism through the media. A few years ago, an ad came out on TV with a child banging his head on the wall, which was meant to develop Autism awareness. For those who watched the movie Rain Man, they might have formed the impression that a person with Autism is somewhat odd but has certain exceptional skills like dealing with numbers, such as what Dustin Hoffman had in the movie. The TV program, Grey’s Anatomy, also featured a doctor with Asperger’s Syndrome, who was highly intelligent and skilled but who had difficulties relating socially with her colleagues. I myself first encountered Autism through the TV show, St. Elsewhere, a hospital drama back in the 1980s. One of the doctors in the show had a son with Autism who exhibited behaviors like rocking himself while seated on the floor, having severe tantrums, and not being able to express himself verbally. The above examples reflect some of the efforts to make people more aware of Autism. Unfortunately, there are still misconceptions about it, such as when the term “Autistic” is used as a derogatory term to insult others. In addition, the common understanding of a person with Autism as someone in his/her own world (“may sariling mundo”) is quite limited.

Autism falls within the Autism Spectrum Disorder (ASD), which as the name implies, is a range. Some people in the spectrum exhibit more severe difficulties whereas others exhibit milder ones. In addition, people with ASD are unique individuals with their own strengths and resources. Nevertheless, people with ASD exhibit three common areas of difficulty: communication, social, and a restricted pattern of interest. However, it is important to note that not all the sample behaviors listed below would manifest in every person within the spectrum.

1) Communication problems include:

• Understanding and using verbal cues. Individuals with autism might talk in a monotone, end each sentence in a lilting manner as if asking a question, or fail to modulate the volume of their speech.
• Understanding and using nonverbal cues. They might invade the personal space of others, exhibit a flat facial expression, and not understand other people’s gestures and facial expressions
• Starting, sustaining, and ending conversations such as intruding on conversations or be too quiet or talkative during conversations
• Delays in language development such as speech delays, use of their own language or “jargon” or exhibit echolalia where they repeat what they hear from the TV, radio, or other people out of context
• Lack of expressive language skills. For example, some do not develop spoken language despite having no problems with hearing

2) Social interaction problems include the following:

•  Failure to develop peer relationships as expected of one’s age. They may, for example, have difficulty joining games, playing with others, and following game rules; they might be too insistent in doing things their way and not have the capacity to compromise.
• Difficulty establishing or sustaining eye contact. They might not look people in the eye when talking to them and need prompts to establish eye contact; they might look at people and things from a sideward angle
• Failure to seek others out to share activities or interests. Children with autism, for example, might be content to play alone and not seek out others to share their enjoyment.
• Lack of social or emotional reciprocity. For example, they might appear indifferent to the emotions expressed by other people and be unable to put themselves in the shoes of another person

3) Restricted pattern of interests. These can include the following:

• Preoccupation with certain topics or things – for example, they might show extensive knowledge about their areas of interest (e.g., dinosaurs, planets, human anatomy) as reflected in their speech, play, and drawings
• Difficulty adjusting to changes in routine – for example, they might get upset when plans change; they might exhibit rigidity in the way they want things to be done (e.g., wanting to follow one particular route to go to school and back home)
• Preoccupation with parts of objects – for example, instead of playing with a toy car in the usual manner, they might be more interested in spinning its wheels
• Repetitive motor mannerisms – for example, they might flap their hands when they get excited or upset, or exhibit unusual movements that do not serve any apparent purpose.

Recent studies in the U.S. show that characteristics of ASD manifest as early as the toddler years. These include a failure to understand gestures (e.g., they do not gaze at the direction in which their parents point), failure to reciprocate through eye contact or expressing emotions when their parents try to engage them in play or conversation, not engaging in symbolic play (i.e., using an object to represent something else – like using a banana as a pretend telephone), and exhibiting repetitive behaviors (e.g., instead of exploring different ways of using a toy, they might just keep banging it).

For many years, Agnes painfully admitted being physically, verbally and emotionally abused by her ex-husband.  A year ago, she managed to separate from him, and is currently living overseas.  “Every time he hurt me,” she reported, “he apologised and acted really repentant.”  And this often led her to take him back, believing what he told her that only she can make him better.  After all, he promised never to hurt her again.  And she believed him.  Only thing is, he did it again.  In fact, he did it again, and again, and again in the 12 years they were together.

Women like Agnes often have a hard time seeing what appears to be obvious for many who see the relationship from outside looking in.  Somehow, they find some reason within themselves to really believe that they were helping their partners become better persons.  For some of these women, they see themselves as some kind of martyrs who need to suffer in order to fulfil their purpose in life, in being some kind of saviour to their man.  For others, their values have misled them to think that they are meant to stay in their marriage for life, despite and in spite of their suffering.  They might even use some religious belief to justify needing to endure such sustained pain.  Still others mistakenly think that having an intact family is ultimately still better for their children, even as the children, whose interests they are so concerned about, often witness the abuse first hand.

Like Agnes, the road to emancipation from the clutches of an abusive relationship is a long and arduous task.  There are generally 4 stages that battered women go through before they start taking care of themselves fully. These stages can be loosely summarised as follows:  1) denial; 2) guilt; 3) enlightenment and 4) responsibility.  Not all abused women go through all these stages, and some feel extremely powerless to move along and get stuck in one stage or another.

The first is denial.  For the longest time, battered women are in denial that they are being abused.  They may even erroneously think that this is typical of any relationship.  Those in this stage sincerely believe that abusive episodes are isolated and will not happen again.  They will even create reasons why their spouse had hurt them in specific instances to excuse them.

The second stage is guilt.  At this stage, the battered woman realises that abuse situations are not isolated and it can happen again.  However, they also think that they were at fault in those situations when they were hurt.  They must have provoked their husbands into doing this to them, and in some twisted way of thinking, that they actually deserved being hurt.  So, they try very hard to live up to the expectations of their partners.

The next stage is enlightenment.  Women who experience this stage are now convinced that they are being abused not because of their own fault, but because of their partner’s misgiving.  They know that it is the husband’s fault and being hurt and put down can no longer be justified by their partner.  Nevertheless, women in this stage still harbour the hope that their husbands will change for the better.  As such, they stay in the relationship.

Responsibility is the final stage in this difficult process.  In this stage, battered women come to realise the fact that nothing they can do or say will ever change their partners.  He and only he can change himself, and this will only happen if he realizes the error of his ways.  This is often the stage when a woman leaves her partner to rebuild her life.

It took 12 long years of suffering for Agnes to start admitting that she was powerless in changing her husband.  She soon found out that she can live separately from him and recreate her life.  She was afraid, but she took a leap of faith.  She knows that this decision took some years to make.  At that point, she felt that she had nothing to lose.  In so doing, she also began to assist her children in rebuilding their lives and their sense of family.  In the safety of a different environment and in the company of supportive extended family and friends, they are learning to live as a real family.

I enjoy watching the TV show, Clean House. It’s a US show where a team of designers renovate a few rooms of a family’s house. Usually, the common problem is clutter and disorganization—just too many things and no place to hold all these items. One of my favorite couples was a police sergeant and his fiancée. They were living together for two years but one look in their house, one could see that if they don’t clean up their mess soon, no wedding was to occur. What I like about Niscy and her team of designers is that they ask three basic questions to every couple:

1. What exactly is the problem?
2. What is your personal style and what dream do you have for this particular space?
3. What are you willing to give up to attain this dream?

To answer the first question, the problem was that Mr. Sergeant collected too many things like shot glasses. He was the one with a collection of stuffed toys! Then he had over 200 Harley-Davidson (HD) shirts which were gifts from his father from his travels all over the US. What about his fiancée? Well, she had right out there in their bedroom her wedding gown from a previous marriage. And I meant out there—though still in its box, it was open and on the floor, not in some upper shelf in her closet! In this portion, couples usually play the blame game here. It’s his fault, his mess! Or her fault, her mess! Convince him to give them all up! Tell him/her let go of his/her stuff! It’s a good thing the designers refuse to be manipulated into joining the fray.

The second question is easier to answer: What dream do you have for this particular space? What is important at this point is that both parties are asked the same question. For this couple, it was their living room area and bedroom that needed renovation. The living room was actually like a storage area with useless furniture and things just strewn all over the place. The bedroom contained all the HD shirts, stuffed toys, and the wedding gown! Moreover, he promised her a home entertainment system. The team made sure that as they come up with their design, they incorporate the couple’s individual tastes and personalities.

But getting their dream has a price tag—they have to give up things in their house—be it personal collections, furniture, everything useless to them and sell them in a garage sale. The money obtained there is used to renovate the rooms of their choice. So enters the third question, “What are you willing to give up to attain this dream? This question, for me, is the most important and the critical factor in cleaning up any couple’s mess. It is also the most difficult.

Here, the blame game can come in again and not one party would want to give up anything. Mr. Sergeant refused to give up the Harley-Davidson shirts and for good reason—they were of sentimental value. They were gifts from his father who long passed away. As for the wedding gown? No way! His fiancee was keeping it to give it to her daughter. This is where I admire the designers as they navigate this tricky area. At times, they were blunt. “You’re a grown man. Give up the stuffed toys!” Or, “Having your wedding gown from a previous marriage for him to see everyday?! Tsk. Tsk. Tsk.” Compromises start here too—and the designers show it by example, like “Here’s what, I’ll make you keep only a couple of stuffed toys but give up the rest!” or “Okay, you may keep 10 shot glasses but give up all the others.”

The thing is, once one of the two initiates letting go, it starts the ball rolling. This is the leverage the designers then use on the other partner. “He gave up all the shot glasses. What are you willing to give up?” “She gave up her dolls, what are you willing to give up?” And as more and more “my” things are given up, more space is now created “for both of us as a couple.”

How did this happen? Commitment happens. It has more oomph when said in Tagalog, Pagtataya. “Nagtaya siya. Ano naman ang itataya mo?” When both parties know what the other has given up, resentment towards the other decreases and appreciation increases. The blame game vanishes. I remember when Mr. Sergeant was taking out the HD shirts to sell in the garage sale, he cried a bit as it pained him to let go of his father’s gifts. His wife saw this and went to him to give him a hug, realizing this as well. But they continued putting into boxes things for the garage sale. The wedding dress? She gave it up and during the sale, her daughter actually bought it!

In the end, this couple raised more than enough money to have their living room beautifully redecorated with new furniture and and a bedroom that was kept faithful to their dream. Mr. Sergeant still had memories of his father as the designers framed one of the Harley-Davidson shirts and put on the table other mementos. She got the home entertainment system that he promised. And space as a couple? Definitely seen and felt in their newly renovated rooms. There was the “we” space which is actually “his” and “her” space integrated—sacred space for their relationship to move towards marriage.

I write this not just for married couples out there as a reflection point on their state of marriage and how perhaps they can improve it but I also write this for couples who are thinking of getting married. As you commit to your partner, there will be always something you need to give up, usually something from your past or single ways. It may be scary to get out of your comfort zone but you have to give space to the possibilities of couple-hood to come true. And as couples na nagtaya realize, the effort to make ‘sacred space for both of us’ is well worth the giving up.