The Secret to Managing Anxiety? Sometimes You Just Need a Good Fart Joke. Book Review: Silent but Deadly By Kirsten Bell

Silent But Deadly Book Review

The Secret to Managing Anxiety? Sometimes You Just Need a Good Fart Joke.

In my work helping clients manage anxiety, depression, and complex trauma (PTSD/cPTSD), we spend a lot of time talking about the crushing weight of keeping up appearances. We are all policing our thoughts, our emotions, and our bodies, trying desperately not to mess up.

That’s why I absolutely loved Kirsten Bell’s hilarious book, Silent But Deadly.  It’s an anthropological romp that dives straight into the "un-askable" questions of polite society: why do we laugh when someone rips one? Why are Americans obsessed with body odor? And what’s with the British obsession with dogs? 
 

Bell is an Australian social anthropologist (and Visiting Professor at King's College London, so she knows her stuff), and she delivers a straight-up, no-messing-about, laugh-out-loud analysis. 

Why I’m Recommending a Book on Taboos to My Serious Clients:

It’s Permission to be Human: The core of anxiety and cPTSD is often a terrifying fear of being "found out" or judged. Bell’s analysis is a brilliant, funny antidote. By showing how ridiculous and arbitrary social "rules" are—from which words are acceptable to which bodily functions must be hidden—she gives you permission to laugh at the pressure and loosen the reins on that exhausting self-control.

A Healthy Break from Heavy Topics: Healing depression and trauma is deep, serious work. Sometimes, the most therapeutic thing you can do is engage your curiosity and find some joy. This book is a delightful way to activate the lighter side of your brain without abandoning the critical thinking your professional mind craves.

The Power of Impeccable Insight (with Giggles): While you're giggling at her Tom Sharpe-esque wit, Bell is sliding in a tonne of information. She’s funny, smart, and her notes are impeccable—the perfect mix of authority and accessibility. It shows you that deep insight doesn't have to feel like a heavy academic burden.

The Takeaway for Your Mental Health:
Silent But Deadly is a five-star delight and an excellent reminder that beneath the lawyer, the doctor, or the manager, we are all just complicated, slightly smelly humans subject to weird cultural rules.

Reading this and ready to move past the "silent but deadly" fear of judgment and start living with more authentic freedom? Email ellen.whyte@gmail.com or WhatsApp: +44 7514 408143 me, and we set up a free 15 minute chat.

Can You Trust Therapy Ratings? Why High Ratings Might Be a Warning Sign

What you need to know about ratings and therapy

Ratings are everywhere. From finding my dentist and GP to choosing a taxi or a restaurant, online reviews are the standard. Clients looking for therapists want to see them too. When they see a therapist with no ratings, they wonder if something is wrong; a therapist with lots of five-star reviews seems amazing.

It may seem counterintuitive, but if you want a good therapist, look for someone who has only a handful of ratings. This is because therapy ratings are generally misleading and often dangerous. Here’s why.

Privacy, Ethics, and The Data Minefield

We’re getting better about talking things out, but for many, mental health issues remain taboo. Working internationally, I know that being known as a person who is depressed, anxious, or seeking help can affect your livelihood. You can be passed over for promotions, and families may insist on ending relationships if they discover someone is in therapy.

It’s not fair, but it’s how things are. Decent mental health practitioners do their utmost to ensure privacy. I am focussed on keeping things super private: I do all my own paperwork. My peers worry about this, too. They fire gossiping staff and keep client records inaccessible.

This commitment means we are extremely careful with listings. Contact information is fine, but ratings are tricky because they automatically identify clients.

Your Data Is Worth Millions (Literally)

Your data is worth money!

Wellness apps and big companies gather client information to share or sell it for profit. This happens all the time. BetterHelp Mental Health App was fined $7.8 million for selling client information to Facebook, Instagram, and other corporations. They are not the only ones; mental health sites do it, hospitals do it, and online services lose it on a regular basis even in countries with lots of regulation like the UK.

A happy client may fill out a private feedback form thinking it's anonymous, but a week later, the PR department or some drug company is texting or phoning with special offers. The people who design these systems do it for money; they don’t care about our ethics.

Today, therapists must have online profiles, and that means ratings. Clients expect them. It’s natural because they are focused on finding a good therapist, not on the privacy risks. Because of this, it is now part of our ethics to tell clients how reviews may affect their privacy.

The Problem with Misleading Reviews

The Nature of the Work

Psychology is a blend of art and science. Most clients are happy, but sometimes there is an occasional mismatch. Usually, we adjust the approach or I help the client find a better fit. Very occasionally, someone is unhappy. One-star unhappy. Feeling disappointed is perfectly human.

The truth is, therapy means working with people who are often in deep distress, sometimes dealing with anger, personality disorders, or addiction issues. I handle this with professionalism, care, and a good dose of patience.

Fake Reviews and Con Artists

I found my dentist and doctor through reviews

People who are unwell can react in difficult ways when upset.  This includes stalking,accusations of mistreatment and so on. It can be quite frightening. Interestingly, it is impossible to tell a fake one-star review from a real one.

For example, a respected colleague had a perfectly proper-looking one-star review that was completely untrue. The client wrote, “he didn’t bother talking to me or listening,” when the case was, “when I demanded drugs, he talked rehab instead of offering to be my supplier.”

There's another issue, too: Con artists coerce and pay for reviews. One of the most notorious con artists in Malaysia has over 100 reviews. He runs his own ‘courses’ and ‘association,’ and if you sign up, you have to rate him at five stars. Because it’s not illegal to pretend to be a psychologist, there’s no stopping him or his friends. 

Putting it all together, mental health service reviews are a minefield.

What Can You Do?

To find a safe, ethical practitioner, I suggest:

• Avoid extremes: Too many reviews often signals a con artist or a practitioner who prioritizes marketing over client safety. I avoid anyone who nets more than six reviews a year.
• Look beyond the stars: Consider that some one-star reviews may be inaccurate and reflect a client’s distress, not the therapist’s competence.
• Find their voice: If the number of reviews is reassuringly low, look for a blog or social media account. This lets you see how they think and work.
• Test their ethics: Ask if they want a five-star review in the first session. A proper answer would be a cautious thank you, followed by a short chat about the privacy implications. If they don't offer this, run!

How I Work with Ratings

Therapy is about connecting

I finally listed on Google this year, in 2025, and frankly, I agonised over it. I wrote a note about privacy and told my clients about the listing. I was grateful that many shared the listing, and a few wrote reviews.

I see about 60 to 80 different clients a month and I have 6 reviews. I am still in two minds because I’m very invested in privacy, but I can't work unless I have some reviews. So I’m choosing to be grateful.

To see if my service suits you, I offer a free 15-minute first chat where we discuss your therapy goals, confidentiality, and other terms. That way, you can make an informed decision based on connection, not just stars.

Originally written in 2022 when I was practising in Malaysia. Updated in 2025 to reflect continuing global privacy and ethics issues in mental health including recent UK data scandals and misuse of client information. 

 

Understanding And Managing Anxiety: A Survival Guide

WHO: 1 in 8 people suffer from anxiety

Anxiety is a feeling of dread that comes from knowing there’s something difficult ahead. Sometimes it can be an actual event, like an angry customer, an important exam, or a public speaking event. Anxiety can also pop up just because of a random thought.

While it’s normal to feel a touch of anxiety here and there, it can be bothersome. In addition, anxiety disorders are on the rise.

In 2019, the World Health Organisation found that 301 million people were living with an anxiety disorder, including 58 million children and adolescents. During the Covid-19 pandemic, they estimate this number increased by 26-28%.

If you have anxiety, know you’re not alone! Also, you need not suffer. Anxiety can be upsetting but there are ways to manage it.

What Is Anxiety?

Anxiety is a stress reaction. Mild anxiety typically includes quicker breathing, a rapid heartbeat, and tense muscles. Moderate and severe anxiety can also make you feel sweaty, give you an upset stomach, cause rashes and more.

Anxiety can be really useful, like if you’re about to start an exam, it can help you focus. But anxiety can also overwhelm–and it can feel bad!

Why Do We Have Anxiety?

Anxiety is a stress reaction that comes from your brain and body trying to look after you.

How does that work? Human beings are optimized to survive.

Our ancient ancestors lived in caves and huts, battling six-meter-long giant monitor lizards and three-meter-tall cave bears. With giant predators, you don’t want to hang about thinking what to do.

As a result, we developed efficient AUTOMATIC survival systems.

Although we’re not battling giant animals anymore, our brains and bodies have kept the ancient systems.   

How Your Body Works When Anxious

As your stress levels rise, your brain preps for disaster. It works to make you quick and strong.

Peter Weller as RoboCop (1987)

What you may notice is that your breathing speeds up. Your lungs suck in oxygen and dump it into your bloodstream. Your heart pumps fast, powering oxygen-rich blood throughout your body. That oxygen powers your muscles.  

What you don’t notice is that your brain switches off all the systems it doesn’t need for now: digestion, growth and reproduction.

What you do notice is that because your body works away, you overheat–so you sweat to cool yourself down.

Plus, another thing you don’t consciously notice is that your brain dumps stress chemicals into your system. They’re designed to make you super sharp and efficient.

Result: you’re geared up better than RoboCop for trouble. The thing is: there’s no cave bear to fight.

How to Manage Anxiety

You can’t poke your brain with a Q-Tip and tell it to stop.

Luckily, you can disrupt the auto-system.

Step #1 How To Breathe To Fight Panic

The key is to take it really slowly. Inhale through your nose over a count of two or three, hold your breath for a further count of two or three, and then exhale slowly–yes, over a count of two or three.

Remember that at this point your body and brain are trying to hit overdrive. So when you mess with that, your brain will recalibrate and then put on the brakes.

Step #2 Give It Five Minutes

Getting your brain to power down will take time.

Take three or four super slow breaths, then give your body time to get itself together. It may take up to five or even fifteen minutes.

Here are some nice ways to distract your mind so your body and brain can get on with the slow-down back to normal:

·         Have a cup of tea.

·         Listen to some cheerful music.

·         Pet the cat or take the dog for a walk.

Also Step #2 Engage in Positive Self-Talk

When your mind goes into overdrive, it can come with negative thoughts. It’s often part of a stress reaction.

If you like, there’s a video that describes how that works here.

If It’s not a huge issue for you, all you need to do is to center yourself.

As long as you’re not a serial killer, you’re probably a perfectly nice person–not perfect, just all kinds of human.

So an affirmation is the way to go. Here’s a good one:

What I’m feeling now is merely my automated system at work. I’m capable and competent. I can handle this.

Take another slow breath.

Step #3 Finish With A Focus On The Present

As you go about petting the cat, Marie Kondo-ing that drawer, or remarking how good your tea is, your stress thoughts will bounce about for a bit.

When you hear them slow down and go, focus on the present.

Counting fives is useful: five colours in the room; five types of square things you see; five things you’d love to do this weekend.

A nice steady flow of positive thoughts will help to ground you, keep you from getting overwhelmed, and push your mind into happier directions.

Final Thought: When To Seek Therapy For Anxiety

The system above should help you manage anxiety. It isn’t an immediate slam-dunk, it will take some practice, but it’s safe, sensible and effective.

To give yourself an extra boost, do some basic background work to leverage and build your resilience:

·         Surround yourself with people who love and support you

·         Sleep 7 to 8 hours a night

·         Eat lots of fresh food and pile on the vegetables

·         Build daily happiness into your life

But, should your anxiety interfere with your daily life or upset you, then seeking help is a sign of strength. Message me today via email ellen.whyte@gmail.com or WhatsApp: +44 7514 408143 for your free 15-minute consultation.

Brain image by John Hain from Pixabay

Can't Find Your Keys? Think You're Losing Your Mind? Don't Panic! It May Be Simple Stress

Stress can mess with your memory

When your memory is shot, you might worry you have an attention disorder. However, it's important not to jump to conclusions.

Daphne can't remember a phone number two minutes after hearing it. She also keeps losing her keys. When she goes to the shops, she has to take a list with her because otherwise she buys everything except for the thing she went out to buy.

Daphne is convinced she has ADD/ADHD. Her attention is messed up, right? And from seeing TikTok videos, she knows that attention disorders are sometimes overlooked.

Social media is terrific for raising awareness. It's also helping people open up and talk about mental health, removing the stigma that has haunted so many of us.

However, social media has some negatives that can sabotage good information.

Understand social media

First, fear and drama sell

It's much easier to attract likes by posting about doom, disaster, struggle and anger than it is to tell a simple story about reasonable people coming together to implement reasonable solutions.

Second, information online has to be bite-sized to be popular.

That's a problem because mental health tends to be complicated. You can't condense a 120 minute Tarantino film into a 22 second summary without losing something.

Third, there is often no quality control, no expert review.  

Sometimes that's okay, especially if it's simple stuff, but with the penchant for fear and drama and the condensing, you can get some very poor-quality information trending.

In the first half of 2022 TikTok was hot on attention disorders. But did you know that poor memory is also linked to depression and anxiety?

Research shows that certain kinds of depression can come with poor memory. Also, certain types of anxiety interfere with memory making. It's not one size fits all, though. There are lots of people with depression who have an excellent memory and the same goes for lots of people with anxiety.

However, studies show that when you combine anxiety and depression, the combination typically wreaks merry hell with memory. And the thing is, you don't need to have severe anxiety or severe depression. It can be as simple as a bit of low mood and a punch of life stress.

Putting it together

So, where does this leave Daphne who keeps losing her keys and being stranded in the supermarket aisle?

Given mental health is complicated, I'd suggest she not look for a quick or easy fix. Like the tailors say, measure twice and cut once. Spend a lot of time figuring out exactly what is going on, and only when you're certain, look at management and treatment options.  

If Daphne has the funds and the access, she can go and see a psychiatrist, a medical doctor who specializes in mental health issues. She will have a long chat with Daphne and based on that, will then decide on the proper assessments to figure out what's going on.

This will likely take several hours and two or even three visits. At the end of that, she'll probably have a pretty good diagnosis at which point she can make informed decisions.

If Daphne can't manage that, she might see a mental health practitioner like me.

I'd start by asking questions:

• Tell me about your memory this week
• Tell me about your memory last year
• Tell me about your memory when you were a kid
• Do you have a family history of attention disorders, anxiety, depression or other issues?
• Are you on any medication? Because some meds mess with your mood and memory
• Are you menopausal? Yup, that can do it, too
• Been in any fights? Played rugby? Been in a car accident? Your basic physical trauma questions
• Have you recently had food poisoning? Because gut health is linked to mood and memory
• What kind of work do you do? Because certain chemicals like paint and insecticide… yes, you guessed it! Have an effect on mood and memory!
• What does your family doctor say about your physical health? Because certain physical issues like wonky thyroids can have an effect on mood and memory
• What's been going on in the last 12 months? Because too much change can have an effect on mood and memory. People don't always remember what's going on, so I have a 50+ item list to kick off with
• How's your sleep? Because sleep deprivation is a killer, literally, and it messes up mental health
• Do you overthink things? Do you ever get short of breath? Do you come out in rashes? Because I'm checking for anxiety
• When you were a kid, did you self-harm? Were you bulimic? Because people sometimes don't know they've a history of stress or anxiety and these issues can be related to anxiety
• What are your hobbies? Are you enjoying them at the moment? Because I'm checking for depression and low mood, both of which can impact on memory
• What's your family like? And tell me about your friendship groups. Connections matter. We're social creatures
• How much happiness is there in your week? I'm looking at daily patterns

As I'm not a medical doctor, I cannot diagnose. But at the end of an hour, I should be able to tell you if I think you need to see a doctor.

Also, I will be able to tell you if I think you have anxiety, depression, both or perhaps something else like a form of PTSD or whether you should consult an expert to see if you have an attention disorder.

Speaking personally, I'm fairly conservative when it comes to medication. As mental health is always tricky, I think it's safest to go for talk therapy first and if that doesn't work, to see about other methods to manage. Assuming of course that you're not in a crisis of some kind.

Surprisingly often, classic therapy approaches for managing anxiety and low mood are enough to bring about significant changes for anyone suffering from too much life stress.

Also, it can't hurt you and if we put in solid goals to make sure we can track progress, it's generally speaking a good first option.

I hope you find this interesting and informative. Thanks for reading!

Image by Tumisu from Pixabay

I Think Of Depression As Spots

Figuring out what's wrong is the first step to health

I think of depression as spots. When you have spots, the first thing is to figure out what they are. 

Maybe you have an allergy to a new washing powder. Maybe you are allergic to something you ate the night before. 

Maybe you have dengue or chickenpox or shingles. It could be acne. Maybe it's boils. 

Or a mosquito bit you. Or perhaps a cobra fanged you. It may be a perfectly simple heat rash.

Figuring out what's causing it will lead you to the appropriate action. There's no point in changing your washing powder if you are allergic to eggs or have chickenpox.

Depression is the same. There are lots of different causes and that's why there are various approaches for managing it. There's not one-size-fits-all.

So if you have depression and can't immediately tell why or what to do about it, that's exactly what I help clients figure out. Send me an email at ellen.whyte@gmail.com or WhatsApp: +44 7514 408143 and we'll work it out together.

Why I Offer A Free 15 Min Chat To Potential Therapy Clients

Target, senior executive office snoopervisor

I offer a free 15 min chat to potential therapy clients for three reasons: 

1) we talk online, so we need to make sure the tech works for us,

2) you tell me very briefly what your goals are, so we can decide if it's something we can deal with in therapy (because amazingly, I'm not a super genius who is trained in everything!). Also, what if you don't like me?, and

3) so I can tell you how confidentiality works, including emergency care, etc etc.

I do this because many people have never spoken to a mental health professional. This way, you get the intro quickly and easily. It helps you make better decisions.

Yes, it costs me time which is money. But so what? It's 15 minutes. I consider it a bit of public service.  

If you ask me, it should be an industry standard.  It's on my list of Laws To Implement when I become Mistress of the Galaxy :-)

A bit nervous and wondering what a first session is like? Read this post 

I'm Rebranding! And A Word About The Politics Of Mental Health Practice

I'm rebranding!  I'm the same person in the same place doing the same thing, but I'm changing my logo, website, blog and titles. The rebrand is because we are currently living in Malaysia, but we plan to move to the UK in late 2023.

Why rebrand? Politics! I think you'll find this interesting, so I'll explain.

Psychiatrists are medical doctors who specialize in mental health. Everyone else in mental health, therapists, psychologists, counsellors and so on, are not medical doctors.

While countries agree on legal definition of psychiatrist, they disagree on how to define other titles.

Sooooo, in some countries you can call yourself whatever you like. BUT in other countries, titles are 'owned' by professional associations. If that sounds weird, consider it's the same for certain kinds of engineers, architects and so on.

Here's where the politics come in. Mental health associations that own titles are usually exclusive, meaning they work to keep people out. They typically only take local people or people from a very small number of schools.

Practically speaking, if you work in mental health, your nationality restricts where you can join and the school you go to also restricts who you can join.

For example, in Malaysia, the title 'Kaunselor' is controlled by an association we call the Lembaga. They only accept people with Malaysian degrees.  So you can have a Master's degree in Counselling from Oxford in the UK and not be accepted.

Other titles in Malaysia are not controlled, BUT associations typically don't let foreigners join as full members.

Also, membership is not automatic. You can live locally or even be a local, have local qualifications and still be rejected. It's just like a club.

Note: this is not to criticize Malaysia. Every other country does the same. Mental health is in many ways just like the cartel. (If I am mysteriously killed tomorrow, you'll know why!)

So, as I am British, I am not a good fit for local professional associations. That's why I joined the British Association for Counselling and Psychotherapy. They are the UK version of the Lembaga.

But it left me with a dilemma. In the UK I am a registered counsellor and psychotherapist. But I can't be a Kaunselor in Malaysia.

As we planned to live in Malaysia forever, I branded my work to be in line with local norms and guidelines. On the advice of friends in the profession, I call myself a counselling psychologist. I have qualifications in psychology and counselling, so that works here.

But now we're leaving for the UK in the end of 2023. And guess what? In the UK, the title of counselling psychologist is controlled by an association I'm not a member of! ?? Sod's law, right?

So, I am changing from 'counselling psychologist' to 'counsellor and psychotherapist'. I'm adding in coaching because I've been taking extra courses and planned to add this to my business anyway in 2023.

The rebranding won't happen overnight as it's a big job but I do already have my new logos. Tell me what you think?

Visa Worries, An Expat Therapist Shares Personal Coping Tips

So about our Talent Visa woes: there’s no change yet, but there have been some questions. Next week we lose our permission to work after 25+ years here in Malaysia, unless someone at immigration wields a stamp. The questions have been mostly, “Why aren’t you going nuts?!”

I’d love to say it’s because I’m the greatest mental health therapist in the entire world, and my calm is entirely due to my using my knowledge about depression, anxiety etc to flow through this. Yeah, I should lie like a rug and say Hire Me! 😊

Truth is, the job does help but it’s also partly experience and personality.

The experience says that this is a tough time, but there have been worse times. Nobody is dead. Nobody is bankrupt. Nobody is at death’s door. So the reality is that there is inconvenience and annoyance, but no tragedy. I find that a massive comfort.

Next, from my work: when you’re in a tight spot, look to your rock. Your rock is whatever it is that gives you safety. This can be religion, a place, money etc etc.

For me it’s money in the bank. I believe that money makes you free. My personal minimum target is if you can do nothing in terms of revenue making for a year and still be okay, that makes you pretty much bullet-proof. I’ve got that, so I’m blessed.

Next, it’s working out what absolutely needs to be done. For me that’s Tom who needs another operation at the end of the year, and moving the cats abroad. Everything else is nice but not necessary. I can abandon my books, my things, everything. It’s just stuff. Only Tom and the cats matter. I can arrange their needs, no matter what.  That is a comfort.

As for the rock, a safety margin of cash, I’ve even got a plan for that. If it all goes pear-shaped in 8 days, I get on a bus, move to a nearby country, set up temporarily and keep working while I arrange for the next big move. Inconvenient, but with my work being entirely portable, it really isn’t a big deal.  

What cements is all is choosing to be happy every day. I know what gives me the feels: petting Target, playing with Tic Tac and Inkie, making very nice dinners and sharing them with Tom while watching old films.

So every single day I set aside time to pet and play then I cook and we watch black and white films. Those moments of happiness are mine. They can’t ever be taken away. They’re locked in my mind and they run through the fabric of my life.   

And finally, I think personality has a lot to do with calm. It’s tough times but I’m the type who breathes through and keeps moving forward. It’s useful for me and my job, but I get it can be super annoying.

With all the drama, I’ve had several mates this week exclaim, “How can you sit there and be so calm!!!!!!!!!!” and advising, “Call immigration! Call the Talent people again!! Write in the newspaper!!! Do something!!!!!!!!!”

I really appreciate that love. It’s heaven to know so many people care. But when you’re anxious, action appears to be useful. Reality is that everything that can be done, has been done. And now we just have to wait and see. 

Update 14 November 2022: we got it!  Five years. But we think the writing is on the wall for foreigners in Malaysia, so we plan to move to the UK in 2023. As I work online, it will be business as usual :-)

Image by jacqueline macou from Pixabay

Is It Okay For You And Your Friend To See The Same Therapist? What About Partners, Exes, Cousins And So On? Talking About Confidentiality And Neutrality

Yes, as long as there are two conditions: absolute confidentiality and complete neutrality.

Here's what that means in practice, and how I handle these situations.

How Confidentiality Works in Practice

If you're worried about confidentiality, that's completely understandable. Therapy requires vulnerability. You need to trust the walls actually hold.

In my practice, I work alone. No shared notes, no staff, no exceptions. What you tell me stays with me, period. This strict approach allows me to work with people who know each other, including colleagues, family members, and even exes without conflicts.

You may think there can be no overlap in a therapist's practice, but that isn't possible. We live and work in the community. Mental health practitioners who work in companies see people who work together and who live in their neighbourhood. Mental health practitioners working in local hospitals see members of the same family, people who work together, sleep together, who know each other on social media. It's a very common situation.

If you see me, I talk to you and to you only. Between sessions, I forget I know you.

If your best friend, cousin, work colleague, or neighbour also sees me, I maintain complete professional boundaries in therapy sessions. In fact, I won't even confirm or deny that you're my client if anyone asks.

I won't talk, but if you want to discuss your sessions with someone else, that's your decision. You know what works for you.

When Relationships Overlap

The therapist's job is simple: help the client reach their goals. In the session, it's all about you.

But with cross connections, I often hear the same story from different perspectives. Like if there's a product launch, I may hear about the event management side from one client and the product side from another.

Confidentiality means that I can't let information I hear in one session bleed over into another. What's said in a session stays in that session.

This gets complicated when secrets are involved.

If Client A tells me their company is cutting staff, and Client B (who works there) is planning expensive purchases, I can't warn Client B without breaking Client A's trust.

With romantic relationships, this becomes even trickier. Secrets about affairs, finances, or future plans can put me in an impossible position if I'm seeing both partners individually.

My Policy on Close Relationships

For new clients, I take this approach:

If you know each other casually - work colleagues, family, neighbours - I'm comfortable seeing you.

If you are dating or partners and are dealing with separate issues - one wants anxiety support, the other wants career coaching - I can see you both individually.

My default for couples who want to talk about their relationship: I refer you to a couples counsellor.

Individual online therapy is as effective as face-to-face sessions. However, research shows managing multiple people in the same session online presents unique challenges. In couples or family therapy, therapists rely heavily on body language - subtle gestures to invite someone to speak, to signal when to pause, to manage emotional escalation. These non-verbal interventions are difficult to deliver effectively through video calls.

For your benefit, I recommend face-to-face couples therapy where the therapist can use the full range of clinical tools.

Exception: If you're in a location where couples therapy isn't available, or you have concerns that make face-to-face therapy unsafe or impractical (LGBTQ in restrictive countries, polyamory, atheist perspectives, throuple relationships, etc.), contact me. We can discuss whether online sessions might work for your specific situation.

In all situations, it comes down to informed consent, which means figuring out how we work best together. We discuss boundaries upfront, including how we'd handle conflicts of interest if they arise.

See how I protect your privacy

What If I Don't Know You're Connected?

Of course, this assumes all the information is out there and up front.

Sometimes relationships aren't clear at the beginning or they change.

I may not know for months that Client A is the ex that Client B is telling me about, or that Client Q works in the same company as Client P. Sometimes Client J is delighted with a new relationship and I discover their new partner is my Client L.

Usually, this arrangement works well. Like accountants, lawyers, doctors, nurses and other professionals, I compartmentalize.

The one curiously tricky situation is when I discover that two clients who I thought of as single or independent are partners.

If they tell me in session, we can talk it over. But if they don't, and I don't know if they know their partner is in therapy, I can't ask without breaking confidentiality.

When connections between clients emerge unexpectedly, I handle it the same way doctors, lawyers, and other professionals do: through compartmentalization and strict boundaries.

Questions About Whether We Can Work Together?

Ready to discuss your situation? Contact me and we'll talk through your specific circumstances. I'll be honest about whether I can maintain the confidentiality and neutrality you deserve.

Image by Pretty Sleepy Art from Pixabay

Expat Life: Staying Sane During Visa Application And Renewal

Digital nomading sounds so glam. Working on your laptop by a sunny pool, in December, freshly squeezed guava juice at your side. What could be nicer?

While it's lovely to travel, working abroad also means endless paperwork for visas. I'm doing ours at the moment, and so it's at the top of my mind.

Here are some thoughts on how to stay sane during this challenging time.

Stress #1 Control, Agency and Importance
The visa directs where you live and for how long, so it's important. 

You have very little control over when or whether it's granted. As human beings don't do well with helplessness, this will be a primary stressor.

Mental Health Tip: Acknowledge that feeling stressed because you are helpless and uncertain is actually a sensible reaction. Breathe through it. Practice self-care.

Practical: You're doing this for a reason, so treat it like a project and set goals for success and failure. Do you want the visa because it looks good on the CV? Because of the income you make? Some other reason?

Whatever it is, put a value on it and figure out how much effort you are willing to spend to get it. Then make a failure target so that you know when to walk away.

For example, "Getting the visa means an international credit on my CV and will net me $1500 a month more in income for two years. I'm willing to invest one month and $5000. If there's no positive by date X or they ask for more money, I walk."

Stress #2 Backup plan
There are usually options, so make a list of alternative destinations and jobs. Maybe you stay home, go home, or try another country.

Most importantly, make sure you work out a timeline! You don't want to be stuck in one country with paperwork that's running out, or having trouble with the revenue stream, on top of being unsure of where you're going.

Stress #3 Confusion and Conflict
Visa bureaucracy typically involves several government departments, all of whom have different agendas. They likely don't talk to each other. If you've applying for a new visa, you may spend all your time dealing with people who are as new to this as you are.

Mental Health Tip: Acknowledge that feeling stressed because you are helpless and uncertain is actually a sensible reaction. Breathe through it.

Mental Health Tip: remember why you're doing this! See the stress as partial payment for what you're going to get out of it when you succeed.

Stress #4 Time Budget
Be certain you have a time budget set aside. As it typically takes several dozen hours of labour of which collecting documents is the simplest part, treat this like a major project with milestones.

Practical: devoting a block of time regularly can be more useful than jumping to respond. Me, I do my paperwork in a one morning block, and devote a whole day to visiting a department. If I finish early, I treat myself to time off and pat myself on the back.

Stress #5: Follow The Basics
Eat properly, get decent sleep, eliminate small stresses and exercise. Yes, obvious, but without veggy, protein and sleep your body can't work. So be certain you don't sabotage your health.

Mental Health Tip: I get off social media and reread favourite books. The lack of notifications lower my overall alert level and the old favourites are a throwback to old comfortable times.  Try it and see!

Stress #6: Rope in Friends
A problem shared is a problem halved, but apart from the emotional support, talking to a local friend will help remind you why you like to stay.

If you're looking for tips, chat to someone from your own country who recently and successfully managed the process. If you're lucky, there may be a shortcut or two you didn't know about.  

Mental Health Tip: remember the points of stress #1 Control, Agency and Importance

I speak from the heart. This is my fifth country, and I'm in the middle of applying for my fifteenth? Eighteenth? Gazzilionth visa. I used to work visas for expat engineers in other countries too, so all in all, I've processed more than a hundred visas over 30 years.

The biggest takeaway is that I've learned that all countries are hostile to expats. You can have politicians moaning they need workers, or raving about luring you in with special promotional paperwork, but it's not them doing the actual visa processing.  

So try not to talk it personally. Decide if it's for you, and if it is, go do it.   

Finally, if you need mental health support, book a session with me. I'm nice and affordable as I live in a developing nation. And I'll know what you're talking about.

Do You Qualify For A Discount? And Are Discounts Racist? Talking About Mental Health Costs And Discounting Frameworks

 

Remember how last October I decided not to increase my rates? Well, it seems to be causing some confusion. It also caused a fight, and therefore I'm doing some thinking.

Let me explain, and tell me what you think.

In my therapy work, I am based at home and online, so I pass on these savings to clients. As I'm in Malaysia where living is cheaper than in Europe, I'm very affordable, charging just US$35 per session.  

In addition, I offer a discount rate to clients in Malaysia. Why? Because Malaysia is a developing nation, and a lot of the people, especially young people, are quite poor.

As I've said before, I'm okay with working a little harder in order to give the people in my community a little bit of a break.

So I charge a local rate of RM110. (correct in Nov 2022)

From time to time I've had people living in first world nations asking for discounts and saying they can get third parties to pay the local rate.  The answer is no.

I'm willing to work a little harder to help my community, but there's a limit. Even my top rate, US$35, makes me significantly cheaper than my peers. 

I also need to earn my living, pay back for the 7 years tuition that is needed to enter work as a therapist, and prepare to look after myself in old age when I can no longer work. 

Some four or five years ago, before I had two separate rates, clients picked the payment method that worked for them. But my pricing structure has changed, so that no longer applies. I now have a two-tier system.

It is also true that some of my younger local clients who started with me while in college in Malaysia and then moved abroad kept the low rate. I closed one eye and let them stay on this as a courtesy because emigration is expensive and mentally challenging. 

And yes, I've also let a few families overseas in trouble in cheap.

Most people are okay with this. However, others misunderstand or resent this flexibility. I got some very nasty responses from one individual recently.

Hence the thinking.

Discounting is always controversial because it's natural to love a discount and to feel bad when you don't get one. Even so, charging different rates is common in mental health practice, mainly because so many can't afford the service but need it.

Typically, practitioners use means testing, where they offer a discount depending on your income. Mostly, they ask to see wage slips. 

I refuse to do this for several reasons. 

I find it intrusive. I don't need to know what you make, and I certainly don't want to get into how you spend your money. For all I know, you're making peanuts and have a rich relative who pays your bills. Or you earn a bomb, and are keeping your huge family. It's none of my business.

Also, as many people link income and personal worth, it may hurt or worry to discuss this topic. I won't do that to my clients. 

As for asking to see wages slips - OMG, that says you don't even trust people to be honest! I'm so not going there. I actually make a point of invoicing after the session, to show I trust my clients.  

I don't say means testing is wrong. But given the issues, it's not for me.

So, is my system of discounting based on geographical location racist? 

It's not racist because I don't ask people about race, but it's probably something 'ist'. Locationist, maybe? My thinking is based on local salaries and local purchasing power. I think that's practical, and although it's not foolproof or ideal, it's the best I can come up with. 

No, I don't want to apply special rates to various countries based on average income. I'm happy to help my community but I'm not a saint. I am running a business, not an NGO. Also, practically speaking, I'm not going to research other economies every time I get a client from a country that's new to me, either.

So there you go. That's my thinking. If I'm wrong, tell me how and why, and I will reconsider.

As for now, I love what I do, but I don't want to fight about money. So here are my rules, clearly and concisely.  

If you're living in Malaysia, you get the local rate. If you're not, you don't. No exceptions.

I'm putting my foot down, establishing my boundaries 😊

Will I adjust my rates for the clients abroad who get a low rate out of courtesy? 

I'm in several minds about this. 

Part of me says that they should not be affected because I'm annoyed by the rantings of some entitled twit. 

But another part of me says that really, if they're now established in first world countries, they should move to the other structure. Maybe I'm a bit too soft there?

I won't make a hasty decision. I'm going to sleep on it. And if you have an opinion, please do share. I'd like the insight.

Update: when people migrate, I'm taking it case by case. As there are no universal moral rules, I'm not going to break my head trying to make them. 25th November 2022