Of Basic Needs and Inner Harmony

In my observation, much of the misunderstanding and conflicts among people take root in the reality or the perception that one or more needs of those involved are not being fulfilled. On the surface level, the conflict might be simply understood from the judgment that one is at fault—that he is being too demanding or hurtful or that he wants more than his fair share. At the risk of sounding too simplistic, I think that most conflicts arise from the misunderstanding of each other’s needs. This may have been borne out of assuming that the other person (should) knows what we want (quite magically, sometimes even without us saying so to the other person) or just a preoccupation with fulfilling our own needs that we forget that other people have needs that we can also help fulfill. Interestingly, what I just described appears to be true for many people, both young and old.

Having said that, what are our basic needs? According to American Psychiatrist William Glasser, we only have 5 basic needs. These include the following:

1. Survival – This includes food and drink, shelter, comfort, safety, good health, and the need to reproduce. These are probably the most basic of our needs.

2. Love and Belong – Relationships, social connections, giving and receiving affection, and feeling part of a group are all part of this. This highlights the social nature of our existence. We need others and we need to feel connected and that we belong to a group we find meaning in joining.

3. Power – The need to achieve, to feel and be competent, to be skilled, to be recognized for one’s achievements, to be listened to, and to have a sense of self-worth are all included in this need for Power. Take note that this need, as it is defined by Dr. Glasser, is not exactly what we think about when we think about the word “power.” This need does not speak of being influential and controlling other people and being a leader. Instead, it speaks of the power we feel within ourselves.

4. Freedom – This need encompasses striving towards independence and autonomy, to know that one has choices and to have the ability to take control of the direction of one’s life.

5. Fun – This need helps us enjoy ourselves in finding pleasure, in playing and laughing, and learning important life skills from these activities.

Bob Hoglund explains Dr. William Glasser's "5 Basic Needs"


Having understood these basic needs, I would like to invite you to apply this knowledge on yourself. In fact, there are many ways that this can be done. For now, however, let me just introduce the strategy I call DUST, which represents the 4 steps in taking ownership of the responsibility to fulfill your own needs and to understand the needs of others. You can begin by thinking about a conflict you are in; it could be a small misunderstanding or a major, even long standing, altercation. Then, go through the following steps by asking yourself the questions below each step:

1. Dissect the situation
• What was the conflict all about?
• What did I want from the other person/situation?
• If I got what I wanted, would I feel better and end the conflict?

2. Understand my need(s)
• What does this thing that you want represent to you? Why is it so important?
• What is it I really want for myself?
• In other words, what needs would be fulfilled if you got it?

3. Satisfy my need(s)
• What can I do that is realistic to fulfill my need without relying on another person?
• Remember that this step will only work if you stick to fulfilling the innermost need, rather than just getting what you want on the surface level.

4. Try if it works
• Be honest with yourself and see to what extent you can fulfill your own needs.
• This might mean letting go of wanting that something you expected from the other person. Forgiving that person who cannot/will not give what you wanted might be an important step as well.
• A word of caution: if you expect to be satisfied in the same way as getting exactly what you wanted from the beginning, you might be disappointed. What I can only guarantee is that you will feel happy after honestly going through these steps.

In the end, if you feel that this has worked for you, teach it to other people. You might even want to teach it to that person with whom you had a conflict. If you are able to communicate honestly with each other about your innermost needs, then your relationship would have already grown.

The Professionalization of Psychology in the Philippines

Since the late 1970’s, the pervading legislative bodies in the Philippines have been debating the professionalization of the practice of psychology in the Philippines. It has been a long and arduous journey because on March 16, 2010, Republic Act No. 10029 was signed into law by the president of the Philippines. Known as the Philippine Psychology Act of 2009, this law recognizes the practice of psychology in the republic, legalizing both Psychologists and Psychometricians as professions. (To view the law in its entirety, see http://www.lawphil.net/statutes/repacts/ra2010/ra_10029_2010.html)


The law defines what it refers to as the “practice of psychology” as the “delivery of psychological services that involve the application of psychological principles and procedures for the purpose of describing, understanding, predicting and influencing the behavior of individuals or groups, in order to assist in the attainment of optimal human growth and functioning (Article III, Section 3 (b)).” These services include a range of work that covers assessment procedures, interventions, and program development and evaluation. These services can be administered to individuals, couples, or groups of people.


So, in what ways does this law make any difference in the practice of psychology in the Philippines? For me, there are essentially four areas that are clearly addressed by professionalizing the practice of psychology, and they are as follows:
1. Legitimizing the practice of psychology. The law legitimizes the practice of psychology in the Philippines. It acknowledges the profession of psychologists and psychometricians.
2. Establishing minimum competencies. A minimum standard in the practice of the profession is established. Apart from academic achievement, licensure also requires passing qualifying national examinations. After receiving licensure, continuing education will also be required, which will ensure that those practicing continue to grow and develop professionally.
3. Defined ethical professional behavior. The profession will be regulated, and a code of ethics common to everyone will be followed. This ensures that people who practice psychology are legally bound to follow the same rules that guide ethical and professional conduct.
4. Guaranteed privacy for clients. Legal rights to privileged communication with psychologists and psychometricians are guaranteed. This protects the privacy of clients seeking the services of psychologists and psychometricians. Simply put, what a client shares to his/her psychologist or psychometrician is private and is inadmissible in court proceedings unless there is informed consent to release such information.

In order to qualify in taking the licensure examinations as a Psychologist, the applicant must have at least a Master’s degree in the field of psychology and 200 hours of supervised clinical experience. And for Psychometricians, the requirement is a bachelor’s degree in psychology. By definition, a Psychometrician can only work under the direct supervision of a licensed psychologist.

The law stipulates that the professional regulatory board will be convened 60 days from the signing of the law. This board comprises a chairperson and 2 members, who will be appointed by the President of the Philippines from a list of nominees proposed by the national organization of psychologists, which is presumably the Psychological Association of the Philippines (also known as the PAP, see http://www.pap.org.ph/).

What is Autism?

This week, I wanted to share 2 videos that I found on You Tube.  The first one outlines the basic features in identifying Autism, and the other one highlights some treatment modalities for children with Autism.  Although both are generally good videos, I must warn you that they express the opinion of the makers of the video, and do not necessarily reflect my professional opinion on all their points.

What is autism?  This question can be better understood in the context of the basic understanding that each person has five (5) aspects within him/herself.  These five aspects are the:  physical, intellectual/cognitive, emotional, social, and spiritual aspects.  As all these aspects overlap with each other and often intertwine, we started developing in each of the different aspects form the time we were conceived, and we continue to do so for the rest of our lives. 

Particularly in the first few years of life, development in these areas is crucial because many basic building blocks for later learning and being happen at this time.  And development in these basic areas is often sequential and fairly predictable.  Autism is one of the conditions where significant developmental delays in these aspects are observed. 

Autism is a condition where children do not develop in ways that are expected.  Essentially, there are three major areas of development that impact on the five (5) aspects of a person mentioned earlier.  These include the following: 

• Communication – Youngsters with Autism do not learn language at the time children are expected to learn it.  Because of this, many are suspected to have hearing impairments when they are young, but this suspicion is promptly disproved by appropriate hearing tests.  When they start speaking, their use of language is often unusual, even nonsensical.  For instance, they often repeat phrases incoherently, have a monotone when they are speaking, and say made-up words that do not exist. 
• Social interaction – Children with Autism have difficulty understanding and engaging in many everyday social interactions that many of us take for granted.  For starters, they often have difficulty establishing and maintaining eye contact.  As such, they have difficulty deciphering social cues and reacting appropriately to the situation. 
• Stereotypic interests and behaviors – Before age 3, children are expected to be able to play with objects in the way they are intended to be used.  They are also able to use their imagination to pretend-play (e.g., using a play telephone to simulate a conversation with another person; using a toy car to run a race with another toy car).  Children with autism often do not use things in ways that the things were intended to be used.  Instead, they typically enjoy watching spinning things and lining up objects repeatedly.  They also tend to be focused on a specific area of interest and hardly veer away from this (e.g., memorizing road maps or flags of countries).  They are rather inflexible, even rigid, in their area of interest and ways of conducting themselves. 

 

Currently, Autism is understood to be: 

• Biologically-based – It appears to have a genetic and neurologic (in the brain) component, although these are not yet fully understood.   
• Lifelong – As it is not a disease but a condition, it cannot be cured.  It is something a person has for the rest of his/her life. 
• A developmental disability – Signs of patterns of delay in development can be observed in the first few years of life, and these delays impact on later development of the person.    
• A spectrum disorder – Autism can be seen across any intellectual level (from the intellectually challenged to the very gifted), and the severity of impairment in language and social interaction is vast.  The development of different children as they get older also varies greatly from one individual to another. 

When Autism is diagnosed by a qualified professional (including, but not limited to any of the following:  Neurologist, Psychiatrist, Developmental Pediatrician, Neuropsychologist or a Clinical Psychologist), parents are often recommended to bring the child for various interventions.  It is important to note the goals of these intervention centers on minimizing the problems of autism and maximizing independence and quality of life.  The child and his/her family are also often helped to cope with the condition in more effective ways. 

Despite progress in the various modalities of treatment, many services in the Philippines are available only in the urbanized areas.  Many of the services required by children with Autism are also private with very limited government funding.  As such, a majority of our countrymen who have this condition are unable to access services they need.

The most effective interventions for children with Autism have been found to have three basic features.  First, they emphasize early intervention (the earlier, the better) and involve the parents and main caregiver.  Many exercises done in intervention sessions need to be reinforced at home, where the child spends most of his/her time.  Second, they are oriented to the particular developmental stage where the child is currently functioning.  Interventions need to have a clear underlying comprehension of developmental stages so that mastery of current skills is reinforced and subsequent incremental development is prompted and rehearsed.  Third, these methods are echoed in the educational techniques used for special needs populations.   

On the part of many parents, the diagnosis of Autism can be both a confirmation of a gut instinct and a devastating blow to their dreams and aspirations for their child.  They have to go through a long process of understanding their child and their role as parents of these children. 

In the years I have been working with such parents and their children, I noticed that the children who make very good progress in the goals of treatment over the years have parents with certain characteristics and habits.  I believe these practices often boil down to the following: 

• Openness – They are open to the reality of the situation, and wholeheartedly deal with their own reactions. 
• Motivation – They are motivated to learn about their child and his/her condition.  They read up, engage various professionals, join support groups, and ask relevant questions.  They apply what they have learned in understanding the specifics of their child and become a true expert when it comes to their child’s special needs.  This brings about a clear understanding of the goals they have for their child, and they engage professionals with this in mind. 
• Delay of Gratification – They realize that their child’s development will be gradual and incremental, and there are no quick fixes.  So, they learn to be happy with the small progress their child is making.  They persist in fostering the hope of achieving the goals of treatment, at least to some extent. 
• Administrative Skills – They manage the needs of the family within the context of the special needs of their child with Autism.  Similarly, they also facilitate the healthy collaboration among the various professionals working with their child. 

Having a child with Autism is both challenging and rewarding.  It is also a gift that we have to learn to appreciate over time, and I know many parents who, after many difficult years of taking care of their child with Autism, tell me that this is an experience they will never ever regret having gone through. 

Clinical Depression: Signs and Symptoms

We all have our moods.  There are times when we are particularly sad or irritated, and there are also occasions when we are quite cheerful.  No one is exempted from these ups and downs.  And yet, there are also periods, sometimes even more prolonged than usual, when we feel listless and sad.  We then refer to these times as occasions when we are “depressed.” 

Although we use this word in everyday conversation, we psychologists (and other mental health professionals) have an understanding of what it means when a person is diagnosed to be clinically depressed.  Although the presentation of each individual may be quite unique, some of the more common telltale signs are as follows: 

• Persistent sad, anxious or "empty" feelings
• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Crying spells
• Irritability and restlessness
• Difficulty focusing on everyday tasks and concentrating
• Loss of interest and enthusiasm in activities or hobbies once pleasurable
• Physical lethargy and fatigue
• Physical aches or pains (e.g., headaches, sore muscles, cramps or digestive problems) that continue despite treatment
• Having disturbed sleep, inability to sleep, or sleeping too much
• Overeating or appetite loss, resulting in significant weight gain or weight loss
• Thoughts of suicide, or even suicide attempts

People who are clinically depressed will display at least five of these signs over a period of at least two weeks. 

Since we Filipinos are generally sociable and fun-loving, we tend to ignore these signs both in ourselves and others.  We can simply brush our feelings aside when we are in the company of others.  We genuinely enjoy the brief, passing laughter with friends, and quickly return to our usual routines.  For those of us who tend to cope in this manner, perhaps the above signs become more pronounced when we are alone.   

Clinical depression is rather common.  No wonder, it has been touted as the “common cold” of mental illnesses.  No one is exempted from it, as it can occur among children, adolescents and adults of both genders across socio-economic levels. 

There is, however, an apparent difference in the way men and women tend to display signs of clinical depression.  In a culture where men are not allowed to show much emotion, with the exception maybe of anger, there is very little room for men to admit to feeling depressed.  And so, men can tend to hide these feelings, sometimes not even able to admit it to themselves.  And so, men will tend to report more fatigue, irritability, and loss of interest.  As for women, feelings of sadness, worthlessness and guilt might be more common.  Also, biological factors, including hormonal cycles (including menstrual cycles and post-partum conditions), may be one factor that influences women’s moods. 

Clinical depression can happen in children as well.  Younger children tend to display depression in a slightly different way.  Some of the signs are as follows:

• Refusal to go to school
• Sudden dip in school performance and/or trouble in school
• Clinging behavior towards parents and other caregivers
• Persistent worrying that a parent or caregiver might leave or die
• Sulking and crying spells
• Recurrent sad themes in stories and drawings
• Defiant and irritable behaviors

Again, these signs often do not occur in isolation, but form a context of sadness, hopelessness, and a lack of energy. 

In severe cases, this condition can also be life threatening, as suicide is a major risk for people who are severely and chronically depressed.  Generally, there are more men who die of suicide than women.  Data from the World Health Organization (2004, from http://www.who.int/mental_health/media/en/345.pdf) show that most reported suicides in the Philippines (1993 data) are in the age range of 15-34 years. 

In many cases, suicide can be prevented.  As suicide is often linked to feelings of hopelessness, clinical depression plays a key role in this phenomenon.  If properly diagnosed and treated, a person’s life does not have to end in suicide, especially given the fact that depression is a very treatable illness.        

So, what can you do if you suspect that you or someone you care about might be depressed?  Seek the consult of a professional; that would be either a psychiatrist or a clinical psychologist, or both.  As this condition is understood to have multiple causes and effects, crossing over biological, psychological (includes both cognitive and emotional aspects), and social aspects, treatment also needs to cover all these areas.  As such, a combination of counseling/psychotherapy and medical interventions is most effective. 

The Path of Acceptance: the Journey of Parents with Children Who Have Special Needs

I have had my share of memorable incidents with parents whose children I have assessed to have certain special needs. I recall one parent who threatened to sue me if anything of what I just told her “got out to other people.” Maybe I was remiss in educating her about the strict adherence to confidentiality in our professional ethics. Perhaps I was not tactful enough in explaining what I thought her son needed. Whether these were factors that justified such threats, I will never know. What I do know is that parents go through a very rough time when they first hear from a professional, like me, that their child has special needs, particularly when these special needs are due to lifelong conditions/disabilities that have no known cure and also bear a stigma in society.


Some of these conditions I am talking about include the following: Mental Retardation (also known as Severe Learning Disabilities, Global Developmental Delay or Intellectual challenges); Pervasive Developmental Disorders (and its specific gradients of severity that are seen in Autism, Asperger’s Syndrome, and what may be termed as the Autism Spectrum Disorder); Attention Deficit Disorders (also referred to as ADD or AD/HD); Specific Learning Disorders (also known as LD’s or Learning Deficits). These conditions are often believed to be life-long and have an impact on various developmental stages of the person’s life. As these disabilities or conditions cannot be strictly classified as illnesses, they have no known cure. Most of the long-term interventions for these groups of young people aim at helping them become as self-sufficient and as well-rounded as they can be.

I know that parents go through the grieving process (as described in my post dated March 26, 2010) when they learn about their child’s condition/disability. I have seen parents spend years in denial, constantly finding potential miracle cures for their child’s condition. They desperately cling to the hope that some fad treatment might work despite scientific evidence that only certain kinds of time-tested interventions have been proven to be effective. Moving along, the threat I got from my story earlier appears to be a combination of this denial and anger, which is also part of the bereavement process. Bargaining is also often mistaken for hope when a cure for the condition is sought through some spiritual healer or novel cure-all food supplement. Over time and with much struggle, some parents begin to feel helpless and depressed after spending much time and energy trying to find a cure.

Only after going through the above-mentioned stages of grief, at least to some extent, can parents really come to terms with the reality that they are facing. Parents who have truly accepted their child’s condition are often at peace. I often observe the following among these parents:
• understanding the unique pace and personality of their child;
• appreciation of the unique gifts of their child;
• joy that come with the acknowledgement of the incremental (often slow) progress and change observed in their child;
• find meaning in having a child with special needs;
• feel at peace, find renewed hope, and enjoy life more; and
• sustain a “life-goes-on” attitude.

On this journey towards acceptance, these parents spend much time educating themselves about their child’s condition. They don’t limit their understanding of their child from the diagnostic and prognostic perspectives only, but also venture into getting to know their child as an individual who has unique qualities and gifts. They reach out to those who can help them understand the individual personality and strengths of their child, including those who share the same situation as they and professionals who help their children. Along the way, their perspectives of their children and themselves as parents make a shift. From the previously held ideas of how children “should” and “ought” to be, they start seeing the reality that all children are unique individuals who bear both inherent strengths and areas of improvement.

Acknowledging their need for self-care is also helpful for many of these parents. They may continue to pursue their personal goals amidst the demands of parenting a child with special needs. They can also benefit from having some alone time.

For some parents, finding a voice for their children through advocacy work gives them a sense of meaning and purpose. They become agents of change in society that work towards promoting the rights of people with these disabilities. In many instances, they even set up schools and organizations that promote the welfare of their own children as well as other children who are in a similar situation.

This path of acceptance is not an easy journey. It is riddled with struggles and self-searching. As the child with special needs grows up, old issues get resolved and new concerns emerge. At this juncture, a question begs to be asked: how is this similar to or different from the path of parenting any child?