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Everyone Lives in Time. Not Everyone Lives in the Same Part of it

2026-07-04T16:04:39.158-07:00

In counseling work, I often see folks with more extreme difference in time perception or the attention to time.

For some, their reality is more biased/focused on the “here and now time spectrum”. Past time spectrum and future time spectrum can be a bit blurry or uncertain. Some may refer to this as “time blind”.

Their strength is the ability to solve tactical problems in the here and now. What’s in front of me. If it’s more future or past focused, then awareness and effectiveness may drop. This may lead to leaving things to the last minute, distracted by the sensory input of the here and now rather than something that may be very important downstream, and avoiding projects that require sustained actions over the span of time stretching into the future. It can also lead to impulsivity in the here and now and less attention to the consequences in the downstream of time although cognitively, they may be very aware.

Sometimes I would frame this as being good for “close range combat”.

At times, I see the complete opposite where folks may have the extreme bias/focus on “pan time perception” and lack perception of the “here and now” leading to too much living in the past, planning for the future and forget to be in the here and now. They are more built for “medium to long range combat”.

Pros and cons.

In family therapy and couples work, not surprisingly, I often see these folks with different biases in time perception, ending up together because they can cover for each others blind spots. It is complementary. However, if unaware, it can also be a common source of conflict due to a lack of shared reality based on time.

In DSM, these patterns can show up in different diagnoses and I wonder if you can relate to them.

The Car Metaphor That Changed How I Explain ADHD

2026-06-12T16:07:13.679-07:00

In counseling work for ADHD, I often use the metaphor of driving a car and simplifications around this for workability.

We have the fuel and the gas pedal to accelerate. This is like “zooming in”, sympathetic nervous system, stress, adrenaline, noradrenaline, cortisol, dopamine, and stimulants.

We have our brakes and shock absorbers. This is like our “zooming out”, parasympathetic nervous system, serotonin, SSRIs, relationships, oxytocin, antipsychotics, clonidine, guanfacine.

But many may forget that we have to drive/steer this car as well. Knowing where to go. Which direction. How to use our Sat Nav. Knowing our blind spots with rear and side mirrors. Mindful of what is on our dashboard. Getting along with our co-passengers and aligning destinations with them. Which time frame are we focusing on because this car can also Time Travel. It can take us to the past, present or future.

And most importantly, are we on autopilot or manual?

The challenge is to know where the primary problem is.

If the problem is no fuel, then easy. Give more fuel. If the problem is not enough brakes, then give better brakes. If the problem is in the driving/steering, then skill building here is required.

The biggest challenge is that the problem is often all of the above and driving/steering this Time Machine is not easy. And a word of caution, if we add acceleration to poor steering, then problems can magnify.

I wonder if you can relate.

Your Anxiety May Be Coming From These 2 Blindspots

2026-05-15T20:53:05.563-07:00

One thing I’ve noticed when working in the mental health space is that people’s anxiety can sometimes arise from their 2 key blindspots.

Their unconscious competence and their unconscious incompetence. The “very good” and the “very bad”.

The things that they have naturally talent in, they are underutilising and the things they are not good at, they are over exposed to. There is a mismatch leading to being a “fish out of water” with “secondary anxiety”.

The key pivot point is to make those unconscious processes more conscious.

I wonder if you are aware of your own unconscious processes.

Finding Wise Mind Balance with DBT

2026-04-25T16:23:00.000-07:00

In DBT Dialectical Behaviour Therapy, the word dialectical can relate to the idea of holding 2 opposing ideas (often opposites) and integrating them. This is often refer to as the “wise mind”.

But in reality, in Family Medicine, I think we often have to hold multiple opposing ideas (not just 2) and trying to integrate them all don’t we?

For example, with every consult, we have to integrate what is evidenced based, what is workable, what fulfils the patient’s agendas and makes them happy, what fulfils our agendas and makes us happy, what fulfils the community’s agendas and makes society happy, which decision is best for the here and now, which is best for the future based on past and present patterns, what’s best for the individual, what’s best for their families, and what’s good for one body system may come at the costs of other body systems.

There is tension among all of the above so trying to find a Venn Diagram for that is not easy especially given our inherent blindspots.

I wonder how much we all struggle with the above and whether some “DBT types of upskilling” can help.

Every Doctor Faces This Dilemma Daily — No One Talks About It

2026-04-18T22:27:00.000-07:00

As a Doctor, we often have to make decisions that considers all 4 of the following criteria.

1. It’s pragmatic and workable in the real world with all the limitations of the real world.

2. It makes logical sense and correct factually and evidence based.

3. It makes patients happy.

4. It makes you happy and helps you to sleep at night.

The problem is, when we can’t find the intersection of all 4 domains, we often neglect/suppress 1,2 tor 3 of the criteria leading to long term issues.

If we neglect No4, we risk burnout.
If we neglect No3, we risk complaints, loss of therapeutic relationship, and increased risk of being sued perhaps.
If we neglect No2, we risk not following evidence based and good guidelines.
If we neglect No1, we risk inaction and being impractical.

We all have our blindspots and depending on which blindspots, dictates which problems we are likely to face. Some are good with the thinking stuff (No1+2). Some are good with the feeling stuff (No3+4).

Part of good self care require good self awareness and self understanding.

I wonder if you can work out what your blindspots are by reversing engineer your recurring troubles.

The Missing Half of Metacognition: Thinking About Feelings

2026-04-03T07:26:00.000-07:00

I recently been invited as a guest speaker to explore and share ideas around metacognition with fellow GP supervisors.

Traditionally, I think metacognition often refer to the “Thinking of thinking” but it’s also important to include the “Thinking of feelings”.

One can also frame this as the “Mindfulness of thinking, feelings/emotions”. Focused and engaged with our thoughts and feelings but not too fused/hyperfocused and not too detached/dissociated either. It’s the “sweet spot”.

In this mental state, the aim is to process the information and find the “Venn/intersection” of both thinking and feelings. I think this is especially important in healthcare as we have to deal with both “things” and feelings.

Hence the saying…

Follow your head and take your heart with you OR for some…

Follow your heart but take your head with you.

It’s a real challenge of course especially if there is a mismatch in the development of one’s “thinking” vs “feeling” abilities.

What If Mental Health Education Started With Emotional Literacy?

2026-03-15T04:13:00.000-07:00

I am a Primary School Doctor on Fridays helping kids and their families with struggles around poor emotional health.

One can frame this as their “EQ” perhaps. EQ for Emotional Quotient (also often called Emotional Intelligence).

Some struggle mainly with processing the “feelings of others” leading to predominantly social anxiety.

Some struggle mainly with processing their own feelings/emotions leading to shame, anxiety, anger, emotional dysregulation, self doubt, and depressed mood.

Some especially with ADHD/ASD wiring, can struggle immensely with both.

Counseling whether it’s in the form of CBT. Psychoeducation, ACT, DBT. EFT, IPT are simply ways of teaching “Emotional Literacy”.

I hope that if we can frame “therapeutic frameworks” as “emotional literacy”, more kids can have access to the above skills at a school level, and if as a society, we are more emotionally literate, then less mental health issues perhaps.

Internal vs External Emotional Language: Why Both Matter

2025-11-01T01:05:00.000-07:00

The 2 important functions of an emotion is to communicate with others through the “language of emotions” and also to communicate with ourselves through our own emotions. This forms a significant part of our non verbal communication externally and internally.

Being great with one does not mean that we can be great with the other. In my mind, they are two forms of “emotional intelligence”. One is more important for “social intelligence” and the other is more important for “self intelligence”.

In counseling work, the challenge I often see is that many can struggle greatly in these domains and hence, impacting relationships and/or self esteem.

I wonder if you have seen what I have seen.

Emotions Are a Language — We Just Have to Learn How to Speak It Better

2025-10-25T15:37:00.000-07:00

Many of the folks I see have emotional regulation troubles and with that, they may want to avoid talking about it and/or working on it. It’s uncomfortable and “not safe”. The problem is, by avoiding it, it’s hard to get better at it.

It’s like a language. The pattern is, growing up, this language is often not well spoken in the family. When we express it incorrectly, we may get strong negative feedback or even shut down so learning to speak “emotionally” well and fluently is difficult. Modelling is also important in learning any language and some may not have great role models in this domain.

So how to regulate a feeling/emotion in simple terms?

If we are too emotive about something that is unhelpful for the context, we may need to learn how to “down regulate” that by noticing it, defuse from it or “zoom out” from it. “Zoom out” just right like easing off the pressure of the gas pedal. Not too much that we are detached or dissociated from the things that matters.

If we are not emotive enough about something that matters, we may need to learn how to “upregulate” that by noticing it and “zoom into” our values, self motivate and taking action.

Simple but not easy.

The rate limiting step is often learning to be mindful and holding space for feelings and emotions of self and others. This can give us “emotional clarity”. Once we have “emotional clarity”, processing feelings/emotions becomes easier.

Why We Need Emotions: 3 Core Functions

2025-10-18T23:07:00.000-07:00

When doing psychoeducation around feelings/emotions, it is often important to highlight to patients the 3 main key functions of an emotion.

1. It activates us into action. Without it, there may be less “urge” or compulsion to act. No action may result in no/little outcome or impact and at the same time, action can be helpful or destructive depending on context.

2. It helps us to communicate with others in a more holistic and non verbal kind of way. Nothing needs to be said and communication can still occur.

3. It helps us to communicate with ourselves and guides us to move towards a life that matters to us, our values/conscience, and to the people we care about.

Without it, we may be lost and without meaning and purpose.

The problem is, if we do not know how to process our feelings/emotions properly and avoid it due to discomfort, we may become lost, stuck with unresolved conflict, and not able to live a life truer to self.

Part of therapy is to become more aware, acknowledge and equip ourselves with better emotional literacy, to improve our emotional wellbeing and our overall biopsychosocial health.

Holding Space for Pain Without Getting Lost in It

2025-10-18T15:17:00.000-07:00

One of things I try to teach Medical Students and Registrars is mindfulness/holding space for the feelings and emotions of our patients especially with the “uncomfortable painful ones”. It’s very important for counseling work and can actually be very difficult for many of us to do.

Not too fused or “zoomed into” the feelings and emotions of our patients but not too detached either.

Too fused or “zoomed into” the feelings and emotions of our patients and we may “catch it”, suffer with our patients, burn out and get compassion fatigue.

Too detached or “zoomed out” and we may risk losing empathy, connection and miss the subtle emotional agendas behind their presentations.

Mindfulness with “the feelings of others” is the “sweet spot”. Not too close but not too far either.

I wonder if you can relate this to our interactions with our patients.

Emotional Literacy: Intuition vs Emotion

2025-10-04T15:15:00.000-07:00

In counseling work, when providing psychoeducation, one of the key fundamentals of emotional literacy is understanding the difference between an “intuition” and an “emotion.”

They are both feelings, but knowing the difference may help us better understand our feelings — and in turn, better regulate them.

For those who are less feeling-oriented and more logic/thinking-oriented, I often use the analogy of “facts” versus “opinions or judgments about those facts.”

In the feeling language, intuition is like a fact, whereas emotion is like an opinion or judgment about that intuition.

So, a fact (or intuition) tends to be more steady and reliable as information — it offers greater clarity.

An opinion or judgment about the fact (or intuition) is often less steady, more changeable, more subjected to biases, and creates an urge or compulsion to act. It is less reliable as information, but much better for driving action.

Therefore, whenever you feel an urge to act, that’s usually an opinion, judgment, or emotion — something more emotive. The stronger the urge to act, the stronger the opinion, judgment, or emotion.

In Acceptance Commitment Therapy ACT, we may refer to this as Fusion. To lessen Fusion, we can learn the skill of Defusion.

When the feeling is steady, with no strong urge to act but rather a mindful awareness, that may be more factual or intuitive. It is less emotive.

In ACT, we may refer to this as Defusion or Mindfulness.

I wonder if you can relate to these concepts and ideas.

The 4 Smarts: Guiding Therapy Through Strengths and Blind Spots

2025-09-30T14:19:00.000-07:00

In counseling work, I often see strengths and talents in people with the following 4 domains.

1. “Practical smart” with practicality. This is great for workability.
2. “Critical thinking smart” with accurate knowledge. This is great for truth seeking and innovating.
3. “Social smart” with empathy. This is great for making others happy and outer harmony.
4. “Self smart” with authenticity. This is great for making self happy and inner harmony.

A hyperfocus or an over-indexation in one domain will come at the cost of the other/s.

For example, too much focus on social smart and making others happy may come at the cost of one’s own happiness.

Too much focus on self smart and making self happy may come at the cost of the happiness or approval of others.

Too much focus on practical smart and workability may come at the cost of scientific truth and integrity.

Too much focus on the strict scientific truth and integrity may come at the cost of workability in the real world.

And so on.

So part of counseling/coaching work is to value and embrace one’s strengths, and be aware and work on one’s weaknesses.

If one’s challenge is in the practical and critical thinking domain, Cognitive Behavioural Therapy CBT with structured problem solving, reality check, thought/fact challenge and behavioural change may help.

If one’s challenge is in the social domain, then social skill training and Interpersonal Therapy IPT may help better.

If one’s challenge is in the self smart domain with poor awareness of self and who we are, then Acceptance Commitment Therapy ACT may be the better fit.

If there is poor integration of all four domains, then Dialectical Behavioural Therapy DBT may help with that integration.

I wonder if you have observed what I have observed or can relate to the above.

Integrating the 4 Smarts for Success in Children with ASD/ADHD

2025-09-22T15:05:00.000-07:00

I recently gave a talk for parents of children with ASD/ADHD at a school. The framework I used was something I’ve put together over time, drawing from an eclectic mix of ACT, CBT, and counseling work with individuals and families living with ADHD and ASD.

🔹 The 4 Smarts

1. Critical Thinking Smart – the ability to process information, reason, and solve problems.

2. Practical Smart – the ability to apply knowledge in the real world, adapt to challenges, and make things work despite limited resources.

3. Social Smart – the ability to connect with others, collaborate, and create harmony in relationships.

4. Self Smart – the ability to understand yourself, pursue what matters, regulate emotions, and sustain well-being.

What I’ve observed is that children with ASD/ADHD often show strengths in the “thinking smarts” (critical and practical). However, schools in the earlier stages may not nurture these strengths, and the subjects or tasks can feel irrelevant, leading to disengagement.

At the same time, many experience difficulties with the “feeling smarts” (social and self). These areas are crucial for building resilience, social skills, managing emotions, and sustaining motivation. When they’re not supported, disengagement can escalate into bigger challenges like depression and anxiety—both at school and at home.

By recognising and working across all four areas, parents, teachers, and professionals can help children not just to cope, but to grow in a balanced and sustainable way.

The 4 Smarts for True Success and Sustainability

2025-09-22T14:46:00.000-07:00

Working “smarter” for success and sustainability requires the “4 Smarts”.

Critical Thinking Smart – the ability to gain good knowledge and process it through critical thinking. This is factual truth and information integrity.

Practical Smart – the ability to apply knowledge effectively in the real world, even with limited resources, external friction and limitations.

Social Smart – the ability to foster harmony, support, and collaboration with others.

Self Smart – the ability to pursue what truly matters to you and your loved ones, to remain happy, content, and authentic despite external success. This is what ensures sustainability.

The challenge is that none of us are truly strong in all four domains. Strength in one often leads to a weakness in another. What matters is knowing where our strengths and deficits lie—this awareness itself is part of “Self Smart.” By recognising this, we can keep learning and collaborate with those whose strengths can complement our own.

A common pattern I see is people who excel at critical thinking, practical application, and/or social connection but neglect self-awareness. This often leads to burnout or unhappiness, even in the midst of great external success.

Ultimately, the goal is not just to be successful and help others, but also to be happy to give sustainability.

The 4 Types of Smart: Which One Are You?

2025-09-05T15:23:00.000-07:00

In my counseling work, I often raise awareness about the 4 types of “Smart”:

1. Practical Smart – the pragmatic, hands-on, street-wise kind of smart that gets things done without paying too much attention to “feelings” or fine details.

2. Book Smart – the science, maths, and theoretical kind of smart. Some would call this being “academically smart.”

3. Social Smart – the kind of smart that comes from having a talent for reading the room and working with the “feelings” of others.

4. Self Smart – the kind of smart that comes from knowing your own feelings and values, and living a life that is true to them. This brings “inner awareness,” “self smartness,” and a sense of congruence in many things they do.

Types 1 and 2 relate to the thinking type of smart.

Types 3 and 4 relate to the feeling type of smart.

I have never met anyone who is equally strong in all four domains.

Most people tend to be:
1. Great or talented in one
2. Good/very good in one
3. Okay/not great in one
4. And perhaps hopeless in one

Knowing your own kind of smart is very important. Equally, knowing your “blind spot” is just as important.

School, parents, and friends often nurture the first three types of smartness. But the fourth – “Self Smart” – is often neglected until we engage in self-discovery, therapy or coaching.

Without this awareness, maladaptation, adjustment difficulties, lack of thriving, anxiety, and stress are more likely.

Supporting the Inner Compass Personality Style in ADHD/ASD

2025-09-05T02:09:00.000-07:00

Many ADHD/ASD folks I see have a very “inner compass” personality style i.e. they are more biased or focused on doing things that “make sense” to them or “feel right” to them, rather than following the “outer compass,” which is what the world wants from them.

To some extent, they are contrarian thinkers, and contrarian thinkers often have a tough life, especially in the early years when they don’t yet have the power, skills, or resources to follow their contrarian thinking.

This can lead to misunderstanding, unmet expectations, and subsequent anxiety/depression.

From a psychotherapy point of view, I try to help them:

1. Embrace their “inner compass” personality style.

2. Work on the “outer compass” skills or find “outer compass” folks to complement them for workability.

3. Most importantly, I encourage them not to judge themselves based on how well they manage the outer compass demands — in order to maintain self-esteem.

If self-esteem is preserved through self-understanding and self-acceptance, then these “inner compass contrarian thinkers” may find far more success in later life, when they have the power, resources, knowledge and skills to bring their inner compass ideas to the world.

The Hidden Struggle: Emotional Colorblindness

2025-08-17T01:43:00.000-07:00

If feelings and emotions are like colors, then some of our patients are “colorblind” to them. This can be mild, moderate, or severe. The challenge is, they may not even be aware of it.

And that’s where the difficulties can begin.

It can lead to grief, anxiety, maladjustment, and relationship issues.

So, what’s the solution?

The first step is to recognize it. Acknowledge that they are “colorblind” to feelings, emotionally accept and embrace it, learn more about it, but do not tie it to their self-worth. Adapt to it, and find trusted people who are not “colorblind” to feelings to complement them.

I wonder if you can relate?

Mac vs Windows: A Metaphor for Neurodiversity

2025-07-19T16:28:00.000-07:00

I often explain neurodivergence versus neurotypical functioning using a simple analogy: Mac iOS vs Microsoft Windows.

Neither is inherently good or bad. What works well—or doesn’t—depends entirely on the context.

A Mac thrives in a Mac environment.

Windows functions best in a Windows-compatible world.

In my counselling work, I often see both neurodivergent and neurotypical individuals struggling—not because of who they are, but because they’re operating in a context that doesn’t suit them.

It’s hard to change who you are. But when you understand your own operating system—your brain, how it operates, your needs, your values—you can begin to find, adapt, or even create the right environment for yourself. And that can make a profound difference.

The right context can reduce stress, ease inner conflict, and lower the risk of developing Adjustment Disorder with anxious or depressed mood.

Understanding yourself isn’t just self-awareness—it’s a pathway to resilience.

When Your Mind Becomes a Trap: How Shifting Roles Can Set You Free

2025-06-13T17:01:00.000-07:00

In counseling work, one of the hardest thing for patients to embrace is the idea of “self as context” i.e. to step out or “zoom out” of your “identity/mindset/thoughts/feelings” in order to observe or shift your perspective on your current context.

It requires one to hold one’s “identity, mindset, thoughts and feelings” more lightly for psychological flexibility.

By seeing and experiencing it in a different way, it can help the individual to get unstuck from their current troubles and pivot.

It’s like your life is happening in a movie studio, and you are playing multiple roles in different movies and in different episodes.

One moment you are a Doctor. In another moment you are a husband, partner or wife. Another moment, you are a sister, brother, friend, impostor, employer, dad, mum, inner child, the “not good enough person” etc.

If you are unable to shift your mindset, identity, character or role, to be more congruent or more helpful for your context, you are in trouble.

An adjustment disorder may be the result.

More Than Achievement: Why Growth Matters Most

2025-06-10T05:31:00.000-07:00

In counseling work, one of the most common pattern I see is, people linking their self worth or “happiness” to achievements.

But when we dig deeper, it’s more about personal growth rather than the objective achievements themselves. Achievements act like a kind of “proxy” for their personal growth journey.

So for some who may have objectively achieved a lot, but if those achievements are stagnating or regressing, they can be deeply unhappy.

Whereas for some who may have achieved much less, but are growing or progressing, they can be very content and happy.

Growth or moving towards/progressing towards their values is a key strategy for better mental health.

I wonder if you can relate or see it in the people you are caring for.

Life’s Puzzle: 3 Keys to Finding Your Perfect Fit

2025-05-30T19:10:00.000-07:00

In counseling work, it can be very useful to use “metaphoric truths” to explore abstract ideas and concepts relating to our life struggles.

I often see people with their context like a puzzle piece “matching up” with other puzzle pieces in their lives to create an ideal picture for themselves and the people they care about.

Some of these pieces seem to “click into” places spontaneously. Some require a bit of work to find the right match. Some even try to reshape their puzzle piece, or force their puzzle piece to match up with the bigger picture. We may call this “masking” perhaps. “Masking” is okay short term but can be problematic when “fake it until you make it” does not eventuate. Having said that, if it does “make it”, then good.

The challenge is that the puzzle pieces are not simple 2D pieces but more like 3D, and often dynamic and changing over time. What matches well today, may not match well at all tomorrow. It’s dynamic and messy.

So to succeed and thrive, one has to know:

1. One’s own puzzle piece very well.

2. The nature of the external puzzle pieces well.

3. The final picture of what they want to create or move towards.

Unmasking Your True Self: Navigating ADHD and ASD with Authenticity and Balance

2025-05-29T14:46:00.000-07:00

When I work with folks who are struggling with ASHD or ASD, the term “masking” often come into the conversation.

So what is “masking” and why does it have a negative impact on our mental health?

In my mind, “masking” is when one cannot live a life true to oneself because when they do, it doesn’t work in their context. This can be conscious or unconscious. Masking comes with an “emotional debt”, and with excessive use, can lead to an “emotional bankruptcy” or burnout.

So what is the solution or strategy from a psychotherapy point of view?

Help our patients to clearly define their values and what matters to them, and to pursue a life truer to self and still make that workable in the external world.

ADHD and the Mismatch of Focus: When Inner Worlds Clash with Outer Demands

2025-05-17T15:49:00.000-07:00

The pattern I often see in people struggling with ADHD is that their minds tend to zoom in on their internal values or thoughts—what matters to them—and zoom out of the things their world, family, or environment expects them to focus on.

When their internal values and thinking differ significantly from those of their environment, it creates a major challenge.

This mismatch often leads to secondary anxiety, stress, low self-esteem, and frequent misunderstandings. One can frame this as the mismatch of the inner and outer focus rather than a “pure focus issue”.

So how can we help them to align those?

First step is awareness and mindfulness of that and with less blame towards the external context or self. “Hold space” or find emotional acceptance of that. With that renewed energy, focus on creating or finding a context that is more aligned with one’s inner thinking and values.

In essence, we help them to fine tune and follow their inner thinking and values, but at the same time, making that workable in the external world.

Finding Your Path: Moving Towards Your Values for a Healthier You

2025-05-17T05:55:00.000-07:00

In counseling work, people usually come to see me when they are experiencing an internal conflict around their hierarchy of values or are stuck in a context that moves them away from those values.

Having said that, they may not have the emotional literacy to describe it in that particular way. They might instead express it as stress, anxiety, burnout, or depression.

Management:

1. Identify and acknowledge what those values are. Values are typically emotive or motivating, so check for “emotional resonance.” If it’s not emotive or motivating, it’s probably not a value of theirs. If it is emotive, then it likely is. The more core it is, the more emotive it becomes because it matters deeply to them.

2. Reconcile by changing your value-based rules but still honoring those values, or hold space for those internal conflicts. It’s quite normal to experience them.

3. With clarity around those values, take actions toward the most important ones, ensuring they are workable for sustainability.

Note: With the “feeling mind,” moving toward our values feels better. Conversely, moving away from our values often feels worse.