Feeling stressed at work from time to time is a normal experience throughout our working career. Experiencing some stress is useful in building our capacity to deal with challenges, learn new skills, improve resilience, and solve problems. Indeed, without some element of healthy stress, we risk becoming demotivated and disengaged in our job responsibilities. However, experiencing work-stress that is severe and over a long period of time can drastically overwhelm our ability to cope and lead to burnout.

Burnout is a state of emotional and physical exhaustion. It is a harmful and serious condition caused by the body’s response to prolonged chronic stressors in the workplace. Globally, burnout cases continue to rise with debilitating and far-reaching impacts felt by companies and governments, as well as individual sufferers, their families, friends and work colleagues.

Some of these signs and symptoms can include the following:

• Persistent sense of being overwhelmed
• Feeling utterly depleted, useless, trapped or defeated
• Feeling isolated and alone
• Excessive fatigue
• Thoughts of hopelessness or cynicism
• Irritability
• Procrastination, difficulty focusing and taking longer to complete tasks
• Perpetual self-doubt

Burnout is impossible to simply ‘snap out’ of. As a condition that develops over a period of prolonged exposure to workplace stress, sufferers need time and support to embark on the road to recovery – from recognising the problem, addressing issues, developing healthy coping strategies, building resilience in order to recover and get back on track.

Companies play an important role in avoiding burnout risk by building healthy workplaces and cultures, with well-designed jobs and structures to match employees’ needs, but where gaps emerge, individuals can benefit from understanding and managing resilience against stress.

If you or are tracking low on the resilience continuum and experiencing burnout, what treatments are available? Treatments can include talk therapy and medical interventions, often including anti-anxiety or anti-depressant medications, but there needs to also be change in workplace structures, job-design, or culture that caused the source of stress. There is no “one-size-fits-all” plan for treatment. It may take some trial and error to find the treatment that works best.

How do you cope if you are experience burnout?

Burnout is caused by the persistent experience of stress without being able to cope. Implementing stress management techniques will be of help to treat your burnout. Common aspects of a stress management plan include the following.

Challenging your thinking filters

Whilst some work experiences invariably include some toxic practices and/or people, sometimes our experience of stress is created by our personal perceptions of a situation. For example, if you hold onto black and white thinking you will be prone to judge yourself and others more in stressful situations. If you tend to filter information and feedback you may feel, unjustly, negatively about yourself when mistakes occur. For a full assessment of your thinking filters read our RED DOOR blog on this topic.

Change your thinking – change your life.

Practice mindfulness

Mindfulness helps to develop greater personal awareness. Its practice teaches individuals to be more aware of their thought processes and reactions in the present moment. So instead of racing ahead in a negative thought cycle a person  is more likely to be able to think in a more removed manner, noticing patterns in their reactions and being able to view situations in terms of their typical reactions and the potential costs and benefits of those reactions in the past. This ‘mindful overview” promotes understanding of being in charge of one own emotions and behaviours. To find out more about mindfulness see one of our blogs on this topic, attached below.

The Making of a Focused Mind: The Benefits of Mindfulness

Time management

The perception that we do not have enough time to do the work we have to do, creates stress. The art of managing the activities, priorities and sequencing of events in our lives can be taught. If you feel that you are not utilizing your time as well as you could, consider reading books on this topic or talking to a performance coach to help you better set your priorities.

Emotional regulation and support

If you are feeling overwhelmed and emotional you need to consider how you can better regulate volatile or oppressive emotions. The best way to do this is to talk to someone about how you are feeling. The more experienced and qualified that person is to help you disseminate your emotions the better. Consider counselling. A good counsellor can help you process some of your emotional experiences, understand your responsibilities and build resilience to deal with challenging circumstances.

Avoid addictive distractions

When we are stressed, we may become prone to self-medicating or distracting ourselves from our stress. Occasionally those distractions can actually maintain our experience of stress, or create new stresses for us to have to deal with. For example, alcohol is well recognized as a depressant. Paradoxically people often engage in drinking, to excess, to numb their stress. However over time alcohol robs us of our ability to produce dopamine efficiently, making us depressed.

Time distractions such a gambling and gaming can become problems because they create new problems such a financial problems or cutting us off from face to face social time with friends and family, which may help us mediate our experience of stress.

Build social support

Social supports – friends and family help us navigate tough times. In our RED DOOR research of the experience of stress among lawyers in Hong Kong, many of our senior lawyers managed their stress by talking to friends or family. The quality of these relationships is important. Do you have the quantity or quality of friends that you need. Recent (2022/2023) observations in our clinic highlighted that people in Hong Kong may benefit from building new friendships. As adults we sometimes are unsure how to build new friends. If this describes your experience then, consider reading our blog on this topic.

A million little things – how we build great friendships and protect against loneliness.

Maintain a healthy lifestyle – including sleep.

When we are stressed we often call into behaviours that compromise our health status. When we are under pressure these healthy behaviours protect us. Maintaining an exercise regime, eating well, and sleeping well (at least 8-10 hours) will help your body deal with stress hormones, and allow you to heal after the pressure has lifted.

Communication patterns

Poor communication can place a lot of pressure on your and those that you need to communicate with. When communication is unclear you can end up guessing what another person wants from you (perhaps incorrectly). It is difficult to work in organisations that tolerate vague or inauthentic communications. What can you do?

Learn to communicate effectively and assertively. There are many books on this topic that you could explore. Assertive communication involves being confident (not aggressive) in your messaging, acting rationally as an adult, being respectful to others in the communication and being clear about what you can, and cannot do. There are a number of Instagram accounts celebrating understanding corporate culture and how to express yourself effectively. Checkout @loewhaley to gain some insights.

Ultilise relaxation techniques

A range of relaxation techniques can help lower your experience of stress. You can use apps such a calm to find guided relaxation exercises, or go to a yoga class. You can also consider incorporating 15 minutes of colouring into your daily routine to reduce some of your experience of stress. Remember this practice needs to be regular, even daily, to help.

Consider anti-anxiety or anti-depressant medications

Many clients are hesitant to take up medications for treatment due to concerns about becoming dependent, potential negative side-effects, and stigma. It is not an easy decision to undertake. Talk to your GP about these medications to see if you can explore some of these fears. If you have tried behavioural and psychological approaches with no success, you might need to consider medications to start help reduce your experience of stress just enough that those behavioural or psychological techniques can start to gain traction.

Burnout is no joke. If you find yourself completely exhausted it is time for a change, and the most effective type of change is going to involve exploring your responses to and relationship with stress. You can feel better.

About the author: Angela Watkins is the head counsellor at RED DOOR Counselling. She offers individual counselling to adults, including those working through workplace topics such as conflict resolution, moving from good to great, burnout, and career change contemplation.

It is natural to be concerned if your teen is engaging in self-harming behaviours such as cutting or burning themselves.

Harming oneself is considered is a serious mental health issue in itself. Self-harm is also often  a  component of other psychological mental health issues such as clinical depression, dissociative disorders, eating disorders and obsessive-compulsive disorder. 

Self-harming as a practice  usually starts in the mid teen years, and mayvcontinue for years, if therapy or treatment is not successful.  

People who have a history of self-harm sometimes may also develop suicidal ideation (contemplating suicide), although this is not always the case.

Potential causes of self-harming practices can include traumatic events including child abuse, stressors such as bullying, family tensions and living under the perception of extreme pressure.  The teen considering harming themselves, may feel lonely, out of control, invisible, and overcome with a deep sense of self-loathing. They are quite likely to have over reactive emotions, to the extent that their reactions can sometimes seem extreme, or such that they seem numb, from previously feeling worries too strongly.

The teenage years can typically be a period of emotional sensitivity which is why self-harming behaviours may emerge at this time. Children who are extremely sensitive, prone to lashing out, have poor impulse control or hold catastrophic perspectives are more prone to pursue behaviours such as self-harm.

The desire to cut is often in response to emotional situations or the thoughts attached to those situations. The world seems too much, too painful, too difficult. Cutting can be an act of externalising the experience of internal pain, remind the teen that they are alive, or even a punishment for behaviours they judged as shameful. When we treat such teens in therapy, we try to help teens deal with their situation and their emotions, and gain back a sense of emotional regulation, essentially an ability to manage their oversensitive emotions.  

Understanding and regulating emotion can be taught. Therapists aim to teach their clients to observe and correctly label emotions, developing emotional literacy. It is important to change the channel internally. Teens can be taught to  utilise a non-judgmental internal dialogue to learn to respond to emotionally charged situations in a different manner than they have in the past.

Typical reassurances that parents may engage such as telling kids to stop, calm down, model themselves after another person, exercise more, or “try to get over it/forget about it”, typically do not work well with emotionally oversensitive people. This is because these teens need to first learn how to understand their personal relationships with the world, before assurances and suggestions may make any impact.

Therapy techniques such as DBT (Dialectic Behaviour Therapy) and CBT (Cognitive Behavioural Therapy) can be effective treatment options for teens who are emotionally charged.  These therapies are often data based, and help teens learn to read their own patterns of thoughts and behaviours through emotional monitoring, thought logs, and response adjustments. A simplified version of this process is described below.

Emotional monitoring can be taught to both children and adults. There are many tools to help people correctly identify and label emotions. Physical experiences such as tension, butterflies in the stomach, headache, clenched jaw are also detailed. Correctly helping identify the expression and experience of an emotion helps the client associate particular thoughts patterns associated with those emotions, or simply help them notice that they feel emotions they thought they had “lost”. Many teens confuse feeling anxious with feeling angry and hence respond by lashing out, rather than behaviours that may help them calm down.

Thought patterns are essential to associate with certain emotions. These thought patterns may have been learnt over many years and may include catastrophising (this is the worst thing ever!) , negative comparisons (She is so cool, I am such a loser) , mind reading ee my blog on common thinking errors). By catching these thoughts in action. Essentially people are taught to catch these thinking patterns and reflect upon them from alternative perspectives. They may be asked to keep a log of negative events and how they felt about those events so that they can be discussed in terms of creating a more rational perspective on the situation being reviewed.

For example, a bad event will be compared with other events to help the client understand its relative importance. A particular teen may consider getting a “C” grade on a test a major tragedy. That teen could be asked to asked to rate it out of ten, and gives it a seven, the therapist might ask what would be a 10. Typically, a score of 10 may be allocated to a severely traumatic event such as death of a loved one. The therapist then asks, what would be a 9? A nine might be chronic illness or injury. The process continues, and the therapist will ask, “Does getting a C still represent a seven out of ten?” Usually using such perspective tools helps client’s better rate the bad event into a more realistic context.

Once thought patterns and perspectives have been regularly assessed cognitive reframing and discourse can be utilised to create a new set of responses. For example in the case given previously, a teen who performs badly on a test, and may have self-harmed as a punishment of perceived poor performance, can learn to talk themselves about the realistic importance of each grade, the steps that they can take to explain or overcome poor grades, ways to study better. Different behaviours, not cutting or self-harming.

During this whole process (which is greatly simplified here), very little judgement is given regarding the actual self-harming behaviour. That behaviour is attached to a range of emotions and thoughts. Instead of challenging the self-harm behaviour directly, and potentially driving the behaviour underground or increasing feelings of shame around that behaviour, we recommend addressing the root of the problem, and learn better emotional regulation. Emotional regulation, hopefully, leads to a better long- term solution, less shame, and more resilience.

If you have a teen who is self-harming please consider counselling for them immediately. The earlier you start to challenge the underlying emotions, the better.

 

About the author: Angela Watkins is a counsellor and psychologist working with teens and adults in Hong Kong. To contact Angela email angelaw@reddoor.hk or send a whatsapp to +852-93785428.

#selfharm

#selfinjury

#reddoor

#teenmentalhealth

#mentalhealth

#emotions

The Resiliency Rx – check-in to check-up

Resilience is the capacity to rise above difficult circumstances. It is a trait that allows us to exist in this less-than-perfect world while moving forward with optimism and confidence. From a psychological research perspective, resilience is collective terms for a range of personal skills (I’ve included 28 elements below) which are developed during the childhood. Many of them can be enhanced or corrected with education, therapy and training– in other words resiliency can be taught, to both children and adults.

Resiliency is required to deal with day-to-day hassles, and is essential when you face exceptionally stressful events. Stress such as that experienced when you are going through a divorce, lose your job, suffer a bereavement, fail a significant exam, or are diagnosed with a serious illness, even fall out with your friendship group at school, require an ability to respond to these acute stressful situations.

In today’s world you need to be resilient. This doesn’t mean you need to accept other peoples’ bad behaviour, but you also need to be able to respond appropriately when other people behave badly, or circumstances turn out unfavourably for you. For example:

• Sexism, racism, prejudice still exist in the world, and you are likely to be exposed to this at some point.
• People can be mean, they can bully and exclude others. And this doesn’t just apply to teens.
• You are likely to encounter at least one person in your lifetime who tries to push you around in a work or learning environment.
• You are likely to fail at test or exam at some point in time. Will you retake that test, or are you willing to only make one attempt?
• Family members are probably going to say something personally offensive to you at some point.
• There might, amazingly, be a global pandemic which means your life suddenly changes completely out of your control.

If you are resilient you are better able to face the stressful slings and arrows that one encounters in a lifetime, rather than resorting to maladaptive coping strategies such as escapism (gaming, having affairs), self-medicating (abuse of alcohol, drugs), or breaking down (depression, burnout, anxiety attacks) or developing other psychological problems (paranoia, obsessive stalking).

Hence, we can think of resiliency as the super multivitamin – and the daily prescription (Rx) provides protection from environmental stressors which might, potentially, make us unwell.

There are a number of tests of resilience – for children, youth and adults. They can be self-administered. I have adapted selection of questions from various tests below to provide some examples of some of the items that are sometimes assessed. I remind you, the test within this blog is not an empirically tested diagnostic test, it serves instead as a potential check-up of your current aspects of functioning – a check-in check-up.

The RED DOOR Resiliency Rx – quick check-up

Let’s begin with some questions about how you see yourself, and then explore other categorical elements of resilience.  Select the frequency that you experience the following thoughts/ feelings or experiences:

How I see myself

It stands to reason that how you see yourself will influence how well you feel you can respond to a stressful situation. Self-efficacy, our belief in our ability to influence the outcome of a situation is a key aspect. If we do not believe we have any chance to change an outcome we are forced to sit inert, whilst unfortunate events happen ‘to us’. How we see ourselves, our positive self-affect (self-liking) is also an aspect of resilience, as is our self-esteem (sense of self-worth). If we think positively about ourselves and see our worth, we can withstand adversity’s impact on our feelings towards ourselves, and our ability to be positive in the future.

A series of beliefs about ourselves, especially if they are distorted, can compromise our ability to cope. If you see yourself as a ‘loser’, or an ‘idiot’, you will expect that situations are likely to end in a negative position.

When stress occurs, those who harbour perfectionist distorted fears, such as a strong fear of making mistakes or have doubts about your actions to the extent that you are forced into in action, maybe in for a harder time when the going gets tough. It stands to reason that how you see yourself will influence how well you feel you can respond to a stressful situation.

Self-efficacy, our belief in our ability to influence the outcome of a situation is a key aspect. If we do not believe we have any chance to change an outcome we are forced to sit inert, whilst unfortunate events happen ‘to us’.

How we see ourselves, our positive self-affect (self-liking is also an aspect of resilience, as is our self-esteem (sense of self-worth). If we think positively about ourselves and see our worth, we can withstand adversity’s impact on our feelings towards ourselves, and our ability to be positive in the future.

On the four questions above I would expect a score of 10 or above to indicate that you see yourself well in terms of ability to be resilient. *

Framing and reframing situations

How you see the situation, and can challenge one’s original interpretations of a  situation – the ability to frame and reframe – also influences your overall resiliency.

Cognitive distortions – beliefs that you hold about the world, influence how well you can respond to it. If you tend to catastrophize about what may happen, you create a lot of additional internal anxiety for your system to deal with, beyond that which is presented by the original situation. Additionally, comparing your work or yourself to others is a guaranteed way to build doubt in yourself over the long run. Even if you are the cleverest, you probably won’t also be the most charming, or good looking, or most popular, or best educated, or best dressed. The list of comparisons you can make is endless, and the only guarantee is that you will, eventually, fall short.

Your ability to brainstorm creatively about resolving problems will lead to confidence to address challenging situations, just as having a positive attitude about challenges, learned optimism also helps. Being present, and mindful, is essential. Tackle each problem step by step and don’t fret over the parts that are a long way off from being realised. Many concerns may not materialise. If you focus on all the potential problems you may encounter in the futurebefore you make a particular decision, it’s enough to make one hide under the covers for days on end, rather than face up to making needed decisions today.

Being grateful is not just for hippies. Being grateful and keeping gratitude lists encourages two positive resiliencies boosting aspects – firstly, the ability to see that many things are good, even when not everything is good, and secondly, the recognition that there are a lot of people who would be happy to have half of what we have. Altruism, and helping others rise, will help you install the ability to bounce back into your own psyche.

On the five questions above, I would suggest that a score of 17 or higher indicates that you frame, and re-frame, situations in a positively resilient manner. *

Current coping mechanisms

Take a moment to consider how you cope with stress now, as it is very likely that you will utilise the same coping mechanisms in moments of acute stress. Maladaptive stress responses include self-medicating through alcohol consumption or recreational drug use, escaping through game playing (on devices or with people), and avoidance (procrastinating, avoiding going out).

There are healthier coping mechanisms that you can learn. A good place to start is in identifying the stressors in your life and how your body responds under stress (for example stomach pains, headache, fatigue, shaking) so that you can identify these symptoms relationship to your anxiety experience. Learn calming techniques, breathing, relaxation, colouring, and mediation to help calm your body.  If you lack assertiveness, consider assertiveness training. Practice stress management techniques (blog coming shortly on this specific topic).

If you score less than 12 on the four questions above, it may be time to evaluate your current coping mechanisms in terms of ability to be resilient over the long term*Take a moment to consider how you cope with stress now, as it is very likely that you will utilise the same coping mechanisms in moments of acute stress.

Maladaptive stress responses include self-medicating through alcohol consumption or recreational drug use, escaping through game playing (on devices or with people), and avoidance (procrastinating, avoiding going out). There are healthier coping mechanisms that you can learn. A good place to start is in identifying the stressors in your life and how your body responds under stress (for example stomach pains, headache, fatigue, shaking) so that you can identify these symptoms relationship to your anxiety experience. Learn calming techniques, breathing, relaxation, colouring, and mediation to help calm your body.  If you lack assertiveness, consider assertiveness training. Practice stress management techniques (blog coming shortly on this specific topic).

If you score less than 12 on the four questions above, it may be time to evaluate your current coping mechanisms in terms of ability to be resilient over the long term*.

Making the most of your support network

In order to be resilient, you need to be able and willing to ask for help and lean on people. What is particularly important, and a key element of our Teen Resiliency Rx course is understanding who are your real friends and differentiating them from those you simply spend time with. We all need someone, actually more than one, person we know has got our backs. Sometimes even trustworthy friends cannot be there for us in a crisis, because of their own life situations, so having a diverse network of support is important, especially for teenagers. Encourage your teenagers to have friends both inside and outside of school.

Resilient people also have healthy relationships with people they spend time with. They have robust boundaries – they understand what is their responsibility and what is yours and do not get those mixed-up. They do not hold negative cognitive distortions about how others see them, and have the skills to appropriately deal with conflict in relationships. All of these skills can be taught if you consider yourself enmeshed in other people’s drama, or constantly thinking people hate you.

I would consider a score of 14 or over to demonstrate that you are doing well in building supportive networks around yourself, providing a safety net, in case you need it. *

Committed to your purpose

If you have had your path in life written for you by others, perhaps your parents or as the trailing partner of an expat, you may feel a lack of purpose. This is because you are not pursuing your own goals, rather that of others. It is important to have a sense of purpose about your life. If it needs some temporary adjustment because of your circumstances, that can be incorporated. You need to know where you are going, and why it is important for you, or you will not feel satisfied when you get there. Build a personal growth plan and an action plan so you feel directed. Manage part of your time to achieve these goals. Believe in yourself, be confident , and committed to your purpose. Enlist help if you cannot do this on your own.

Part of being committed to a purpose is to ensure that you make it to the finish line. Your health is a priority. Many of us place our health needs on a back burner because of today’s pressing needs. Your body and mind need you to be as healthy as you can be, so that if an acute stressor occurs, you have your health to rely on.

If you score 13 or more you are on your way to your purpose. If you score below this, please consider what you can do to help yourself build purposeful resilience into your daily plans*.

How did you do?

If your resiliency check-up went well, then congratulations. If your scores didn’t add up the way we recommend, then consider what might be areas for development for you. Part of being resilient is reaching for advice when you need it.

*Please remember this is not a true empirical diagnostic test. Low scores indicate you can work on areas, high scores do not guarantee that you will be resilient when hit by a crisis. If you have any concerns about your resiliency score contact our team at RED DOOR for more discussion. reception@reddoor.hk

#reddoor #resilience #personalitytest #support #mentalhealth #perfectionism #stress #selfefficacy #selfesteem #anxiety

Have you ever questioned your relationship with alcohol? Its a common question at this time of year.  Have you ever made rules for yourself in regard to your drinking behaviours. For example do you find you promising yourself ” I’ll only drink wine, nothing stronger” or “I’ll only have 3 drinks max before I go home – no more”? Has anyone close to you asked you about your drinking volume or behaviours? Do you ever wonder if your drinking is getting out of your control? Many of us do. You are not alone. From time to time, it is healthy to reflect on the aspects of your life which are working, and are not. Take a moment to think about if your drinking is making your life better, or is possibly a contributing factor in making your life experience, worse.

 

When people look at their relationship with alcohol they often consider taking a break. Taking a break is a great idea. I recommend a month rather than a week. If this sounds an overwhelming request, read on.

Perhaps you don’t feel confident to break up, or perhaps you think you really need alcohol in order to be you (ie a co-dependent style relationship). Its actually very common for people to be concerned about their drinking. Catherine Gray, in the book, The unexpected joy of being sober, suggests that that one third of regular drinkers are worried that they drink too much, but only half of those who worry actually do something about their drinking behaviour.

It isn’t your fault if you are confused or even ashamed about your relationship with alcohol. You have been tricked, entangled, and trapped, in that relationship. Advertising and society treat alcohol as a social lubricant when it is more of a social charlatan, suggesting it is the route to a good time, rather than communicating the reality of alcohol as silent poison which destroys more relationships than it creates. The harmful use of alcohol is a global problem as alcohol is a major risk factor in health and social issues such as violence, accidents, child neglect, absenteeism and mental health issues.

If you want to take a break there are a number of options for you to consider – from books, to online resources, to face to face support. There are a number of resources that can help you give up for a week, a month, a year, or longer.

Books

There are a number of books that support breaks from alcohol, of any period. In my opinion the books sharing the experience of the author seem more compelling, and less judgmental than some of the more academic books. I have included both styles of books in the following list. Many of these books are recommended by online support groups. These books can easily be found from online book retailers.

This Naked Mind – Annie Grace 

It is easy to understand why this book is a best-seller. This book explores links links between the unconscious and conscious mind to help create motivation for change. The techniques used help readers explore their relationship to alcohol, so that giving up reminds you that you are embracing regained freedom rather than focusing on what you fear you might be missing out on. I would recommend this as a first book to read if you are considering any kind of break.

The Unexpected Joy of Being Sober – Catherine Gray

Another popular best-seller, the unexpected joy is a well written memoir with extremely practical advice and insights. Gray provides information to help you staying sober for 30 days, and abstinence beyond . There is a great Facebook page attached to this label online.

Glorious Rock Bottom – Bryony Gordon.

Bryony Gordon recounts her lived experience of quitting and recovery from alcohol and cocaine addition. Simply put she describes her journey as, “I stopped drinking because I wanted to start living”. A raw and heartfelt account of her movement into and out of the shame of her addiction. Whilst the truth hurts, it also heals.

Alcohol Lied to Me – Craig Beck 

Craig Beck was a highly functional, “2 bottles of wine a night” drinker. From the outset, he looked like he had his drinking under control, but that wasn’t his reality. Craig Beck has written a treasure trove of quit drinking books and has programmes attached to his model. The process starts with exploring misconceptions that we hold about alcohol.

Nothing Good Can Come from This – Kirsti Coulter 

This memoir of one woman’s journey to sober, provides a sometimes funny, and worrying, commentary on women and their problematic love relationship to alcohol.

Girl Walks Out of a Bar – Lisa Smith

Another recover from alcohol focused memoir, this book explores cases of individuals who have been successful career wise, but struggled in their relationships with alcohol. Lisa Smith provides a real, emotive take on her experience of recovery. One of the most common excuses people use to keep drinkings, is that they are still able to, successfully, hold down a job.

Push off from here – Laura McKowen

This personal account of alcohol recovery is a deep dive into the 9 messages that McKowen need to hear, learn and accept as part of her journey to sobriety. For each of the 9 messages McKowen recounts how she came to assimilate each of the key learnings. This is a helpful book to help you understand that its not your fault, but what you choose to do is your responsibility.

Almost Alcoholic – Robert Doyle & Joseph Nowinski 

A fairly academic book written by clinical psychologists. This book outlines the problematic drinking behaviour which does not reach the level of diagnostic classification, outlining the cost of their drinking and providing practical cessation and limitation guidelines.

Sober Evolution: Evolve into sobriety and recover your alcoholic marriage – Matt Salis

Part lived experience, part advice, Matt Salis details his journey to sobriety and through marriage repair. A loving relationship and alcoholism can not co-exist. This is the reason that there is a 50% divorce rate for alcoholic marriages. Salis does not hold back. His message, for people who have out of control relationships with alcohol you have three choices: quit now; quit later; or drink yourself to death. Salis doesn’t sugar coat the reality of how difficult and shameful it feels to not drink when you associate with your regular drinking friends. Additionally marriage recovery is not automatic – there is still work to do. Salis, though, thinks it is well worth it.

Drinking: A love story – Caroline Knapp.

“I drank when I was happy and I drank when I was anxious and I drank when I was bored and I drank when I was depressed, which was often”.

Caroline Knapp exemplified the phrase “high functioning alcoholic”, until she didn’t. Like many others, her ability to work well delayed her decision to quit. This is another great lived experience book that may motivate you to explore your relationship to alcohol. Knapp, had been able to follow her own rules around drinking, and therefore avoid the consideration that she might have a problem. Through starting to explore her relationship with alcohol she realised that booze had become a great love affair, and like other affairs, it was not actually helping her be the version of herself she wanted to be..

Online support groups

Online groups and platforms provide support and discussion possibilities. Some are free whilst others are paid for. The most popular groups can be found on Facebook and online. The benefit of these groups is that you can maintain some degree of anonymity but still get some support.

One Year No Beer – http://www.oneyearnobeer.com. 
One Year No Beer is a cessation programme that provides paid for support alcohol-free challenge options for one month, 3 month and 1 year programmes. Boasting over 55,000 members and plenty of tales from successful challenge completers, you can sample OYNB content on their Facebook page first to see if this is a good match for you. Many of the OYNB members take on positive health challenges aligned to their break from drinking, with added potential health benefits.

The alcohol experiment – http://www.alcoholexperiment.com

Attached to the Naked Mind platform, this 30 day free program (beyond that there is some cost) provides groups, mentors and advice how to move away from alcohol. Currently there are 35,000 users, and many success stories.

Online and in Person support groups

If you have a more serious issue with alcohol a face-to-face option may be your best choice. You can also discuss these options with your general practitioner. Some defining questions follow this section to help you frame if it is time for you to consider change.

Alcoholics Anonymous http://www.aa-hk.org

With more than 35 meetings a week in Hong Kong, this is the most famous alcohol recovery programme on the planet. This 12 step program includes all the great milestones of change management including support groups, mentoring, personal exploration and no judgement. Some people have reservations about elements of AA, but there is no denying the good that AA tries to do to support people recovering from problems with alcohol.

SMART RECOVERY https://www.smartrecoveryinternational.org/meetings

SMART recovery is an alternative to AA, and doesn’t involve the attachment to higher power which some people find hard about the AA process.

You can connect with Smart Recovery on Facebook and On Instagram.

SMART RECOVERY  is a global community of 3000 support groups in which participants meet weekly to help each other overcome the life challenges caused by any addiction (to drugs, alcohol and behaviours such as gambling). Using SMART (Self-Management and Recovery Training), they find the power within themselves to change and lead fulfilling and balanced lives guided by a science-based and a 4 point programme focused towards building the motivation to change, be able to manage cravings of addiction, managing the thoughts and behaviours attached to addiction and lead a balanced life.

Face-to-face therapy: Counselling – various 

You may start your exploration of your relationship with alcohol in a relationship directly with a counsellor familiar with addiction recovery. Sometimes individual counselling is a nice complement to support groups. Therapeutic alliance, ie how much you feel you fit with your counsellor, is a major factor in the success of your therapy, so shop around to find the right fit for you. RED DOOR offers addiction counselling for alcohol and substance misuse. If you’d like some more questions about the RED DOOR offering feel free to contact reception@reddoor.hk.

How do you know if you have a drinking problem, not just a drinking habit?

The following is NOT a diagnostic test, but includes some of the types of questions that would be used for a formal diagnosis of substance abuse issues. Please answer Yes or No to the following 10 questions.

1. In the past year have there been times when you have consumed more alcohol, or drank for a longer period, than you had originally intended?
2.  In the past year, has your drinking interfered with your relationship with friends, family or work colleagues.
3. In the past year, have you missed work, or key appointments on a few occasions because of alcohol consumption the night before? 
4. In the past year, have you wanted to cut down your drinking amount or frequency and found yourself unable to do so?
5. In the past year, have you blacked-out as a consequence from drinking alcohol?
6. In the past year, have you lost personal items such as your keys, or wallet, whilst you were inebriated?
7. In the past year, have you missed work, or key appointments on a few occasions because of alcohol consumption the night before?
8. In the past year, have you noticed that your tolerance to alcohol has increased, and you now need to consume more alcohol in order to feel it’s effects?
9.  In the past year, have you found yourself in situations where you may have compromised your personal safety, or the safety of others, as a consequence of consuming alcohol
10. In the past year, have you started to experience some of the symptoms frequently labelled as  alcohol withdrawal, when you are not drinking including shaking, experiencing a racing heart, sweating more than usual, nausea, or trouble sleeping.

Scoring: How many questions did you answer with a “YES” response? If you answered 3 or more with a YES, then I recommend you consider to break-up with the booze, if only for a short period (3 months), and possibly longer. You can break free of the shame of that you can feel when alcohol dominates your life, and decisions, and you want to feel and act differently. You CAN put that shame behind you and live a better life.

About the Author.

Angela Watkins is a counsellor and psychologist working out of RED DOOR Counselling in Hong Kong. Angela has an interest in helping families and individuals with anxiety and depression. Sometimes drug and alcohol consumption is a component of those emotional challenges. You can feel better. Come in and talk to someone about it.

#reddoor #alcohol #alcoholdependence #alcoholrecovery #alcholicsanonymous #thecabin #oneyearnobeer #alcoholexperiment #thenakedmind #theunexpectedjoyofbeingsober #alcoholliedtome #girlwalksoutofabar #smartrecovery #pushingofffromhere #soberevolution #gloriousrockbottom #almostalcoholic #nothinggoodcancomefromthis.

Note about this article. An earlier version of this article first ran in June 2020. This article was updated, including adding more reading recommendations and republished in October 2024.

The Benefits of Group Counselling and Support in Hong Kong

While I love counselling individuals, I acknowledge that group therapy can be a powerful alternative to achieve therapeutic results. Group counselling offers unique benefits—working through challenges collectively can reduce feelings of isolation and shame, provide access to shared resources, and often be more affordable than individual therapy.

Who Leads Group Therapy?
Groups can be led by qualified mental health professionals, such as counsellors or psychologists, or facilitated by individuals with lived experience. When choosing a group, consider the facilitator’s qualifications and experience. Some with lived experience are highly capable of guiding others, especially when they have received appropriate training.

Cost and Accessibility
Group sessions vary in cost—some are free, while others charge a fee. Typically, group therapy is significantly less expensive than individual sessions, making mental health support more accessible.

Effective Group Dynamics
Successful groups are run by competent leaders who establish clear rules regarding privacy and respect, share the group’s goals, and manage members who may disrupt progress—such as those experiencing emotional dysregulation, refusing to participate, or bringing unrelated issues to the group.

Below is a list of current English-language groups in Hong Kong covering various topics. Please note I haven’t personally experienced all of these groups, so this information isn’t an endorsement but a resource guide.

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Counselling & Support Groups in Hong Kong

Iron Fairies
A therapeutic support group for women navigating divorce, run by RED DOOR Counselling. Led by an experienced psychologist and counsellor, it has been active since 2017. The group meets fortnightly at RED DOOR’s Central office, with additional support via a mobile app.
Fee: HKD 300
Contact: WhatsApp 93785428 | Email: angelaw@reddoor.hk

The Care Bridge

The Care Bridge is an online group run by counsellors and counsellors in training from RED DOOR Counselling. The group supports adults as they care for relatives at a distance. It can be stressful and worrying looking after people who you are far apart from. The group meets via zoom. Attendance at the group is free.

Contact: WhatsApp 93785428 | Email: angelaw@reddoor.hk

Talk Hong Kong
Offers support groups for survivors of sexual abuse and assault, for both men and women. Facilitated by peer leaders with lived experience, these monthly groups aim to build coping skills, understand personal trauma, and establish healthy boundaries.
More info: https://www.talkhongkong.org/

St. John’s Counselling (Young Adults)
A peer-support group for young adults facing mental health challenges, facilitated by counsellors. Suitable for those seeking an alternative to face-to-face individual counselling, with weekly meetings held at St. John’s office.
Contact: 2525 7207 | Email: kimberly.ho@sjcc.hk

Special Needs Network Hong Kong
A longstanding support group for parents of children with disabilities, providing education, support, and community connection. Open for over 20 years, it meets monthly—ideal for parents of children with special educational needs.
Website: https://www.snnhk.org/

Alcoholics Anonymous (AA)
A global organization focused on overcoming alcohol addiction through the 12-step program. Meetings are held weekly both in person and online. AA’s approach may not suit everyone, but it remains one of the most effective programs available.
More info: https://www.aa-hk.org/

SMART Recovery
An alternative to AA that does not involve spirituality. It employs a science-based, four-point program empowering individuals to manage cravings, change thoughts and behaviors, and lead balanced lives. Meetings are weekly, available both face-to-face and online.
Instagram/Facebook: @smartrecoveryhk | Website: https://smartrecovery.org/

OCD and Anxiety Support
Monthly group therapy for individuals experiencing severe anxiety, led by qualified counsellors. A donation is requested, with discounted counselling options available. For OCD.
More info: https://www.ocdanxietyhk.org/

The New Normal
A charity offering monthly mental health support groups on topics like grief, cancer, and unemployment. Led mainly by trained volunteers, these sessions are usually free.
Website: https://www.thenewnormalcharityhk.org/

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Final Thoughts

Trying a support group can be highly beneficial—you may find it complements individual therapy or serves as an effective standalone approach. If a group isn’t suitable or available, individual counselling remains a valuable option.

About the Author
Angela Watkins is a private practice counsellor and psychologist based at RED DOOR Counselling Hong Kong. She supports adults through divorce, anxiety, depression, substance misuse, abuse, and career transitions. Angela also leads the Iron Fairies group for women navigating divorce.

Note: If you operate an English-language mental health support group and would like your information

#grouptherapy

#divorcerecovery

#parentingspecialneeds

#alcoholicsanoymous

#smartrecovery

Probably every parent has encountered a morning when their child refuses to go to school. We try to convince our child to get their acts together, and get ready for school. Sometimes it works, sometimes it doesn’t. This is usually very stressful for parents. Now, imagine this happens every day.

What is school refusal?

School refusal is made up of a persistent pattern when a child is reluctant to attend school and remains at home and the parents know about this absenteeism. In most cases the child has had an episode which accompanies their refusal – including expressed fearfulness, throwing temper tantrums, or presenting with somatic illnesses, which possibly disappear when they are allowed to stay at home.  Most parents have usually attempted to secure the child’s attendance at school and are not, initially at least, supportive of school absence (Heyne et al, 2013).

From an academic research perspective, school refusal requires a pattern of absence, adding up to above or near 10% of school days (Havik & Ingul, 2021).  It is different from time missed from school due to truancy. Truancy involves absence without the parents awareness or consent (Heyne et al, 2013).

Before the COVID pandemic, school refusal occurred at a rate of 1 in 25 kids. It is suspected that since the since pandemic there has been increased absences in schools and growth of the number of children missing more than 10% of school days (Havik & Ingul, 2021).

School refusal poses a serious threat to a young person’s development because it affects their learning and achievement, places the youth at higher risk of dropping out of school completely, it places the youth at risk of becoming socially withdrawn, and can place the young person at greater risk of later mental health issues and/or developing other anti-social style behaviours (Henye et al, 2013; Havik & Ingul, 2021). So its not just a missed learning issue.

And as any parent will tell you, it is not just the child that is affected. School refusal can be a source of family stress and conflict (Henye et al, 2013).

Why does school refusal occur?

Looking at the academic research about school refusal we can identify the features about the refusing child, their family home, the school and the greater environment that may drive this behaviour.

About school refusers

School refusal occurs when stress within the individual exceeds support, when the risks to self are greater than resilience, and the factors that promote non attendance outweigh the factors that encourage attendance (Havik & Ingul, 2021).

Individuals refusing to go to school may have heightened fear of failure, low self-efficacy, and physical illness (Maynard et al, 2018).

Children’s anxiety is often a factor in their absence from school (Totsika et al, 2024). Anxiety disorders are present in about 50% of clinic referred youth exhibiting school refusal (Maynard et al, 2018). School refusal might be about avoiding school because it provokes such negative feelings such anxiety, depression, and distress (Havik & Ingul, 2021). For younger children the presence of separation anxiety may be a key component in their refusal to attend school (Roué et al, 2021). The correlation of mental health factors such a anxiety and depression may be a precursor or a maintainer of the refusal behaviours. Because of the mental health aspects, and the complication of understanding what is motivating a situations, versus what is maintaining a situation, professional help from a psychologist or experienced counsellor is paramount to support children displaying school refusal.

There is also the possibility that some of these emotional experiences are actually indications of underlying learning issues finally being brought into the light of day. Many children with learning issues find it possible to fake some form of learning progress, until the content that they are learning becomes too complicated for their compensation style behaviours or skills to fake learning any more.

Children who are neurodiverse – including those with dyslexia, dyscalculia, dysgraphia, ADHD, ADD, and autism – have a particular vulnerability to school refusal. It is suspected that in addition to internal anxiety and fears over failure, that school refusal may be due to a mismatch between the child’s needs and the schools ability to accommodate with appropriate learning adaptions (Totsika et al, 2024). Additionally, neurodiverse children may be more at risk of social exclusion at school, a school factor which drives school refusal (Totsika et al, 2024).

Age is an individual factor determining the severity of school refusal. Adolescents may see return to school to be solely determined by them rather than collaboratively with parents (Heyne et al, 2013) Teenagers are also more likely to be more physically capable of resisting parental efforts to return them to school. Therefor older children tend to present with more complicated cases of school refusal to treat, and cases with younger children are often easier to treat successfully (Heyne et al, 2013).

It is important to also consider what is happening after school has been avoided. School refusal might be about avoiding school in order to pursue another tangible reinforcements outside of school. For example children may be refusing to go to school in order to stay in bed, talk to friends outside of school (in different time zones), and to engage in gaming (Havik & Ingul, 2021).

What might be happening at home

School refusal might be about avoiding school to gain attention from others, particularly parents. Havik and Ingul (2021) suggest this might be the root of use of somatic illness as a method to refuse attendance at school. Other researchers highlight that family factors such as divorce of parents, individual parents mental health challenges, general family dysfunction and parents feeling overprotective of their children may be components of a child’s desire to refuse school attendance (Maynard et al, 2018).

This highlight the needs of professionals, and the school, to understand the home environment when attempting to build a school attendance plan to overcome lost learning as a consequence of school refusal (Roué et al, 2021).

School factors

The school itself may be a part of the school refusal puzzle. School factors include bullying, the structure of the school, and the level of schooling (Maynard et al, 2018).

The older the child, and the age of children in the school, the more complicated school refusal treatment can become:

“Socially and academically, the secondary school environment is more demanding than the primary school environment. This together with increasing importance of academic performance, peer influences, and identity formation during adolescence, can make it more difficult for school-refusing adolescent to overcome school refusal, relative to a school-refusing child”.( Henye et al, 2013)

School refusal might be about avoiding school to avoiding evaluation situations (Havik & Ingul, 2021) . Very academically aggressive curriculum may be more pressure than some children can bear. Additionally, schools may not be designed to meet the holistic needs, or learning needs of all of their members (Havik and Ingul, 2021).

The social world at school is also a challenge. Schools have a lot of difficulties managing bullying and exclusion and compromised relationships between children/ teens can be a factor in school refusal (Havik &Ingul, 2021; Henvik et al, 2015). Many teenagers in Hong Kong experience exclusion, and want to miss school as a reaction to their social difficulties at school.

In the wider environment

Societal pressure towards academic pressure may be a component in school refusal (Maynard et al, 2018). Pressure to perform well at school is common in Hong Kong, and is a factor in school engagement, and many other mental health challenges (Chyu & Chen, 2022).

During the COVID pandemic many individuals worked from, or studied from home. As with work, it it seems like the relationship with school became optional. This is not just affecting children, teachers also seem to feel this way (Havik & Ingul, 2021).

How do counsellors treat school refusal?

School refusal requires treatment, not just a plan, because of all the intricate forces that create the behaviour and perpetuate it, including ongoing mental health challenges. (Maynard et al, 2018). One element I want to highlight to parents is that school refusal treatment usually requires an evolving plan needs to involve the child, the parents and the school, and may take several weeks to implement successfully.

Counselling is recommended for school refusers. Family therapy is promising to help resolve school refusal (Roué et al, 2021).  Cognitive behaviour therapy (CBT) styled treatments are usually recommended (Heyne et al, 2013).

A plan around sessions and discussion by a counsellor with a child or teen who has been refusing to attend school might include the following:

Similar discussions need to take place with parents.

School refusal has a major impact on families, and may stretch a parents’ vulnerability. Additionally, the degree of commitment of school personnel toward children with school refusal largely depends on their parents’ attitudes (Roué et al, 2021). Programmes need to have sessions including parents or family therapy sessions so that all concerns, barriers, learning and scheduling accommodations to discuss with the school, and the goals can be agreed. Family or parenting sessions could cover understanding the reasons and impact of school refusal, developmental expectations of the child, understanding what reinforces school refusal in the home setting (Maintenance), helping build new communication tools within the family, Helping parents build new responses to school refusal signals and behaviours and improving overall family dynamics (Heyne et al, 2013; Roué et al, 2021).

Counsellors may also work with the school, and family, to help explore the school’s ability to coordinate and organise around the requirements of the child at school including flexible scheduling, looking at means to overcome lost learning, help build in structures to support for anxiety, and build strategies around social difficulties the child may have been experiencing (Heyne et al, 2013). Unfortunately schools are organisations with limitations and sometimes accommodations can not be made, but many do as much as they can. In the end, sometimes a change of school may be required.

Special consideration for parents of school refusers in Hong Kong

In Hong Kong the typical school calendar is 190 days, so if thresholds to consider school refusal a problem is are usually around 10% of school days on offer, 19 days of missed school would be considered indicative of a school refusal problem.

Every day you encounter a school refusal issue, you might like to put the school refusal behaviour in context to this overall threshold. It isn’t just one day. Ask yourself, “If my child had to repeat a whole year if they miss 10% of the days, would you allow your child to stay at home?”

Remind yourself, and your child, what makes school worth attending and considering. Listen to your child, and see if you can summarize their arguments back to them. Remember, they might not want to tell you the whole story that they are struggling with learning of friends. Try to get to the bottom of what is going on, and consider professional help, such as a counsellor, to achieve this.

Please appreciate, some aspects of the school experience are uncomfortable. Think about what you want your child to become use to, rather than avoid, in the list of elements about school that can be difficult for them. Ask yourself you are able and willing to help your child navigate what they find uncomfortable.

Are you willing to make your child’s requests to stay home uncomfortable in different ways? Ask yourself are you willing to remove any excuses for them to stay home? For example, unless they are sick, the child can’t stay in bed all day. Would you be willing to remove their access to devices so that gaming to talking to friends online is not an option? Can you sit with your child whilst they do their schoolwork at home?

Schools in Hong Kong, do try, but probably need to do more, about bulling and exclusion. There is an attitude, especially among teenagers that they should be able to navigate these delicate social troubles on their own, without adult intervention, and we may need to assess if this is wise.

For neurodiverse kids school life may include exclusion and and bullying. This is not okay, but is quite common unfortunately. What supports exist at the school help your child navigate social situations? Some of these resources may be outside of school. For example, Red Door hosts a social social skills programmes on Saturday mornings, and many of our students consider that group of individuals their safe group of friends, rather than relying on school for close friendships.

Schools may find supporting your learning differences too difficult. Explore what they can and can’t do. Perhaps school may not be perfect, but it may be good enough for some of the time. Also consider what external supports could help to lighten the expectation on the school? This would also require schools to be more flexible on their attendance parameters. You may want to think changing school, but not before you have secured another spot for your child. Learning support spots at schools in Hong Kong are highly sought after, and limited.

One last note, treating school refusal can take time. Parents naturally want quick results, but this doesn’t happen immediately. I highly encourage you to seek the imput of an experienced counsellor or psychologist to help. I hope this article helps you better understand some of the nuances of refusing to go to school

About the author. Angela Watkins is a psychologist and counsellor working our of RED DOOR Counseling in Hong Kong. Angela works with children and families on a range of issues, including school refusal. To contact Angela email angelaw@reddoor.hk

References to this article.

Chyu, E.P.Y; and Chen, J-K; (2022) Associations Between Academic Stress, Mental Distress, Academic Self-Disclosure to Parents and School Engagement in Hong Kong. Front. Psychiatry, 14 July 2022

Havik, T; Bru, E; and Ertevåg, SK (2015) School factors associated with school refusal and truancy – related reasons for school non-attendance. Soc Psychol. Edu. Vol 18:221-240

Havik, T; & Ingul, J. M. (2021) How to understand school refusal. Frontiers in Education.

Heyne, D; Sauter, F.M.; Ollendick, T.H. Van Widenfelt, B. M.; and Westenberg, P. M. (2013) Developmentally sensitive cognitive behavioural therapy for adolescent school refusal: Rationale and case illustration. Clinical Child Family Psychology Review.

Maynard, B. R.; Heyne, D; Brende, K. E; Bylanda, J. J; Thompson, A. M; Pigott, T. D. (2018) Treatment for school refusal among children and adolescents: A systematic review and meta-analysis. Research on Social Work Practice. Vol 28(1).

Roué, A; Harf, A; Benioit, L; Sibenoni, J, and Moro, MR. (2021). Multifamily Therapy for Adolescents With School Refusal: Perspectives of the Adolescents and Their Parents. Frontiers in Psychology. June 2021.

Totsika, V; Kouroupa, A; Timmerman, A; Allard, A; Gray, K.M; Hastings, R.P; Heyne, D; Melvin, G.A; and Tonge, B. (2024) School attendance problems among children with neurodevelopmental conditions one year following the start of the Covid19 Pandemic. Journal of Autism and Developmental Disorders; Vol 54, 2998 -3007.