To know yourself very scary for some Psychotherapy helps cut mental instabilities

THE stress of discovering your identity in a society where divergent information and perspectives come into conflict with traditions and culture can lead to a variety of mental instabilities. Attention deficit hyperactivity disorder (ADHD) and learning issues are also quite common in both children and adults. However, Psychologist Dr. Vincenza Tiberia assures that there are effective treatments for individuals to come to terms with who they are and eradicate the conflicts within themselves. That is provided that the right therapists are sought, only a few of whom are available in Kuwait according to Dr. Tiberia. She believes that the standards and ethics of psychotherapy must be applied by all licensed psychologists, regardless of the society where the practice is located. This is to ensure the most effective treatment and the well-being of clients. Read on to find more about psychotherapy in Kuwait and the latest developments in the field.

Question: How is psychotherapy regarded in Kuwait?

Answer: The late Amir Sheikh Jaber Al-Ahmad Al-Jaber Al-Sabah established several psychotherapy clinics in the 1990s to help citizens move past the Post-Traumatic Stress Syndromes (PTSDs) of the Iraqi invasion. He introduced the country to psychological services and was successful. He made people understand the importance of psychotherapy especially post the first Gulf War and that PTSD is real.
Unfortunately, most of the clinics established by the Amiri Diwan have been closed. Psychotherapy has spread to the private sector, so you have people trying to capitalize on the need for psychological services.

When I came in 1998 from Miami, where even then there was still some stigma attached to going to a psychologist, I was delighted to discover that in Kuwait even traditional and conservative people were willing to take advantage of psychological services. It was an amazing phenomenon.
But as of late there has been a sort of backlash due to some sensational claims entering the market because of the lack of regulations. As a result of this debasement people started becoming wary and distrustful of mental health services. One of the claims was that a full psychological analysis and a report could be had in one hour, so people were enticed to try it. But when they get disappointed they may become disillusioned with psychology in general and would be reluctant to give it another try even with a licensed professional.

The market has also changed in the fact that people are going on the Internet more now for everything and, even if they are referred to me by a friend or a family member, they still want to check on the Internet to see who I am and get more information.
Unfortunately, psychotherapy in Kuwait is on the brink of being pushed down to the lowest common denominator of substandard service and qualifications, but my colleagues at Al Razi Center and I continue to uphold international standards for confidentiality, ethics and treatment in Kuwait.

Q: What are the responsibilities of a licensed psychologist towards a patient?

A: In Kuwait, there are currently only four licensed psychologists. Getting a license means that you are adhering to standards of practice in order to maintain that license, and have passed exams and internships and became a member of the APA. It also means that if you do something wrong, the patient has a way of complaining.
The initial appointment with a patient is for consultation purposes, assessing what the problem might be and possible treatments. For example, if you are a parent and have questions about your child, we open a file and we discuss the history of the child and the problem and collect any pertinent medical reports or school documents.
The next session would be the start of the actual treatment. I always do testing to get as much accurate information as possible. For example, if my patients are a married couple I would give them personality tests Online and evaluate their compatibility.

My neuropsychology test battery follows extremely high standards. For example, if a child has learning difficulties the Attention deficit hyperactivity disorder (ADHD) test is done to see if he has a concentration problem. ADHD is extremely common in Kuwait. The prevalent use of technology makes it worse by having a severe impact on the developing mind and nervous system and they actually lose the ability to focus and concentrate.
So my battery includes the ADHD and memory tests, aptitude and achievement tests, as well as some kind of emotional testing. For older children and adults, I also use vocational and career testing and personality testing.

For example children’s learning problems cannot be accurately assessed or diagnosed with just one test; therefore I assemble a battery which targets various areas of functioning to conclusively establish the right diagnosis. So my psychotherapeutic motto is accurate diagnosis and effective treatment. By adopting this as your standard you are going to provide professional service because you want your patient to get well. Many of them get well fast through my ten-day intensive program and then they are OK and never have to see me again. I seek to provide the most effective treatment and not to prolong the patient’s suffering.

Then there are some cases which are more long-term because Jungian analytical principles need to be applied for self development. But 90 percent of the cases are based on problems that need to be resolved – a learning problem, an emotional or behavioral problem, a marital problem, career issues, an addiction problem – and all of these can be targeted and resolved through short term therapy.
You will find that many parents are motivated to go to a psychologist for the very first time because of their kids. The teacher or counselor may have informed them of behavioral or learning problems in their child. A lot of times with smaller kids, the parents may actually need the therapy instead of the kid. Children under the age of 10 tend to express the emotional state and conflicts of the parents through their own unconscious behavior. We have people oftentimes coming to therapy because of relationship issues and marital problems.

Kuwaitis who could afford it used to go overseas for treatment as confidentiality is very important to patients and maintaining that is the therapist’s primary responsibility. The standard is you do not reveal anything that could possibly suggest who your patient might be.
In a place like Kuwait, it is easy to identify a person if the language, the nationality, the work and the look is revealed publically. If anything like this would occur in the US, there would be repercussions and they would shut down the office of the offending therapist.
Also, psychologists want to establish a rapport with the client. Therefore, sitting behind a desk is not recommended as it is a message to clients that “I am separate from you, I have all this stuff on the wall” and that is intimidating. One of the ways you can put the client at ease is through the way you dress.

For example, if my client is traditional I am going to dress more conservative that day. Incorrect or unprofessional dress can send a very distorted message of which the professional therapist should be aware.

Q: Are there differences in practicing psychotherapy in Kuwait and western or European countries?

A: In my opinion, there is no difference between practicing psychotherapy in the US or Kuwait because the universally accepted standards for practice should be maintained regardless of geographical location. For example, if someone who is suicidal comes to me, I do a suicide assessment. Over the past couple of years, suicide has gone up in Kuwait in all levels of society.
There is a technique for finding out if someone is suicidal or not. I was trained by former APA President Dr. Nicholas Cummings on suicide prevention and how to interview somebody who may be suicidal. A lot of people don’t even know they are suicidal because the problem lies in their subconscious, so you have to confront them in a particular way to make them realize their plans.

First of all, you have to know how to assess suicide risk. Then you have to know what to do once you find out that is the case. There is no confidentiality when it comes to suicide risk, you must notify the family and make suicide-watch accommodations and you must refer the patient to a psychiatrist and so on.
Another unethical activity that is noticeable in Kuwait is having informal relationships with patients outside the therapeutic environment, such as going shopping together. It would be considered taking advantage of the client using your position.
In the US, however, the most recurrent ethical breach is having sexual relations with your client. You can lose your license for that. But in Kuwait, there are no statistics for ethical violations.

Q: What are the prevailing psychological problems in Kuwait that locals and expatriates should seek treatment for?
A: Many people in Kuwait have ADHD or impulse-control disorders which contributes to anger management issues and leads to behavioral problems such as road rage. Learning disabilities may also be related to poor impulse-control.
Also, there is a lot of stress in Kuwait because of the rapid development of the society. The divergent factors and influences that are constantly feeding into the social environment, most of which are coming into conflict on a daily basis. You find people trying to juggle very different types of activities and thoughts. For example, you might have a liberal personality but have to appear very conservative to please your family.

When I do personality testing, the schizophrenia index is often elevated but the person may not be schizophrenic. In other words, you have to know how to interpret the results within the cultural context. What looks like schizophrenia rarely is because having divergent thoughts and feelings is the norm and occurs on a regular basis.
This causes individuals to have a crisis of identity. With more money you have access to everything but you also must maintain your traditions to keep your family happy. The new generation has a very hard time reconciling all the new information they are getting through the Internet and their travels and friends and also maintain the culture and tradition they were born into. It is very stressful and people end up with a lot of contradictions within themselves.

Q: How has psychotherapy developed over the years and what do you believe would be the future of psychotherapy?

A: We went from the psychoanalytical approach, lying on the couch and saying whatever comes on into your mind through free association. In the US, there is the experimental-behavioral approach where you change the patient’s behavior. It is more evidence based and systematic as there are targeted goals to be systematically achieved.
The trend of the future is computer-based treatment. I was first to introduce computerized testing and treatment in Kuwait. I have two computerized programs that are designed for the treatment of learning disabilities, neurological disorders, memory and concentration problems.

Q: Isn’t the over-use of computer and technology the cause of attention deficit disorders in the first place?

A: That is correct. Randomly surfing of the Internet and constantly playing computer games can negatively impact the developing brain of children as well as adults. The rapid stimuli constantly bombarding their nervous system can result in classic ADHD symptoms.
However, computerized treatment is a different usage of that technology. You can utilize that technology in a very structured way to actually rehabilitate cognitive functions. If used improperly, computer can cause the debasement of cognitive functions. But if used in a systematic programmed way, these programs can cure the same problems. My programs have very focused activities with immediate feedback mechanisms on how they are doing.
There are also virtual therapies that are being used for PTSD where for example the traumatic scene is recreated for a soldier so that it can be re-experienced with another perspective. That is how you treat PTSD, you have to remember everything through consciousness and work through it with a therapist so that those problematic experiences do not control you on the sub-conscious level.
Computer-interfacing with the human mind is the new frontier called Engineering Psychology.

Q: Speaking on a taboo subject, how prevalent is homosexuality in Kuwait?
A: There are no statistics on homosexuals in Kuwait because it is not out in the open. I do have people coming in for treatment for sexual issues, some of them are happy with their sexuality, some of them are not.
Homosexuality can come from abuse. For example, when I give the personality test, the PTSD index may be elevated which would indicate abuse and I ask about it. 100 percent of the time there would be abuse when the PTSD index is elevated. It’s a closed society, so the lack of opportunity to have a healthy interaction and learn about the opposite sex can give rise to abnormal and problematic behaviors.

Q: Do you advise the general public to seek psychotherapy?
A: I hope people would view psychology in a different way. To know yourself is very scary for some people but it is worthwhile. You can be very apprehensive at the beginning but once you get your personality resolved and start facing our demons, you will be very happy that you did. The whole anxiety level goes down and stress becomes manageable if you understand yourself. If you don’t understand yourself, you won’t be able to understand others or have good relationships and accept the goodness of others.

In order for society to move forward in this hectic environment where you are bombarded with so many things, you need a way to understand yourself first and then you can make your plans and interact with others.
I love my work and is it is very rewarding. Kuwait is very fascinating for me as a psychologist to work and the experience that I have here is so vast and diversified. I would never have had this kind of experience anywhere else because of the wide variety and types of people, nationalities and mind sets. I enjoy seeing people progress and become well and they are very happy and grateful for that.

biography
Dr Vincenza Tiberia is a Licensed Psychologist with over 40 years of experience in educational psychology, clinical psychology and neuropsychology, who has practiced in the United States, Europe and Kuwait. Dr. Tiberia earned her Bachelor of Arts degree in Honors Psychology at The University of Michigan, Ann Arbor in 1974, her Master’s degree in Educational Psychology at The University of Southern California in Los Angeles in 1975 and her Doctor of Philosphy Ph.D. in Professional Psychology at United States International University, School of Human Behavior, Scripps Ranch San Diego Campus, California in 1981. While completing her doctoral degree, Dr. Tiberia had the unique opportunity of studying under some of the most famous names in modern psychology, including the founders of the School of Human Behavior who were among the most influential original contributors to the theories of human behavior and the practice of professional psychology— including such giants as Abraham Maslow, Victor Frankl, Rollo May, Everett Shostrom, Harold Greenwald, Carl Rogers, Herbert Blumer, and Max Lerner.

After completing her doctorate in professional psychology, Dr. Tiberia married and moved to Miami, Florida where she took the position of Clinical Director at the Epilepsy Foundation of South Florida. Dr. Tiberia was licensed in Florida in 1986 and maintained a private practice in South Miami for ten years, during which time she also provided neuropsychological assessments in local Miami area hospitals. During this time Dr. Tiberia was awarded Allied Health Professional Privileges with Humana Healthcare, Mercy Hospital and the Miami Heart Institute. In 1992 Dr. Tiberia relocated to Switzerland and while living in Ticino, she provided educational assessments at a prestigious local private school. Dr. Tiberia obtained her Swiss license to practice psychology in 1993. Most recently in January of 2011, she also became licensed as a psychologist in the State of California.

In 1998, Dr. Vincenza Tiberia arrived in Kuwait as a consultant with the Amiri Diwan, Social Development Office where she developed supervised internships and continuing education programs for local psychologists. She was later appointed as the first Educational Psychologist for the American Academy for Girls and The English Academy. Since 2001, Dr. Tiberia has been practicing at Al Razi Counseling and Assessment Center in Salmiya, Kuwait specializing in school assessments, psychotherapy, marital counseling and brain-based ADHD treatment programs, including her signature Cognitive Retraining Program (CRP) for children and adults.