The Caregiver’s Journey–Part 2

In last week’s post, we explored the specific parts of the Caregiver’s Journey–the beginning, middle and end stages–what can be expected at each stage and ways to cope.  Today, we’ll specifically look at the burnout that can be experienced by some caregivers.  What are the risk factors?  How do you know if you’re feeling burnout?  What can you do to prevent burnout?  This is the second in a three-part series on care-giving.

The information in this post is a partial summation of  information that was presented by Dr. Virginia Wesson, Psychiatrist and Dr. Rhonda Feldman, Psychologist.   Both Drs. Wesson and Feldman see patients, and their families, at The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer’s Support and Training.

A Story…

Dorothy and Marion (both aged 74) have been together for 40 years.  Ten years ago, when they retired from their careers (Marion was a teacher, Dorothy an operating room nurse) they had plans to travel.

Shortly after Marion left her job, she developed a cough that wouldn’t go away.  She lived with it, but became concerned when she started to experience a tightness in her chest and shortness of breath.

Rather than visiting the doctor, Marion decided that maybe a change of climate would be helpful, and the couple planned a trip to Arizona to visit friends.  “Perhaps the heat and rest would improve Marion’s symptoms”, Marion thought.  Unfortunately, there was no change in her health.  In fact, once out of her home environment, Marion became easily tired and was unable to join Dorothy and their friends on day trips.

When the pair returned home, Marion agreed to seek medical advice.  She was diagnosed with the Chronic Obstructive Pulmonary Disease (COPD)–a chronic inflammatory lung disease that causes obstructed airflow from the lungs.

Marion and Dorothy were shocked by the diagnosis.  Both had been smokers at various times in their lives, but had quit ten years earlier.  However, one of the causes of COPD is smoking and the habit had left its mark on Marion’s lungs.

At the beginning, after the shock wore off, the couple found ways to cope with the changes in Marion’s health and her decreased energy level.  Long-distance travel was out of the question, and with Marion’s new medication, they were able to make the most of day and weekend trips.  Because they were both retired, Dorothy found it easy to take over some of Marion’s tasks.  The women were able to cope in this first stage for a long time, adjusting as Marion’s health slowly deteriorated.

Risk Factors for Burnout

As explored in last week’s post, burnout often starts to appear during the middle stage of the care-giving journey.  In the beginning, the illness is a consideration in lifestyle decisions, but not a main component.  However, as the illness becomes more severe, it becomes a major factor in how the person who is ill and their caregiver function on a daily basis.

As the caregiver continues on this path of support, they may be at risk for burnout depending on:

  • the severity of the illness or behaviour of the person they are supporting
  • if they feel able to handle situations that arise
  • the type of relationship the caregiver has had in the past with the individual (i.e. it is often easier to take care of someone with whom you have had a loving relationship)
  • degree of knowledge about the illness
  • level of quality support (informal, formal and professional).  The more support, the less risk for burnout.

Based on what we know about Marion and Dorothy, we can assume that Dorothy may not be at a great risk for burnout, if she is careful.  When Marion was first diagnosed, both women did a lot of research into COPD.  Because of Dorothy’s connections in the health care field, she was able to put supports in place well in advance of them being needed.  The couple had been in a loving, stable relationship for a number of years and were committed to supporting each other through the illness journey.

However, not every caregiver has the resources that Dorothy was able to access.  What are the symptoms of burnout?

You May Be Experiencing Caregiver Burnout If…
  • You have developed a new health problem.  If we don’t practice self-care, taking care of a loved one can stress our immune system, causing our own health to suffer.
  • Depression.  At times we can feel that the situation is hopeless–especially if we know that our ‘person’ isn’t going to get better.  Feelings of being overwhelmed, overtired and under appreciated can all lead to depression.
  • Anger.  While anger is a normal response to life not turning out as we had wished, excessive anger is a warning sign of burnout.
  • Substance Use.  Care-giving is difficult and we all have our own ways of coping or self-soothing.  However, using substances as a way to make yourself feel better is not a healthy way of self-care.
  • Social Isolation.  Social isolation can be a vicious circle.  We may have to stay home all the time in order to be there for our ‘person’–especially if there are no supports in place to give us a break.  However, the more isolated we become, especially if depression sets in, the less time we want to spend out in the world.
  • Loss of Relationships.  This is directly related to the degree of social isolation you may be experiencing.
  • No interest in self-care.  If you are not eating well, taking time to exercise or spend some time doing activities that you enjoy, burnout may be the reason.
The Story Continues…

Through forethought, planning, good communication with Marion and lots of support, Dorothy was able to avoid experiencing serious burnout.  Of course there were days or weeks when she felt overwhelmed, but because she felt that the care she was providing for Marion was important, she was able to get through the rough patches.

By this time, Marion was housebound due to exhaustion.  Her medication wasn’t as effective as before and for various health reasons she wasn’t a candidate for surgery that is sometimes an option for COPD patients.  Due to her lack of energy, Marion spent a lot of her day sleeping.

If someone had asked Dorothy how she was doing (we don’t often ask the caregiver, but instead focus on the person who is ill), she would have responded that she is able to handle the medical piece because of her nursing training, and the house chores as they can afford to hire help when needed.  Her biggest heartache is that she misses Marion (the ‘old’ Marion).  She misses having someone to go out with and share experiences with.  Marion isn’t psychically absent, but she sleeps most of the time, so isn’t always available.  Dorothy wonders when she stopped being Marion’s partner and became her full-time nurse.

This sense of loss is common for caregivers.  Even if they have support for the practical things, the grief experienced around this is often lonely and hard to explain to others.

What’s a Caregiver To Do?

Does the above list describing burnout sound like you?  Can you relate|?  If so, there are things that you can do.

  • Ask for help from other family members, friends, medical supports, etc.  As humans we often feel that we can do it all by ourselves, or that no one else is able to take care of our ‘person’ as well as we can…and we can’t and other’s can (though it may look different from how we would take care of them).  Do yourself and them a favour and get some support.
  • Check into support groups for the type of illness/condition that your loved has.  Many groups, such as the Alzheimer’s Society and Hopespring Cancer Support Centre offer support groups for patients and their caregivers.  Your medical supports may be able to provide advice on where to look or check out the web.
  • If you are feeling housebound due to your care-giving role,  and are computer savvy, there are on-line support groups available.
  • Let your doctor know that you are struggling–especially if you are feeling depressed, using substances or other unhealthy means as a way to cope.  There are things they can do to help by suggesting medication or referrals to other professionals.
  • No matter where you are on the care-giving journey, counselling is always an option as a tool to help you cope with negative emotions (such as anger) that can come up, inappropriate ways of coping, feeling socially isolated.  Having an impartial third party to talk to about what is going on, can release some of the stress and pressure that you feel.
The Story Still Continues…

Marion and Dorothy are still living in their home.  Marion’s health continues to decline, and Dorothy has come to terms with her ‘new’ relationship with her.  At Dorothy’s request, family members have started taking on a more active role in Marion’s care.  More and more household duties are being done by paid help or family members.

Dorothy is still grieving the loss of the ‘old Marion’ and recognizes that this is reality. She is thankful that she is able to provide so much care for her partner.

And now, let’s lighten the mood.  For those of us who are trying to figure out summer plans for our children, here’s a classic camp song from Alan Sherman…Enjoy!

 

 

 

The Caregiver’s Journey–Part 1

I recently attended a one-day conference (organized by Hospice Waterloo Region) for caregivers and professionals who support them.   As I sat with the other participants, and heard the stories of people who are actively being a ‘care partner’ for a loved one(s), I was struck by the love and dedication that helped them to make meaning of the difficult role that they had agreed to take on.  I was also aware of the feelings of exhaustion, frustration, fear and loneliness that many bravely shared as they told their stories.  This is the first in a three-part series on Care-giving.

The information in this post is a partial summation of  information that was presented by Dr. Virginia Wesson, Psychiatrist and Dr. Rhonda Feldman, Psychologist.   Both Drs. Wesson and Feldman see patients, and their families, at The Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer’s Support and Training.

The Caregiver’s Journey

According to data presented that day, there are 3.3 Million caregivers in Ontario.  Of those, 500,000 of them are ‘young’ caregivers (falling between the ages of 6 and 25).  If as a society we were asked to pay for the caregiving services provided free-of-charge by loved ones, the bill would be in the Billions of dollars.  Wow!

Based on the numbers, if we are not personally affected  by the need to take care of a family member or friend, then we know someone who is–a friend, co-worker, other family member…the list goes on.  As people in our circle, how can we support them as they support others?  I suggest that a first step is to understand the path that they are walking.

Dr. Wesson believes that there are three stages to the caregiving process:  the early stage, the middle stage and the late stage.

The Early Stage

When a partner, spouse, close friend or family member has been diagnosed with a debilitating illness we often experience shock and grief.  While we may have suspicions that our ‘person’ has been struggling, having it confirmed can still be devastating.  We don’t know what the future really looks like, and we may feel that we are starting an ‘endless’ journey.

If we are the primary support, we can be overloaded with information by medical staff or our own research.  On the other hand, we may feel that we are being provided with little information and not sure where to turn.

Once the initial emotions subside, and if the disease in question is progressing slowly, the illness may intrude in our life, but we are able to carry on with a sense of normality.  You may be providing more emotional support vs. physical support for your loved one, taking on more of the hands-on chores that may now be more difficult and becoming a ‘manager’ of the care required by your loved one (i.e. managing medical appointments).

Coping Strategies for the Early Stage

It is during the early stage that you can start to put supports in place for the future.  Will there be physical changes that need to be made to your surroundings?  Are you aware of community organizations that can be called upon when needed?  How may other family members or friends can be asked for help?  What do you need to take care of yourself–such as self-care activities?

This is the time for planning.

The Middle Stage

By the time you have reached the middle stage, you have realized that your loved one isn’t going to get better.  Their illness is a constant consideration as you plan your day–both personally and professionally.  Some people may have decided to leave their jobs, or scale back their hours of work.  Many may be coping with the financial stresses brought on by the illness–either through loss of income or rising expenses.

Feelings of loneliness and overwhelm can be common at this stage–especially as your world is shrinking due to care-giving responsibilities that never seem to end.

Coping Strategies for the Middle Stage
  • Be realistic about what you are able to do.  Don’t be afraid to ask for help.
  • If you have not done so already, now is the time to call on your support system for help…friends, family members, outside organizations.
  • To the best of your ability, keep up with your self-care practices–eating well, exercise, and any activities that help you to cope.
  • Be aware of the abilities of your loved one, due to their illness.  It may be less frustrating when we understand that their actions are due to physical challenges vs. negativity.
  • Try to find any positive aspects or meaning  in the care-giving role.
The Late Stage

By this stage, caregivers may be feeling that “I can’t do this anymore”.  If they have had little or no support, they may be suffering from burnout.

There may be feelings of both internal and external conflict as the need to make decisions start to arise.  Internally, there’s the struggle between the guilt you could be feeling as it becomes more difficult to take care of your loved one in their home and the possibility of them moving into a place with full-time paid staff; and the recognition that continuing the current way of doing things is becoming impossible.

Family conflict may come into play if family members are not agreed on next steps, or resentments have come out regarding the sharing of care-giving duties.

Coping Strategies for the Late Stage
  • As above, be realistic about what you can do…physically, mentally and emotionally.
  • Look to your medical supports for information about what can be expected during the late stage of illness and how much care will your loved one require.
  • Access mental health support either privately or through community organizations that specialize in your loved one’s illness.  Organizations such as Cancer Support Centres, Alzheimer Society, etc. have care-giver support groups.

While it may seem like it, as a care-giver you are not alone…no matter where you are on the journey.

Next week, we’ll look at care-giver burnout and further ways to cope.

And now…a TED talk on the positive effects of exercise on the brain…Enjoy!

 

Are You Ready to Change? Let’s Find Out!

One of the concepts in Buddhism is that ‘everything changes…nothing stays the same’.  While I have found this to be true, change can come in different ways.  Sometimes it’s foisted upon us, and sometimes we are the initiators.

The focus of this post is on changes that we put in place, and specifically, the mindset and process (Stages of Change) that make self-directed change possible.

Meet Phil…

Phil (age 60) has lived through a difficult five years.  His troubles started when the manufacturing company where he had worked since high school shut down, and he was unable to find a comparable job.  Phil, already somewhat of a curmudgeon, became more so as he chose to spend endless hours at home.  His wife, Joanne, worked long hours–leaving Phil alone for most of the day.

While he wouldn’t admit it, Phil missed his job and work friends.  However, he didn’t feel like getting in touch–it was too much effort.  Phil spent most of his days feeling angry, sad, lonely and incredibly bored.  Joanne suggested that he could take over some of the household responsibilities (it would make her life easier), but Phil believed that he hadn’t cooked dinner before, so why start now?  Instead, Phil started spending hours of his time on the internet watching episodes of his favourite 1970’s tv shows on or napping on the couch.  Due to his inactive lifestyle, Phil gained a lot of weight.  The more weight he gained, the less active he became.  Eventually, Phil decided that he didn’t care if he ever worked outside the home again and fell into a rut.

The second blow fell two years later.  Joanne, frustrated with Phil’s behaviour and tired of working long hours with little household or emotional support, decided to leave their relationship.  Phil was surprised as he didn’t think there was a problem.  He believed that Joanne wasn’t really going to leave, she was just mad because he wasn’t helping around the house.

Today, three years later, the couple are divorced, and Phil is living in a small apartment.  His lifestyle hasn’t changed.  If anything, he has moved from being a curmudgeon to being bitter.

The Stages of Change

According to the Stages of Change theory, there are five steps that we move through to make successful and lasting changes: pre-contemplative, contemplative, preparation, action and maintenance.

Using Phil as an example, it’s clear that he’s in the pre-contemplative stage.  While Phil is feeling bitter, chances are that he doesn’t want to change.  In fact, he may not even realize that he has a problem.  Phil has continued his lifestyle because on some level he believes that it’s working for him.

Back to Phil…

One day Phil returned from the store to discover that the elevator in his building wasn’t working.  This had never happened before!  As his apartment was on the third floor, Phil decided to take the stairs.  By the time Phil reached the top of the first flight, he decided to leave his shopping bag in the stairwell as it was ‘too heavy’ to carry.  Walking up the second flight, he decided to stop halfway to catch his breath.  Anyone watching would have seen Phil crawling up the third flight on his hands and knees–breathless, his face red and covered in sweat.

Reaching his apartment, Phil was scared.  What had happened to him?  What if his unit was on the fourth or top floor?  He wouldn’t have made it.  For the first time, Phil wondered if something might be wrong.  Phil had entered the contemplative stage.

The Contemplative Stage

People in the contemplative stage have started to understand that there is a problem and that maybe they need to do something.  This is the pro vs. con stage.  Phil may be thinking, “I’m out of shape”.  “What if the elevator breaks again?”  “What will I have to do to get back in shape?”  “To get back into shape, I might have to give up my daily bags of chips, but if I don’t, I may die in the hallway!”

During this stage, no action is being taken, but things are bubbling below the surface.  This stage can last a long time because we over-estimate the benefits of staying where we are and think that changing will require too much effort.

Phil Moves On…

Eventually the level of fear that Phil experienced that day decreased.  Once the elevator started working, he was able to get his bag of chips from the stairwell.  He didn’t change his behaviour, but each time he reached for a salty snack he remembered sitting on the flight of stairs, unable to move.

Phil started to become aware that he sometimes found it hard to get up from the couch or was out of breath if he stood for too long.  Putting on his pants, he noticed that his belt was on it’s last hole–how did that happen.  Perhaps it was time to do something!  Phil had reached the preparation stage.

The Preparation Stage

During this stage the person wanting to change is moving to outward behaviour–not only do they want to make a change, they are coming up with a plan.  For Phil, this meant using the internet to find ways to get back into shape.  He searched for blogs written by older men who were doing what he was thinking of.  He figured out that he would need to lose some weight, so he started researching a healthy weight for someone his age.  Realizing that he would need to move to a healthier diet, Phil called a ‘skinny’ friend to find out what he eats.  He decided to buy ‘one of those gadgets’ that will tell him how many steps he’s taken.

After all his research, Phil came up with his plan.  He decided that for two weeks, he would cut back to one bag of chips a week, walk 1500 steps a day around his apartment, and add a daily salad to his diet.  Phil decided that he would start his plan on June 1.  Phil was on his way to the active stage.

The Action Stage

At this stage, the person is changing their behaviour–making the change.  This is the exciting stage as it becomes clear that something is happening.  The person is committed to the change and is starting to reap the benefits of their first actions.  A positive feed-back loop is created…a behaviour change is made…a benefit is noticed…motivation to continue is created…

Unfortunately, this is also a dangerous time in the change process.  In the honeymoon phase of action, people can sometimes underestimate the amount of effort it takes to continue new behaviours over the long haul. It’s important to note that a change hasn’t been accomplished until you are able to maintain it.

Let’s Check In on Phil…

On June 1, Phil was ready to go.  He had his ‘gadget’ and a week’s worth of salad greens were ready in the fridge.  Seven servings of potato chips were packaged for his daily treat.

At the beginning, 1500 steps felt like running a marathon.  His daily bag of chips seemed to grow smaller as the days went by, and he decided that salad wasn’t his favourite food.  However, by reading blogs from others who were also working to improve their health, Phil was able to stick to his plan for the first week.

The second week didn’t feel as difficult, and one day he noticed that he had walked 2000 steps without really trying.  Near the end of that week, Phil decided that he wanted to create a new plan for the next two weeks.  He repeated this process and, after six months, Phil’s fitness level had improved, he had lost some weight, and spent more time out of his apartment.  His mood had improved.

All was going well until…

Welcome to the Relapse

One day Phil woke up and he didn’t feel like doing his walk through the neighbourhood.  He hadn’t slept well the night before and was in a bad mood.  This had happened before, and he had been able to move past it.  Today, something was different.  As he lay in bed he thought about all he had accomplished over the past six months he felt tired.  It suddenly occurred to him that if he wanted to keep in shape, this was a life-long project.  As a wave of overwhelm flooded over Phil, he decided to take the day off.  “No salad for me today!”  “No walk and I’m going to treat myself to two portions of chips!”  Phil felt better immediately and enjoyed his “day off”.

Sadly, as often happens, one day turned into a week, then two and before he knew it, Phil had slid back into some of his old habits.  It was only having to move to a bigger belt hole, that shocked Phil back into reality.

Relapse is very common as we work on making a change.  Once we realize that we need to keep working in order to make a change permanent, or we become over-confident that the change is permanent, and we don’t have to be aware of our behaviour any longer; we run the risk of losing ground.

However, all is not lost…there is the maintenance stage.

The Maintenance Stage

The purpose of the maintenance stage is to avoid relapse and consolidate the benefits that have started to pile up during the action stage.  It is during this stage that, based on what we have learned in the action stage and any relapses, we discover the minor tweaks we need to make to the plan(s) in order to remain successful in our new lifestyle.

It is during the maintenance stage that we learn to be gentle to ourselves.

Phil Maintains…

As Phil recovered from his relapse, he realized that getting back to his routine wasn’t as difficult as he had thought.  He wasn’t starting from the beginning because he already had a plan and skills that he had developed throughout the previous stages.  Phil realized that it was unreasonable for him to be so strict with himself about his behaviour.  He wanted to think about ways that he could keep improving his fitness level and lifestyle changes while still taking an occasional break.

Over time, Phil stopped seeing his relapse as a failure and instead as a learning opportunity.

The Value of the Stages of Change Theory

In this post, I’ve created Phil’s story relating to his desire to change his behaviours in order to improve his health.  His change process can be used for any change that you would like to make.  This particular theory is often used to help people overcome substance/alcohol addiction.  As well, you can determine where you are in the change process (i.e. which stage) and have a road map of where to go from there.

And now…in a nod to 1970’s memorabilia…a classic from the Partridge Family…enjoy!

https://www.youtube.com/watch?v=wAXFkUaQoAs&start_radio=1&list=RDwAXFkUaQoAs

Please note:  Due to the upcoming Ontario provincial election, youtube appears to be airing political ads before showing their clips.  Blaikie Psychotherapy has no control over what clip is shown and isn’t aligned with any political party.

 

 

 

 

 

 

 

 

 

 

The Stealthiest Predator

The individuals who have come forward through the #MeToo movement have highlighted the high incident rate of sexual abuse.  However, what about those incidents of abuse (not only sexual) that don’t come under the rule of law and are often unreported?  

Below is an excellent article by Wendy L. Patrick, Ph.D, that appeared in the June 2018 edition of Psychology Today.  Dr. Patrick not only describes the characteristics of the charismatic social predator, she also explains the way that they groom potential victims, their methods of abuse and how they often manage not to get caught.

I have posted this article in its entirety because being aware is often our most valuable tool is being safe.

Anthony, a senior member of an editorial team at a media company that covers extreme sports, appears to be a case study in modern-day chivalry. He is charismatic and confident, holding the door for female colleagues and instituting a checklist to ascertain that women are never asked to cover “excessively dangerous” events without their explicit consent (and many a precautionary measure, if they assent). He has a great reputation and a mile-long resume to match. He’s a good listener, often spending extended periods of time helping coworkers brainstorm story ideas. His rapt attention frequently causes them to overshare—disclosing not only what is on their minds, but also in their hearts. Unfortunately for them, Anthony is not only a good listener, he is also a good manipulator.

Exploiting the vulnerability of his colleagues is easy, once he has identified the cracks in each person’s armor. Tom, who was long considered the underachiever in his family, is empowered by Anthony’s consistent praise of his intellect—which Anthony couples with requests to create pitches that he then claims are his own. Maria, recently dumped by her boyfriend, maintains her sense of desirability through Anthony’s compliments on her appearance—which he couples with requests for her to help him finish late work in order to make deadlines.

Anthony’s manipulation flies under the radar for months. When a staff writer finally complains that he stole her material for a story on high-tech secrets used by Olympic athletes—information that she shared with him in confidence—her allegations fall on deaf ears. Reluctant to lose a source of positive attention and affirmation, colleagues and higher-ups take Anthony’s side—even those who recognize his manipulation.

Like other social predators, Anthony charms his way through personal and professional settings, using flattery and positive attention to win over those who will help him get ahead. These predators do not violate the law; they violate loyalty. They exploit their victims financially, reputationally, emotionally, and sometimes sexually, carefully covering their tracks to avoid any “official” wrongdoing. They seduce and discard a broad spectrum of trusting individuals.

Social (and sexual) manipulators have had years of practice hiding their darker traits. Many such people share another dangerous feature: They are smart enough to pull off the disguise. I will use the term “social predator” here to refer to these most stealthy offenders, although the categories of offense can blur. Social predators can certainly engage in sexual misconduct; on the other hand, they may do nothing whatsoever that meets the legal standard for offense. The commonality is that they prey on victims’ emotions or resources, either for their own gain or simply because they enjoy doing so.

Many social predators have psychopathic traits, yet if formally evaluated they might fall short of an actual diagnosis of antisocial personality disorder. They may lack the ability to perceive or care how their behavior affects others, leading them to break promises, reveal private information, and take credit for others’ accomplishments. They get away with it by ingratiating themselves in an often drawn-out dance with victims that targets their ego and unique vulnerabilities.

Grooming involves desensitizing a victim to inappropriate social or sexual advances through progressive boundary-probing, while at the same time developing a foundation of trust. It is a recipe for a power imbalance. The primary purpose of grooming is to normalize inappropriate behavior. Whether pursuing sex, money, power, or just the thrill of inflicting emotional harm, predators use victims to benefit themselves.

Sexual predators groom a child by providing the affection and attention the child covets. Social predators groom their boss by providing the admiration and respect he or she craves. In both cases, although pursuing drastically different goals, predators manipulate through focused flattery.

“Wow, Ms. Patrick, you really destroyed that witness. You are such a great advocate. I sure hope you go easy on me.” Who do you suppose such a compliment came from? It was, in fact, a defendant in a case that I litigated. I have prosecuted defendants who spent the entire trial complimenting me on my quick thinking and trial advocacy skills, despite their attorney’s repeated admonitions not to talk to me.

The objective? Obtaining a reduction or dismissal of charges, of course—a request they include with the compliments. Everyone has areas in which they are uniquely susceptible to praise, affirmation, or validation. Because some people become suspicious when showered with obvious flattery, predators often target more subtle and insidious areas of need or weakness. A manipulative boss may at first seem no different from a superattentive one. Both might tailor an employee’s work schedule to allow her to attend to personal needs. But the manipulative boss’s compassion comes with a price. Whether the motive is sexual or financial, he or she expects repayment. And, considering how the victims’ personal, private needs have been accommodated, they are likely to oblige.

Social predators won’t just focus on a person’s needs but will often confide how much his or her emotions personally resonate with them, using what researchers Paul Babiak and Robert Hare refer to as a psychopathic fiction to cultivate false similarity. Consummate chameleons, social predators will profess the exact same emotions as their prey, leaving victims feeling both grateful and relieved to have finally met someone who knows how they feel. Never mind the details (which are often fuzzy due to flaws of fabrication), it is heartening for them to realize that someone can relate.

Victims on Trial: The Credibility Contest

Amy loves spending time with Jack, a man she met at the local library. He approached her as she was browsing the Victorian romance novels, admitting (after much hemming and hawing) a similar penchant for historical love stories. Normally reserved and private, Amy is thrilled to have met a man with a taste for this type of literature and with whom she feels comfortable sharing her feelings. Jack asks about her childhood and her goals for the future and seems genuinely interested in her responses. Believing that they have established a relationship of trust over several dates, Amy willingly reveals her fantasies . . . and her sexual past.

When they’ve known each other for two months, Jack shares that he has a sick mother living abroad whom he needs to bring stateside for treatment, and asks to borrow money to help with the medical transport. Flattered that he would turn to her for assistance, and grateful for his companionship, Amy writes a check. Although she is reluctant to admit it, her generosity is fueled in part by wanting to keep Jack on her good side, given the amount of private information he now knows about her.

The fact is that Jack’s questions were never designed to acquire understanding, but ammunition. If he seeks to further exploit Amy sexually, financially, or even reputationally, she will be unwilling to fight back, lest her personal revelations be exposed.

Having prosecuted sex crimes for more than two decades, I have heard scores of victims complain that they feel as if they are the ones on trial. Unfortunately, in a sense, they are. The credibility of an accuser is front and center in a sex crimes case, particularly if there are no witnesses. In a he-said-she-said scenario, the victim is always on the hot seat in the courtroom, subject to unrelenting cross-examination by the defense. Many questions derive from the information a victim has willingly offered the man who now stands accused of a crime against her.

Clever predators create an uneven playing field right out of the gate. During the grooming process, social predators use more than strategies of seduction. They also use strategies of reduction—casting aspersions on the victim’s credibility. They hunt and gather sensitive, embarrassing information about their victims early—to be filed away and retained for purposes of bullying or blackmail. If the victim dares to file a complaint, the character assault begins.

In such cases, a social predator publicly discloses private facts to discredit a victim. Labeling a woman a gossip, a disgruntled employee, an unreliable historian, a problem drinker, a slut, or worse, ensures that the perpetrator wins a credibility contest if a victim ever files a complaint or simply seeks to alert others to the predator’s true nature.

 The Ruse of Reciprocal Disclosure

Brenda meets Tyler at the gym. He is attractive, attentive, and surprisingly transparent, given his position as a federal law enforcement officer. A few weeks into their dating relationship he’s already shared much of his life story, swearing Brenda to secrecy as he brands many disclosures “confidential.”

As a single mom running an online jewelry business from home, Brenda is enamored of Tyler’s glamorous job, especially given the steady diet of forensic crime drama she watches on TV. She is flattered to be counted worthy of his trust, and determined to prove that she feels the same way about him. To match his openness, she discloses information about her struggles, health concerns, and messy divorce. She even shares information about her children.

When Brenda and Tyler dine with some of his colleagues, she discovers in conversation that he has shared some of her stories about dealing with an unpleasant ex-husband. Apparently Tyler did not deem her private information to be confidential. What is she going to do about it? Nothing. Tyler has just demonstrated that he has no qualms about repeating her confidences. It would not be worth the exposure, shame, or humiliation that could ensue if Tyler were to retaliate by sharing more details.

Now, what to make of Tyler’s disclosures, which are essentially braggadocio about his professional feats, and all of which are confidential? Sharing information “in confidence” does not make it more credible. In fact, if it is supposedly confidential, the alacrity with which it is offered, early in a relationship, should flag it as less credible. This is particularly true when a new paramour holds a position of public prestige.

The “top secret” information a manipulative new love interest reveals is often false. It is G-rated fiction, and a social predator is virtually guaranteed to be the long-suffering protagonist. In contrast to the often sordid disclosures a victim is prompted to share, a predator’s private information might be sympathetic, but it definitely will not be salacious. Manipulators never tell scandalous or embarrassing stories that could be used against them.

Another red flag is the sharing of details that cannot be corroborated. Predators with professional status or community prestige are careful not to be exposed as liars. Relating stories about being duped by an ex-business partner “who shall remain nameless” ensures that no real personal or professional contact is impugned.

One of the few specific individuals about whom a predator may disclose information is his or her current romantic partner. He or she is “unstable.” The marriage is “coming to an end.” This is almost always a ploy to stoke emotional investment and romantic interest on the part of the victim. The predator wagers (usually correctly) that the victim will not directly confront the current partner. After all, predators size up levels of empathy and conscientiousness in choosing their targets.

The Masquerade Of Malevolence

Karen’s new mentor at the pharmaceutical company where she works is a traveling regional manager with a small car. He insists on taking her to his appointments at various regional hospitals to “show her the ropes.” When they are in the car together, he constantly reaches over her to access the glove compartment, checks her seatbelt, paws around for his coffee in the cupholder (and misses), or makes other superfluous physical moves in her direction. “Accidental” touchings happen frequently. When Karen finally tells her direct supervisor she does not want to accompany her mentor to any further meetings, her supervisor asks why. She is too embarrassed to catalog the minute but real chain of infractions, so she instead cites logistical problems, allowing his inappropriate behavior to go unreported.

Public officials, corporate managers, and other power players routinely serve as mentors and role models to interns, new hires, and local youth, with the goal of empowering and encouraging them to step up and fulfill their potential. Both social and sexual predators seek out such roles but with very different goals. They capitalize on the inherent power imbalance present in mentoring relationships—in pursuit not of victim empowerment but of exploitation. Should a victim complain to a third party, the power differential provides a ready-made credibility contrast, such that the perpetrator expects to “win” every time.

Predators know that they must always have plausible deniability, so they find legitimate ways to isolate a subordinate, having an aide stay late at the office to prepare for an event the next day, for example. Successful predators are smart enough not to invite anyone to their homes or hotel rooms; they strategically arrange other options. I have prosecuted sexual predators who ensured the office space they used to make moves on victims was out of the line of visibility from windows or cameras, so that their behavior could not be documented or corroborated.

Victims With Compromised Credibility

Sexual predators must be even more vigilant than social predators, as the consequences are far more severe if their behavior is exposed. Accordingly, they often select victims who already lack credibility, based on background, social status, criminal record, or other historical or situational factors.

Sexual predators masquerading as mentors often volunteer to work specifically with problem employees as part of a peer-support network, or with troubled youth in the community. In these situations, increased victim vulnerability coupled with decreased credibility provides a potent power imbalance, which also serves to decrease the likelihood that a victim will report any perpetrator who crosses the line.

I have prosecuted many cases where perpetrators specifically preyed on victims with damaged reputations. These cases included men raping prostitutes, assaults on prisoners, teachers molesting emotionally troubled adolescents, and coaches abusing players with documented behavioral problems. The victims’ social status inures bystanders (and jurors) to the weight and import of the crime.

Sadly, countless cases are never reported. Many victims of sexual harassment or abuse who suffer from compromised credibility remain submissive and silent. They fear the perpetrator will expose their own disreputable past or emotional problems and are afraid they would never be believed over an individual who holds relative power.

Idealize, Devalue, Discard in the #MeToo Era

In a world caught up in so-called social climate change, the behavior of men in the workplace is under a microscope. Men who in an earlier era might have committed overt misconduct will be more inclined to do what some predators have always done—to simply toy with a victim’s emotions. Victims are left feeling violated and humiliated—but unsure whether they have even been victimized.

Jeffrey and Susan are website designers. Although they work for the same large online company, their interaction has been limited to the exchange of pleasantries. One day, Jeffrey approaches Susan in the staff lounge, where she always takes her 3:00 P.M. break, to compliment her on a memo she shared in an internal forum. Susan is extremely flattered, because Jeffrey is the only colleague who has acknowledged her efforts, much less complimented her on her work. Susan notices that Jeffrey is as attractive as he is attentive. This positive contact leads to additional conversations, which begin to occur at 3:00 P.M. almost daily.

Encouraged by Jeffrey’s apparent fascination, Susan opens up to him about her life. She shares personal information, goals, dreams . . . and photographs. Because she has developed a crush on Jeffrey, when he asks if she has photos of a recent vacation, she happily complies. When he stipulates that he’d like to see her in a swimsuit, she sends a few bikini-clad selfies. After his enthusiastic response, she decides to share a few more, which she describes as “me in my PJs.” She is wearing only lingerie.

One day, Jeffrey fails to show up at 3:00. He never comes again. Susan is confused and distraught. She immediately checks the internal forum to ascertain that his username still exists and even takes a trip to the adjacent building on campus to ensure that he is still at the company—only to see him at his desk, working away. Her emails and text messages to him go unanswered.

After a week she returns to his building to ask, in person, if anything is wrong. He politely smiles and explains that he is busy. Susan is devastated, and the two never speak again.

Yes, it is possible that this is simply a romance that never got off the ground. If Jeffrey is a predator, however, he is practicing a time-honored MO of deliberately luring Susan into oversharing so as to obtain photos, often just to humiliate and destabilize her. Predators engage in this type of behavior simply because they can. In fact, Jeffrey will take pleasure in gaslighting Susan by denying that he was ever interested in her. And given their tech-savvy positions, Susan worries every day what Jeffrey will do with those compromising photographs.

The worst aspects of human nature do not change merely because a societal spotlight finally shines on them. But public awareness of subtle predatory tactics can drastically reduce the likelihood that men and women will fall prey in any arena.

How to Fly Under the Radar: The Predator’s Toolkit

  1. Selective Attention Social predators express unique nonsexual interest in potential victims, a tactic designed to test receptivity and create vulnerability, without using any inappropriate behavior or language. Such behavior comes after the predator has gained the victim’s trust.
  2. Too Much Information Predators overshare to prompt reciprocity, making victims feel obligated to disclose their own private, sensitive information, which can then be used for blackmail.
  3. Strategic Privacy Predators arrange office furniture to create a zone of privacy away from windows or surveillance cameras. Beware of areas that are obviously designed to be out of the line of sight.
  4. Creating a Captive Audience A moving vehicle is the perfect trap for a predator seeking to corner a victim alone. The small space inside a car is where “accidental” touchings occur, yet such close quarters allow the perpetrator the benefit of the doubt.
  5. Red Flags After 5 p.m. Social predators in supervisory positions impose obligations on victims, requiring them to attend after-work “team-building” events where alcohol flows and cell phone cameras capture moments of weakness. Such outings are designed to compromise victims’ physical state, judgment, and ultimately, reputation.

Rest and Relaxation

The temperature is rising.  The birds are singing.  Trees are budding, and spring flowers are blooming.  Welcome to the first long weekend of the summer (even if the beginning of summer is a month away)!  Hopefully Mother Nature cooperates making outside activities a possibility.

Whatever your plans, I wish you a restful and enjoyable weekend.  See you next week.

Once Upon a Time…

Once upon a time…this may be one of the most magical phrases ever written.  Young and old alike know that with these four little words they are about to be swept to another world…joy, sorrow, danger, who knows?  I suggest that when someone says “Once upon a time” we settle into our seats and prepare for a journey.

A Simple History of Stories

The ability to create, appreciate and share stories are part of what makes us human.  While no one has been able to say precisely when the first stories were told, historians suggest that storytelling was created as people started to form smaller and then larger clans/tribes.  Storytellers shared events between members of the tribe as well as pass them on to other tribes.  Until humans were able to write, storytelling was an oral tradition–relying on individuals’ ability to listen and remember.  Storytellers were respected as keepers of a clan/tribe’s history.

Over time, writing was created.  Depending on the era, stories were captured on stone, papyrus, parchment (dried animal skins), or forms of handmade paper.  Various methods of ‘printing’ were completed starting with handwritten characters to using tools such as reeds and ink, or carved wood blocks and ink.  Until the creation of the printing press (1440 -1450 CE), books were the property of the wealthy or religious orders.  As printing became cheaper and easier, written ‘stories’ from a wide-range of sources became available to anyone who could read.   If you’re interested in an in-depth history of printing, check out this site.

Today, stories are all around us…in print, digital and audio format.  We tell our stories through music, art, literature, etc.  Like in the past, stories continue to not only record events,but entertain us.  Stories can also affect our mental health.

Our Personal Stories

Many studies have been completed showing the correlation between ‘negative’ stories (violent video games, movies, etc) and increased incidents of violence, aggression and desensitization to violence.  On the positive side, this 2016 Huffpost (UK edition) article links watching comedies to improved mental health.  Both of these ideas could be a blog post on their own.  However, that’s not what I’m thinking about here.  I’m thinking about the stories of our lives and those that we tell ourselves.  While we can often choose what ‘outside’ stories we let influence us, our ‘internal’ stories are harder to avoid.  In fact, we often don’t even know that we are telling them.

Once Upon a Time…

Once upon a time, a long time ago, there was a little boy who wanted to learn to knit.  His mom was a knitter.  So were his grandmother and aunts.  He loved family gatherings when all his aunts would bring their needles and wool. After dinner, they would sit in the living room creating amazing things out of ‘sticks and string’.  The colours were wonderful and he’s watched his grandmother make him mittens in his two favourite colours.

His dad, uncles and older brothers were not knitters.  Instead, after dinner they would disappear to the den where they would watch sports, or to the garage where they would  build stuff using wood and cement.  Their materials were hard, not soft like wool.

As the little boy grew older, the men of the family started to invite him to join them in the den or garage.  His mother encouraged him to go with them, and he was subtly discouraged from following the women into the living room.  For his tenth birthday, the boy was given his own set of tools.  As his family members watched him open his gift, he felt pressure to like the tools, but he found it difficult to fake his enthusiasm.

The years went by and the boy became a man.  He remembered his desire to learn to knit, and would join the menfolk in the den or garage after dinner.  When he saw his wife and mother knitting in the living room, he ‘knew’ that this was a female activity.  If he told you this story (his story), he would tell you that there are things that men do and things that women do. It’s not manly for men to knit….so he won’t….no matter how much he wants to.

Our Stories in Therapy

We all have stories–it’s how we make sense of our lives.  When we are getting to know someone we share our stories; increasing, over time, their level of depth and intimacy.

People often come into therapy because of the pain of their stories.

Sometimes the story is traumatic and hard to live with. They need help sorting through the details, finding meaning and finding a place for it in the perspective of their life.  Sometimes people are hurting and don’t know why.  Often they have been telling themselves stories that don’t serve them, and they are unaware that they are whispering them to themselves.  In this case, the therapeutic work involves discovering these tales, testing if they are true and then deciding whether to keep or discard them…and write a new story.

Once Upon a Time…Continued…

One day the man realized that he wasn’t happy.  He couldn’t put his finger on it.  Something was missing.  He decided to talk to someone and made an appointment with his friend’s therapist.  At the first session, the therapist asked him what he liked to do.  Did he have any hobbies?  “Nope”, replied the man.  “Well”, said the therapist, “if you could have any hobby, what would it be?”.  The man thought, the expressions on his face moving from joy to despair.  “What’s going on?” ask the therapist.  The man told his story…and the process began…

And now…one of my favourite stories…Enjoy!

 

 

Depression Comes in Many Types… Meet Dysthymia

When my children was between the ages of 4 to 7, dinosaurs were of huge interest.  They were fascinated by all things prehistoric.  Not only could they identify many of these creatures (T-Rex, Triceratops, Stegosaurus…), they could tell you all about them.  Who knew there were so many types of dinosaurs?

We can think of depression in the same way.  Just like “dinosaurs” is a major category including many types, “depression” is a major category.  Some types of depression that you may already be aware of:  major depression, bipolar depression (also known as manic depression), seasonal affective disorder (SAD), postpartum depression, psychotic depression…  Who knew there were so many types of depression?  What about dysthymia?

Dysthymia

Dysthymia (also known as Persistent Depressive Disorder or PDD) affects up to 6% of the general population with women being three times more likely to be diagnosed than men (US stats according to Health Research Funding.org ).

This ‘dinosaur’ is characterized by a mild depression that lasts at least two years.  The symptoms are less severe than major depression, but are longer lasting or chronic.  Thankfully, the more severe symptoms that mark major depression—including anhedonia (inability to feel pleasure), psychomotor symptoms (particularly lethargy or agitation), and thoughts of death or suicide—are often absent in PDD.

Unlike other types of depression, dysthymia often goes under the radar because people are able to function.

Meet Agnes…

Agnes (a 30 year old woman) hasn’t felt ‘happy’ for a long time.  Even though she gets plenty of sleep (maybe too much, she wonders), she doesn’t have any energy.  At work, she has difficulty concentrating.  At home, Agnes can’t make decisions about simple things.  Unable to decide about what to have for dinner…most nights she stands in front of the fridge eating whatever comes to hand.  Healthy eating has become a thing of the past.  When Agnes thinks back over the past few years, she can describe a few weeks when the ‘fog’ lifted, but it always returns.  While Agnes is able to get through her days, she is starting to feel hopeless…that she will feel this way forever.

On the advice of a friend, Agnes recently talked to her doctor who, based on her symptoms, suggested that she may be suffering from dysthymia.

Am I at Risk?

If 6% of the population may suffer from dysthymia during their life time, am I at risk?  Let’s look at the five main risk factors:

  • A first degree relative (parents or sibling) has been diagnosed with depression,
  • You have recently experienced a traumatic or stressful life event,
  • Negative personality traits (e.g. low self-esteem, self-critical or pessimistic),
  • Personal history of other mental health disorders (e.g. antisocial, borderline, obsessive compulsive),
  • Being isolated or having a lack of social connections.

Having one or more risk factors doesn’t mean that you will develop dysthymia, but it does mean that you may want to take care of yourself.  But how?

The Power of Self-Care and Awareness

Working with clients who are learning to cope with any form of depression, one of the first things we do is talk about self-care.  When we take care of ourselves, we are healing current conditions and preventing future ones.  So what can we do?

  • Control stress:  Exercise, meditate, do an activity that you enjoy.
  • Reach out for support:  As people become more cut-off from each other, incidents of loneliness are increasing.  Think about developing your own support system.
  • Get help at the first sign of dysthymia:  Talk to your doctor or a therapist before your symptoms become chronic.
  • If you have already experienced and overcome dysthymia, consider long-term maintenance treatment to prevent a relapse.
Treatments

If you are currently suffering with dysthymia, there are two main areas of treatment:  prescription medication (SSRI’s such as Prozac, Paxil or Zoloft) and psychotherapy–specifically Cognitive Behavioural Therapy (CBT) that helps to change negative ways of thinking.

Dysthymia, or any other form of depression, doesn’t have to be a life-sentence.  There are things that you can do.

And now…I wonder if this well-known character suffers from dysthymia?  Enjoy!

 

 

 

 

What Not to Say to Someone Who Has Cancer

Often the best information comes from people who have personal experience.  A friend shared the following First Person (a daily personal piece submitted by readers) article that appeared in the April 20, 2018 edition of The Globe and Mail.  I think that the author, Alana Somerville’s wisdom speaks for itself.

I should have known. But at that particular moment, I had no idea what to say. So I asked my friend, a young mother with terminal liver cancer, “How can I help? Is there anything you need?”

“A new, healthy body would be fantastic,” she answered.

I felt like an idiot. Of course that was what she wanted. But I couldn’t give it to her, so why on earth had I asked that?

Often, when we know someone who’s been diagnosed with cancer, we don’t have any idea what to say, or we say or do the wrong things. I should have known better.

When I was diagnosed with cancer at the age of 33, I had a hard time dealing with my diagnosis. It took some time, but eventually I figured out that I had to move forward and think positively. However, it was really difficult to keep up my spirits when some of the people around me said and did things that I still can’t quite believe.

There were the people who started their sentences with “At least …”

“At least it’s September so when your hair falls out you’ll be able to wear a hat throughout the winter.”

“At least you have two kids now because who knows what chemotherapy will do to your eggs.”

“At least you caught it early because my friend didn’t, and now she’s on her death bed.”

And then there were also the people who said, “If I were you …”

When that happened, I couldn’t help but think, “Well, you’re not me, so stop right there.” Don’t try to sugar-coat this, and don’t try to find the silver lining. Please, just let me know that you can feel my pain.

My Dad was someone who didn’t know how to handle my diagnosis. When he showed up at my door upset and crying, it only made me think, “Maybe this is all worse than I realize?” Sure, if he hadn’t been upset, that would have been worse, but it also meant that my job shifted from caring for myself to consoling him. At a time when he should have been my rock, I was forced to be his.

When you’re dealing with this kind of internal struggle – to stay positive while it feels like your world is falling apart – you’d be amazed at how eye contact and non-verbal gestures can affect you. You already feel self-conscious, and the stares from complete strangers don’t help. When I was bald from chemotherapy – and I mean no hair, no eyebrows, no eyelashes – people gave me sympathetic looks when I went to the grocery store. I don’t need your sad eyes, I thought, because I am not going to die.

Even offers of help can be interpreted the wrong way. It may seem weird, but when you’re sick, having someone offer to help carry your groceries can make you feel weak. Try to think about things from the sick person’s viewpoint before you offer. Do you know them well? Do you know what they want? I had people who weren’t even my friends offer to buy my children Christmas presents, which I found so odd. I couldn’t help but think, “Hey! I’m still here and they’re my kids! Why would you want to take that away from me?”

What did help? Some of my friends organized a dinner club and made meals that they would drop off at my house every other day. They wouldn’t stay to visit, unless I wanted them to. They put the dinners in disposable containers, which meant I didn’t have the added burden of having to wash and return their containers. I always connected with my friends to thank them, but they were respectful of the fact that I wasn’t always up for conversations.

That my friends didn’t have any expectations was so freeing for me. They simply gave. That felt so precious at a time when I simply didn’t have it in me to give in return. It was the gift of understanding and I still can’t believe how precious that was.

Other friends who felt too uncomfortable with the situation or with seeing me sick simply dropped off gifts at my door, things such as sweaters, books and bathrobes. To me, these incredibly kind gestures meant that although they didn’t really want to talk about things, I knew they were thinking of me.

What also helped immensely were words of encouragement, rather than questions. Comments such as, “You got this,” “You are the strongest person I know,” “The world needs you,” as opposed to just saying, “I’m sure it will be fine.” When I heard that last one, I couldn’t help but think, “How do you know?” whereas the former statements weren’t anything I could argue with. I also appreciated that these weren’t open-ended questions, asking me what they could do to help. The last thing I could do was to think of ways for people to help me.

This whole experience with cancer, and writing my memoir Holding on to Normal, has been an incredible learning journey. I am still learning. I still question what to say when a friend or loved one has been diagnosed with cancer. When in doubt, I still run things by friends and comrades who are breast-cancer survivors.

When someone you love has been diagnosed with cancer, remember that words of hope are better than no words at all. Don’t be a stranger and don’t feel awkward. Try to remember that this isn’t about you. Just treat them normally, the way you always have and like you always will. That in itself will give people hope, which is the biggest gift you can give.

Alana Somerville lives in Fort Erie, Ont.

 

Are you Rooted?

Are you rooted?  If you are a gardener, your first thought may be about plants; but I’m talking about being connected to a place.

When our children were preschoolers, my husband and I seriously considered moving  from our home to a bigger city in order to be closer to family members.  We had arrived in our city due  to employment, and the plan had been to stay for a few years before moving on.

As part of the decision-making process we listed all the things that we would like to have in a new community.  What would we miss by moving away?  How could we replace the doctor we relied upon, my hairstylist who had been part of our children’s first haircuts? Where could we find a neighbourhood park that we loved as much as the one we already had?  What about our friends and neighbours?

After creating many lists of the pros and cons of going vs. staying; we decided to stay. We could visit family, and so many things about our community were irreplaceable. We were rooted.

The Importance of Being Rooted

“To be rooted”, philosopher Simone Weil once wrote, “is perhaps the most important and least recognized need of the human soul.”  When we are rooted, we feel that we are a part of something bigger than ourselves.  We have a vested interest in the health of our community.  We develop a sense of ‘hometown pride’.  We care.

When we feel attached to our community, we’re more likely to be social and volunteer. We feel a connection to our local economy and may support neigbourhood businesses by spending our money locally.  As we learn more about our community, we may support local farmers at the market or join a Community Shared Agriculture group.

A key benefit is that the system is reciprocal…when we give to our community, it gives back.  Our support systems grow, there are more local choices, and there is a sense of belonging that we experience when we walk down the street and say ‘hello’ to people that we know, or the local barrista already knows our order when we walk in the cafe.

Being Rooted in our Community is Good for Us

Research confirms that being rooted in our community is good for us.  In the July/August 2016 issue of  Psychology Today,  author Melody Warnick (in her article”Right Where You Belong“) describes a study conducted in Tokyo.  This study discovered that elderly Japanese women who felt attached to their neighbourhood were more likely to be alive five years later than were women who didn’t care about their communities.  For women who liked where they lived and also interacted with their neighbours, their chance of survival compared to more ambivalent residents increased by 6 percent.

In her book Lonely:  Learning to Live with Solitude, Emily White describes her experience with loneliness.  She cites many studies that show the connection between loneliness, loss of health and increased mortality.  However, we may be less lonely and have an already-developed support system in place when we are rooted in our community.  These support systems are there when life becomes difficult.

Rootedness In Practice

When I think about support systems, I  often remember a particular example of individuals being rooted in their community.  There was a group of widows that attended the same church.  As Sundays can be difficult for people on their own, this group of women would plan a day’s worth of activities (church and lunch, followed by a matinee or concert).  By the time each arrived home, the day was mostly over– they had connected to others and enjoyed themselves.  These women made a point of including anyone they knew who needed to take part in this group–especially new widows.  Participation ebbed and flowed, and the group continued to be there when needed.  They looked out for each other.

Being Rooted Takes Effort

Being rooted and building community are reciprocal, and takes effort.  For many years a laminated copy of this poster hung beside our door.  It was a reminder of how to grow roots.  It recommended:

  • Turn off your TV
  • Leave your house
  • Know your neighbors
  • Look up when you are walking
  • Greet people
  • Sit on your stoop
  • Plant flowers
  • Use your library
  • Play together
  • Buy from local merchants
  • Share what you have
  • Help a lost dog
  • Take children to the park
  • Garden together
  • Support neighborhood schools
  • Fix it even if you didn’t break it
  • Have potlucks
  • Honor elders
  • Pick up litter
  • Read stories aloud
  • Dance in the street
  • Talk to the mail carrier
  • Listen to the birds
  • Put up a swing
  • Help carry something heavy
  • Barter for your goods
  • Start a tradition
  • Ask a question
  • Hire young people for odd jobs
  • Organize a block party
  • Bake extra and share
  • Ask for help when you need it
  • Open your shades
  • Sing together
  • Share your skills
  • Take back the night
  • Turn up the music
  • Turn down the music
  • Listen before you react to anger
  • Mediate a conflict
  • Seek to understand
  • Learn from new and uncomfortable angles
  • Know that no one is silent although many are not heard. Work to change this.

These ideas may sound like a lot of work, and the payback is tremendous–much more than is originally put in…and it’s good for us and others!

Now, for a flashback to how some of us learned about community; here’s some vintage Sesame Street.  Enjoy!

 

 

8 Frequently Asked Questions About Therapy

When someone learns that I’m a psychotherapist, I’m often told that they think they should “talk to someone”, but that the whole idea is overwhelming and scary.  I understand their fear and hesitation.  Talking to someone that you don’t know about personal things is really difficult…and that’s after you’ve gone through the process of finding someone.  The goal of this post is to answer some of the frequently asked questions that I get, in the hope that contacting a therapist will be less intimidating and you will be able to find the right therapist for you.

Why would I want to talk to a therapist?

People usually decide to talk to a therapist when the pain of what they are trying to cope with becomes too big for them to handle on their own and they recognize they need help.  For more ideas, this previous blog post gives 10 reasons why you may want to see a therapist.

How can I find a therapist?

Once you’ve decided that you would like to speak to a therapist, here are a few different ways to find one:

Referral from a friend or family member.  While seeing a therapist is not something we often share with others, in our close relationships we may know of someone who is.  If you feel comfortable disclosing to this person, you can ask if they are happy with their therapist and ask for their contact information.

Web Searches.  You can search on-line for a therapist in your  area.  Psychology Today and Theravive are two sites that provide listings of local therapists.  Professionals on both sites have been vetted for their credentials.  There is detailed information about their specialties and links to the therapists’ website if they have one.

Health Professional Referrals.  Medical professionals (doctors, chiropractors, massage therapists, naturopaths) often have a referral list for therapists.  There is a connection between physical and mental health.  Sometimes health professionals will suggest counselling and provide a list of potential therapists.  If not, and you want a referral, all you need to do is ask.

What should I be looking for?

There are lots of very good therapists out there–doing all types of therapy.  However, studies show that more important than the type of therapy, the biggest indicator of client success is the therapeutic relationship that develops between the therapist and client.  In other words…there needs to be a ‘good fit’.

If possible, have a phone or email conversation when you first make contact with a potential therapist.  Ask if this person has experience in helping people to deal with your area of concern.  If that goes well, then book a first meeting.  You will have to pay for the first session, but it’s money well-spent if you decide that this isn’t the therapist for you.  Trust your instincts.  Your friend may feel comfortable with their therapist, but that doesn’t mean she’s ‘your’ therapist.

What happens in a therapy session?  Do I have to lie on a couch?

Lying on a couch is no longer required!  Instead, clients come into an office (that’s usually quite comfortable) and talk to the therapist.  Sometimes the therapist will have a plan for what to talk about during that session; at other times, the client drives the conversation.

I’ve found it helps clients to have an idea of what will happen in a session, so I have a basic structure.  The session starts with the client telling me about what has been happening for them since our last meeting.  We check in on any homework that was suggested.  I ask the client if there is anything they want to talk about.  Normally the client has outlined goals for therapy (what they would like to be different when therapy is finished) and that always provides areas for conversations.

This is your therapy, so again you get to choose!

How long will I be in therapy?  Do I have to go forever?

While therapists learn various types of therapies (Cognitive Behaviour Therapy, Emotionally Focused Therapy, etc.), therapy is also an art.  Every client is different, with different needs for the amount of time they will be seeing a therapist.

Personally, I operate from the perspective of ‘this is your therapy’ and you get to choose.  If a client is in crisis, then I suggest meeting weekly until things become more stable.  Once the crisis is past, we move to bi-weekly or even monthly.  It depends on what the client chooses as well as what is in their best interest therapeutically.  Ethically, a therapist shouldn’t want a client to have to come forever.  The overall goal is that people feel better and go back to their lives.

Once clients ‘graduate’ from seeing their therapist, many treat their therapist as one more tool in their health toolbox–checking in when necessary.

How does confidentiality work?

Basically, whatever you say in therapy, stays in therapy.  However, there are times when a therapist is legally obligated to break confidentiality:

  • Harm to self or others.  If a therapist believes that you are in imminent danger of hurting yourself or someone else, a family member, police or ambulance will be called to ensure safety.
  • A child under the age of 16 or older adult in care is in danger.  In these cases Family and Children’s Services or the police will be called.
  • Your files are subpoenaed by the court or by the College of Registered Psychotherapists.
  • A client experienced a health emergency during a session.  In this case, medical staff would be provided only with necessary information.  No information  about why a client is in therapy will be shared.

Some therapists (myself included) carry confidentiality into the community.  I inform clients that if I see them in the community I will not say hello.  I don’t want to put anyone is a situation where they have to explain how they know me.  I am always open to speaking to clients outside of the office, but they get to make first contact.

My benefits plan covers services provided by a psychiatrist, psychologist, psychotherapist or social worker.  What’s the difference?

Since each of these professionals can provide mental health services, it can be confusing to figure out which one is right for you.  The best way to explain it is by breaking down the services they provide.

Psychiatrist:  A psychiatrist is a medical doctor (MD) who has done extra training in psychiatry.  Psychiatrists are able to diagnose a mental health issue, such as schizophrenia, and prescribe any necessary medication.  Some psychiatrists provide therapy to their patients, but due to the shortage of psychiatrists, in my experience they usually  provide diagnosis and medication management.  Psychiatrists may refer their patients to counsellors for therapy.

Psychologist:  Psychologists hold at least a Masters degree in psychology.  They are qualified to diagnose mental health issues, but not prescribe medication.  Some will do counselling.

Social Worker:  Social workers can be put broadly into two camps…clinical (do counselling) and community.  Community social workers do such activities as working for Family and Children’s Services providing case support and assessments, helping governments or local agencies with social policy, etc.  Social workers can either have a Bachelors degree (BSW) or Masters degree (MSW).  All social workers must belong to the College of Social Workers in order to practice.

Psychotherapists:  Psychotherapists are counsellors.  That is our speciality.  We hold a Masters degree (or equivalent) in psychotherapy and must be registered with the College of Registered Psychotherapists of Ontario (CRPO).  If I have a suspicion that a client may be dealing with a specific issue that would benefit from a diagnosis or an exploration of the use of medication, I will suggest that the client talk to their family doctor.

I don’t have benefits, and can’t afford to pay out of pocket.  Is there anywhere I can go?

Seeing a therapist is expensive and not everyone is covered under benefits.  Some therapists provide a sliding scale or see different groups of clients at a discounted rate.  Many agencies (KW Counselling, Carizon, etc.) have a sliding scale based on income.  As well, agencies such as KW Counselling offer free weekly drop in counselling services.

Making the decision to talk to a therapist takes courage…and studies show that counselling works!

And now…Bob Newhart shows us the type of therapist we may not want to see.  Enjoy!