Category Archives: Pyschotherapy

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!

Travel and Therapy–Both Are Adventures

As I continue on my travels, the following post from the archives explores how we can have adventures (in therapy) without even leaving home!

In February 2015, I was able to spend two weeks in Thailand.  While it was a once-in-a-lifetime, amazing trip; getting to my destination was a challenge.  Travel time was over 24 hours door-to-door, including 22 hours on three separate planes.  I arrived in Bangkok feeling exhausted, disoriented and overstimulated.  After leaving cold and snowy Waterloo, walking into a hot and humid Bangkok evening was a shock.  Thailand is 11 hours ahead of Waterloo, making jet lag a factor.

After a good sleep and breakfast, I started taking in my surroundings and appreciating where I was.  Everything was completely different from what I was accustomed to–the food, language, population density, weather, currency and customs.  I had no idea how to get where I wanted to go.  I had been set down into a different world!  Fortunately, I was travelling with family members who knew Thailand well.  They led the way.  I was able to relax into the experience and know that I was safe–even if not always comfortable.

The Connection Between Travel and Therapy

During my trip back home, I mulled over my experiences and wondered about the similarities between travel and taking part in therapy.  Here are a list of the correlations I discovered.

Travel and therapy are often started by choice.
In come cases, people are mandated to attend therapy (court ordered or at the strong request of family and friends). However, individuals, couples and families usually seek therapy because they find themselves at a difficult point in their lives and want some help. When we travel, we usually begin the journey, not because we are in crisis, but because we want to explore new places.  Unless we’re being forced to attend a particular out-of-town event (weddings of third cousins, once removed!) we get to choose.

Therapy and travel can be uncomfortable at the beginning.
Long distance travel is uncomfortable–first and business class passengers, and NEXUS Card holders excepted!  The long lines, security checks, boarding, cramped seating, baggage claims…the list goes on.  However, once you arrive at your destination, the hope is that the scenery, people and once-in-a-lifetime experiences are worth the discomfort.

Let’s look at the similarities with therapy.  At the beginning of a plane trip, you are checked by airport security–questions asked, carry-on searched, and shoes, belts and coats removed.  In therapy, you are not asked to remove your shoes, but the therapist can ask some uncomfortable questions as he or she starts to learn your story about what brings you into therapy.  The topics discussed in sessions can be painful and bring up feelings of guilt, anger, sadness, fear or other difficult emotions.

On long flights, it’s important to bring things that will help you to be comfortable–a neck pillow, warm socks, music.  Therapy is no different.  Sometimes clients will carry something into a session that has meaning for them and provides stability (a picture, piece of jewelry, favourite article of clothing).

I usually check in with clients after a therapy session as to how they plan to take care of themselves for the rest of that day as they make themselves comfortable while their emotions ebb and flow.

Travel and therapy can land us in new and wonderful places.

Travel brochures are created to entice us to take trips.  I grew up in a time when booking on-line wasn’t possible, and the walls of the travel agent’s office were full of racks of booklets touting possible destinations.  Browsing the pamphlets, it was easy to imagine myself hiking across England or lounging on an island beach.

Unlike travel, there may not be exciting brochures promoting therapy.  My office doesn’t have pictures of happy families, loving couples or emotionally centered individuals. The reason for this is that therapy is completely individual.  Unlike a packaged tour, you get to pick where you go in therapy.  What are your goals?  Where do you hope to be at the end?  Your therapy is your therapy. I often ask clients to imagine that if I could wave a magic wand, how would their life be different after we had finish our work together–and that is the road map that we keep in mind when meeting.

Ideally, we have a guide for the journey.

Because I had never been to Thailand before, I really appreciated that my family members knew the terrain.  When I became overwhelmed trying to negotiate the traffic in Bangkok or find our hotel in Chiang Mai, I was able to relax because they knew what they were doing.

While you are the expert on you; during therapy, your therapist is your guide and companion.  Just as I was comfortable with my children showing me around Thailand due to our relationship, it’s very important that you feel that you can rely on the therapist that you have chosen.  When trust has been developed, you are able to relax into the process knowing that your therapist is knowledgeable and has your best interest at heart–even when the going gets tough.  Therapy is often a process of two steps forward/one step back, and it’s important to know that it’s normal to temporarily move backwards.

After travel or therapy, we never quite look at our world in the same way again.

Therapy and travel change the way we see the world. What we see, we can’t ‘unsee’.  After spending time in numerous Buddhist temples and studying the intricate mosaics, I now have a greater appreciation for any mosaic pieces that I encounter at home, or anywhere else that I travel.

When I work with clients, I often explain how certain ideas are relevant to their situation. A popular theory, Triangulation, describes how we often get pulled into being a third person in difficult relationships. This is done in the hope that our involvement will decrease the level of stress felt by the original two people.  Once clients have learned this idea, they often report that they see the dynamic everywhere–at home, work, with friends.  Not only can’t they ‘unsee’ the behaviour, but now they have tools to prevent themselves from being pulled in.

Finally, we are stronger than we think.

Both travel and therapy can be hard.  Depending on the type of travel you like, you may be backpacking and staying in hostels, trekking up the side of mountains and tenting on ledges, or driving a camper van and looking for places to sleep on the spur of the moment. Travel requires ingenuity and stamina.  Even on tours, where everything is provided, can be grueling–ten countries in ten day?!

We are no different during therapy.  Instead of exploring different countries, we’re exploring our past–including the sad and messy bits that we would rather pass over. This too takes strength, stamina and courage.  And we do the work, because the result is worth it.  The plan is that we will feel better at the end of the therapy process than we did at the beginning.

One of the benefits of travel is that we get to do and see things that we don’t at home. Since elephants are not usually found in Kitchener-Waterloo, here’s a video of a baby elephant from a sanctuary in Chiang Mai, Thailand.  Enjoy!

 

 

It’s the Middle of February…Are We Having Fun Yet?

A colleague greeted me today with the announcement, “I’m so done with winter.”  I think that many of us would agree…the recent snow, fluctuations in temperature that bring the gift of freezing rain, clearing the driveway yet again.  A local newscaster announced yesterday that there is a shortage of sidewalk de-icer!

Seasonal Affective Disorder

All fun aside, some people need spring, and the longer hours of daylight, for bigger reasons than to get a break from the cold and dark.  These are people who suffer from Seasonal Affective Disorder (SAD).

SAD is a type of depression that is related to the change of season.  It is experienced by individuals who are not usually depressed at other times of the year.  It often begins, and ends, at the same time every year.  While most people who suffer from SAD do so in the winter, some may do so in the summer instead.

How Do I Know If I Have Seasonal Affective Disorder?

There are a variety of symptoms that people coping with SAD are dealing with.  These include:

  • Low energy
  • Moodiness
  • Irritability
  • Problems getting along with other people
  • Hypersensitivity to rejection
  • Heavy, “leaden” feeling in the arms or legs
  • Oversleeping
  • Appetite changes, especially a craving for foods high in carbohydrates
  • Weight gain
What Causes SAD?

While there are no known clear-cut causes, we do have some ideas of what may bring on SAD.

  • Your biological clock (circadian rhythm).The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body’s internal clock and lead to feelings of depression.
  • Serotonin levels.A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.
  • Melatonin levels.The change in season can disrupt the balance of the body’s level of melatonin, which plays a role in sleep patterns and mood.
What Can I Do?

There are many ways that you can cope with SAD symptoms.   Depending on the severity of your symptoms, some or all may help.

Increase Your Exercise
While it’s easy to hunker down during the winter, especially when feeling depressed, increasing your level of exercise has been shown to improve negative effects of SAD. Exercise releases endorphins (the ‘feel good’)  hormone as well as improving seratonin levels.

Cut Back on Simple Carbs
During cold days, when we spend more time on the couch, we may also be spending more time with white pasta, candy, potato chips, cookies and other ‘comfort’ foods. Unfortunately, these foods cause sharp spikes in our glucose levels that play havoc with our moods.  If you’re suffering with Seasonal Affective Disorder, it’s a good idea to pay special attention to eating well.

Take Advantage of Natural Light
When possible open your drapes or shutters to let in the sun (when it makes an appearance!).  Spend time outside by going for a walk, shoveling the driveway, or inviting friends over for a snowball fight or snowman-building competition.  As long as you dress warmly, it can be fun.

Use a Natural Spectrum Energy Light
If Mother Nature doesn’t provide enough natural light, box light therapy is an alternative. Natural spectrum energy lights mimic the sun’s rays.  While data on the results of these lights is mixed, many people say that they are helpful.

Make a Point of Socializing
When we’re feeling depressed, often the last thing we want to do is be with other people. However, this is often what is needed.  If possible, plan a regular get-together with friends–even a coffee date will do.

Meet with a Therapist and/or Medical Professional
As with any form of depression, sometimes it becomes difficult to cope with.  If you are feeling unsafe, hopeless, attempting to self-soothe with self-harming behaviours, alcohol or drugs, feel that SAD is taking over life or are experiencing suicidal thoughts, reach out for professional help ASAP.  You don’t have to cope with this alone.

And now…here’s a break from the winter.  No sunscreen required!  Enjoy!

 

 

The Meaning of Life…What’s Yours and Why Should You Care?

This week’s post asks us to think about the meaning of life from different perspectives–it’s own meaning and why it matters.  Enjoy this popular post from the archives!

What is the meaning of life?  Big question.  If you asked Douglas Adams (creator of the Hitchhiker’s Guide to the Galaxy series) he would answer “42”.   If you asked Thomas Merton (monk, writer, social activist and mystic) he would reply that “Love is our true destiny. We do not find the meaning of life by ourselves alone – we find it with another.”; and if you asked Dr. Seuss (writer), he would tell you that “sometimes the questions are complicated and the answers are simple”.

How would you answer?  What gives your life meaning?  Is it your partner, your family, your passions?  Perhaps it is your spirituality or how your beliefs lead you to interact with the world. While your meaning may be similar to that of others, it will be as individual as your own fingerprint.

No matter what gives your life a sense of meaning, the key is that you have discovered meaning, and it’s something that you have to find yourself.  No one else can tell you your meaning of live.

The Importance of Meaning

When we haven’t found a sense of meaning in our lives, or have lost our sense of meaning, we run the risk of wandering aimlessly. We drift from one thing to another–looking for purpose in random activities.  We can experience feelings of disillusionment as we are never quite satisfied by our activities.  In our pain, we may become selfish.  Some people try to self-soothe with substance use, retail therapy, etc. Ultimately, we can reach a place of asking “What’s the point?”.

Alternately, when we’re in touch with our meaning, we operate from a sense of purpose. We focus on what we believe to be important, and this belief helps us to structure our activities, allocate our resources and provides contentment and a sense of accomplishment.  We believe that we are on the earth for a reason.

Searching for Meaning

If you are struggling with a lack of meaning in life, a wonderful resource is “Man’s Search for Meaning” by Dr. Viktor Frankl.  Dr. Frankl was a recognized Austrian neurologist, psychiatrist and published author when, in 1942, he and his family (wife, parents and two siblings) were deported to the Nazi Theresienstadt Ghetto and ultimately to various other camps.  Only Dr. Frankl and his sister survived.

“Man’s Search for Meaning” is Frankl’s description of his time in the camps and his observations.

Based on his experiences, Frankl believed that people are primarily driven to find meaning in their life, and that it is this sense of meaning that enables people to overcome painful experiences.  Dr. Frankl makes a key point, that while we cannot choose what happens to us, we can choose our reactions.

Meaning and Psychological Resiliency

Psychological resiliency is the ability to bounce back from negative events and stressors. Having a sense of meaning in life increases our level of resiliency.  Dr. Frankl discovered that prisoners who had been able to attach some meaning to their camp experience (whether through helping a friend, or staying alive in order to reconnect with loved ones) were more resilient to the horrors of camp live.  Those with greater resiliency choose how to view and respond to their experiences in the camps.   As their sense of meaning rose, so too did their ability to choose their responses. Ultimately, their resiliency increased.

Frankl also observed that once someone had lost their sense of meaning (perhaps when learning of the death of a loved one), their resiliency decreased, they ‘gave up’ and soon died.

How Is This Helpful?

Most of us go through periods when we feel that we have lost our sense of meaning and purpose…when we wake up in the middle of the night wondering ‘What’s the point?’.  It’s important to recognize that this is normal.  One of the wonderful challenges of being human is that we develop and learn.  In doing so, we can outgrow our current sense of meaning and then need to look for a new purpose–in a continuing cycle.

By recognizing the importance of meaning and resiliency, we can choose not to give up or fall into the trap of aimless wandering.  Instead we can choose to spend time exploring what has given us focus in the past and look for new versions of those activities or beliefs.  We can be mindful of our levels of resiliency and aware of what our struggles teach us.

We can continue to evolve.

If you are curious about Douglas Adams’ answer of ’42’, here’s a quick peek at a snippet of The Hitchhiker’s Guide to the Galaxy.  Enjoy!

10 reasons to talk to a psychotherapist

I often ask clients that “If I could wave a magic wand, what would be different in your life?  “. This question is the beginning of setting goals for the work that we will do together to help reach that new place.  The following post from the archives, outlines ten reasons to talk to a psychotherapist.  If any of these apply to you, please reach out to a therapist that you can trust.  It can make a big difference in your life!

It was all going so well until…. The only constant thing is change.  It’s true, and how do we cope when the changes are not positive, on our timetable or by our choice?  Sometimes life gets messy and we need help to cope with the stains.

Let’s explore times when you may want to talk to a therapist. Continue reading 10 reasons to talk to a psychotherapist

Let’s Get Past the Stigma! A New Resource for Mental Health

One of my roles as a psychotherapist is to be an advocate for those who experience mental health challenges.  A positive way to do this is to help raise awareness about brain health as well as attempt to dispel common negative beliefs about mental illness and the individuals coping with the challenges it can bring.

Sometimes this feels like an uphill battle.

Some Numbers on Mental Health

According to the Centre for Addiction and Mental Health (CAMH), in any given year, 1 in 5 Canadians experiences a mental health or addiction problem.  By the time Canadians reach age 40, 1 in 2 have–or have had–a mental illness.  That’s 50%!

Coupled with statistics regarding the stigma of mental illness and we have a major problem.  A 2008 survey by the Canadian Medical Association (CMA) reveals the following disturbing statistics:

  • Just 50% of Canadians would tell friends or co-workers that they have a family member with a mental illness, compared to 72% who would discuss a diagnosis of cancer and 68% who would talk about a family member having diabetes.
  • 42% of Canadians were unsure whether they would socialize with a friend who has a mental illness.
  • 55% of Canadians said they would be unlikely to enter a spousal relationship with someone who has a mental illness.
  • 46% of Canadians thought people use the term mental illness as an excuse for bad behaviour, and 27% said they would be fearful of being around someone who suffers from a serious mental illness.
Effects of the Stigma

A big outcome of the stigma about mental health is that individuals, family and friends don’t reach out for the help and support that they need.  A person suspecting that they may be suffering for anxiety, depression, burn-out they could choose to suffer in silence rather than seek help.  I suspect that the more severe the mental health issue, the less chance there is of disclosure–unless the problem has reached a level where it is impossible to hide.

Having a friend or family member dealing with a brain health challenge is difficult and can negatively affect relationships.  Due to the stress of support, caregivers can not only experience compassion fatigue, but anger and guilt (resulting from feelings of anger).  Once again, the stigma of mental illness may prevent people from getting needed support.

In some cases, a mental health diagnosis is not provided for fear that the individual would be stigmatized for the rest of their life.  This can be a problem as it may prevent people from obtaining necessary social supports and funding that would help to make their lives easier.

A Light in the Darkness

The Mental Wellness Network of Waterloo Region was formed in 2012 under the name “The Waterloo Region Mental Health Work Group.” The group came together after a local Waterloo Region community picture identified healthy eating, physical activity, and mental health as three key areas to focus local policy advocacy work.

After working with the Sustainable Societies Consulting Group and consulting with the local community on how to promote mental health, The Mental Wellness Network of Waterloo Region recently launched this website.  The goal of the site is to promote well-being.

The website is organized around three main areas:  Mental Health and Wellbeing (including a list of local crisis resources and contact information); Ways to Wellbeing in the areas of connection, exercise, mindfulness, learning and volunteering;  and a Resource section for both individuals and professionals.

I heartily recommend this site. Not only is the information useful, but the resources and contact information are local to Waterloo Region.  The website looks at mental health as part of holistic wellness–encouraging us to look at ourselves from the perspective of body, mind and spirit.

Decreasing the Stigma Around Mental Health

Hopefully websites such as this one will help to lessen the negative impressions of mental health struggles and the individuals who strive to cope with the impacts on a daily basis.

When speaking with someone who is feeling shame about their decision to seek help for mental illness, I will ask if they would have the same hesitancy if they were dealing with a broken leg or chronic pain.  Mental health deserves the same consideration.

Canadians Are Not Alone

This powerful, nine minute TED Talk shows that as Canadians we are not alone in our stigma about mental health.

Take care.

 

Core Beliefs…We’ve All Got Them!

If someone asked you how you know something, what would you answer?  I learned it at school.  My parents taught me.  I checked on Google.

When we’re talking about facts or skills, it’s often easy to remember how or when the information came to us.  However, if I asked you about a personality trait or ability, such as if you are kind or able to keep a secret, your response may be, “I’m not sure, I just know (whether I am or not).”

Depending on the question, you may feel embarrassed or proud. Either way, there is an emotional charge that is a result of how you feel or what you believe about yourself, in the context of the trait or ability.  In other words, my question would have come upon one of your core beliefs.

What Are Core Beliefs?

Core beliefs are the very essence of how we see ourselves, other people, the world, as well as the future.  Our core beliefs then inform how we operate in the world.  Below is a list of common negative core beliefs.

  • I’m not good enough.
  • I can’t get anything right.
  • I’m stupid.
  • I’m inferior/nothing/worthless.
  • I’m a bad person.
  • I’m insignificant.
  • I’m unattractive (ugly, fat, etc.).
  • I’m useless.
  • I’m a failure.
  • I don’t deserve anything good.
  • There’s something wrong with me.
  • I’m abnormal.

While it’s painful to think these things about ourselves, the pain is increased when these belief systems are used to navigate our way in the world.  When we incorporate negative core beliefs into our psyche, they become self-fulfilling.  We think we’re a failure, so we don’t try new things, which seems to prove that we’re a failure…and the cycle continues.

Where Do Core Beliefs Come From?  An example. 

A kindergarten class is preparing for the end-of-year concert.  Everyone is working very hard to get the song right and the teacher keeps moving individual children around to maximize the quality of the sound.

In the back row stands a boy named Jeremy.  Jeremy loves to sing and has been practicing the words every day as he walks home from school.  Jeremy sings with enthusiasm and his teacher has moved him a few times in order to find the appropriate place for his ‘sound’. Finally, in exasperation, the teacher suggests that Jeremy not sing, but whisper the words, in order to fit in with the group.  While Jeremy doesn’t completely understand what just happened, part of him sees that his way of singing doesn’t fit.  Maybe he doesn’t fit? Maybe there’s something wrong with him?  Jeremy grows up, never to sing again, and becomes hyper-aware of being ‘too much’ when out in the world.

Core Beliefs in Therapy

Often a key part of therapy is discovering our core beliefs (both negative and positive) and then exploring their history and validity.  One way to do this is through life review therapy.

Life Review Therapy involves looking at our past from the perspective of today.  The goal is to help the individual, couple or family to find meaning and resolution regarding a painful incident and be able to move on with greater awareness and sense of calm.  Often the painful incident involves the creation of a negative core belief.

The Example Continues…

Our young singer, Jeremy, is now 35 years old and has decided to see a therapist to deal with long-term social anxiety that has affected his life on many levels. He made his education and career choices (accounting) to fit in with his fear of interacting with groups of people.  He choose a smaller post-secondary school and a program that would allow him to work somewhat alone.

Jeremy accepted a junior management position three years ago, and discovered that he is good at it.  Due to his management skills, he was recently offered a promotion that will involve speaking in front of groups of people to present financial information. On one hand, Jeremy wants the promotion–he’s become bored with his current position and would like the extra income.  On the other hand, he is terrified at the thought of presenting and ‘making a fool of himself’ in front of his colleagues.

With his therapist, Jeremy explores the history of his social anxiety. He talks about the thoughts that are linked to his feelings when having to interact with groups of people. They treat the process like a science experiment–looking for similarities in thought content and events. Jeremy reports that he’s afraid of being ‘out there’.  He remembers that people are often telling him to “speak up” as they can’t hear what he has to say.  This direction increases his anxiety as he swings between wanting to be heard and ‘being out there’.

During therapy, Jeremy remembers his kindergarten experience and is able to begin to unravel his current feelings and how this core belief has affected his life.  Is this belief accurate? He was also able to process the anger that he feels on behalf of his young self towards his teacher and her actions.

Jeremy did accept his promotion and learned skills to cope with his social anxiety.  A big piece of his ability to move forward was that he was able to question the negative core belief that was holding him back.

This is a very strait forward example and determining our core beliefs are not often this direct.

I invite you to think about your core beliefs.  What are they?  Do you know?  How many of them are positive?  Are they helping you to go the places in your life that you want to go, or are they preventing you from living your best life?

Now for something fun…Enjoy!

 

 

 

A Trip Through the Past: The Genogram

None of us were created out of the mist, but have generations of family members that came before us.  Even if we are no longer speaking to them, or know nothing about them, these people continue to  have an influence on us–even it’s unconscious.  How do we bring this influence into consciousness?  Enter the genogram!

A Geno-what?

Simply put, a genogram is a graphic representation of a family tree that displays detailed information about relationships among individuals. It is more complicated than a traditional family tree as it can include individuals’ characteristics, health history, cause of death, emigration patterns…basically anything that the therapist and/or client feel they would like to add to the document.

If you’re curious and want to discover more about the structure and history of genograms, you can check out this Wikipedia entry.

The Use of Genograms in Therapy

When I begin to work with a new client, one of the first things we often do is create a genogram. This is a joint process, and the document is created from the client’s perspective.  We start with the client and work outwards by adding partner(s), siblings, children, parents, etc.–going as far back as grandparents–though sometimes farther back if it will be useful.

Once we have the added the people, then we start to include ‘relationships’ between the client and key people on the chart.  Are they close or distant?  Who doesn’t speak to whom?  Who disappeared from the family never to be heard from again?

Often a useful component is the addition of a few words describing each person on the chart.  As a client tells their family history/personal story, additions are made to the chart. For example, perhaps emigration is a large part of a family  history, which effects the relationships between members that stay in the country or origin and those that leave.  It’s also interesting to track items such as divorce, suicide and drug/alcohol use over the generations.

While genograms follow a definite structure and use specific symbols, each chart is as individual as the person creating it.  In fact, their usefulness is due to their flexibility as we can include any information that feels important to the creators.

The genogram is a ‘living document’ and the product of an iterative process.  As more information comes to light during the course of therapy, it may be added to the chart.  We can also go back to the chart during sessions to confirm thoughts or perceptions when needed.

The Client Response to Creating a Genogram

Ideally, creating a genogram is an enjoyable activity. It can be interesting to look at our family history from this perspective.  When I ask clients what they think of the process, I often hear about how they never thought of their family in this way and are enlightened when they start to see the patterns that emerge.

Clients often apologize when they don’t know information for the chart.  However, it’s all good information–even not knowing is valuable.  Why don’t they know?  What does this say about their family system? It’s acceptable not to know as it’s all grist for the mill.

The Use Of Genograms In Couple Work

Genograms can also be completed when working with couples.  In this case, we complete a chart for both partners–‘marrying’ it into a whole picture.  It’s often fascinating to see how family of origin pieces affect their current relationship and how each person is being affected by family history.

The Benefits of Creating a Genogram

Besides showing multi-generational patterns, one of the benefits of completing a genogram is that it puts some distance between the clients and the current concern(s) that brings a couple or individual into therapy.  We can see the challenge from another, less-personal perspective.

Another benefit is the unveiling of family secrets.  Holes in family of origin information often point to family secrets.  Why don’t we know what happened to Great Uncle Ed?  Why did Cousin Louise disappear only to return suddenly?  How come no one talks about Aunt Nancy?  Family secrets are important as they are part of the rules that govern families. As these rules often affect our core beliefs and subsequent mental health, it’s important that we explore them.  A genogram is often the first hint that a secret exists.

A third benefit of a genogram is as a tool to encourage interactions between family members.  While in grad school I created a complex genogram as part of a family of origin course.  In order to fill in missing information, I had to initiate conversations with family members that wouldn’t have occurred otherwise.  While these talks were not always easy, the results were worth the effort, both for information gained and relationships renewed.

It’s Not Our Ancestors’ Fault–At Least Not Intentionally

One of the pitfalls of a genogram is the possibility of blaming our family for our current struggles. While they may have a part to play–especially as patterns are repeatedly acted out, at the end of the day it’s safe to say that parents desire to love their children unconditionally and attempting to do their best.  However, this doesn’t always seem to be the case.  Why?

Dr. Gabor Maté, in his book, When the Body Says No:  Exploring the Stress-Disease Connection, writes about how multi-generational stress and trauma affect the ability of parents to attach to their children.  It is well-documented that our attachment style (secure vs. insecure) is a key component of our mental health and the way we interact with others. Our ability to handle stress is deeply related to brain development, both before and post birth, as much of our brain development continues well into the first years of age. Therefore, if our grandparents were stressed and unable to attach securely to our parents, it affected our parent’s brain development and their ability to attach…and on it goes.

Dr. Maté states:

“Parenting styles do not reflect greater or lesser degrees of love in the heart of the mother and father; other, more mundane factors are at play.  Parental love is infinite and for a very practical reason:  the selfless nurturing of the young is embedded in the attachment apparatus of the mammalian brain…Where parenting fails to communicate unconditional acceptance to the child, it is because of the fact that the child receives the parent’s love not as the parent wishes but as it is refracted through the parent’s personality. … For better or worse, many of our parenting attitudes and responses have to do with our own experiences as children.  That modes of parenting reflect the parent’s early childhood conditioning is evident both from animal observations and from sophisticated psychological studies of humans.” (p. 211-212)

What Do We Do With The Information?

Once we have looked at and integrated the information from a genogram, what do we do with it?  Awareness is the key.  When we begin to notice patterns, both in ourselves and in our relationships with others, we have taken a big step in making things better.  We can choose to do something differently.  We can choose not to continue the pattern to our children and grandchildren.

The “7th generation” principle taught by Indigenous tribes and Native Americans say that in every decision, be it personal, governmental or corporate, we must consider how it will affect our descendants seven generations into the future.  This also relates to taking care of our mental health.  When we do the hard work of healing the results of multi-generational stress and trauma, we not only benefit ourselves and those we are currently in relationship with, but also generations to come.

Now for some vintage comedy…family dynamics from the Carol Burnett Show.  Enjoy!

 

 

 

The Highly Sensitive Person in Therapy

Last week I posted a book review of The Highly Sensitive Person:  How to Thrive When the World Overwhelms You by Elaine N. Aron, Ph.D.

In this post, I’ll explore what taking part in therapy may look like for a highly sensitive person (HSP).

A Fictional Story

Jenny (age 23) had recently graduated,  with a certificate in Business Administration, from a small community college in her hometown .  Due to financial restrictions, she had chosen to live at home throughout her coursework.  After graduation, job prospects where she lived were in short supply, so she happily accepted a receptionist position at a busy company in a large city three hours away.  Jenny was looking forward to moving to ‘the big city’, making new friends and starting her ‘grown up’ life.

Jenny arrived in the city a few days before she was due to start her job.  She moved in with a young woman that she had found on Kijiji who was looking for a roommate.  The apartment was small, but she told herself that wouldn’t matter as she had her own room. Plus, her roommates was going to become a new friend.

Jenny’s first day at work was a whirlwind.  The subway ride from her apartment to the office was hot and crowded.  The reception area where she sat was in a busy lobby that echoed with the sound of hundreds of people rushing through the space.  If the phone wasn’t ringing, there was someone waiting to meet another employee or a courier asking her to sign for packages.

By the time Jenny ‘fought’ the subway to get home, she was exhausted and overwhelmed. She was looking forward to spending a quiet evening at home getting to know her roommate. However, when she arrived she was greeted by deafening noise!  Her roommate had invited work colleagues to the apartment for their usual “Thank Goodness Monday is Over” party.  They invited Jenny to join them, but she was so tired that she declined, promising to join them another time.

Jenny’s first day turned out to be the pattern for most work days–busy days, followed by some sort of social gathering taking place in her apartment at night.  Weekends were somewhat quieter as the office was closed, but her ‘home’ became pre-party central both Friday and Saturday nights as her roommate and her friends warmed up for their evening adventures. Jenny often spent her time at the apartment, curled up in her bed with her head under her pillow.  Jenny started to feel lonely and miserable.

After six months of living this ‘grown up’ life, Jenny was struggling to cope. On the advice of a friend from home, she decided to find a therapist.

The Therapy Experience

By the time individuals like Jenny start to meet with a therapist, they are often overwhelmed and doubting their abilities.  Many HSP’s think that they are failing at life and that there is something wrong with them.

As a therapist, once a client and I have talked about what is bringing them into therapy, if I suspect that the individual may be highly sensitive, I will talk to them about the concept of HSP’s.  We will explore the characteristics of high sensitivity–looking at past and present behaviours, situations and experiences.

I often suggest homework to my clients, and at this point will ask that they read The Highly Sensitive Person, not only as a way to gain more information, but also to discover some tools and coping strategies.

If the idea of high sensitivity rings true for them, this concept can provide a new lens for the client to look at their way of being in the world.  For the therapist, being aware that they are working with a client who is highly sensitive can help them to adjust their way of working with that client and the types of interventions they may recommend.

HSP’s and Types of Therapies

When working with clients, it’s helpful if a therapist has different ‘tools in their toolbox’ to help them.  The art of therapy involves matching specific therapeutic tools, from different types of therapies, to particular clients.  What are some common therapies and how can they be adapted to be the most beneficial with working with someone who is highly sensitive?

Cognitive Behaviour Therapy (CBT): 
CBT helps to relieve specific symptoms by exploring how our thoughts and beliefs affect our behaviour.  It’s fact-based, and involves keeping track of thoughts and behaviours. This type of therapy tends not to focus on feelings or motivations for actions.

When working with HSP’s, I like to use CBT not only as a way to explore symptoms (monitoring the thoughts and behaviours in the same way that we would a science experiment), but also as a way to gauge if the coping strategies learned in the Highly Sensitive Person are proving to be useful.

One of the skills possessed by highly sensitive people is an ability to focus on details.  This is very helpful when observing/tracking symptoms in CBT.

Dialectical Behaviour Therapy (DBT):
DBT takes Cognitive Behaviour Therapy  further by looking at the emotions that are not explored in CBT.

I find that there are two benefits of using DBT with highly sensitive people:  the first is that DBT teaches calming and distraction skills that can help HSP’s to cope with the sense of overwhelm they can feel in specific circumstances.  The second–DBT encourages acceptance of current situations, while at the same time realizing that there needs to be positive change.  This acceptance allows HSP’s to begin to feel comfortable with their way of being in the world, while learning new skills and making changes.

Narrative Therapies:
We usually equate therapy with talking, and talking is at the heart of the narrative group of therapies where feelings and motivations are explored.  HSP’s can feel very comfortable with this type of therapy as they tend to have a rich inner life and are sensitive not only to their relationships with others, but are intuitive regarding interpersonal dynamics. Their attention to detail and awareness help them to recognize patterns in behaviour and circumstances.

Medications:
As a psychotherapist, I don’t prescribe medications, though I sometimes suggest that a client consult with their doctor to explore if medications could be a useful addition to therapy.

For many highly sensitive people, their sensitivity includes their physical self.  They may have noticed that they are more sensitive to physical stimulation such as sounds, light, touch.  They may have discovered that they are more sensitive to alcohol, caffeine and over-the-counter medications.  They may react to prescription medications.

It’s important for people who feel that they are highly sensitive to let their health care providers know.  For many prescription medications, compounding pharmacists can create specific dosages for individuals that can be slowly increased over time–eventually arriving at the ideal dosage while minimizing side-effects.

The End of the Story

When Jenny learned about the possibility that she may be highly sensitive, she felt that a big piece of her personal puzzle fell into place.

With her therapist, Jenny explored her negative beliefs about her feelings of failure and that there was something wrong with her.  She looked at how her current living and working situations were affecting her health.  Jenny thought about whether she wanted to continue her current lifestyle  (using her new coping strategies and tools) or if she wanted to try something else.  Jenny gave herself permission to dream about what a new lifestyle could look like and used her therapist as an accountability partner as she planned for a change and set these plans in place.

By the end of therapy, Jenny had decided to fine-tune her lifestyle.  Using what she learned in therapy along with her past experiences, she decided look for a new job at a smaller company.  She updated her resume to help her obtain a specific position that didn’t involve working with the public in an open space.  She decided that she liked living in the big city, but wanted to do so on her terms. She found a bachelor apartment that allowed her to live alone at a rent she could afford.

Jenny  used the HSP coping strategies to travel to work on the subway and organize her social calendar.  Jenny found that when looking at her life though the HSP lens she was able to take care of herself and do so without embarrassment.

Let’s Take a Break

Now, for all of us who would like to take a break from the business and noise of life; here are two clips.  They both feature the famous cellist, Yo Yo Ma.  The first  is a clip of his 2015 concert at the Royal Albert Hall in London, England.  The second is of a seven-year old Yo Yo Ma (accompanied by his sister) at the his American debut performance at the Kennedy Center for the Performing Arts.  Enjoy!

 

Experiential Learning Theory and Mental Health…Is There a Connection?

As a therapist, one of my professional goals is that the people I work with will leave therapy with a greater understanding of the issues that brought them to see me, as well as tools to cope if the challenge should occur in the future.  As a way to work towards this understanding and skill development, I often ask clients to complete homework assignments.  The assignments may be to reflect on part of our discussion, practice a new skill or write a letter (not to be sent) to a difficult person.   Over time, I have found that clients’ willingness to complete homework outside of our sessions has a positive influence on their therapeutic success.  Because of a presentation I recently heard on Experiential Learning Theory, I now have a clue as to why.

What Is Experiential Learning Theory (ELT)?

Simply put, the theory is based on the idea that people learn through “discovery and experience”.

Imagine that you want to learn how to ride a bike.  If someone told you how to ride a bike or you read “Bike Riding for First-timers”, you could gain theoretical knowledge about physical balance or types of bikes. You may even get an idea of how to fix a bike, but would this information be useful in fulfilling your desire to race through the neighbourhood on your own steam?

Instead, now imagine that you are standing beside your ‘new-to-you’ bike.  You are brimming with determination to start riding.  My guess is that you would be using a process of ‘trial and error’ to figure out how master this new skill.  Learning would involve finding ways to sit on the seat, pedal, turn and stop–while not falling off.  It would take time, and while a book or lecture could be helpful, their content may make more sense after your had the experience of actually playing with your bike.  This is experiential learning!

David Kolb and the Experiential Learning Cycle (Kolb Learning Cycle)

In 1984, David Kolb (social psychologist) coined the term “experiential learning” when he published Experiential Learning:  Experience as the Source of Learning and Development.

Kolb’s cycle has four parts:  experience (doing something), reflection (review what was experienced), conceptualization/generalization (making sense of what happened and the relationships between these elements, and experimentation (putting what was learned into practice).  When we see how what we learned is useful in our lives, we’re more likely to retain the knowledge.  The gift of this cycle is that it is a cycle–we can keep repeating the process as a way to fine-tune our knowledge when learning a new skill.

Let’s return to the bicycle example–you want to learn how to ride your bike.  To begin (experiential stage), you straddle the bike, sit on the seat and put a foot on a peddle.  So far, so good.  However, as soon as you start to lift your second foot off the ground, you feel a loss of balance and find yourself on the ground!  The reflective stage starts as you think about what just happened (one second sitting on your bike, the next lying on the ground).  As you make sense of this experience (conceptualization/generalization) you may be thinking about how unsteady you felt as you moved for the second peddle.  You may decide to go back to “Bike Riding for First-timers” and re-read the section on balance–this time with a new perspective.  Finally, after your bruises have healed, you will return to your bike and apply what you have learned (experimentation).  As you repeat this cycle, you will roaring around the streets in no time!

What Does ELT Have To Do With Mental Health?

As I was listening to the presentation, I was thinking not only about how this could explain the success of therapy homework, but also how it could affect the development of phobias and be used in their treatment.

Phobias are learned behaviours–based on previous experiences.  Common treatments for phobias are Exposure Therapy (treating the avoidance behaviour by helping individuals to slowly become acclimatized to the phobic trigger) and Cognitive Behaviour Therapy (CBT)(exploring thoughts around the feared object, as well as develop alternative beliefs about the phobia and its effects on their life).

If we bring in the Experiential Learning Cycle, can the Learning Cycle help to explain the creation of a phobia?  There was the original experience (for example being bitten by a small dog).  A time of reflection–“I was just bitten by a small dog!” followed by conceptualization/generalization–I put my hand out and a small dog bit me, so small dogs bite.  Finally, experimentation when we put what was learned into practice–“I’m staying away from small dogs!”… and a phobia may be born.

On the other side, does CBT and  Exposure Therapy use ELT concepts to help people explore and unlearn the basis of the phobia–especially when used together?

I’ll Keep Suggesting Homework

Experiential Learning Theory has confirmed for me the value of therapy homework, as the homework is assigned based on a specific client experience.

Let’s take the example an argument with a co-worker.  In therapy we would reflect on the argument, look at past incidents with the co-worker, and talk about emotions connected to this event.  We would explore possible ideas of what could be done differently in the future.  We may move into role-playing a specific communication skill or conversation.  The resulting homework would be to practice the skill, and perhaps, have the conversation with the co-worker.  The cycle continues at the following session when we debrief the homework, fine-tune and explore where to move from that point.

Experiential Learning Theory In Practice

Here’s a great example of experiential learning.  Thankfully, most people don’t have this experience on network television!  Warning…there are lots of bleeps due to language.  Enjoy!