I have had a year full of rich learning experiences. My training in dance/movement therapy began and I experienced movement in new ways as courses progressed throughout the year. With an artistic background in dance, I have been trained to look, move, and perform a certain way. Engaging in the therapeutic aspects of the movement has been an eye-opening and challenging experience. I found myself defaulting to the comfort zone of performing rather than allowing my innate internal rhythms to lead. It is emotionally safer to produce choreography and follow dance steps than it is to engage emotions and allow them to move through me. As I reflect on this past year, I realized the comfort zone can be a difficult place for many of us to leave.
Living in Greater Vancouver, the normal flow of life is going from one event to the next without taking a break to recalibrate our system and allow the body to catch up to our mind and emotions. Many of us go from dropping off our children at school, straight to work, to appointments or extracurricular activities, and then crash at the end of the day. Our nervous systems are being stimulated with sensory input at an 80/20 ratio throughout the day (80% incoming, 20% releasing).1 This can be extremely overwhelming for our systems, particularly for children. To release ourselves from the busyness of life requires us to move outside of our comfort zone and the life patterns we have created for ourselves.
The Mind-Body Disconnection
With the imbalance of incoming and outgoing stimulation, we risk losing our mind-body connection and become influenced by our external environment. Interoception information is received and transmitted from inside the body.2 When we are interoceptive, we are aware of things like hunger, pain, and body sensations our emotions elicit. The butterflies in our stomach when we’re nervous, the tightening of our chest when we’re angry and the crushing headaches associated with grief are all examples of interoception.
When we push through symptoms signalling us to slow down or take a break, we tend to lose our interoception. The accumulation of this mind-body disconnection has adverse effects on our health. We get fatigued, stressed, and sick. All emotions have a muscular pathway. If emotions are not permitted to sequence through the neuromuscular system, the consequences are ill health, both physically and mentally.3
Dance/movement therapy (DMT) takes individuals to the edges of their comfort zone to integrate the mind and body to support wholistic wellness. Deriving from modern dance, the field of dance/movement therapy began in the early 1930s. Marian Chace was a pioneer in the DMT field being the first to bring dance into hospital settings as an intervention for war veterans battling post-traumatic syndrome disorder.4 Chace developed therapeutic dance/movement interventions as mental health treatment and supported the creation of the American Dance Therapy Association, serving as the first president.
Today, dance/movement therapy is recognized world-wide with therapists serving in schools, hospitals, rehabilitation centres, forensic settings, prions, and more. The goals of dance/movement therapy are to support the integration of emotional, physical, cognitive, and social aspects of an individual. A common misconception is dance/movement therapy is limited to dancers. No dance experience is necessary to engage in DMT. Movement therapy occurs on a continuum of movement. Engaging in DMT can be as simple as discovering your breath pattern, moving your arms while sitting, or finding movement through speaking.
The body has a memory and sometimes those body-based memories arise without our understanding. In dance/movement therapy sessions, individuals may be answering questions non-verbally with a series of movements. Emotions always result in physical actions.5 The only way to work through the pre-verbal experiences is through the body. Dance/movement therapy allows individuals to integrate interoception with their externals worlds by sequencing innate movement patterns before verbally naming the process.
Discover Your Movement
Our first relationship is self-to-self. We are designed to move and our bodies are in constant motion. From blood surging through our veins to cells moving across our systems, we are in constant motion. Dance/movement therapy creates opportunities for us to connect to the self and embrace the motion within. When we are learning to be internally aware, moving can promote self-expression, rhythm, synchrony, and cohesion. The mind-body connection allows for self-integration, resulting in an improved understanding of the self and of others.
Beneath each movement lies a need. Movements may come as metaphors or communicate a clear need. Who are we as moving beings? Our bodies have a story to tell. May your courage move you to step out of your comfort zone and discover the flow of your unique movement.
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Would you like to learn more dance/movement therapy? Join me on Tuesday, January 7, 2020, at 6:30 pm for a free information session at Alongside You. Discover the healing benefits of therapeutic dance/movement and how the mind-body connection contributes to wholistic well-being. Registration (while free) is required.
Here we are again – that time of year that gets us all excited about lights, smells, food, and relatives. Oh, and friends, cookies, the Stanley Park train, and…
Wait. Why are we excited again? Is anyone else stressed? What is this peace that people keep talking about? What’s the secret, and who actually experiences peace this time of year? I’m like everyone else. I can let the stress get to me too. So, what I’ve done is some thinking and some research that will hopefully help all of us figure out how to get some peace this year. I don’t know about you, but I think we could use it. Here are three practical ways to experience peace this Christmas, I hope they’re helpful to you!
Say “yes” to what matters most to you, and practice presence when you are there.
“It’s crazy. I can’t believe how much I have to do!”
We nod our heads and empathize, “Yes, I know. Me too. It’s just too busy!”
I am guilty of making these kinds of “Christmas complaints.” I am also aware that these rote responses make us feel that we’re “all in this together.” What a shame it is to forget that we often have a choice in the matter and that much of what we’re begrudgingly doing may, in fact, be worth enjoying.
Christmas parties, school performances, family dinners, and year-end activities – everything can be meaningful and life-giving. If you find yourself excited about a particular activity, and you think it is a worthwhile investment of your time and energy, show up with your Ugly Christmas sweater and your party hat on! What a gift it is to be alive!
One of the keys to connecting with the activities in a positive way is to be mindful. The best way to practice mindful presence at your chosen festivity is to set your intention, going in with the knowledge that this event is not imposed upon you, but gratefully chosen by you. Allow yourself to enjoy the people you speak with, the food you choose to eat, the melody and rhythm of the music you hear, and the décor creatively displayed for your aesthetic enjoyment. Breathe deeply, attune to your five senses – sight, smell, touch, sound, taste – and pay attention to what is right in front of you in that moment.1,2
Say “No,” to what is not a priority, and learn to be okay with disappointing people.
If it is true that we can choose to be gratefully present at an event, it is also (usually) true that we can gratefully decline to attend. In fact, it can be very liberating to do so. When we choose to simplify our schedules and scale back our commitments, we are giving our enthusiastic ‘yes’ to what we do show up at. We may also disappoint a few people along the way.
It can be very difficult to let someone down; it is even more difficult, long-term, to live with blurry boundaries and residual resentment. We may think that we have to jump when our friends and family say “jump,” and perhaps we’ve done it our entire lives. Perhaps it’s instinctual, and to do otherwise would create tension. Part of our work as humans who work toward self-identity and emotional health is to know what is not for us at this time. It does not mean that we cannot change our minds in the future and show up meaningfully then, but that in this season, at this time, we cannot take it on.3
There is a way to communicate boundaries in a respectful, effective manner. It takes practice, but with new learning and perhaps some help from a counsellor, it is possible to become skilled at lovingly communicating our intentions and expectations to others.
Say nothing at all, and take time for solitude.
For some, it will be a challenge to take a break from the busyness, to be alone and recharge. It may feel selfish to have time away from your partner, children, parents, or co-workers, to collect your thoughts in quiet. You may literally be thinking that you will make time for yourself next year. While it is possible to push through and strong-arm this season, we remember that if we feel coerced or obligated to be somewhere (in this case, to be with people), we may find it difficult to remain present with them. One of the best gifts we can give ourselves, and those we love is to take some time alone.
It is also true that for some of us, this season will feel lonely, even when we are in a crowded room of people.4 Or perhaps we will actually be alone more than we’d like, and the idea of choosing to turn down holiday activities out of sheer busyness seems like a happy person’s privilege. There can be peace in this season for you, too. Take very good care of yourself and reach out to one person who makes you feel known.5
Wherever you find yourself this Christmas, and with whomever, you choose to spend your time, try to be intentional about when you say “yes,” what you say “no,” and when to say nothing at all.
If you struggle with some of the decisions and boundaries I’ve talked about here, give us a call. We all struggle with these things at times and sometimes an outside perspective, listening ear, and some validation can go a long way in getting us from stress to health; or, as the young people say, from the FOMO (fear of missing out) to the JOMO (joy of missing out). Ok, it’s not that simple, but boundaries don’t have to be complicated. We can help.
Goldin, P. R., & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, 10(1), 83–91.org/10.1037/a0018441
de Vibe M, Bjørndal A, Tipton E, Hammerstrøm KT, Kowalski K. Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults. Campbell Systematic Reviews 2012:3 doi: 10.4073/csr.2012.3
Wuest, J. (1998). Setting boundaries: A strategy for precarious ordering of women’s caring demands. Research in nursing & health, 21(1), 39-49.
Kar-Purkayastha, I. (2010). An epidemic of loneliness. The Lancet, 376(9758), 2114-2115.
As I sat in church this past Sunday, I was reminded that this time of year is supposed to be about hope.
For those of you who may not be familiar with the Nativity Story, the story of Jesus’ birth, is one about hope. Namely, that God came down in the form of a baby to save the world. What’s even more important to know, however, is that this is said to have happened in quite possibly the most awkward, unexpected, and improbably way possible: a virgin birth. This was beyond counter-cultural (and actually dangerous) in the culture at the time – both Joseph and Mary had some seriously difficult decisions to make and actions to take if this was to come to fruition without either of them losing their communities or quite possibly, their lives.
This got me thinking about mental health (yes, my brain goes there more often than not). It got me thinking about how I don’t often get excited about this time of year and wondering why that is. I think this year it simply crept up on me without notice and here I am, apparently in the Christmas season, and I haven’t even had time to think about it. I’ve written some of my thoughts previously, which you can find here. In short, I don’t get particularly excited about the holidays, presents, or otherwise. Some of it stress-induced, some of it is I’m not a particularly excitable person for these sorts of things, and some of it being I’m already thinking about January and it’s barely even December.
I’m Tired of Things That Don’t Last
I think part of my reticence around Christmas is that it seems to have turned into simply a gift-giving season where we give gifts that disappear shortly thereafter. Now, I actually really like giving gifts. When I have time, I tend to get creative and go all-out. I’ve never been one to get particularly excited about getting stuff. This goes for pretty much any gift, but especially the stuff we all give and get that lasts for a bit and ends up in the closet, only to be thrown out the next time we need to move.
Now, I should add to this, I always appreciate the gifts people give me. I appreciate the time that went into them, I appreciate how they taste (most people know I love chocolate and act accordingly), and most of all, I appreciate the time I spend enjoying them with others. For me, the real enjoyment comes with spending time with the people who gave me the gifts. This is what hits home, and this is what I remember.
All I Want For Christmas Is Hope
I haven’t been asked yet, but invariably I’ll get asked soon by people what it is that I want for Christmas. I honestly cannot think of a single thing I want for Christmas. For better or worse, I have every tangible thing I need – I’m very fortunate that way. This takes the discussion from needs to wants. That list is challenging because it’s very small, and generally, very expensive (i.e. I want to renovate my kitchen, there’s a laptop that could use replacing, etc.), and I would never ask for that for Christmas. And even in those areas, I’m fortunate in that I can usually find ways to get what is wanted, or I simply wait until it’s possible.
But there is one thing I both need and want. It doesn’t need to cost money, and it’s in plentiful supply if we’re all willing to give it.
“This Christmas, I need Hope.”
As I sat there in church thinking about anything but the sermon, tears came to my eyes as I realized what it was that I needed. Hope. It seems so simple, yet so difficult. One of the challenges of being a Registered Clinical Counsellor and running a growing mental health team is I am faced daily with the pain, heartache, and trauma that people experience within our community, and in our world at large. This takes a toll.
Before any of the people reading this who know me freak out, this is not a cry for help or a sign of burnout. I’m fine. I’m simply very aware of the degree to which people are hurting and are in need of hope.
This is simultaneously one of the things I absolutely love about my job, and about what we do at Alongside You – that is, we bring people hope, and often in times where they can’t see any hope for themselves.
Bringing Hope Can Mean Some Difficult Decisions
Part of what struck me about the Christmas story and the decisions and actions that Mary and Joseph had to make was how similar they were to some of the decisions we have to make when we’re recovering from mental health. It’s not an easy road, that’s for sure.
This can be a hard one! Relationships are front and centre in any battle with mental health. Whether it’s depression, anxiety, PTSD, trauma, addiction, or otherwise, relationships are front and centre. Sometimes the difficult decision may be to tell a loved one about our struggles. Sometimes it may be to tell a close relationship that what they are doing is hurting us. Sometimes it may be that we need to end a relationship in order to pursue healing and recovery.
Sometimes, like Mary, it may mean telling someone something so personal, and even unbelievable, while simultaneously being scared that it will end the relationship and have significant negative effects on our lives.
On the flip side, sometimes, like Joseph, we’re the one being told something incredibly difficult to imagine or manage. What if our loved one tells us something so difficult that we have a hard time processing it? Staying present with it? Staying in a relationship with them, knowing this new information?
It’s difficult all around. The choices we sometimes have to make in mental health can be full of anguish, and even despair.
There are plenty of potential consequences to the situation Joseph and Mary found themselves in. What about us? I know in my own journey with mental health, there have been many times where my battles have had very significant negative consequences on me and also those around me.
We don’t always make wise decisions when we struggle with anxiety, depression, suicidal thoughts, addiction, or other areas of mental health. In fact, more often than not, we can’t make wise decisions. It’s not that we don’t want to, it’s actually that we can’t. When we’re in fight or flight mode, our limbic system is in control and our cortex has flipped its lid. Other times, we’re simply human and we make bad decisions just like everyone else; it just means that sometimes the consequences are more dire or significant.
This Holiday Season, Focus On Experiences
I want to be excited about Christmas, I really do. I’m sure that once I’m off work (in theory) after December 20th, I’ll maybe start getting excited. My goal, however, is to get excited before then. I’ve decided I’m going to focus on experiences in my gift-giving this year, in the hopes that my gifts will last beyond the season, and selfishly, in the hopes that it gets me a little more excited even before I take some time off.
Why experiences you might ask? Well, because they don’t go to the landfill, for one. But the main reason is this:
Connection is what gives us Hope when we need it most.
As I sat with a client today, I reminisced a little bit about this, and it reminded me of one thing: In my entire history of working with clients, particularly with addiction, I can’t think of a single case where the connection wasn’t the solution. It doesn’t mean that medications, therapy, exercise, nutrition, and all of these other pieces aren’t important, because they are; what it does mean is that without connection, we don’t have hope. Without hope, we lose the point and the motivation for the other pieces.
Without connection, nothing else matters and nothing else works.
I truly believe this. Without connection, I don’t care if you have the best therapist, the best doctors, the best meds, the best exercise plan, or otherwise, it will not work.
So, this is a bit tongue-in-cheek, but I’m also serious. All I want for Christmas is hope. This is what I get excited about – people. People and hope are what drives me every day. It’s literally all I can think about in terms of what I want for Christmas.
I want people to have hope.
This is why all of my Christmas gifts are going to be experiential in some way. Not stuff. Things that will help people experience themselves, and the world in a more positive way.
So, if you want to get me something for Christmas, give someone an experience, a chance to connect with you in some way. And while what I’m about to say may sound like hyperbole, it really isn’t – you can change someone’s life simply by giving them this type of a gift. It may not categorically change their life at the moment, but maybe, just maybe they’ll believe that you care about them, that they are worth it, that they have meaning.
If you really want to get me something for Christmas, come to our conference in January called Let’s Talk Hope. This is a chance for all of us to get together and find hope for mental health in our community – through connection. If you’re stuck for a present for someone you care about, bring them too.
This isn’t me schilling another conference for the sake of a conference or selling tickets. Between you and me and the rest of the internet, we aren’t running this for profit. In fact, if we cover our costs we’ll be happy. Anything over and above our costs goes straight back into helping people with mental health struggles.
I’m asking you for this for Christmas because I truly believe it could be the start of something that changes the face of mental health in our community. Not in and of itself, not as a one-stop solution, but as a start to something that points towards hope.
If you are alive and are human, we need your voice in the discussion of mental health. It doesn’t matter if you’re a professional, someone who suffers from mental illness, a parent, or otherwise. Your voice matters.
If we sell this thing out, and we come together as a community to bring hope to Delta in the face of some of the most challenging times we’ve ever had, it will be worth it.
If only one person leaves and feels more worthwhile and valued, and loved, it will be worth it.
And I guarantee it will be the best $15-30 you will ever spend.
I believe in this so strongly that if being able to afford the cost of the ticket is keeping you from coming, please contact me directly. I will personally cover the cost of you coming to the conference because I believe it will be more than worth it, and I believe you are worth it. No questions asked.
“If I spend all my Christmas money on giving you hope, it will be the best Christmas ever.”
Christmas Is About Connection
As this is my one and only blog post about the holidays this year, I want to wish you and your loved ones a Merry Christmas, and happy holidays as you enter this special time of year. It is full of surprises, stresses, and joys. It is my hope that it will be full of connection for you.
The connection is what brings us together, reminds us that we are worth it, and reminds us that there is hope in all things and in all situations.
No matter what this season brings for you, know that we believe in you and your value, and I look forward to seeing you in 2020.
In today’s world, many of us have experienced events that are deeply troubling. These include car accidents, physical assault, gruesome deaths, difficult childhoods, witnessing violence, working in fields where tragic things occur, etc. None of these experiences in themselves will result in post-traumatic stress disorder. Indeed, many events in life can be extremely upsetting but may not lead to post-traumatic stress disorder. For some, however, such events stay with the individual and change their ability to cope significantly.
Let’s begin with a bit of discussion about the difference between a difficult event and a traumatic one. I like to refer to difficult events as small-t traumas. These are events that can upset us for days, weeks, and even months. They take time to adjust to and with time and social support the individual is eventually able to function as well as they did prior to the difficult event. Capital-T traumas tend to be events that impact the psyche in ways that prevent us from returning to our previous ability to function. These tend to be events that are outside of the realm of normal human experience, i.e., they are statistically unlikely. Therefore, it is difficult for the sufferer to find social support as most people cannot identify with the events that have occurred. In addition, traumatic events tend to happen quite suddenly and therefore overwhelm the brain in terms of its ability to process what has occurred. There is a great deal of science that explains this but it is beyond the scope of this blog. Capital-T traumas can result in full-blown post-traumatic stress disorder.
How do I know when I need to get help for PTSD?
How does one know if they have post-traumatic stress disorder and should, therefore, seek help? There are several factors that experts agree are consistent with a diagnosis of post-traumatic stress disorder.
The first of these is physical symptoms. Following a traumatic event, it is not uncommon for the sufferer to report extreme fatigue, dizziness, headaches, as well as a host of gastrointestinal difficulties. In addition, the event itself may have left the individual with chronic pain. For example, motor vehicle accidents often result in observable injuries that are painful. If these symptoms persist beyond the length of time in which healing should occur, this may be a symptom of PTSD.
Secondly, those with post-traumatic stress disorder typically report nightmares about the traumatic event and other flashbacks. Flashbacks sometimes called triggers, occur when something relatively small reminds the sufferer of the entire traumatic event and the sufferer experiences a very high level of distress. An example of this might be smelling alcohol following an event in which an assailant was intoxicated or smelled like alcohol. The sound of sirens can also be a common trigger.
In addition, PTSD sufferers tend to exhibit a specific form of anxiety in which they begin to avoid situations that might remind them of the traumatic experience. This is done so that the sufferer can avoid feeling the distress and pain that they felt during the initial event. For example, if the traumatic event involved harm coming to a child, the sufferer may begin to avoid settings where there are children. These avoidances can make it very hard to resume normal life as some of them are quite common settings and or objects.
The next symptom that commonly occurs with PTSD is social withdrawal. This can take the form of an otherwise friendly person who begins to decline invitations that they would normally attend. The sufferer may also begin to spend time alone and become very quiet even within their own family. Added to this, the sufferer may begin to use alcohol or drugs in an attempt to withdraw from the feelings and memories associated with the trauma. They may also begin to engage in risky and seemingly wild activities such as driving erratically, walking alone in high-risk situations, etc., as a means of distracting themselves from the traumatic memory.
Repression or trying to forget the event is another symptom of PTSD. This can take the form of the sufferer destroying anything that might remind him or her of the traumatic event. It can even go so far as to result in a memory loss wherein the sufferer does not have a conscious memory of the traumatic experience.
Folks with post-traumatic stress disorder often become emotionally numb. Their loved ones may begin to notice a difference in that the sufferer appears to have no feelings. Sufferers themselves often describe feeling numb. This is the mind’s way of protecting us from becoming overwhelmed when something horrible has occurred.
Another common symptom of PTSD is what is called hyperarousal. Basically, this means that the individual becomes very jumpy and is easily startled. They may be startled by a sound that was present during the initial event such as a loud banging sound or may as easily startled by anything that they consider sudden. Individuals with PTSD often appear to be on edge as if they are waiting for the next bad thing to happen.
With all of the triggers, nightmares, hyperarousal, attempts to avoid being reminded of the traumatic event, and physical discomfort that may be present, it is no wonder that trauma survivors are commonly irritable. Irritability is the final factor that is typically present in a person with PTSD.
Is there hope for me or my loved one if PTSD is involved?
If the above describes yourself or someone you love, there is much reason for hope. PTSD is not a lifelong condition. However, it can be life-threatening if it is not addressed because the suffering is so intense. Ways of addressing PTSD include talking about it with someone trusted and who can really listen. Formal help in the form of counselling is recommended. It is important to identify and work with a therapist who has expertise in the assessment and treatment of PTSD. Such a therapist is likely to use methods such as progressive relaxation, Eye Movement Desensitization and Reprocessing (EMDR), talk therapy, art therapy, or neurofeedback, and may work in concert with the sufferer’s physician or other members of a healing team.
It is possible to return to living a full and happy life just like before the trauma. While the traumatic event cannot be forgotten, it does not have to define or debilitate a person who has survived a terrible experience. With the right help, it is possible to learn from even life’s most terrible experiences rather than be controlled by them.
Kathryn Priest-Peries is our newest Associate at Alongside You, starting in January. She has lived experience with, and a high level of expertise in working with Post-Traumatic Stress Disorder. If you identify with this article and would like to meet with her, please contact the office and we would love to set up an appointment for you.
Research shows that client engagement in the counselling process strongly predicts the success of treatment.1 In other words, when you arrive, you are not coming to be fixed by a counsellor, but instead to work in partnership with them. There are several ways that you can prepare yourself for a successful experience in counselling, but ultimately your only job is to show up, and however, you do so is commendable and brave.
Know Your Preferences and Needs
Here are some things you might consider before coming to see a counsellor at Alongside You. First, think about what kind of counsellor you believe would be a good fit for you. Your preference may vary depending on your phase of life, and unique circumstance, and that’s okay. Some people prefer a female or male counsellor (for reasons of comfortability or life experience), someone within a certain age demographic, or someone who works within a specific therapeutic model. You may also have a need for someone very soft and gentle, or you may need someone who is willing to challenge you directly. If you can come up with ideas on these preferences, we can help to guide you in picking a counsellor.
It’s also helpful to know what it is you’d like help with. You may feel like your list of concerns are long and complex. That’s ok, you’re not alone. Although it can feel overwhelming to narrow it down, it is often helpful to come to your appointment with one or two issues that are, at present, the most problematic for you. It doesn’t mean this can’t change over time because it often does, it just means there’s some focus to start out the work. That said, sometimes we don’t know what’s wrong, we just know that something is not right and we need help figuring out what’s going on. That’s okay too!
Openness in Counselling
When you arrive for your first appointment, try to be as open as you can to establish a relationship with your counsellor. Research indicates that the therapeutic alliance (the relationship between the counsellor and client) strongly determines the effectiveness of therapy.2 The therapeutic alliance will go the distance when you work through difficult things together and so we (as counsellors and as clients) cannot overlook the significance of trust, empathy, and connection. We understand that it’s a big ask! As part of our professional practice, counsellors do clinical supervision, and many also have their own personal counsellors that they see. You may find it helpful to know that it’s not easy for us either when we’re the ones “on the couch.”
Honesty & Feedback
If part of what makes counselling effective is the therapeutic alliance, the relationship between the counsellor and the client should be strong enough to handle honesty. As counsellors, we value when clients provide honest feedback. This can occur at the moment (“I don’t think you have a clear understanding of what I meant by that”), or after working together for some time (“I find that I feel frustrated when we start our sessions a few minutes late, and I wanted to let you know”). Counsellors want to hear if something is, or is not, working for you. When you don’t agree, or don’t feel your counsellor is fully understanding you, your counsellor prefers that you speak up. Statistically, when a client offers feedback, it usually serves to strengthen the therapeutic relationship, not weaken it.3
Furthermore, be honest about what you believe you need from counselling, whether it be guidance, problem-solving, empathic response, acceptance, non-judgement, or practical insight. It is okay to communicate this. Although each counsellor and client will naturally create a dynamic (or a certain way of being with one another), your counsellor will be better equipped to work with you if they have a clear understanding of your needs. It helps your counsellor to know your objectives for therapy, but also, it can provide insight as to who you are as a person.
As you participate in counselling, aim to implement some of the homework (sometimes called “between-session interventions”) agreed upon in counselling. Counselling homework usually consists of experimenting with new behaviours, making cognitive shifts, acknowledging feelings in specific moments, or keeping track of a combination of all three during the time you are not with us. Homework, at its best, enables integration between the counselling hour and the client’s regular life. Ultimately, homework can be a meaningful way of facilitating healing and growth outside of the time spent with your counsellor.4 As my supervisor, Andrew Neufeld, sometimes illustrates – if you go to see a physiotherapist for your knee and the only work you do is with the physio in session, your knee will likely eventually get better but it will be a long, drawn-out process; whereas, if you do exercises in between sessions your recovery will likely proceed exponentially faster. The same is true for counselling – the work you do between sessions will significantly influence the speed at which you recover and heal.
Last, and perhaps most significant, try to practice self-compassion as you enter and proceed with therapy.5 Counselling can be exhausting, and emotional, and it always requires bravery. Your counsellor knows this and appreciates this about you. Try to be especially gentle with yourself during the process, and treat yourself with tenderness, care, and grace.
Shaw, S., & Murray, K. (2014). Monitoring Alliance and Outcome with Client Feedback Measures. Journal of Mental Health Counseling, 36(1), 43–57. https://doi.org/10.17744/mehc.36.1.n5g64t3014231862
Duff, C. T., & Bedi, R. P. (2010). Counsellor behaviours that predict therapeutic alliance: From the client’s perspective. Counselling Psychology Quarterly, 23(1), 91–110. https://doi.org/10.1080/09515071003688165
Murphy, K. P., Rashleigh, C. M., & Timulak, L. (2012). The relationship between progress feedback and therapeutic outcome in student counselling: A randomised control trial. Counselling Psychology Quarterly, 25(1), 1–18. https://doi.org/10.1080/09515070.2012.662349
Cronin, T. J., Lawrence, K. A., Taylor, K., Norton, P. J., & Kazantzis, N. (2015). Integrating Between-Session Interventions (Homework) in Therapy: The Importance of the Therapeutic Relationship and Cognitive Case Conceptualization: Therapeutic Relationship and Homework. Journal of Clinical Psychology, 71(5), 439–450. https://doi.org/10.1002/jclp.22180
Galili-Weinstock, L., Chen, R., Atzil-Slonim, D., Bar-Kalifa, E., Peri, T., & Rafaeli, E. (2018). The association between self-compassion and treatment outcomes: Session-level and treatment-level effects. Journal of Clinical Psychology, 74(6), 849–866. https://doi.org/10.1002/jclp.22569
Winter is coming, and so too are shorter days and longer periods of darkness. For a sizable percentage of people (~3% of the Canadian population1), this change to our environment can bring about a seasonal form of depression called Seasonal Affective Disorder, SAD. Those who experience SAD experience an onset of clinical depression in the fall season, which spontaneously improves in the summer, a cycle that usually repeats for at least two calendar years in succession. Interestingly, the symptoms of SAD are not typical of non-seasonal depression.2 Depressed mood, loss of interest in activities, and withdrawal from social interaction is common to both, but where typical depression usually includes insomnia, anxiety and reduced food intake, SAD is characterized by hypersomnia, carbohydrate craving and increased body weight. The symptoms look superficially like seasonal rhythms in animals as they prepare to hibernate.
In fact, many of the same biological mechanisms which prompt the onset of hibernation in animals like bears are similar to the processes which give rise to SAD in humans. This is because most organisms have internal body clocks which track daily and annual cycles in the external world. Our body clocks, for example, are capable of tracking how long the sun is present each day. While we don’t yet fully understand why this process affects mood, we know that SAD is associated with day length because data from different American states reveal that the incidence of SAD are higher in more northern states.3 This is also true of the ‘winter blues’, or sub-clinical SAD. We also know that the issue is in terms of day length and not the amount of sunshine a location gets because Calgary (~51° N) has much more winter sunshine than Vancouver (~49° N) but similar daylengths and population rates of SAD. This is particularly important information for us Canadians who live north of the 49th parallel. We may get plenty of sun, but we still experience shorter days.
So, as we get less daytime during these seasons, is it possible to trick our body clocks into thinking the days are longer?
Remarkably, one of the most effective remedies for SAD is bright light treatment. Introducing bright light in the Fall and Winter can prevent or reverse SAD, with roughly 2/3rd of SAD patients responding to the treatment4. The research indicates that it is as effective an antidepressant as any pharmaceutical used to treat SAD and when used correctly is accompanied by relatively few possible side effects. Importantly, however, bright light therapy may trigger mania in individuals with bipolar disorder5, so please consult with your doctor before considering the treatment. The minimum effective dose is approximately 2500 lux, which is about the intensity of sunrise outdoors.6 Bright light treatments, however, will often exceed 10,000 lux. Indoor, room lighting typically emits 500 lux and is thus an ineffective treatment. Those susceptible to SAD can purchase bright light-emitting visors or, alternatively, there are bright light lamps which allow one to sit or work in an environment containing ambient day-time levels of light. These devices can also be used strategically to ease certain sleep disorders and help realign one’s body clocks during jet lag.7
Because many of the symptoms of Major Depression and SAD are shared and the two disorders are often comorbid, traditional psychotherapy is also a highly effective treatment for seasonal depression.2 Research using group-based cognitive-behavioural therapy (CBT), for example, has demonstrated antidepressant effects which nearly mimic 30 minutes of 10,000 lux bright light treatment.8 Health professionals who utilize CBT teach skills to those suffering from various forms of depression which help to change their perceptions of the world.9 Cultivating emotional regulation, developing personal coping strategies, and learning to disrupt patterns of negative thoughts and actions are key constructs of CBT. Bright light treatment and psychotherapies like CBT may be used alongside one another, as well as in conjunction with other therapies like medication or mindfulness practices. Research also suggests that people whose depressive symptoms look more like the ‘winter blues’ than seasonal depression should improve their diets by limiting starches and sugars, exercise frequently, manage stress (especially around the holidays), increase social contact and connection, and spend more time outdoors.10
Finally, vitamin D, an essential building block for our bones and muscles, is in short supply in the Canadian Fall and Winter months. A deficiency of vitamin D has been associated with depressive symptoms and some research suggests that taking vitamin D before winter darkness sets in may help prevent symptoms of SAD.11 During the winter months, those living roughly 33 degrees north or 30 degrees south of the equator synthesize very little, if any, vitamin D.12 People beyond these latitudes rely primarily on eating fish and egg yolk or taking nutritional supplements to get the vitamin D needed.13 It is important that most of us, and perhaps especially people experiencing SAD, ensure that we have sufficient levels of vitamin D during these darker months. Thankfully, the Canadian government acknowledges this problem and mandatorily requires that products like cow’s milk, margarine, and calcium-fortified beverages have vitamin D added to them.14 Planning a mid-winter vacation may be valuable for its increased light exposure and onset of vitamin D synthesis, and who doesn’t like taking a vacation as a form of treatment?15
Thankfully, there are multiple options for Seasonal Affective Disorder which allow for more personalized treatment plans. If you’re feeling blue this Fall and Winter, Alongside You offers an abundance of counselling and well-being services that can help you if you identify with any of the discussion above regarding SAD.
If we can be of help to you, please don’t hesitate to ask. This is why Alongside You exists – because we believe that everyone is worth it. Feel free to contact us to see how we can help!
Adam Manz recently graduated from Simon Fraser University with a Bachelor of Arts majoring in Psychology. He is currently pursuing a master’s degree in clinical psychology while maintaining a love for meditation, podcasts, and hiking. Adam is volunteering with us here at Alongside You and we’re glad to have him on board!
1Body and Health Canada. (2019). Seasonal affective disorder. Retrieved from https://bodyandhealth.canada.com/healthfeature/gethealthfeature/seasonal-affective-disorder.
7Burgess, H. J., Crowley, S. J., Gazda, C. J., Fogg, L. F., & Eastman, C. I. (2003). Preflight adjustment to eastward travel: 3 days of advancing sleep with and without morning bright light. Journal of Biological Rhythms, 18(4), 318–328. doi: 10.1177/0748730403253585
9Canadian Mental Health Association. (2013). Seasonal affective disorder. Retrieved from https://cmha.bc.ca/documents/seasonal-affective-disorder-2/.
5Chan, P. K., Lam, R. W., Perry, K. F. (1994). Mania precipitated by light therapy for patients with SAD (letter). Journal of Clinical Psychiatry 55:454
4Golden, R. N., Gaynes, B. N., Ekstrom, R. D., Hamer, R. M., Jacobsen, F. M., Suppes, T., … Nemeroff, C. B. (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. American Journal of Psychiatry, 162(4), 656–662. doi: 10.1176/appi.ajp.162.4.656
13Health Link BC. (2019). Food sources of calcium and vitamin D. Retrieved from https://www.healthlinkbc.ca/healthlinkbc-files/sources-calcium-vitamin-d.
3Horowitz, S. (2008). Shedding light on seasonal affective disorder. Alternative and Complementary Therapies, 14(6), 282–287. doi: 10.1089/act.2008.14608
14Janz, T., & Pearson, C. (2015). Health at a glance: Vitamin D blood levels of Canadians. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11727-eng.htm#n2.
11Kerr, D. C., Zava, D. T., Piper, W. T., Saturn, S. R., Frei, B., & Gombart, A. F. (2015). Associations between vitamin D levels and depressive symptoms in healthy young adult women. Psychiatry Research, 227(1), 46–51. doi: 10.1016/j.psychres.2015.02.016
10National Health Services. (2018). Treatment of seasonal affective disorder (SAD). Retrieved from https://www.nhs.uk/conditions/seasonal-affective-disorder-sad/treatment/.
8Rohan, K. J., Mahon, J. N., Evans, M., Ho, S.-Y., Meyerhoff, J., Postolache, T. T., & Vacek, P. M. (2015). Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: Acute outcomes. American Journal of Psychiatry, 172(9), 862–869. doi: 10.1176/appi.ajp.2015.14101293
12Stewart, A. E., Roecklein, K. A., Tanner, S., & Kimlin, M. G. (2014). Possible contributions of skin pigmentation and vitamin D in a polyfactorial model of seasonal affective disorder. Medical Hypotheses, 83(5), 517–525. doi: 10.1016/j.mehy.2014.09.010
6Tam, E. M., Lam, R. W., & Levitt, A. J. (1995). Treatment of seasonal affective disorder: A review. The Canadian Journal of Psychiatry, 40(8), 457–466. doi:10.1177/070674379504000806
15Targum, S. D., & Rosenthal, N. (2008). Seasonal affective disorder. Psychiatry (Edgmont), 5(5), 31–33.
2The National Institute of Mental Health. (2016). Seasonal Affective Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml.
One in five Canadians lives with a mental illness according to statistics from the Canadian Mental Health Association. In my experience, the rate at which people struggle with mental health issues of some kind is much higher. Most people suffer in silence. Statistically speaking, we are all connected to someone struggling with mental illness. While you’re reading this, look around you. I guarantee someone you just saw is struggling with mental illness and/or a mental health issue of some sort. It’s guaranteed. Are you surprised?
I remember the first time I knew what it meant to feel sad and not know why; and the time I realized that I felt this way a lot of the time, and still didn’t know why. I was six years old. It confused me deeply. I had loving parents, we had a house to live in and food to eat, I went to a good school, I had a good community of people around me. I still felt sad. A lot.
When I was a kid, nobody talked about mental illness, mental health, or anything in the middle. It simply wasn’t something that was a part of the dialogue. As I contemplated what I was going to write this morning, I realized that actually, I don’t recall any public conversations about mental health growing up, whether it was elementary school years, or high school. And while I like to joke that I’m getting old, it wasn’t that long ago that I was in high school.
It wasn’t for lack of experiences that could lead to a discussion either. I had friends who had very difficult home lives, knew people who lived through tragic accidents, I’ve lost friends to suicide, and more, never mind the statistics we now know about the rate at which mental illness affects the population as a whole. I’m not sure why it was not talked about, it just wasn’t.
Now that I’m older, and in the mental health field, I’m glad that there is more talk about mental illness and mental health management. What I find now, however, is that I can grow tired about simply talking about it and creating awareness, probably to a fault. Awareness is very important. I can only imagine the difference it would have made for me, or friends I now know struggled in childhood, if we could have heard about mental health and had discussions about it. The discussions, however, leave me asking the question, “So now what?” Many of the discussions I hear sound hopeless and don’t offer many solutions. As a professional, I’m also well aware that the solution isn’t simply more professionals and more mental health services.
Let’s Talk Hope
One of the things I’m known for, and is written all over my bios on various websites, is that I don’t believe in hopeless causes. It is one of my fundamental beliefs that there is hope in every situation, even if we can’t always see it when we’re in the middle of it. Last year, I connected with Connie Jakab who formed National Hope Talks and we collaborated on a conference in Calgary this past January. The conference is all about hope.
This time around, in January 2020, the conference will be hosted in Edmonton and Calgary, and together with 140 Sports, we’re bringing it to Delta. It’s time we went beyond talking and start acting like we believe that there’s hope.
What Is Let’s Talk Hope?
Let’s Talk Hope is a conference, or perhaps an unconference where we bring together students, teachers, parents, mental health workers, business people, non-profit leaders, and more to talk about Hope. We’ll have some speakers with lived experience and unique insight into mental health. This will set the tone for the day, and give some valuable information about what some of us are seeing in the community in terms of mental health. We’re also going to have workshops that incorporate different art forms and help build skills to manage mental health in our own lives, the lives of our community, and beyond.
The peak of the experience at Let’s Talk Hope are the incubator sessions. In these sessions, we get into small groups where people are mixed up to have at least one teacher, student, business leader, mental health worker, non-profit leader, etc. Each person gets 2-3 min to share their perspective and what they are noticing about mental health. Each group then writes down what was commonly shared and what could potentially be the solution.
We know we aren’t going to solve mental illness in one day. What we are going to do is create hope, and get creative, and talk solutions. Solutions that will come from every part of our community, not just the professionals.
Join us in Bringing Hope to Delta in January 2020
I can tell you that the first Let’s Talk Hope conference this year was one of the most powerful, encouraging, and hope giving experiences I’ve had in my work in mental health. It helps bring the message of hope in mental health forward, knocks down silos between providers, clients, and the community, and gives us a renewed sense of connection, of togetherness in this fight for mental health in our own back yard.
Does this sound like something you’d like to be a part of? We need to hear your voice and have you as part of the solution to bring hope to our community.
It can be difficult for a parent to watch their child struggle with big worries. As parents, we want to be able to fix our child’s problems – preferably this would happen quickly and easily. If we can’t fix what concerns them (which we often cannot), we are left to support the child through their anxiety. This may sound simplistic, but I assure you, it’s not. Parental support is vitally significant for the child, and often, empowering for the parent. As the saying goes — a good parent prepares the child for the path, not the path for the child. Approached with gentleness and kindness, encouraging support can be a great gift to their developing identity and self-confidence.
Practical Ways Parents Can Support Their Anxious Child’s Wellbeing
Children require consistent, predictable routines in order to flourish1. These don’t have to be rigid or excessive, but a general structure for the course of a day allows a child to predict what comes next, and to prepare for it. For example, create a rhythm to the bedtime routine that becomes so predictable and soothing that it lulls the child to sleep (figuratively speaking). When a child knows what time they go to bed, and the events that lead up to it, they can begin to gear down and relax, knowing that the adult in charge will be helping this process the same way every night. Avoid screen time two hours prior to bedtime as the emitted blue light inhibits the release of melatonin (the hormone responsible for sleep cycles and circadian rhythm).2 Instead, read books together, discuss a moment of gratitude, ask questions about their day, or speak words of affirmation to your child.
During daytime hours, a child’s pace of life should be slow and sustainable. Children need plenty of time for play and quiet exploration.3 Children who are expected to run at a pace that is beyond their capacity may experience an increase in anxiety. As an adult, you may have a clear perspective on what is manageable for your child. They may be excited to join five different sports teams this fall, but you are the one with the foresight to understand that, within a short time, this may lead to them feeling overwhelmed. This, of course, evolves as children get older, and every child is truly unique in what they can tolerate – much like their adults!
Lastly, create space in your day (or week) to connect with your child. Follow your child’s innate interests and spend one-on-one time enjoying what they do.
Some ideas to get you started:
If they’re interested in food, bake cookies
If they love sports, kick a soccer ball around, just for fun
If they enjoy physical activity, go on a bike ride or for a walk
If they’re into music, listen to a new song they’re excited about and show them what you know on the guitar or piano
If they’re interested in mechanics, have them help you change the oil, or open the hood of the car to look around together
Intentional investment of time spent with your child will pay dividends when it comes to their behaviour, but more importantly, to their sense of belonging and connection. The attachment that is formed from these positive connections bolster a child’s confidence to face the world, and increases resilience to stress.4,5,6
Ways Parents Can Emotionally Support Their Anxious Child’s Wellbeing
Emotional support is an extension of practical support. A parent may become overwhelmed by their own feelings (of guilt, or frustration, or panic) when they see their child in the throes of anxiety. It may be important to take a moment to check in with yourself before running to the aide of your child. First, accept that your child is feeling anxious, and notice your own feelings about this. Give yourself some time to regulate your own emotions. When you feel ready, approach your child to validate their feelings, and to name what you see happening for them. For example, “I see that your fists are clenched and your eyes are wide. These must be big worries for you.” Sit with them as they feel the weight of their worry without trying to rush them, or brush it off. Once the child has walked through the experience of their big feelings of worry, re-direct them to calming activities.
Some ideas to get you started:
run a warm bath
go for a walk together
somatic breathing exercises
progressive muscle relaxation
Lastly, show your child that you, their hero, can make mistakes, do hard things, go on to survive the experience, and thrive. It can be very helpful to practice self-compassion in a way that is visible to the child.7 For example, if you find yourself running late at the school drop-off, model taking a few deep breaths, smile, and acknowledge, “Wow, we sure are running late today! I can’t get it right every day though, and that’s okay! Today we might be late, but maybe tomorrow will be different.”
It can be soothing for a child to observe their parents set boundaries that guard their own time and self-care in fact, it reinforces that it is acceptable for the child to do the same.
If you or your child would like to come in to discuss their big worries, or yours, please contact us and we would be happy to help! I’d love to work with you while I complete my internship. We also have a whole roster of Registered Clinical Counsellors available to work with you as well.
Spagnola, M., & Fiese, B. H. (2007). Family Routines and Rituals: A Context for Development in the Lives of Young Children. Infants & Young Children, 20(4), 284–299. org/10.1097/01.IYC.0000290352.32170.5a
Fletcher, F. E., Conduit, R., Foster-Owens, M. D., Rinehart, N. J., Rajaratnam, S. M. W., & Cornish, K. M. (2018). The Association Between Anxiety Symptoms and Sleep in School-Aged Children: A Combined Insight From the Children’s Sleep Habits Questionnaire and Actigraphy. Behavioral Sleep Medicine, 16(2), 169–184. https://doi.org/10.1080/15402002.2016.1180522
Mrnjaus, C. (2013). The Child’s Right to Play?! Croatian Journal of Education, 16(1), 217-233.
Neufeld, G., & Maté, G. (2004). Hold on to your kids: Why parents matter.
Priest, J. B. (2013a). Anxiety disorders and the quality of relationships with friends, relatives, and romantic partners: Anxiety disorders and relationship quality. Journal of Clinical Psychology, 69(1), 78–88. https://doi.org/10.1002/jclp.21925
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books
Neff, K. (2013). Self compassion. London: Hodder & Stoughton.
Last week, Andrew wrote a blog about the logistics of getting counselling for your child, I would like to provide some insight into what happens inside the counselling room. I absolutely love working with children. I find it challenging, inspiring, rewarding and unique. Often folks ask me “So, does the child just sit on a couch and tell you how they are feeling, does that even work with kids?” I chuckle and assure them that counselling with children is going to look very different than counselling with adults.
Enter PLAY therapy.
What Is Play Therapy?
I believe that play therapy is the most developmentally appropriate therapeutic approach for children. I feel that it is doing children a disservice if we ask them to communicate their inner world the same way we ask adults, which happens primarily through talk therapy. Children do not have the same cognitive ability as adults, therefore, play therapy bridges the gap between concrete experience and abstract thought.1 Play therapy provides the opportunity for children to express their feelings and thoughts in a way that is familiar to them because typically children love to play.
To this, some might question, “Are you just playing then?” The answer is unequivocal, “No, quite the opposite.” There is much meaning in play; Froebel says, “children’s play is not a mere sport. It is full of meaning and import.”2 Play is the natural language of children. Play is the way children communicate. Garry Landreth says, “toys are used like words by children, and play is their language.”3 While engaging in play therapy, the child uses the toys in the room to communicate thoughts, experiences, situations and feelings.
My Approach To Play Therapy
Each counsellor who works with children has a different way of engaging with the child through play therapy. For myself, I adopt a posture of curiosity; I want to see the child’s world through their eyes. Typically, the first session is about establishing trust and rapport, just like a session with an adult client. Personally, I find sitting on the floor and meeting the child at their level is helpful. I have a box of fidget toys that I have available on the floor or table, these are for the child to squish and fiddle with as we talk and play. Often if a parent is in the initial session, I will encourage the parent to use a toy too.
In order to help facilitate the sometimes awkward first meeting jitters, we play Getting to Know You Jenga. This is a tower building game with a twist – each block has a question. The child is encouraged to answer the question and this helps establish a rapport and points of connection. One of the things that never ceases to amaze me is the child’s ability to direct the conversation to the areas that are needed to be focused on. This is modelled in the way that child answers the questions and, in turn, ask me questions. When I have my initial meeting with the parent, I often share that my trust needs to be earned. Often a child might share a small piece to “test the waters” and see if I am paying attention. Like playing pass with a ball, I need to catch what they have shared with me and convey to the child that I have heard them.
What Is A Play Therapy Session Like?
Each play therapy session can look different. For me, I am all about the feelings. It is vital for children to grow up with a greater understanding of their feelings and learn healthy ways to express their emotions. I try to incorporate as many different modalities as I can. Sometimes it might be colouring pictures of feelings and emotions, other times it is outlining their body and drawing where they feel that emotion. Other times it is playing in the dollhouse and sharing about their family. There are incredible books that provide wonderful language for children as they process their feelings. One of my favourites is In My Heart, which beautifully describes some of the many emotions that are found in our hearts. For the more active children, we can play catch and answer questions back and forth. I really try to tailor the activities to the likes of each child.
One of my favourite ways to work with children is through the use of the sand tray. Picture a mini sandbox complete with figurines to play with. The child is encouraged to use the sand tray to create a scene. The child can build a magical world or perhaps create a scene that is more realistic. The beauty of the sand tray is that often it is a way to visibly show what a child might be feeling internally. As the child creates, depending on the preference of the child, I am asking questions and gaining insight or silently attending to what they are sharing with me.
How Can Play Therapy Help My Child?
Just the same as adult counselling, when I am in the room with a child, it is my desire to provide empathy, congruence and unconditional positive regard, as these are the core conditions that help to facilitate change.5 I truly believe it is the relationship with the therapist that helps to promote growth and healing. However, that does not negate the important role the parent plays in the relationship. When a child has shared something significant or created something powerful, I encourage the child to invite the parent into the room to see and learn together. As I remind the child, we only see each other during sessions, but you see your parent more. I want the parent to be well equipped to take the themes and language that was spoken during the session and translate that to home. I want to thank you, parents, for trusting me with the most precious gift: your child. I want to work with you in order for a child to learn, grow and develop into a confident and healthy person.
Although the mediums used in play therapy are often very fun, many times, the work that is done in play therapy is difficult – children work hard at expressing and understanding their big feelings. It is my role to help facilitate these discoveries through conversation and play. Play therapy can be a powerful experience where great changes can happen for our kids – changes that may not happen without the freedom and safety of the play therapy sessions. Play therapy is a place where children get to be who they are at their core and have that be ok and celebrated. A place where they can explore difficulties in life in a safe, supported way.
Working with children is a privilege and one I do not take lightly. If you are interested in learning more about play therapy or setting up an appointment for your child, please do not hesitate to contact me through our website.
Bratton, S. & Ray, D. (2000). What the research shows about play therapy. International Journal of Play therapy, 9, 47-88.
Froebel, F. (1903). The education of man. New York: D. Appleton.
Landreth, G. L. (2012). Play Therapy: The art of the relationship. Third Edition. New York: Brunner-Routledge.
Piaget, J. (1962). Play, dreams, and imitation in childhood. New York: Norton.
Rogers, C. (1951). Client-centered therapy, Its current practice, implications, and theory. Boston: Houghton Mifflin Company.
We’ve been receiving more questions about counselling appointments, and particularly appointments for children with a Registered Clinical Counsellor. So, we thought we’d write another article to address some of the things that are unique about counselling appointments for children. I won’t repeat the details of the last article, so you may want to read that one first, and continue here.
Consent and Confidentiality in Counselling for Children
Consent to Counselling
One of the questions we get asked is, “Who can consent to treatment, and can my child consent?” This is a bit of a tricky question in some situations, particularly around parental separation and divorce. I’ll save the intricacies for another article, but in general, one or both parents need to consent for their child to see a Registered Clinical Counsellor. If there are no court orders involved, either parent can consent but we always like to get both parents to consent, and also to provide history and input because we believe it’s in the child’s best interests to operate this way in most situations. The more information we can get and the more support the child can get, the better off everyone is.
In terms of when a child can consent to their own counselling, there is no black and white line drawn in BC in terms of the age at which a child can consent. One of the most commonly-used ages is 14 and is generally accepted by most service providers. If, however, you can make an argument that the child is what is called a mature minor, the child can consent as early as age 12, or possibly earlier as long as they understand what they are consenting to. In most situations, we use the age of 14 as a guideline here at Alongside You.
Confidentiality in Counselling for Children
Many parents find it unnerving to send their child to counselling when they are not in the room to witness what is happening and being said. As a parent, I can easily understand this anxiety – I know I want to know what is happening for my kids all the time! Here’s the challenge – counselling relies on a safe, secure relationship between the client and the counsellor built on trust. If the child thinks the counsellor is going to turn around and tell the parents everything they are saying, what are the chances the relationship of trust will survive? Probably not very high.
Every Registered Clinical Counsellor at Alongside You is responsible for their professional practice and so there may be some variability in how much input from parents is sought. What I would suggest is that most counsellors will seek to collaborate with parents as much as possible, with the best interests of the child in mind. The degree to which information is passed, however, is going to depend on the comfort level of the child and the strength of the therapeutic relationship with the counsellor. It will also depend on the counsellor’s judgement of what information would be helpful to pass on. If there is a suspicion of imminent risk to the child, confidentiality can be breached without consent, but this is a judgement call on the part of the counsellor and up to their professional discretion. I know this involves a great deal of trust on the part of parents, and it is not lost on us as professionals. We want the best for your kids and will hope to strike the greatest balance between these needs to help your child.
Who Comes To The First Appointment?
The answer to this question really depends on the age of the child, or what the child wants. For younger children (i.e. approximately 12 years old or younger), it’s quite common for the first session to be with the parents alone to get some history and background and answer any questions or concerns. This first appointment can also be split between the parents and the child, at the counsellor’s discretion.
For older children, it’s likely going to come down to what the child wants. If the child wants the parents to come into the first session, then that’s likely what will happen. If, however, the child wants to come in alone, it’ll likely be just the child in the session. This is to build trust between the counsellor and the child and allow them to establish boundaries around safety and trust.
How Can I Help My Child While They Are In Counselling?
Encourage Your Child
Going to counselling can be scary for anyone, and it’s a lot to take in for a child. One of the best things you can do is to be encouraging. Let your child know that this is a time for them to have a safe place to talk about what is happening for them. Emphasize that this is an opportunity to work through some of the difficult things in life, it’s not a place to go to get fixed because there’s something wrong with them. They are wonderfully made human beings who sometimes need a little extra help.
It may also be helpful to let your child know that you’ve gone to see a counsellor before and share how it helped you, in as much detail as you’re comfortable with and as is appropriate for the age of your child. Common experience and reassurance can go a long way.
Avoid Interrogating Your Child After The Session
I get it – you want to know what happened. We all do as parents. But, it’s not going to support the process if the child then worries about being interrogated after coming out. Instead, a helpful question can be, “Is there anything you’d like to tell me about your time with the counsellor?” Realize that answer may be, “No,” and this needs to be okay. You want to give your child the opportunity to share their journey with you, not make a demand that they let you in if they’re not ready to do that yet.
Understanding The Reports You Get Back
We all love our children, and we want to believe everything they say. I remember when my parents would ask me what I did at school, invariably, my answer each time was, “I played and had a snack.” I, of course, didn’t do this, and this only every day at school. I was a very forthcoming child apparently. I also know, that what kids report back to parents isn’t always accurate (the same goes for adults), or the full story. This isn’t intentional necessarily, it’s just how our communication patterns work. I remember a client that I was doing EMDR with one time had gone home and told their parents that we had been doing ECT. Yes, that ECT that involves significant electrical charges to the brain in a hospital setting. Thankfully the parents called me to clarify and assumed that something got lost in translation. I’ve also heard clients tell parents, “All we did was talk about boring stuff,” or, “All we did was draw a picture.” While some of this may be true, there’s usually a lot more to the story.
It’s helpful if we all start with the assumption that the counsellor has the best interests of the child in mind and that we may not be getting the whole story when we get it from our child. Be curious, ask general questions, and if you have any concerns, contact the counsellor to clarify.
Trust The Counsellor and Your Child
I know it’s unnerving to trust someone else with the care of your child. I get that on both sides, as a Registered Clinical Counsellor and as a father of two young girls. Again, trust goes a long way and goes both ways in the relationship between parents and therapists. We want what’s best for your child, and we’ll do whatever is possible to help. Sometimes this involves us not divulging information you may want to know, and sometimes that may be unnerving for you.
We want to include you in any way we believe will be helpful for your child and your family. This sometimes takes time to develop, understand, and plan for. Your patience is much appreciated, as is your commitment to a process that may have you feeling like you’re standing on the outside at times.
Thanks for reading to the end! I hope this helps with some of the questions you may have about the first appointment with a Registered Clinical Counsellor for your child, and a bit about the ongoing process. Sending your child to a counsellor for the first time can be nerve-wracking, and challenging at times. Please feel free to ask any questions you like as you’re booking, we’ll answer them as best we can!