3 Things You Can Do Between Counselling Sessions To Thrive

3 Things You Can Do Between Counselling Sessions To Thrive

When I meet with clients, I often remark that of the 168 hours in their week, I get 1 if I’m lucky. That’s assuming that I get to see them once per week, which is not necessarily the case. Most often I see clients every other week, or even further between sessions. In this case, the hours I don’t get to be with them becomes multiples of the 168. I highlight this because I want to encourage clients that as important as the work we do in-session is, it is truly what they do between sessions that promotes lasting change. It’s not that I discount the importance of what I do, I simply recognize the importance of what my client does day in and day out between our times together.

One thing that I love about Dialectical Behaviour Therapy (DBT) is the emphasis on skill development. In our DBT groups, we focus on both skills and process, but the homework in between groups is heavily focused on skill development. Whether it’s Mindfulness, Distress Tolerance, Emotion Regulation, or Interpersonal Effectiveness they’re working on, there are concrete activities and worksheets clients can follow in between sessions to work on these areas. Clients get all of these resources in a book as a part of the group and the clients who really work at this, come back each week with a well-worn book! It’s wonderful to see clients invested in their process.

One of the questions I am asked a lot is, “Why do you have so many different things at your clinic?” The answer to this is because we believe in a holistic approach to recovery. I’d like to highlight three things you can access in our clinic between counselling sessions that will promote your wellbeing and recovery in those in-between times. The great thing is that all of these also promote things you can do on your own at home that don’t cost more money!

 

Open Studio Sessions

One of the things people are most curious about in our clinic is our art studio. People regularly wonder why we have an art studio, but the answer is very simple: because it helps people recover. We do this both through 1:1 sessions, and our Open Studio Sessions. There is a large body of evidence showing the power of creativity and art to help people recover from mental health, chronic conditions, chronic pain, and more; it also helps people connect inter-generationally and with family members and friends. All of these are great things! In our studio, you can learn Mindfulness-Based Art Therapy (MBAT) techniques that you can use at home, and we can even help you figure out what materials you’ll need and give advice on where to source supplies for reasonable prices. Many of our clients come to the studio sessions to learn new techniques and then go home and use them in their daily life. You can come to connect or learn new things, and then work on them on your own at home!

 

Trauma Sensitive Yoga and Yoga Therapy

The second most surprising thing to people about our clinic is that we have a yoga studio. We have a yoga studio because we saw a need that people had that wasn’t being filled. As you might imagine, not everyone is comfortable with large studio yoga, particularly if they’re struggling with trauma, anxiety, depression, or other difficulties. Further, as wonderful as larger studio yoga is, it’s not specifically designed for people struggling with trauma and mental health, or physical health challenges. Our Trauma Sensitive Yoga (TSY) programs and Yoga Therapy programs are specifically geared toward helping people recover from these things. The techniques are evidence-based and the programs are designed specifically to each client’s unique needs. Once again, the goal is to help you recover and work on your own, in-between sessions. Our certified yoga therapist will work with you individually in our safe, trauma-informed space to design a program specifically for you that once you learn, can be done safely at home on your own. When you want to learn more or brush up on techniques, you can come back in for some sessions. It’s flexible, safe, and geared specifically to you and your unique needs. 

 

Mindfulness Practice

Mindfulness has become something of a buzz-word in pop psychology, but that is not a bad thing! Mindfulness is the practice of focusing on the present, allowing your brain and body to calm and be in the here and now. We’ve written previously about it on our blog, and you can look forward to more articles on this in future. It’s a vital practice that supports holistic health in body, mind, and soul. We can approach mindfulness training in a number of ways here: individual sessions with our DBT therapists and the curriculum from the dialectical behaviour therapy programs, one on one sessions in the art studio with Meg Neufeld to learn Mindfulness-Based Art Therapy techniques, or with our yoga instructors using breathwork and yoga techniques. Once again, all of these are skills you can learn and take home with you and practice on your own!

At Alongside You, our goal is to support you both in-session as we provide counselling, and outside of sessions to help you cope, grow, and thrive using holistic methods. This not only increases the effectiveness of your counselling, it also promotes autonomy, choice, and increases the chances of your recovery. Our belief is that all of our clients possess unique strengths and gifts that can be used to journey toward wholeness and resilience, and our job is to help identify these, support them, and encourage you. I hope this article gives you some ideas on how you can support yourself along the journey! If you are interested, feel free to contact us!

Emotionally Focused Therapy with Diverse Couples

Emotionally Focused Therapy with Diverse Couples

With an increasingly multicultural society, it is becoming more important than ever for therapists to consider the impacts of these different cultural aspects on their clients4. Today’s couples are becoming more diverse in terms of culture, socioeconomic status, ability, ethnicity, and religion, just to name a few. This means that we as therapists to adjust our practice appropriately. In this blog, we’ll look at how therapists can support diverse couples in relationships from different religious or faith backgrounds in a therapeutic setting.

 

The Challenge

 

Interaction among different religious, cultural, and ethnic groups has been shown to be beneficial in platonic relationships when the interactions are “amicable, positive, and voluntary”, but romantic relationships may present a greater challenge. Separately, marriage has been shown to positively correlate with physical and psychological health and religion has proven to be a protective factor for many; together, marriage and religion can spur additional external stressors. Differences in religion can often mean differences in culture, tradition, and ethnicity, which has the potential to create additional stress on the relationship. These external stressors often come in the form of extended family, or society as a whole, when traditions appear altered or compromised. Research has shown that these factors can have a detrimental impact on the psychological well-being of couples with different religious backgrounds.

There are particular factors within religiously diverse couples that can tip the scales in either a more positive, or more challenging direction. First, couples vary on how strongly they use religion to define a relationship. Religion may enforce particular “rules” to determine how interpersonal or family challenges are addressed, such as sexuality, parenting, or power. Second, religiosity exists on a spectrum, so factors such as religious practice, involvement, activity, and belief intensity all contribute to potential stress in a relationship; both individuals in a relationship can even be of the same religion and differ in the strength of religious faith or religious motivation. Third, underlying values may overlap in different religions allowing couples to find common ground; for example, many religions view extramarital sex as unacceptable. Couples from different religious or faith backgrounds can be successful if differences are addressed, understood, and respected; if left unaddressed these differences can become conflictual and threaten the relationship.

 

How Can We Help?

 

From a therapeutic perspective Emotionally Focused Therapy (EFT), a form of couples counselling has shown to be effective for addressing distress in relationships. EFT believes that relationship distress stems from perpetuating negative interaction cycles, which often result from unmet needs. For example, this could be shown in how a couple manages conflict; is the conflict discussed and resolved or does an argument ensue that leaves both parties angry and resentful? The goal of EFT is to develop secure attachment through identification, experience, and expression of emotional and attachment needs. The basis of EFT in the attachment is a leading reason why it is thought to be so successful as a couple’s therapy. From a diversity perspective, the ability to adopt EFT to accommodate different religious or faith backgrounds is why this form of therapy can be successful for a multitude of different couples.

There are three main stages to the EFT model of couples therapy: de-escalation, restructuring attachment interactions, and consolidation and integration. De-escalation involves learning about and understanding negative interaction cycles that are perpetuating distress in the relationship. This can relate back to the previous example; when conflict occurs in the relationship is there one party who actively wants to resolve the situation and one party who chooses to remove him or herself? Restructuring attachment interactions are all about shaping new core emotional experiences and interactions to lead to a more secure attachment. Change in EFT is not achieved through insight, catharsis, or improved skills, but rather from formulation and expression of new emotional experiences as it pertains to attachment needs and emotions. What does each partner need to feel heard and understood? Consolidation and integration are the final of the three stages in EFT and can also be referred to as withdrawer re-engagement. During this stage, the partner whom previously avoided conflict and engagement with their partner openly expresses attachment needs and is more open and responsive to their partner.

The rooting of EFT in emotion and attachment makes it very flexible and therefore adaptable to couples of many diverse backgrounds. At Alongside You we love working with couples from diverse backgrounds and we have specific training in Emotionally Focused Couples Therapy. If this article resonates with you and we can be of help, please let us know, contact us, and give us a shout

 

Technology: the new social drug?

Technology: the new social drug?

Note from Andrew

Hi everyone, I want to take a minute to introduce you to Laura. She’s a local South Delta resident who is going to be volunteering with us. She is a graduate student, currently enrolled at Trinity Western University, working toward becoming a counsellor. Her program works to provide counselling knowledge in different areas of mental health, multiculturalism, family domestic violence, career and vocational counselling, psychotherapy, sexual abuse, addictions, child protection and family and child therapy. Laura sees herself as a sounding board for people to become empowered finding solutions and to be a source of support during times of change or reevaluation. During her undergrad, she volunteered at a suicide crisis hotline and also worked at an afterschool program for at-risk youth where she discovered her passion for counselling. We’re excited to have her on board, and you’ll be hearing more from her in the coming months!

 

Technology: the new social drug?

The world of technology has given people new ways to connect, share, and keep up to date with friends and loved ones. In just about 20 years we have gone from not having an email to being able to watch the live stream of our friends’ daily activities. We have the ability to show the world what we want of ourselves whenever we want to. There has been a recent wave of new types of social networking sites (SNS) as well as a flood of concern for the young people of this generation who are growing up in a technological age.
The purpose of this article is not to deter anyone from using social media websites (or else you wouldn’t be reading this). The hope is that by the end of this article you will have gained some awareness of how SNS’s, particularly Instagram, can affect our mental well-being as well as behaviours. Having an honest conversation with ourselves about our purpose for sharing and posting particular content could be helpful for identifying a particular need that has not been met in our personal lives.

Instagram is sometimes called the new Facebook. When a user scrolls through the home page of Instagram they will see only pictures with captions underneath that have a limit of 2200 characters but rarely exceed 20 characters. The captions are very small and the photos people share take up the entire screen of the smartphone.

Studies involving college-age students have identified that larger amounts of time spent on SNS’s are correlated with a greater body dissatisfaction. Women are more likely to have greater body dissatisfaction than men because they tend to compare themselves to members of the same sex more frequently. Comparing oneself to one’s peers on an SNS has also been shown to lead to emotional eating for girls.

Research is also highlighting that the more followers someone accumulates on Instagram the more selfies that person will post, almost as if they feel they are in demand. Students who take more selfies to show off their appearance are more likely to believe they are perfect but also believe that no one else sees them that way. This form of narcissism can be referred to as vulnerable narcissism. This is in contrast to grandiose narcissists who believe they are perfect and insist that everyone around them agrees. Murray’s research also shows that young adults and adults who take selfies to show off their appearance report characteristics of fragile self–esteem and a tendency not to reveal their weaknesses. This could show that people who are vulnerable narcissists use their physical appearance selfies to declare a sense of confidence through social media, where it feels safe. In short, people are using social media because it makes them feel better in the moment but has the opposite effect long-term. It may be important for us to keep this in mind next time we scroll through our Instagram feed and find a gorgeous peer who seems to have it all. It may be wise to give it a second thought – appearances are not necessarily what they seem.

All of this information brings up the question of what people are trying to do on social media. Many people seem to be after a sense of connection – but this usually isn’t the result. Research is showing that people who post a high amount of self-pictures on Instagram are much lonelier than either passive browsers or users who use it to message people. In other words, on social media, the harder we try, the lonelier we become!

Fortunately, if you identified with any of the people groups, it doesn’t have to stay like that. Social media can be a great distraction from loneliness or insecurities. However, distractions do not fix the problems just like comparing yourself to others and getting likes and comments from strangers won’t make you like yourself more or feel happier in the long run. Admitting that we are not perfect can be scary and difficult but it can be empowering if we are willing to put down our quick fixes and honestly evaluate things we may like or may try to ignore about ourselves. Perhaps the first step might be putting down our phones and getting off social media for a bit and meeting a friend in-person at a coffee shop?

How Do I Love Someone with Borderline Personality Disorder?

How Do I Love Someone with Borderline Personality Disorder?

One of the most common questions I get from people when I give talks on Borderline Personality Disorder (BPD) and Dialectical Behaviour Therapy (DBT) is the question of how to support someone with BPD? So many individuals, couples, and families are struggling with how to love, care for, and support someone in the midst of what often feels like total chaos and painful experiences.

Shari Y. Manning, former President and CEO of Behavioral Tech and Behavioral Tech Research, the research organizations founded by Marsha Linehan to provide training in BPD, wrote a book on just this, titled “Loving Someone with Borderline Personality Disorder” and in it she focuses on how to keep the out of control emotions from destroying relationships between individuals with BPD and their families and other supports. She highlights the difficulty of balancing compassion for the person, while still wanting to help them find ways to change their behaviour and managing their emotions.

I’ll admit that it’s not easy to help someone struggling with BPD. It may seem that they are manipulative, egocentric, and focused on their own needs exclusively. The reality is that it’s not actually too far from the truth. The key to supporting someone with BPD without losing our own sanity, in my mind, is in our approach and how we frame what we’re observing. This is where Dialectical Behaviour Therapy (DBT) skills come in handy for us as well.

 

Interpersonal Effectiveness and Manipulation

Let’s talk for a minute about the idea that people with BPD are manipulative. It’s common to hear, both amongst clients with BPD, support systems, and yes, even professionals. I remember years ago that I used to get very angry when I heard this because I felt very compassionate toward clients with the borderline personality disorder and their need for help. Then it dawned on me – that is, they are being manipulative. And so are we.

See, manipulation is nothing new in relationships. We do it all the time – in fact, as I said to my intern John this week in supervision, we’re all in relationships to get what we need from the other person. None of us would be in relationships if this weren’t true. The difference is, we do it in a mutually beneficial way that serves everyone involved. The fact remains, however, that we’re all trying to get what we need from others, we just have more ability to do so effectively. This is what interpersonal effectiveness skills in DBT do for clients and for members of support systems; they teach us how to get what we need from others in an effective way.

 

Why Individuals with BPD Behave the Way That They Do

I remember back many years ago when I began working with individuals with developmental disabilities, we often repeated the phrase with staff and caregivers, “All behaviour is communication.”  This is a very important concept and applies just as much to kids and adults alike, as well as individuals with BPD. When we can’t use words to communicate, we use actions. Further, when we see the often extreme behaviours of individuals with BPD, it’s important we remember what is happening to them at that moment, and how it got that way.

 

Personal history

We’ve learned from research that individuals with BPD have reasons for interacting with the world in the way they do, just as we all do! Linehan’s theory from 1993 is the most substantiated, and it suggests that BPD can be the result of the interaction between biological and psychosocial factors, including adverse childhood experiences. One of the predominant factors is invalidating developmental contexts where emotional expression is invalidated in childhood. Further research suggests that between 30%-90% of individuals have experienced abuse and neglect in their lifetime. This has a significant impact on the developing brain.

 

Brain Function

What we also know from brain science, and certainly I’ve observed this in my clinical work, is that individuals who have histories of abuse, neglect, invalidating emotional environments, and other traumas, have brains that are more sensitive to danger. The limbic system is designed to keep us safe and also regulate our emotions. At its’ best, it keeps us safe when we’re in danger, and regulates our emotions to keep us at an even keel. At its’ worst, it’s being triggered in situations that aren’t dangerous and causing us to react in ways that would make sense if we’re in danger but make no sense when we’re not. It’s also important to remember that when this system is acutely active, it shuts down our frontal cortex, which is where our rational thought mechanisms are housed. So, when we’re in danger, as I often say to clients, we can’t think to save our lives. This is the brain state that individuals with BPD are in when they react in extreme ways. Their brains are in full-blown fight or flight mode and simply reacting, trying to do anything they can to be safe. Most often, they turn to their closest relationships.

 

Relationships as Safety

Ever heard the idea that we hurt the ones we love the most? This is often the case with individuals with BPD when they react in extreme ways. But why is this? Many people with BPD have a very externalized locus of control, meaning, they don’t believe they can contain their own emotions, especially when they’re overwhelmed. You know what? They’re right. When they’re in fight or flight the mechanisms in their brain responsible for regulating emotions and behaviour are not rational, and are just reacting and they can’t contain it. This is simply a more extreme version of what happens to all of us. So then, what’s the difference?

I believe the difference is the level of fear experienced in these moments. The idea of not being able to contain extreme emotions would be, I imagine, quite terrifying. Coupled with the fear of being left by the people they are closest to, the proverbial pot boils over and they have to do something extreme to get attention. I often hear, “Oh they’re just attention-seeking,” to which I reply with an emphatic, “Yes, of course, they are!”

Remember the idea that all behaviour is communication? When people with BPD are at this heightened state they are unable to communicate effectively and are doing their darndest to communicate their pain and fear to us, asking us to help them contain it. What may look to us like someone simply showing out of control behaviour, I believe, is a desperate attempt at seeking safety and containment.

Can you imagine what it would be like to be in this position? Having BPD, feeling so unsafe and so in pain that you have to go to such extreme lengths to try to get help? I can’t. The idea of being there is far too terrifying to me. Quite frankly, I don’t want to know what it feels like to be in that place, but it gives me a great deal of compassion for those who are.

 

What Do We Do To Help?

One of the best ways to be supportive is to help those struggling with BPD to get the help they need. Dialectical Behaviour Therapy (DBT), on an individual basis as well as in skills groups, is very effective in helping those with BPD manage their symptoms. With the right help, individuals with BPD can learn the skills they need to manage their emotions and relationships and ultimately, have a life worth living! This was Marsha Linehan’s goal in developing DBT, to help those struggling with suicidal thoughts have a life worth living. We’re proud to say that our DBT programs have been effective at doing just that for our clients, and we’d love to help even more people this way.

We have often been asked if we run groups for family members and other supports who are trying to help someone with BPD. Unfortunately, we don’t at the moment but it’s on our radar. We are looking into doing exactly this in the future. What we can do, however, is teach DBT skills on an individual or family basis for those supporting someone with BPD. We have a number of counsellors available for this, and you can talk to Doug, Share, or Kelly about this if it would be helpful.

Education is also very important as once we understand what is happening, it gets less scary. There are many books that can be very helpful. Here are a few ideas to get you started:

Stop Walking on Eggshells by Paul Mason

Loving Someone with Borderline Personality Disorder by Shari Y. Manning

DBT Made Simple: A Step-by-Step Guide to Dialectical Behavior Therapy by Sheri Van Dijk

Finally, self-care is absolutely paramount to your survival for yourself and the person struggling with BPD. As the airlines often remind us, we need to put our mask on before we can help anyone else! If we don’t take care of ourselves, we will flip our lids and react in much the same way as those we’re trying to help.

 

I hope this has been helpful – if our team can be of any help to you as you support someone with BPD please feel free to give us a shout. Our Dialectical Behaviour Therapy program is comprehensive, and we would love to teach you the skills needed to be a solid support, for yourself and your loved ones with BPD!

Can Neurofeedback Fix My Anxiety?

Can Neurofeedback Fix My Anxiety?

Anxiety is one of the most common mental health difficulties in Canada, and across the world. No doubt you’ve seen numerous articles on the subject, describing what anxiety is, why we suffer from it, and what to do about it. One of the questions I get asked quite frequently is whether neurofeedback can fix anxiety. It’s a great question, and here’s my answer!

 

Why Neurofeedback?

 

The premise of neurofeedback is that if we are stressed out, anxious, depressed, or are suffering from others negative symptoms, our brain is likely to be operating less than optimally. Neurofeedback is a tool that helps train the brain to adjust how it is operating so that it can function more optimally and efficiently. You might think of it as gym training for the brain. The fact that it is training is an important distinction – it is not a treatment for a specific symptom, it is a training that helps your brain optimize itself over time and learn how to do so for the long term.

 

What is Neurofeedback?

 

You may never have heard of neurofeedback before, so here’s a quick primer on dynamical neurofeedback, which is the main type of neurofeedback we do here at Alongside You. Dynamical neurofeedback uses EEG equipment and software to monitor your brain activity, and feed information back to the brain about what it is doing. A crude analogy is to equate the neurofeedback system with a giant mirror being held up for the brain so that it can see its own processes and gain the information it needs.

Why does the brain need this information you may wonder? See, the wonderful thing about our brains is that they are self-regulating. If given the necessary information, our brains can change themselves to function more optimally, back within the parameters they were designed to operate within. The brain doesn’t need us to push it, or pull it in any particular direction if we can provide the brain with the information it needs. This is what dynamical neurofeedback helps the brain with. Our primary system monitors the brain, and feeds back information 256 times per second, allowing the brain to see what it is doing and adjust accordingly.

 

Can Neurofeedback Fix Anxiety?

 

There are numerous theories as to why people get anxious. There are personality factors, biochemical factors, life factors, brain function factors, and many more. The trouble with trying to fix anxiety by any means, is there are no guarantees. This is true of counselling, psychiatric medications, and every other form of therapy or treatment out there. I’ve been in this field long enough to know that none of the treatments or therapies we employ can be guaranteed to fix what ails us. This is, however, different than asking whether something can be helpful with anxiety, and if we ask this question, the answer with regard to neurofeedback is a resounding yes in my experience. I’d like to share three ways I see neurofeedback being helpful for anxiety.

 

3 Ways Neurofeedback Can Help Your Anxiety

 

    1. If you have been on medication, maybe some have worked really well or some have not. Often there are side effects to medications and in some cases, the side effects are worse than the symptom you’re trying to treat. Another concern can be when medications work for a time and then stop working. Sometimes people just simply don’t want to take medications for various reasons. This is where neurofeedback can be helpful and this is because neurofeedback is another way of working with the brain biology without the use of medications.
    2. If our brains are not functioning optimally when we’re anxious, neurofeedback can train our brain to function better. What’s important about this is that we’re not simply treating, or masking undesirably symptoms, we’re helping the brain function better and learn how to do this long term. Again, the analogy of going to the gym is helpful. If you get injured playing sports, you can simply take some medication to mask the pain. More effective, however, is going to the gym, under the guidance of a physiotherapist or other rehab professional, and working on the muscles, joints, and other areas to rehabilitate the injury and hopefully prevent a new one. This is what neurofeedback does for your brain.
    3. One of the main triggers for anxiety is the activation of the central nervous system (CNS) and interaction with the autonomic nervous system (ANS). In fact, some of the most exciting research coming out right now around anxiety, depression, and trauma has to do with the CNS and ANS, and particularly, the vagus nerve (but that’s a whole topic on its own). Check out this article if you want to geek out on this information. One of the most exciting things for me in working with my clients with anxiety is that neurofeedback can directly influence the CNS and ANS and induce the relaxation response, lowering the triggers for anxiety. This is especially exciting for those suffering from generalized anxiety because it is one of the most difficult forms to treat by other modalities. I can tell you that in my experience with clients, as well as my own personal experience with a generalized anxiety disorder, neurofeedback has been one of the most helpful things I’ve ever seen or experienced, both personally and professionally.

 

If I’m Interested in Neurofeedback What Should I Do?

 

If you’re interested in neurofeedback for your anxiety, please give us a call. It’s not necessarily a fast treatment (in our experience and the data for the system we mainly use, 12-20 sessions is the average), but it’s an effective tool that has long-lasting effects and trains your brain to function better for the long term. It can be used in conjunction with medications, and it actually has the potential to reduce the need for medication and enable a lowering of doses in some cases. Neurofeedback is an exciting tool in our toolbox, and another way to we can bring holistic, integrated approaches to care for our clients. As you can probably tell by now, I’m pretty excited about this.

Please contact us or give us a call if you have any questions or if you want to explore whether neurofeedback might be right for you. We’d love to chat!

Suicide: Stigma and Warning Signs

Suicide: Stigma and Warning Signs

Suicide. To most this can be a feared word, much like, “He Who Must Not Be Named,” but as Hermione Granger would say, “fear of a name only increases fear of the thing itself.” 1 While a helpful illustration, we shouldn’t let the Harry Potter quote take away from the gravity of the subject of suicide. With knowledge comes power and although there are things in life that may ultimately be outside of our control, it is important for us to be informed.

One author writes, “stigmatization of…mental health disorders is alive and well,” and perpetuated by misinformation, miscommunication, and media sensationalization, despite the best efforts of good intentioned campaigners. 2 Those with mental health disorders are often painted as “crazy,” “violent,” or “untrustworthy,” but could these descriptors not also be attributed to those without mental health disorders? I am certain that most of us could think of someone in our life that we have a colourful moniker for, much like those aforementioned, that does not have a mental health disorder. The truth of the matter is that research shows that individuals living with mental illness are more likely to harm themselves than others.2 Stigma can produce profound impacts, including social disgrace and shame, which then serve as obstacles to identifying and acting on warning signs of suicide.3 Individuals may recognize warning signs for suicide as easily as they do those for physical ailments (e.g. heart attack or stroke) but tend to respond less urgently.3 All this to say, if we want to do something to reduce suicides, we need to reduce stigma, and be aware of the warning signs.

Determining the risk of suicide for an individual with one hundred percent accuracy is impossible. Suicide assessments consider a complex interplay of variables encompassing risk factors, protective factors, and warning signs. Due to these complexities, it takes much training, supervision, and experience to thoroughly conduct suicide risk assessments and should only be done by an experienced professional.

So if suicide risk assessments can only be completed by trained professionals what can you do? If you are concerned about a family member, friend, or colleague there are ten common warning signs to be aware of6 :

 

  1. Ideation or communication about suicide
  2. Substance abuse
  3. Purposelessness
  4. Anxiety or panic
  5. Trapped feelings
  6. Hopelessness
  7. Withdrawal from social groups
  8. Agitation or irritability
  9. Reckless behaviour
  10. Mood changes

 

An important thing to remember is that nothing is certain. Warning signs are just that, signs. The presence of a warning sign does not automatically mean that an individual is suicidal, just as the lack of warning signs does not automatically mean that an individual is not suicidal. The purpose is to recognize the signs and start the conversation, get more information, or seek the help of a professional. Let’s start treating mental health like physical health and take preventative measures to ensure the health and safety of our loved ones.

 

Resources

 

Crisis Intervention and Suicide Prevention Centre of BC

Anywhere in BC 1-800-SUICIDE: 1-800-784-2433

Mental Health Support Line: 310-6789

Vancouver: 604-872-3311

Sunshine Coast/Sea to Sky: 1-866-661-3311

Seniors Distress Line: 604-872-1234

Online Chat Service for Youth: www.YouthInBC.com (Noon to 1 am)

Online Chat Service for Adults: www.CrisisCentreChat.ca (Noon to 1 am)

 

S.A.F.E.R (Suicide Attempt Follow-up Education & Research)

8:30 am to 4:30 pm Monday to Friday             Call: 604-875-4794

 

Aboriginal Wellness Program (AWP) Vancouver

Call: 604-875-6601

In an emergency call 9-1-1.

 

 

References

 

[1] Rowling, J. K. Harry Potter and the Philosopher’s Stone. (1997). London, England: Bloomsbury Publishing Plc.

[2] The Lancet. (2013). Truth versus myth on mental illness, suicide, and crime. The Lancet, 382(9901), 1309. doi:10.1016/S0140-6736%2813%2962125-X

[3] Rudd, M. D., Goulding, J. M, & Carlisle, C. J. (2013). Stigma and suicide warning signs. Archives of Suicide Research, 17(3), 313-318. doi:10.1080/13811118.2013.777000

[4] Fowler, J. C. (2011). Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments. Psychotherapy, 49(1), 81-90. doi:10.1037/a0026148

[5] Granello, D. H. (2010). The process of suicide risk assessment: Twelve core principles. Journal of Counseling & Development, 88(3), 363-371. doi:10.1002/j.1556-6678.2010.tb00034.x

[6] Wu, R. (2017). Individual Appraisal for Counsellors in Practice. Suicide risk Ax. [PowerPoint slides]. Retrieved from https://adler.hotchalkember.com/courses/15984/files/743942?module_item_id=36008

 

A Grief Observed: How We Process Grief and Loss

A Grief Observed: How We Process Grief and Loss

As some of you may have picked up, the title is a tribute to one of my favourite authors of all time, C.S. Lewis, who was no stranger to grief and loss. A part of his story is the loss of his wife, and A Grief Observed is a tribute to her and commentary on his own grief process; and I dare say, well worth the read. It’s not reading his books, however, that has me thinking about grief and our own emotional processes.

The past month or two has been a difficult one in our local community of South Delta as well as our new home in South Surrey. There have been a number of lives lost, families coping with tragedies, car accidents with serious consequences, and even new developments in a case where a family lost a husband and father due to a violent incident in Tsawwassen.

How does one take all of this in, and continue? I’m often asked how it is that I do my job every day, dealing with trauma (much of my clinical caseload), and tragedy in the community that we love so deeply. I’m not going to lie – there are days where it’s difficult. Some days where it’s incredibly difficult. This past week was one of the hardest. I was asked to speak at a service for a young man who took his own life. There is nothing I could possibly write here to describe the devastation felt by his family who loved him so very much. There’s nothing that I could write here that would come close to trying to explain their loss and pain, or the pain that leads him to end his life by suicide at such a young age.

This, however, is the reality of our existence. Grief and loss are ubiquitous – it doesn’t matter how young or old, how rich or poor, how educated or not, we are – things happen in life and we are left with the consequences. How is it that we are to respond to grief and loss when it enters our lives? What do we say to an individual, a couple, or a family in any of these situations? The truth is that there really is very little that can be said. What we need in these times is empathy.

Brené Brown speaks a lot about empathy, and one of the things that she has said rang truer to me in this past week than any other, and that is that very seldom can anything we say make anything better. What makes things better is a connection – the knowledge that someone is there with us, walking through this difficult part of life, and connecting with us on an emotional level.

This is the heart of counselling, and why it is that I do what I do, and why we take a trauma-sensitive, emotion-focused approach at our clinic. I know that as I’ve processed my own grief and trauma throughout my life, the help of a Registered Clinical Counsellor has been invaluable. Knowing that it’s not something someone says that makes things better, how is it that a counsellor can help us in our process? Sometimes it’s hard to put a finger on. Here are three ways that I believe counselling can help us as we walk through our own grief:

  1. We can be heard without judgement.

In the same video I referenced above we heard Brené Brown comment that it’s hard to refrain from judgement because most of us enjoy it. We carry judgements around with us throughout our days and our lives, it’s a natural human tendency. Often, rather than trying to understand, we’re listening to respond. This is where a counsellor can be helpful, and where we can all practice the empathic stance of non-judgement – it’s an intentional choice, and one of the key skills a counsellor employs. We listen to understand, and we suspend judgement.

  1. We can be understood from our own perspective.

One of the key skills taught to counsellors in their training is what is called the “not knowing stance” and it is something that I focus a lot on with the interns that I train. One of our natural tendencies as human beings is to assume that we know and understand how someone feels when they have an experience we have also had. Often, we may respond with, “Oh yeah, I totally know what how that feels!” This is dangerous, however, because just because we have a similar experience, doesn’t mean we have similar emotions and reactions, and it doesn’t mean the event has the same impact on us that it does on someone else. If we respond in this way, we run the risk of the person feeling that they aren’t heard, and definitely, aren’t understood. This “not knowing stance” assists counsellors to get to the client’s understanding of their experience and understanding it from their perspective – this is the root of empathy.

  1. We can know that we are not alone.

What you get from reading A Grief Observed, is a picture of the ongoing process of grief. Grief is not a linear, finite path; instead, it is a winding road that goes over hills, through valleys, and up mountains, and occasionally one reaches a clearing and finds peace. That is until the journey begins again. This is a difficult, emotionally draining journey – I imagine if I were to undertake a literal grief journey, I’d want someone there with me while I walk. This is true of our emotional journey, and the role of the counsellor in the process of grief. A journey mate, a companion, one who reminds us that we are not alone in the good, the bad, and even the ugly; and also, not alone when we find times of peace. One who also has the skills to help us participate in the journey, and travel safely.

There is more to be said about grief and loss, but I hope this helps some of you who have been on this journey recently, and some who have been on it for a while. Know that you are not alone, there are people around you to listen, hear, and understand. If one of our Registered Clinical Counsellors can be helpful in your process, please give us a call; we’re here to journey with you.

3 Reasons Why Valentine’s Day Doesn’t Suck

3 Reasons Why Valentine’s Day Doesn’t Suck

I’ll admit it right off of the bat – I’m a hopeless romantic; always have been, always will be. Little known fact about me is that while Meg and I were dating, I was voted Most Romantic Man in Vancouver by my friend who owned the local flower shop. But that’s a story for another day. Needless to say, I am indeed a fan of love. I suppose that’s why I became a marriage and family therapist – if we’re destined for love, I wanted to have a positive impact on the type of love we have.

Here’s the problem – Valentine’s Day kind of sucks. Or at least, that’s often the impression we’re left with. You’ve probably heard it all by now, “It’s too commercialized…it’s a scam by the retail industry…they just wants our money…I hate pink…,” and so on and so forth. Well, here’s the thing, the people saying these things aren’t totally wrong. Valentine’s Day is very commercialized, retail outlets do scheme to make money on the holiday, and they do want your money, and some people really do hate pink. I’ll even admit that as a self-proclaimed hopeless romantic, I sometimes get tired of the hoopla around a single day, and the fact that I’m often behind the 8-ball and running around last minute trying to figure out what to do.

So, I reflected on Valentine’s Day this year while I was making some of the preparations, asking myself what it is that I find important about Valentine’s Day, and why I make the effort. Here are the three reasons I came up with this year:

 

  • Relationships are important, and it’s okay that we celebrate this. Furthermore, it’s so easy to overlook relationships when we get busy and the advantage of having Valentine’s Day is that it forces us to remember the importance of our relationships, and particularly our romantic ones.

 

  • Valentine’s Day doesn’t have to be about romantic love. Every year, we give our kids Valentine’s Day cards and gifts, but I wanted to do something slightly different this year. I am fortunate to have an incredible wife and two amazing daughters. This year, I gave them each a journal and inside, I wrote a message to each of them about something specific that I believed about, hoped for, and appreciated in them and that my hope was that the journal would be a place where they could reflect on these things in the coming year. I wanted to make sure that each of them knew how special they were, and uniquely so. This is something we can do for anyone special in our lives – a repurposing of the original intent perhaps?

 

  • Being reminded of love reminds us of the importance of connection. Attachment and connection are two of the most important things in life, and a reminder to us that we are indeed relational beings who thrive on relationships with others. Also, by loving others, we remind ourselves that we, too, are worthy of love. If we are enamoured with someone we think is incredible and know that they choose to be with us, then either we must also be special, or they must be delusional for spending time with us. I don’t know about you, but I’m pretty sure the former is more likely and true. Sometimes we need this reminder in life, especially if we are struggling.

 

Now, for some of you, Valentine’s Day is a painful reminder of the romantic relationship you don’t have that you long for. I can only imagine what that’s like. What I do know, is that you are worthy of love, romantic or otherwise. My hope is that while your Valentine’s Day may not have been about romance this year, perhaps there was a reminder of how someone in your life values you.

To take a slightly different spin, some self-compassion can go a long way. I’m going to suggest an exercise here, both for those in romantic relationships and those who aren’t, and it may sound a little weird. I’m going to suggest writing yourself a love letter. Yes, I said write a love letter to yourself. Why? Because self-compassion is simply taking the compassionate stance we find so easy to give to others, and turning around and giving it to ourselves. Most of us are our own worst critics – it’s so easy to see, and pounce on our own faults. We’d never say half the things to someone else that we say to ourselves.

To flip it around, I find it so easy to write a letter to my wife or my kids. I can immediately think of so many things I think are incredible and unique about them, and my hopes and dreams for them. I find it much harder to do this for myself, but it’s an important exercise because it affirms our own worth, our uniqueness, and our status as worthy and deserving of love and compassion.

I know it may sound weird, but I’m going to challenge you to try it. It may sound like a strange counselling exercise that only a Registered Clinical Counsellor or therapist would suggest, and you may be right – but that doesn’t mean it won’t be helpful. If you do try it, I’d love to hear your experience and how it impacted you. Please feel free to contact me through the website with your feedback, even if you just want to reiterate how much Valentine’s Day sucks. That’s ok, at least we’re connecting. But I would be very surprised if you could do this exercise and not find something helpful in it.

If you’re struggling with your relationship with your significant other, or your relationship with yourself, we’d love to be of help. Please contact us or give us a call, that’s what we’re here for.

Moving From Talking To Connection

Moving From Talking To Connection

Yesterday was Bell Let’s Talk day. Last year, it raised over $6.5 million for mental health initiatives. Over $85 million has been donated toward mental health since its inception. I don’t know about you, but that seems pretty significant to me. We talk about ending stigma, and I’m all for it, but I’m also practical and always ask the question, “So how is this doing something to help people on a practical level?” This is what I really appreciate about Bell Let’s Talk Day – that it not only starts a conversation about mental health, and normalizes the experience, but it’s also using the conversation to drive innovation and services to help those impacted by mental health.

I sat down to write this article yesterday, but I just couldn’t. I’d initially wanted to write an article as a part of Bell Let’s Talk, but it just wasn’t going to happen. See, yesterday marked another anniversary for me and for one of my very best friends. Yesterday was the anniversary of my friend losing her life to mental health. I’d known her since I was about 6 years old and her brother is one of my best friends. We grew up together, experienced life together, and both experienced the ups and downs. She was a firecracker of a personality, a talented musician, adventurer, pusher of boundaries, and more recently, a mother.

As many of us do, she tried all sorts of things to deal with her difficulties, some proactive, and some reactive; some helpful, and some not so much. Nothing seemed to work, and it wasn’t for lack of trying. This is the reality for some – no matter what is tried, the symptoms are still there. I know I’ve had counselling clients who have sat in my office saying, “Andrew, I feel like I’ve tried everything, and nothing is making this go away.” I’ll tell you, as a professional, there’s nothing that makes me feel quite so powerless. But this is the reality for some, and I know this from my own personal experience with mental health – sometimes we try everything and nothing makes it go away.

What then? Do we give up? Do we throw in the towel and just come to terms with the fact that mental health problems are here to stay regardless of what we do? Absolutely not. If this was how I felt, quite frankly, Alongside You would not exist. My clients will often hear me say that I don’t believe in hopeless cases, and it’s true. I can’t promise my clients that we can make the anxiety, depression, psychosis, or trauma go away; I wish I could believe me! I do believe, however, that there is always hope – no matter how awful things are, there is always hope. I’d like to propose three things that bring hope for those of us who struggle with mental health, and those who support others in their struggle.

 

Empathy

The word empathy has been gaining traction and is being talked about more and more, and I couldn’t be happier about it. See, empathy is very different than sympathy. Sympathy is often our natural reaction, likely in response to our own pain over the suffering of others. We want to make it go away so we try to make it sound less awful. It’s really an attempt to soothe ourselves, but it has the opposite effect on the person we’re trying to help. Brené Brown gives a great definition of empathy in this video, and I encourage you to watch it; it only takes a few minutes. The take-home message, however, is that empathy drives connection, sympathy creates disconnection. A connection is what we need, particularly when we’re in pain because words rarely make something better, as Brené Brown notes, what makes it better is the connection.

 

Connection

A connection is being used as a buzz word in many circles these days (particularly in business), but what does it really mean to connect? It depends on the context. It could send a text message, it could be getting together over coffee, or it could be something deeper. All of these options can be good things to do with people struggling with mental health, but I want to highlight one thing that I think gets in the way of connecting, and that is fear. Mental health can be a scary thing, especially if we don’t have lived experience with it ourselves. What do we say? How do we respond? What if we don’t understand?

The beauty of empathy, and of connecting with someone on any level, is that we don’t need to understand, we just need be with them. Even though I’ve had my own difficulties with mental health over the years, I still don’t understand everything my clients, friends, colleagues, or family members experience. Some of what I come across is scary or makes me feel helpless, or downright confused. But if I remember that I don’t have to understand, I just have to connect, I can get past the fear and be with the person.

If you’re not sure how to be with the person, just ask them. This not only alleviates the pressure of having to figure out what the person needs and understand what’s going on, it empowers the person to tell you what they need, which in and of itself is beneficial. Remember, we are not dealing with issues, we are dealing with people.

 

Education

Finally, I want to highlight the importance of educating ourselves. I know I just said we don’t need to understand all the time in order to be there with someone, but some understanding sure does help. It also acts as an antidote to fear so that we can be ourselves with others as they are in their pain and suffering. There are so many resources now to educate ourselves on mental health it’s amazing. Here’s a few to start with:

We hope our blog is also a resource for you. If you have topics you’d like to see addressed on the blog, please contact us with what you’d like to know more about and we’ll do our best to address it in an upcoming post.

 

You Are Not Alone

If you’re reading this and you are struggling, please know that you are not alone. Struggling in silence, while I can completely understand it, isn’t going to get you the help you need. I know from my own journey that if I’d spoken up, and talked about it more when I was at my worst, life could have been a lot better and the suffering could have been much less.

Please reach out; whether it’s to us at Alongside You, to your local mental health team, to your family, your friends, your pastor, or otherwise, please reach out to someone so they can connect with you and ask how it is they can help.

You are loved.

My Love-Hate Relationship With Mindfulness

My Love-Hate Relationship With Mindfulness

My Love-Hate Relationship With Mindfulness… and why you should really, really consider practicing it

Mindfulness has been a buzzword in the health community of late. I’m hoping that after reading this, you’ll have a basic idea of what it is and why it helps.

Western culture is full of busy-ness – depression and anxiety are more common than they’ve ever been. Typically, I like to simplify depression and anxiety somewhat, down to past and future. Anxiety is the uneasiness and even fear of some future threat – generally, one that isn’t exactly easy to define. We might be really anxious about an upcoming presentation, but have a harder time nailing down where that comes from – perhaps it might come from baggage that we carry around from some intense public shame that we’ve felt in the past, and the risk of putting ourselves out there again heightens us to a degree that feels like it doesn’t even make sense (our bodies remember shame a lot more acutely than our minds do). Anxiety is often designed to warn us and protect us against the threat of more hurt like this.

Depression, often, is oriented in the reverse direction – maybe our past experiences have coloured our world in a way that joy is difficult to experience, and it’s hard to believe that we will experience anything different going forward. Depression tends to affect the innate and beautiful sense of curiosity and wonder that comes with being a human being (think of a young child you know interacting with the world around them).

Please understand that these are simplistic definitions, designed to give a basic idea of where mindfulness comes in. Often, depression and anxiety can keep our thoughts in the future or past, which is exhausting. Constant worry or feeling down can lead us to do a number of things that are very adaptive and reasonable in the moment (such as distracting ourselves from a painful experience), but they are exhausting in the long run. Mindfulness brings us to the present. It gives our brain a short break from the constant worry and just brings us into right…now. Young children (for example) are generally really good at being present in the moment.

 

Being mindful can help ease stress

Mindful meditation might involve focusing on our breath, the food we’re eating, the physical sensations in our bodies, or the sounds outside. It is inviting ourselves to experience the present moment for what it is – without judgment. I have a lot of tension on my shoulders, for example. I carry it with me everywhere, and I really hate having it around. But when I’m mindful, I’m not focusing on how much I wish it weren’t there. I’m just noticing it and training myself to be OK with it, just for a minute. Or, I’m noticing the sounds of the traffic outside, and I’m not thinking any thoughts at all – just experiencing the present for whatever it is. This is really hard – especially at first, and even more so when we are experiencing physical or emotional discomfort.

If you’d like to know the why behind things, I’d like to tell you about the work of two people I admire (who are just like you and me, and also happen to have a long list of impressive credentials that I won’t outline here) named Jon Kabat-Zinn and Dan Siegel. They’ve spent a lot of time researching and exploring mindfulness, and their work is very impressive.

 

Benefits of mindfulness

One of the main things mindfulness does is increase left forebrain function. This increased brain activity fosters that beautiful curiosity I was talking about. If we can notice and be curious when we’re stressed, we’ve already won. We start seeing ourselves from an outside perspective, with more grace and compassion (have you ever wished you could see yourself the way you see somebody you care about?). We can learn to calmly respond to things that otherwise would have sent us into a frenzy.

I could talk forever about this, but I’ll just give you a quick list of the amazing benefits you can find in mindfulness:

  • Direct help with physical symptoms such as chronic inflammation and pain
  • Reduced anxiety, stress, and depression
  • Improved immune system function and mood
  • Healthier coping – an increased ability to bounce back after one of the hard experiences that are so common in life

Sounds too good to be true, right? It is sort of. It’s not a pill – it takes the effort to be mindful. I hate it, actually. In many ways being regularly mindful is a primary component of my job, and I still suck at it. But, I’m getting slowly better – then worse – then better again. But even a little bit helps – if you can manage even 20 seconds a day, you will notice a difference.

If you want to read more about this, the works of Jon Kabat-Zinn and Dan Siegel are a great place to start. Jon Kabat-Zinn has a website and a variety of videos on YouTube that are really interesting. I’ve provided a few links below to get you started.

If you want to get started with a mindfulness practice of your own, there are quite literally endless free resources online in both video and audio format, but I recommend the Headspace app. It teaches you the basics and gives you easy, situation-specific guided meditations.

If you want more information on how to actually do the thing, here’s a Harvard blog that covers the basics pretty well:

https://www.helpguide.org/harvard/benefits-of-mindfulness.htm

Here’s Jon Kabat-Zinn on making what you already do in the morning into a mindful practice (this way, you don’t even need to learn to do anything new!):

https://www.mindful.org/jon-kabat-zinn-how-to-make-your-morning-routine-into-a-meditation-practice-video/

Lastly, if you want to fact check my claims, I have a resource list of academic papers I’d be happy to share with you. Here’s one I really like (you may need access to an academic database to read it):

Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., . . . Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-570.

I hope this has been helpful for you. Sometimes we love what helps, sometimes it’s aggravating; one thing is for sure – mindfulness helps us keep calm, be present, and cope. If I, or anyone else on the team at Alongside You can be helpful in working through this with you, please contact us and give us a call.