What Do I Do If I Use Substances During the COVID-19 Coronavirus?

What Do I Do If I Use Substances During the COVID-19 Coronavirus?

The COVID-19 coronavirus pandemic has affected everyone in some way – many of us are unable to work, unable to find access to child care or other important resources (one friend of mine has even been barred from doing laundry in his building). For some, like someone I know of who runs a milk delivery company, the pandemic is like an early Christmas present. Significantly and unfairly, the pandemic most adversely affects those who are most vulnerable: people living in or close to poverty who are out of work, people who are homeless, and those at highest risk to develop illnesses.

An important, but often overlooked group impacted by COVID-19 coronavirus are those who use substances. That includes those who rely on alcohol, cannabis or other drugs for medicinal or functional purposes (such as anxiety management), injecting drug users who rely on access to safe injection sites, and users of a variety of other substances for whom access has now dried up or become increasingly unreliable.

Imagine having to go device-free for a week, or longer – no phone, TV, computer, or other screen. For many of us this would involve literal symptoms of withdrawal, as we have become accustomed to using screens to cope with negative emotions, stress, anxiety, and to connect with others. I’m willing to bet you couldn’t, or wouldn’t, pull it off. A substance user’s drug of choice likely serves a similar function and is very likely quite painful to suddenly lose access to, without any sense of choice or control. My colleague very kindly reminded me of the difficulty some people will go through losing access to substances during a very uncertain and stressful time, and I feel sad to think of the number of us that will go through painful withdrawal symptoms (physical pain, uncontrollable anxiety or panic, and severe depression are just a few) and as a result will be forced to find other ways to cope.

People are incredibly resilient and will generally find ways to get through difficulties whatever the cost. I wanted to talk a little bit about the ways we can cope with difficulties, even in the face of withdrawal from something as mild as social isolation or as severe as substance addiction. Recovery from substance dependency involves building recovery capital, which is a blanket term referring to resources (both external and internal) that allow us to slowly build up capital – a wealth of other ways to cope. There are hundreds of examples, but some key themes are relationships with others, health (physical, mental, and emotional), strategies and tools, and a relationship with oneself.

Substances can be an effective tool in the short-term, but they have shortcomings: they don’t tend to last very long, they take a physical toll, and they can keep us away from some opportunities for the growth that comes from going through difficulty with the right support. Substances are considered part of passive coping, just like video games, junk food, and ignoring a problem. Passive coping is not bad, it is an important resource and we don’t want to overuse it. Active coping is also an important resource: exercise, diet, certain types of social support, therapy, learning, and other health behaviours fall into this category. Simply put, active coping is anything we do to directly cope with a difficulty, and passive coping tends to avoid the implications of a difficulty. The trick is striking a healthy balance between the two.

If you have recently lost access to substances or access to other important habits, I’m really sorry – you didn’t get to have a choice in the matter; an invisible and seemingly uncaring force made the decision for you. That really, really sucks, and now you’re stuck managing as best you can. Some that I have talked to will use tools such as exercise or meditation to achieve another type of “high,” and focus on emotional, spiritual, or intellectual pursuits when they have the energy to do so. When they don’t, they will use whatever means necessary to get through the really hard moments: sleeping a little more, indulging in TV or video games, venting to friends, or eating a little extra sugar.

You will find a sample list of different coping tools and a couple resource links at the bottom of this article. However, I’m not really here to give a bunch of advice, as everyone is different, and there aren’t any one-size-fits-all solutions. If you want help taking care of yourself right now and want to talk about creating a short-term plan, let me know and I can help with that. But you know yourself best, and you know what will get you through this better than anyone else does, and hopefully you know when you might need to seek support. Mostly, we just want to say that whatever your situation, we are thinking of you and rooting for you to get through it, because there is a lot of uncertainty and difficulty for a lot of us right now. Always feel free to reach out, and most of all, take care of yourself.

 

Tips for the “Green Zone” – when we have some energy or motivation:

 

  • Don’t overdo it – quality over quantity. Give yourself a realistic and short amount of quality time (say 15 minutes) to spend on something that your ideal version of yourself would do: go for a walk or a run, listen to some music, do yoga, spend some time reading, writing, singing, or drawing, complete a short work task, organize your cupboards – whatever. When you’re doing this, try to let all your focus rest on the activity at hand. Here’s a quick video tip from a children’s book I’m a fan of.
  • Try meditation. Focus for a few minutes on your breath, and spend some time being curious about yourself: how do I feel at this moment? What physical sensations do I notice? Do I feel anything towards myself or towards those sensations? Try to avoid positive or negative judgments during this time, and if they arise, just notice that they are there. The goal is just to be, to observe yourself internally at that moment.
  • Spend time cooking yourself a healthy meal from scratch, and eating it without any distractions, focusing on how good it tastes, and feeling good about yourself for putting the energy in to make it. If you can, even better to share it with someone.

 

Tips for the “Yellow Zone” – when our stress is present but manageable:

 

  • Notice what thoughts and feelings are coming up with as much compassion as possible. Imagine the things that are happening internally are happening to someone you really care about (real or imaginary). What would you tell them? How would you want to care for them? Try to identify a small way you could care for yourself in that moment. If all else fails, take some deep, slow, breaths.
  • Exercise. Get your blood pumping and get moving, this will give you an adrenaline spike to help you get through the next while. If you are tired later, you’ve earned a break! Take a nap.
  • Put on some music to match your mood, and paint, draw, or write along to it.
  • Call or chat with someone. Most of us have time on our hands – talk (or even vent) about what is stressing you, ask how they are doing and try really hard to listen well. When we share with others, or work hard to understand others, our relationships deepen and we feel closer and more comfortable. If you’re not up for a conversation, just play some online video games together. If you are struggling with something specific, try to find an online chat group that specializes in that type of thing. If substance use is your thing, there are tons of online chat groups full of people who have good advice and good support, all anonymous and for free.
  • If you have a therapist, an online session might be a good idea.

 

Tips for the “Red Zone” – When the bomb hits or is about to hit:

 

  • Breathe. Inhale for 3-5 seconds, hold for 2-3, and exhale slowly for 7-10, like you’re blowing on something to cool it.
  • Douse your head in cold water for a few seconds – this activates a survival “dive reflex” that calms the body. You can also try grabbing some ice cubes and squeezing them in your hands, focussing on that feeling and seeing how long you can go before having to let go. It’s pretty hard, and good at redirecting the brain.
  • Reach out to whoever feels safe to reach out to, in whatever way feels ok.
  • Feel free to use your favourite passive coping mechanism: watch a movie, eat something (preferably deliberately slowly), try to take a nap.
  • Imagine or daydream.
  • Write or draw – destroy some paper with whatever you’re feeling at the time.

 

There are countless other things you can do, and lots of online resources for meditation, emotional regulation, practical addiction support. Again, individuals vary wildly, so if you want help creating a specific plan for yourself, feel free to reach out to a mental health professional. We’re in this together, and we’re rooting for you here at Alongside You.

 

 

What Can I Do For My Mental Health During the COVID-19 Crisis?

What Can I Do For My Mental Health During the COVID-19 Crisis?

Can I get real here? We find ourselves in very difficult and unsettling times. As a mental health professional, I am struggling to provide a sense of hope or assurance to my clients during this time. What can I say? What can I offer? So, let’s be honest. It is scary. Yep, we can admit that we feel scared!  It feels as if control is slipping through our fingers. Things are changing every day…even hour by hour.

Over the past few days, I have been focusing on what I know to be true. I would like to share some of these thoughts with you.

 

  1. It is ok to feel anxious. FULL STOP. You do not need to put on a brave face and pretend that you are fine. Anxiety is normal. It feels different for everyone. Some folks get sweaty, others find themselves feeling angry or bursting into tears. Other people experience a tightness in their chest or racing heartbeat. Anxiety looks and feels different for each person. Please remember to be kind to yourself and others as we are all doing the best we can. Some great resources for anxiety can be found at anxietycanada.com

 

  1. It is ok to feel disappointed. For many of us, plans have changed. Trips are cancelled. Events are postponed. School is stopped for the unforeseeable future. Many folks have lost their jobs. These are extremely disappointing times. Something I have noticed lately is, when someone is sharing their disappointment, they try to downplay it because it is “not as bad as someone else” So now, folks are heaping shame unto their disappointment. Please do not do this. You are allowed to feel your feelings. I would love to give you permission: you are allowed to feel disappointed even if your disappointment is less than someone else’s.

 

  1. BREATHE. It sounds trivial, but I cannot stress the importance enough. I tell my clients from the little ones to the not as little ones; breathing is the fastest way for your body to calm down. I am not talking about small shallow breaths; these need to be deep down in your belly breaths. Slow, deep breath provides your brain and your body the fuel it needs to continue to support you and calm you down.

Some great resources on helping with breathing and calming down can be found at calm.com.

 

  1. DO NOT FEED THE FEAR; FOCUS ON FACTS

Just because something is on the internet, does NOT make it true.

Some questions to ask yourself:

Is this information coming from a valuable source?

How do I feel when I am reading this?

Is this helpful for me?

Some reliable sources may include:

Fraser Health Authority

Vancouver Coastal Health

BC Centre for Disease Control (and the BC COVID-19 Symptom Self-Assessment Tool)

 

  1. Limit your time online.

Reading articles, searching for answers, watching clips and listening to perspectives and options sometimes just gets a bit too much. Turn off your phone. Power down your computer. Your mental health will thank you.

Some things to try instead:

If you can, get outside and go for a walk.

Start a hobby- pick up that guitar, start writing that book, paint, colour, draw

Read a book

Have a nap

Clean your house

Organize your closets

If you need some screen time, try these:

Watch a movie.

Start a new series on Netflix

Take an online class, lots of universities are providing free courses…a FREE online course from Harvard…um…YES PLEASE!

Take a virtual tour of a famous museum

 

  1. CONNECT. Just because we are keeping our social distance, does NOT been we need to be distant from each other. Take this time to check in with folks:

Text.

Call.

Have tea via Facetime.

Send an email.

We need each other. Make sure you are reaching out when you need to connect. I know this is difficult for some folks, so be gentle with yourself and do what you can.

 

We have also just launched the COVID-19 Online Community Mental Health Support Group. This online community support group is focused on helping folks check in and process their feelings in a safe and secure clinical setting, with a special focus on tools to manage anxiety. If you think this would be helpful for you, please read more about it through the link above.

Or, would you prefer talking one-on-one with a counsellor? At Alongside You we are working hard to enact precautionary measures that so that clients can safely continue to attend in-person appointments if they choose to – please see our social media for all the precautionary measures we’re taking as a clinic. We also are offering online counselling appointments for any clients who may prefer to receive therapy from home during this time. If you would like to be paired with a counsellor and booked for a first appointment, the best way to get in touch at the moment is to fill out our contact page.

We are doing our best to respond to messages as soon as possible. If you have a counsellor already, please reach out to them directly for more information about booking a session, whether in-person or online.

For many of us, things feel out of our control. We wait. We wonder. We try to plan. I would encourage us all to focus on what each of us can do.

 

What are the things within our control?

Wash your hands. Often.

If you feel sick, STAY HOME.

Keep a social distance. 6 ft is recommended.

Practice gratitude each day.

Don’t forget to breathe.

 

The unknown is scary. Uncertainty is hard. Yet, as I tell my clients:

“We can do HARD things…together.”

What on Earth is EMDR?

What on Earth is EMDR?

If you’ve ever wondered what on earth EMDR is, you’re not alone! While EMDR is well supported by research and has been found to be highly effective for many clients, it can sometimes be a strange concept for people to get used to.

 

So, What Is EMDR?

 

EMDR has been around now for about 25 years and is a highly evidence-based method of treating trauma and anxiety. EMDR stands for Eye Movement Desensitization and Reprocessing and gets its name in part from the fact that it primarily relies on eye movement to work.

 

A client undergoing EMDR is encouraged to move their eyes from side to side in a slow, steady manner while contemplating questions or discussion pieces that relate to their treatment. As odd as it sounds, the reason EMDR works is precisely because of how the brain processes memory. When we are asleep, our brains enter REM sleep (Rapid Eye Movement), and during this stage of sleep the brain is processing and filing the day’s experiences into our memory, so the next day can occur with a relatively clean slate.

 

Sometimes we get stuck on intrusive thoughts or traumatic material because the experience or issue has not managed to get appropriately filed in our memory. EMDR replicates the REM stage of sleep while the client is awake and alert, and supports the processing of painful memories or recurring intrusive thoughts. Interestingly, because EMDR mimics REM sleep it tends to work quite quickly. If the issues are not too complex, clients can often feel a sense of relief from their suffering in just a few sessions.

 

It’s important to know that at no time during EMDR is the client out of control or in a trance of any kind, and of course, the client can always choose to end an EMDR session at any point if they don’t prefer working in this way or find that they are too uncomfortable. This said, clients almost always leave an EMDR session feeling better than when the session began.

 

The second part of EMDR stands for Desensitization and Reprocessing. The goal of EMDR is to desensitize the client to something that was previously painful and to support them in reprocessing the painful issue.

 

So, what does this look like in an appointment? A client undergoing an EMDR session can expect to meet with a therapist in a comfortable room where they will both sit. The client will be asked some questions by their therapist, and then guided to use back-and-forth eye movement. During this time all the client has to do is sit quietly and allow themselves to think. Following about 1 minute of this, the therapist will check in with some questions and guidance. The eye movement sets will be repeated a number of times as the therapist leads the client through a set format of questions and feedback. Toward the end of the session, the therapist will switch gears and invite the client to “reprocess” the issue being addressed.

 

Clients then typically end an EMDR session feeling quite calm. The only side effect is that some folks find EMDR somewhat tiring, as the brain has been stimulated to work quite hard for the time of the session.

 

The good news is that while EMDR is especially effective for conditions like PTSD, it has also been reported as effective for panic attacks, complicated grief, dissociative disorders, disturbing memories, phobias, pain disorders, performance anxiety, stress reduction, addictions, sexual and/or physical abuse, body dysmorphic disorders and personality disorders.

 

As not all therapists have the necessary training, it’s important to note that EMDR should be done only with a therapist who is properly certified in working this way. If you’re curious about whether this treatment could work for you, reach out to us! We’re here to help.

 

Kathryn Priest-Peries is a Registered Clinical Counsellor and Registered Social Worker who has Advanced Level Training in EMDR and has been a practicing therapist for over 30 years.

Read more about Kathryn here.

Click here to request an EMDR appointment with Kathryn.

5 Signs of Burnout and What You Can Do About It

5 Signs of Burnout and What You Can Do About It

Mental and emotional burnout is something different from keeping a busy schedule and feeling tired at the end of a week. It occurs when a person has experienced pervasive and prolonged stress. Burnout can be described as occurring in a predictable manner in which it begins with excessive ambition and commitment, leads to changes in values wherein personal care is neglected and emotions are displaced, and typically ends in feelings of sadness, emptiness and/or defeat.

While many people live a full life and are invigorated by pace and productivity, burnout is often demonstrated by a persons’ inability to reenergize and struggle to stay focused. Although true burnout will affect each individual in unique ways, there are standard warning signs that your nervous system may be overloaded, and that you’ve neglected parts of yourself in the process. This list is not exhaustive, but it captures some common signs of burnout:

 

  1. You’re easily irritated and find it difficult to be patient with others.

When other people’s requests of you begin to feel like an assault on your capacity to provide what they need, it is an indication that you’re feeling depleted. Normally, a request is something we can consider, and decide in a relatively neutral way what we’d like to give.

What can you do about it?

Begin to check in with yourself more often to see what you need. When you feel that your own needs are taken care of, you’re much more likely to be able to meet the needs of others. When you have taken care of your own needs (for rest, solitude, exercise, nutrition, enjoyment, etc.) you will be better set up to meet those needs for others.

 

  1. You’ve lost the motivation to engage in activities you normally enjoy and may be more likely to procrastinate.

Procrastination tends to occur when we feel overwhelmed; our “system” (mind, body, spirit) is taxed and so we lose motivation. When we lose motivation, we’re less inclined to engage in activities we normally enjoy or the responsibilities we’ve committed to. When we’re not enjoying our activities, we’re likely to procrastinate in making them happen.

What can you do about it?

This may boil down to scaling back activities and responsibilities. It may also be a matter of tackling responsibilities in “bite-sized” pieces. Some people find it helpful to break down one big task into several smaller pieces, identifying deadlines and rewarding for a job well done.

 

  1. You feel detached from your own feelings, and your day-to-day life can feel robotic.

When a person experiences burnout, they have learned to function at such a high capacity that they have had to shed a certain degree of their “humanness” to do so. When a person begins to think (consciously or subconsciously) that emotions get the in the way, or that slowing down to be present in their experience is cumbersome, they will adjust to a way of being that sees those elements of the human experience eliminated.

What can you do about it?

It requires, yet again, a turning in toward yourself – toward your feelings, your present experience, your needs. Do regular “check-ins” to note the physical responses, the thoughts, and the emotions you’re experiencing. If you operate in a robotic manner, return to the things that make you feel human. Mindfulness practices can be really helpful. For example, hold a cup of tea and feel the warmth on your hand, note the scent it releases, and observe the design of the mug itself. Taking moments to look for what brings you pleasure can eventually lead to a slower, more human experience.

 

  1. You become emotional at unexpected times, and you are quick to cry.

If it is true that we are more inclined to detach from feelings if we are experiencing burn out, then it stands that our emotions will bubble up unexpectedly, as we know that they have to find their release somewhere J. If you find that you can go weeks at a time without identifying any significant emotion, but then suddenly cry at a car commercial, you may be experiencing burn out.

What can you do about it?

There are many ways to facilitate an open acknowledgement and acceptance of the emotion. Some people need to process it verbally with a good friend who listens well, or with a therapist. Some people find that journaling can be helpful as it forces a person to reflect on their experience. No matter how you begin, it requires a method for tuning in to your feelings, and this requires slowing down enough to make this possible.

 

  1. You experience an increase in worry and anxiety.

The capacity to process your environment is compromised, and your stress responses are weakened when you are burnt out. When your body and brain have operated as if you’ve been under threat for a prolonged period of time, the resources for dealing with everyday stress are inhibited, and you are likely to experience an increase in anxiety.

What can you do about it?

First, try to eliminate obvious stressors. An honest look at your schedule may illuminate the ways you’re overextending yourself, and where you can cut back. Second, don’t try to push away the feeling of anxiety. It can be very tempting to attempt to detach from anxiety, much like detaching from other emotions or feelings when experiencing burnout, but this can be counterproductive. Sometimes it can be helpful to follow the “thread” of the anxiety, to become curious about what it’s about, and to see if there’s something beneath the explicit fear. Particularly with burnout, it can be helpful to stay with the feelings of anxiety, as it can point us toward what we need.

To provide a personal example, when I was experiencing a strong sense of overwhelming several years ago, I began to worry – more than usual – about my children. I found more reasons to be concerned about their safety and wellbeing. It was during this time that I was also taking quite a bit of school work. When I became curious about my anxiety, and how it generally pertained to my children, I realized that I was really missing spending as much time with them as I had in previous years. I felt more distracted and less connected to them, and that was unsettling for me. My anxious feelings pointed me toward what I was really in need of at the time – to drop a course and to fit in more time with my young kids.

 

If you recognize yourself in any of the items listed above, it may be helpful to take some time alone. In the quiet of solitude, we are more likely to reflect on who we are, and what we need. In addition, it’s likely you could benefit from the support and guidance of a counsellor. If you think working with someone to process some of this could be helpful, give us a call, we’re here to help.

Creating Out of Rest

Creating Out of Rest

It’s a new year, and like always February comes faster than we can possibly think!  I am so happy to return to Alongside You after a year away.  It’s wonderful when you can return and rejoin the work of walking alongside others. 

This is truly a joy for me. 

Yet, rest and recovery are important.  Have you ever been sidelined?  Taken a hit out of the blue?  What do you do?  Worry? Pray? Meditate? Call all your best friends and chat? Eat? Drink? 

Think about it for a moment with me.  

More times than I can recall, I move towards worry. Other times, I am quick to pray.  Even other times I reach out, call someone – anyone who will listen. How does this scenario play out for you? 

When we are sidelined, or unable to make decisions, it is okay to reach out.  It is okay to talk to someone.  It is okay to get centred and understand what your priorities are, and will be. 

Taking time to rest, ponder; consider choices and opportunities, even when you are sidelined or surprised is okay.  Out of rest something magical – dare I say miraculous – happens. Creativity flows, clarity happens, and you may just get in touch with your “Knower.”  You know, that deep place inside of you, where you are at peace, you understand with clarity what you want, and where you want to go. 

If you struggle with quieting your mind or resting in the busy, and you keep putting off decisions to move forward in your life, call someone, call us, and call me. I’m here to listen and understand. 

In the meantime, know you are not alone.  Rest, and let’s look together at what can be birthed in this new season. 

 

A Note from our Director

 

We’re very happy to have Kezia back working with us after her time away! Kezia works with evidence-based treatments such as CBT, EMDR, DBT Skills, Mindfulness, and Creative interventions.  As a part of her return to work, she will be providing all of her counselling services through our online counselling platform.

Why would you want to do counselling online? There are many reasons, and you can read a bit about them here. Some of the many benefits include scheduling, lack of travel to an office, or if you’re having to travel for business, you can still have your counselling session.

Sometimes people wonder if online counselling is secure. We use a HIPAA/PIPA/PIPEDA compliant platform to provide counselling that meets all of the privacy laws in BC. It is encrypted end-to-end which means it is secure from whatever device you use, to whatever device we use.

If you’d like to try it out, give us a call and book a session with Kezia. As Kezia says, she looks forward to, “Working together face to face, online, so you can pause in your busy to mentally strengthen your day!” 

Moving Out of the Comfort Zone

Moving Out of the Comfort Zone

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

 

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.

 

* * *

 

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.


Saturday, January 28, 2020
Let’s Talk Hope Conference

If you have any questions, please feel free to connect me directly.

 

References:

  1. Kemble, H. S. (2019, September). Introduction to dance/movement therapy I: basic theory, methods, and techniques. Russian Hall, Vancouver, BC.
  2. Hindi, F.S. (2012). How attention to interoception can inform dance/movement therapy. American Journal of Dance Therapy, (34), 129-140.
  3. Kemble, H. S. (2019, December). Introduction to dance/movement therapy II: applying methods with clinical populations. Russian Hall, Vancouver, BC.
  4. Chaiklin, S. & Wengrower, H. Eds. (2009). The art and science of dance/movement therapy: life is dance. New York: Routledge.
  5. Betty, A. (2013). Taming Tidal Waves: A Dance/Movement Therapy Approach to Supporting Emotion Regulation in Maltreated Children. American Journal of Dance Therapy 35 (1), 39–59.
Three Practical Ways to Experience Peace this Christmas

Three Practical Ways to Experience Peace this Christmas

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!

 

  1. 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

 

  1. 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.

 

  1. 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.

 

Reference

 

  1. 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
  2. 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
  3. Wuest, J. (1998). Setting boundaries: A strategy for precarious ordering of women’s caring demands. Research in nursing & health21(1), 39-49.
  4. Kar-Purkayastha, I. (2010). An epidemic of loneliness. The Lancet376(9758), 2114-2115.
  5. Wright, R. Coping with Loneliness.
All I Want For Christmas Is Hope

All I Want For Christmas Is Hope

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.

 

Relationships

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.

 

Consequences

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.

Do you know why? Because without connection, the therapy won’t work, the doctors won’t work, the medicine won’t work, and it will all be for naught. The research shows us this fact.

 

 

What To Get Andrew For Christmas

 

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.

What Is Post-Traumatic Stress Disorder (PTSD)?

What Is Post-Traumatic Stress Disorder (PTSD)?

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.

Kathryn Priest-Peries

How can I get the most out of counselling?

How can I get the most out of counselling?

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.

 

Homework

 

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.

 

Self-Compassion

 

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.

 

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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