Yesterday, I took the day off from work. Originally it was scheduled so that I could take my wife to another of her recurrent surgeries for her chronic pain, which thanks to COVID-19, has been cancelled indefinitely. It happened to line up nicely, however, with cabinet install day for our home renovation that is thankfully heading ever so much closer to the finish line. It also coincided with a need that I’ve identified lately – that is, a need for rest. What I didn’t expect is to be spending most of the day feeling sad. For a while, I didn’t know why I was feeling this way, until the question loomed in my mind, “How do I respond to racism?”
You see, I’m one of the ones who is, on most given days, gleefully ignorant about racism. It’s not that I am not aware of it, because I am aware because on different parts of the world I’ve lived in, different ethnic groups I’ve worked with, clients I’ve seen, etc. It is, however, because on any given day, I am not personally subjected to it. In fact, it’s been exceedingly absent in my life. While I was pondering this question about how do I respond to racism all day yesterday, I realized that I can only think of one time in my life where I was keenly aware that I was being treated poorly because of my race. The details of the situation aren’t important here I don’t think, and likely wouldn’t spark any sort of helpful conversation, but it does highlight that in 39 years I can only think of one time where I was very aware of being discriminated against based on my race.
This doesn’t mean that I haven’t been aware of being treated differently, because I have been while travelling. While I would suggest that it’s still not okay, it’s normal, in my experience, to be seen as other when you’re in another country, and even hearing words like gringo if you happen to be white. Or, if you’re living in Ukraine and your friend is from Korea, it’s not uncommon for kids to stop dead in their tracks and stare simply because they’ve never seen an Asian person before.
There’s a massive difference, however, in the experiences I’ve had versus those from whom we’ve all been hearing from in the past few days through the Black Lives Matter movement and protests, and the devastating events around the death of George Floyd. In all of my 39 years, I can only recall one instance where I felt unsafe or threatened as a result of my treatment based on my race.
This is in contrast to some who can’t go 39 days, or 39 minutes, or perhaps 39 seconds between experiences that make them feel unsafe, threatened, or less than.
This makes me sad.
It makes me feel a whole lot of other things, including mad, confused, angry, frustrated, scared, and more. But, if I give myself the time to actually sit with the emotions and discern what I’m feeling, the core of it is sadness.
I’m sad because although I do my very best to honour everyone, regardless of race, colour, creed, ethnicity, or otherwise, I know that at some point I have unwittingly made someone feel this way myself.
I’m sad, because a part of my heritage story is related to culture – my family came to Canada in the early 1900’s because they were literally being killed off for being who they were, and coming to Canada saved their lives. And we still have the same problems over 100 years later.
I’m sad because although my wife and I do our best to raise our girls to love and respect everyone they meet, from all races and creeds and backgrounds, they too will struggle to follow through and will make mistakes, and this will inflict further pain even into the next generation.
We come from privilege. We are white, middle-class, and I am male. This carries a privilege that I am becoming more and more aware of. It carries a responsibility to realize this, and understand this, and do better in our actions as we move forward.
Now, some of you may have just cringed at that last paragraph. Some of you may feel that what I’m saying means that those of us who come from privilege need to be sorry for, repentant of, or similar for the fact that we are white, grew up reasonably well off, and may be male.
That’s not at all what I’m saying, and that’s not at all what privilege means. It simply means that we have some advantages in life that others do not, simply by being born into what we’re born into. With that carries a responsibility to be aware of this, and use this privilege to care for others.
It also doesn’t mean we didn’t work hard to get what we have, to do what we do, and that we shouldn’t appreciate it, and enjoy it. It simply means that if we didn’t have the privilege we do, it likely would have been harder for us to have the same successes in life.
How Do I Respond To Racism?
Herein lies the problem. I am by no means an expert on race relations, cultural history, sociology, or otherwise. I don’t have any perfect answers to this, or even particularly qualified ones. Instead, here are some thoughts I’ve had over the past few days that hopefully might be helpful to us all as we wrestle with this issue of racism that I don’t believe is going to go away anytime soon. How do we respond? What do we need right now to make changes?
We Need Grace
Nothing highlights the need for grace more to me right now than writing this article. I know that it is nowhere near perfect, and doesn’t come up with any astounding answers to any of the massive, looming questions many of us have. I know I’ve made mistakes in this article in my own ignorance.
This highlights our need for grace as we navigate this challenging issue, in a challenging time. While this article isn’t authoritative, or perfect, it is honest.
This are simply my honest wrestling with an issue I don’t know enough about. It is the start of an attempt to lend help, even in my own imperfection, with initial thoughts on a complex issue.
I ask for your grace as you read this, and I would ask for grace for us all, from those who are subjected to racism on a daily basis. You don’t deserve this treatment, and we don’t deserve your grace – but, if you can muster some grace for us while we try to change our understanding and our behaviour, we will all hopefully win in the end.
With grace, we can have hope for a different future, one that honours everyone, from all races and cultural backgrounds. A future that holds promise for us all.
We need to feel sad
Understandably, there is a lot of anger right now over the state of race relations, and particularly over the death of George Floyd. And, there should be anger over what happened to Mr. Floyd, and what has happened to far too many people over the years who have been subjected to similar treatment.
In my area of expertise, psychology, we understand generally that anger is a basic emotion (one of the 6 basic emotions according to the Gottman Institute). Anger, however, is often a secondary emotion – based on underlying emotions that aren’t expressed.
One of the most common source emotions for anger that I see, particularly in men, is sadness. I know for myself, I am far more likely to express anger than I am sadness. It’s not particularly socially acceptable in North America for men to express sadness, but it is much more socially acceptable (if only for being more common) to be angry.
The problem is that very few productive conversations happen through anger and the expression of anger. It doesn’t mean it’s not valid, it just isn’t as effective in communication. If someone is angry with us, our back usually goes up and we become defensive. Very rarely is our response to ask something like, “Can you help me understand why you’re angry, please tell me more.” Instead, our fundamental biology kicks in through our limbic system and we go to defensive mode, and most likely, enter into our fight-or-flight stance (or freeze for that matter).
What happens, then, if we embrace the underlying sadness? I’d suggest it instructs us better (I can easily describe right now why I’m so sad about all of this versus if you asked me in the angry moments to describe why I’m angry), and it’s more effective in communication. If someone tells us they’re sad, we’re far more likely to respond in curiosity and kindness wanting to know more, simply because our limbic system isn’t firing.
“Anger is valid and ok, but we shouldn’t gloss over the underlying sadness.”
We need to educate ourselves
This may seem blatantly obvious, but it’s still the truth. We are woefully uneducated as a whole about racism, no matter what our background is. This is where I will plead ignorance regarding resources because I’m at the stage of doing my best to find out what some of the most helpful resources are.
There are two main reasons that we need to educate ourselves: to understand, and to reduce pain.
While I am early on in my journey toward education on this subject, I did come across this article that lists a number of resources that I have seen posted many, many times and seem to be helpful. Our very own Rebecca Farnell posted the book, Me and White Supremacy: Combat Racism, Change the World, and Become a Good Ancestor on her Instagram feed and it seems like it would be a good resource for those of us wanting to learn more. I am continuing to look to find resources that are suggested by people who know far more about this than I do. I’ll update this post as I find more resources as I hope it will be helpful to others. The second reason we need to educate ourselves is because when it comes to pain, the inevitable result of racism, current pain science research shows that it is one of the greatest modifiers of the pain we experience.
Since I do have a particular interest in chronic pain and the psychological management of pain, I was reading The Explain Pain Handbook: Protectometer yesterday to try to find some resources for a client. In this book they explain that in terms of physical pain, embracing bioplasticity and education about pain can adapt the body to reduce pain and disability and increase life satisfaction (p.30). They also state that bioplasticity is based on the research on neuroplasticity which is the research showing that our brain is able to change over time, no matter our age.
What we do know, is that physical pain and emotional pain act the same way in the brain, and hit the same receptors. We have documented data on the effects of traumatic stress on the brain. It seems to me that if education can reduce our physical pain, it should help our emotional pain. If we know what is happening, we can respond differently, and this can change the impact on our neurobiology.
We need to connect
More than ever, we need to connect around this issue. We need to learn together, do better together, change together. I’m convinced that the solution to our problem with racism lies in human connection. It’s going to be a long road, but connection is where we start.
If we connect, we can learn from those who are hurting and change our behaviour. If we connect, those who are hurting can understand the perspective of the perpetrators and what they are trying to do to change, thus reducing their pain. Note well, this is not to excuse the perpetration, it is to understand one another’s positions and the efforts being made to change for the better, and to reduce pain in the meantime.
If we connect, we can reduce pain. I remember a study that Sue Johnson mentioned once (and I’m actively trying to find the study), where subjects participated in a random controlled trial on secure relationships and pain response. From memory, they had three conditions:
Subject enters the room, is shocked with electricity, and their pain response is measured.
Subject enters the room, a random person is also sitting in the room, and the subject is shocked with electricity and their pain response is measured.
Subject enters the room, another person they have a safe, secure relationship with is also in the room, and the subject is shocked with electricity and their pain response is measured.
In that third condition, the study found that they could get the pain response down to almost zero. Let’s remember, the other person in the room did nothing other than sit in the room with them.
This is how powerful safe, secure human connection is. If we can find ways of doing this in the midst of our pain around racism, we stand a chance to weather the storm while we try to make the changes we need to make to do something about it.
Our commitment at Alongside You
I hope it goes without saying that everyone is welcome at Alongside You. We embrace all races, cultures, and backgrounds at our clinic. Our staff and associates come from all backgrounds, as do our clients. Our intent is to welcome anyone and everyone and that they would feel loved, and cared for.
I also understand that we are not perfect, and we too make mistakes. Here is my commitment as the Director of our clinic – if anyone has had, or in future has any concerns about how they are treated by our clinic for any reason, and particularly with regard to race and ethnicity, please contact me directly and I will sit down with you personally to listen, to learn, and to see what if anything needs to change at our clinic.
Safety, security, compassion, and respect are core to our values and I commit to doing anything I can do ensure that these values are communicated to every client by our words, our actions and our policies.
Thank you for taking the time to read this, and if you’re struggling with racism in any way, we’re here with you in the middle of it. Let us know how we can help.
Grief is a bit of a mystery to us, and something that our brains and our bodies have a hard time processing. Many times we might wonder, “How do I support someone who is going through grief?” It can be hard to know what to say or do when someone you care about is grieving a major loss. Some people may be afraid of saying or doing the wrong thing, or maybe think that there is nothing they can do to make things better. Others may simply feel uncomfortable with the intense pain and emotions that grief brings. These are common fears that we all experience when someone we deeply care about is going through a difficult time. It may help to know that there is no magic pill – no cure for the pain of loss, and nothing that can take it all away. But that doesn’t mean that there isn’t anything we can do to support someone who is grieving. You don’t have to have all the answers or be able offer great insight or advice for your loved one to feel supported and know that you care about them. Often times, your mere presence is enough. The bereaved would benefit from just knowing that they are not alone in their suffering, and that they have a caring and compassionate friend to turn to if they need to. This alone can help the bereaved process the pain and slowly start to heal.
Nonetheless, here are some good ground rules to keep in mind when you’re trying to answer the question of how to support someone who is grieving.
Your friend or loved one may have not had the chance to share their thoughts and feelings about the loss with anyone. Often times, those who are grieving may avoid talking about the deceased with close family members or friends so that they don’t bring them too much pain. This means that they may have never had the chance to share their grief story. Just by listening to them, without judgement or restriction, you offer them a unique opportunity to verbally process the loss and express the impact it has had on them, which can be healing in itself!
Give Permission to Grieve
Some of us may be uncomfortable with this step because of the intense pain and emotions that grief brings. We may feel propelled to offer advice, or provide intervention or direction in some way, which is understandable – no one wants to see their loved ones suffer! But as mentioned earlier, the most helpful thing we can do is offer our presence and remind ourselves that there is nothing we can do to take their pain away. Depending on your relationship with the person experiencing grief, you can encourage them to express their grief, especially if they consider you to be one of their safe and close friends. Keep in mind that grief may not only involve feelings of sadness, but can also include intense feelings of guilt, anxiety, anger and despair. Allow them to express the range of emotions they may be feeling, without judgement. Many people hide their grief and pretend that everything is alright, so giving them permission to express their grief, with all the extreme emotions it involves may be very freeing. You can say something like, “tell me about your dad,” or, “this must be really hard,” and let them know that grieving is a normal and healthy response to loss. You can even tell them, “I’m not sure what to say, but I want you to know that I care.”
Share Information About the Grief Process
Grief often comes in waves, and many people don’t know what to expect from it. Some people may be surprised by the duration or intensity of it and they may judge themselves for how long it’s taking them to heal. It can be helpful to remind them that grief affects everyone differently, and that their journey is unique to them. Not only that, but it is also normal and expected to have some good days along with the bad. Reassure them that this does not mean that they love the individual they lost any less – finding ways to cope with the loss and finding a new normal is part of the healing journey.
Assist in Practical and Concrete Ways
Lastly, helping the bereaved in practical ways can be one of the most helpful ways to support them, especially in the early days after the loss. They may very likely have no energy to ask for support at this time or may not know exactly what it is that they need. That’s why it’s helpful to take initiative to make a practical, concrete offer that would lessen the burden of their daily responsibilities. This could be something like offering to deliver them a meal, babysit their children so that they can have some time to themselves, or take long walks with them for fresh air and exercise.
Finally, it’s important to practice self-compassion as we support someone else on their journey through grief. It’s hard when we see those close to us suffer. Even though it’s not our own suffering, their pain still impacts us, and we may experience it as our own. That’s why it’s important to show kindness towards ourselves and acknowledge how hard it is for us to know that a loved one is going through a difficult time and that there is nothing we can do to take their pain away. This allows us the capacity to be there for those who are suffering and not get lost in their pain. If we are able to attend to our own emotions and have compassion for ourselves, we increase our capacity to be there for others and offer them the gift of our presence.
If you or someone you love is experiencing grief, we’re with you. If we can be of any help to you on your journey through grief please give us a call.
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!”
Here we are again – that time of year that gets us all excited about lights, smells, food, and relatives. Oh, and friends, cookies, the Stanley Park train, and…
Wait. Why are we excited again? Is anyone else stressed? What is this peace that people keep talking about? What’s the secret, and who actually experiences peace this time of year? I’m like everyone else. I can let the stress get to me too. So, what I’ve done is some thinking and some research that will hopefully help all of us figure out how to get some peace this year. I don’t know about you, but I think we could use it. Here are three practical ways to experience peace this Christmas, I hope they’re helpful to you!
Say “yes” to what matters most to you, and practice presence when you are there.
“It’s crazy. I can’t believe how much I have to do!”
We nod our heads and empathize, “Yes, I know. Me too. It’s just too busy!”
I am guilty of making these kinds of “Christmas complaints.” I am also aware that these rote responses make us feel that we’re “all in this together.” What a shame it is to forget that we often have a choice in the matter and that much of what we’re begrudgingly doing may, in fact, be worth enjoying.
Christmas parties, school performances, family dinners, and year-end activities – everything can be meaningful and life-giving. If you find yourself excited about a particular activity, and you think it is a worthwhile investment of your time and energy, show up with your Ugly Christmas sweater and your party hat on! What a gift it is to be alive!
One of the keys to connecting with the activities in a positive way is to be mindful. The best way to practice mindful presence at your chosen festivity is to set your intention, going in with the knowledge that this event is not imposed upon you, but gratefully chosen by you. Allow yourself to enjoy the people you speak with, the food you choose to eat, the melody and rhythm of the music you hear, and the décor creatively displayed for your aesthetic enjoyment. Breathe deeply, attune to your five senses – sight, smell, touch, sound, taste – and pay attention to what is right in front of you in that moment.1,2
Say “No,” to what is not a priority, and learn to be okay with disappointing people.
If it is true that we can choose to be gratefully present at an event, it is also (usually) true that we can gratefully decline to attend. In fact, it can be very liberating to do so. When we choose to simplify our schedules and scale back our commitments, we are giving our enthusiastic ‘yes’ to what we do show up at. We may also disappoint a few people along the way.
It can be very difficult to let someone down; it is even more difficult, long-term, to live with blurry boundaries and residual resentment. We may think that we have to jump when our friends and family say “jump,” and perhaps we’ve done it our entire lives. Perhaps it’s instinctual, and to do otherwise would create tension. Part of our work as humans who work toward self-identity and emotional health is to know what is not for us at this time. It does not mean that we cannot change our minds in the future and show up meaningfully then, but that in this season, at this time, we cannot take it on.3
There is a way to communicate boundaries in a respectful, effective manner. It takes practice, but with new learning and perhaps some help from a counsellor, it is possible to become skilled at lovingly communicating our intentions and expectations to others.
Say nothing at all, and take time for solitude.
For some, it will be a challenge to take a break from the busyness, to be alone and recharge. It may feel selfish to have time away from your partner, children, parents, or co-workers, to collect your thoughts in quiet. You may literally be thinking that you will make time for yourself next year. While it is possible to push through and strong-arm this season, we remember that if we feel coerced or obligated to be somewhere (in this case, to be with people), we may find it difficult to remain present with them. One of the best gifts we can give ourselves, and those we love is to take some time alone.
It is also true that for some of us, this season will feel lonely, even when we are in a crowded room of people.4 Or perhaps we will actually be alone more than we’d like, and the idea of choosing to turn down holiday activities out of sheer busyness seems like a happy person’s privilege. There can be peace in this season for you, too. Take very good care of yourself and reach out to one person who makes you feel known.5
Wherever you find yourself this Christmas, and with whomever, you choose to spend your time, try to be intentional about when you say “yes,” what you say “no,” and when to say nothing at all.
If you struggle with some of the decisions and boundaries I’ve talked about here, give us a call. We all struggle with these things at times and sometimes an outside perspective, listening ear, and some validation can go a long way in getting us from stress to health; or, as the young people say, from the FOMO (fear of missing out) to the JOMO (joy of missing out). Ok, it’s not that simple, but boundaries don’t have to be complicated. We can help.
Goldin, P. R., & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, 10(1), 83–91.org/10.1037/a0018441
de Vibe M, Bjørndal A, Tipton E, Hammerstrøm KT, Kowalski K. Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults. Campbell Systematic Reviews 2012:3 doi: 10.4073/csr.2012.3
Wuest, J. (1998). Setting boundaries: A strategy for precarious ordering of women’s caring demands. Research in nursing & health, 21(1), 39-49.
Kar-Purkayastha, I. (2010). An epidemic of loneliness. The Lancet, 376(9758), 2114-2115.
Research shows that client engagement in the counselling process strongly predicts the success of treatment.1 In other words, when you arrive, you are not coming to be fixed by a counsellor, but instead to work in partnership with them. There are several ways that you can prepare yourself for a successful experience in counselling, but ultimately your only job is to show up, and however, you do so is commendable and brave.
Know Your Preferences and Needs
Here are some things you might consider before coming to see a counsellor at Alongside You. First, think about what kind of counsellor you believe would be a good fit for you. Your preference may vary depending on your phase of life, and unique circumstance, and that’s okay. Some people prefer a female or male counsellor (for reasons of comfortability or life experience), someone within a certain age demographic, or someone who works within a specific therapeutic model. You may also have a need for someone very soft and gentle, or you may need someone who is willing to challenge you directly. If you can come up with ideas on these preferences, we can help to guide you in picking a counsellor.
It’s also helpful to know what it is you’d like help with. You may feel like your list of concerns are long and complex. That’s ok, you’re not alone. Although it can feel overwhelming to narrow it down, it is often helpful to come to your appointment with one or two issues that are, at present, the most problematic for you. It doesn’t mean this can’t change over time because it often does, it just means there’s some focus to start out the work. That said, sometimes we don’t know what’s wrong, we just know that something is not right and we need help figuring out what’s going on. That’s okay too!
Openness in Counselling
When you arrive for your first appointment, try to be as open as you can to establish a relationship with your counsellor. Research indicates that the therapeutic alliance (the relationship between the counsellor and client) strongly determines the effectiveness of therapy.2 The therapeutic alliance will go the distance when you work through difficult things together and so we (as counsellors and as clients) cannot overlook the significance of trust, empathy, and connection. We understand that it’s a big ask! As part of our professional practice, counsellors do clinical supervision, and many also have their own personal counsellors that they see. You may find it helpful to know that it’s not easy for us either when we’re the ones “on the couch.”
Honesty & Feedback
If part of what makes counselling effective is the therapeutic alliance, the relationship between the counsellor and the client should be strong enough to handle honesty. As counsellors, we value when clients provide honest feedback. This can occur at the moment (“I don’t think you have a clear understanding of what I meant by that”), or after working together for some time (“I find that I feel frustrated when we start our sessions a few minutes late, and I wanted to let you know”). Counsellors want to hear if something is, or is not, working for you. When you don’t agree, or don’t feel your counsellor is fully understanding you, your counsellor prefers that you speak up. Statistically, when a client offers feedback, it usually serves to strengthen the therapeutic relationship, not weaken it.3
Furthermore, be honest about what you believe you need from counselling, whether it be guidance, problem-solving, empathic response, acceptance, non-judgement, or practical insight. It is okay to communicate this. Although each counsellor and client will naturally create a dynamic (or a certain way of being with one another), your counsellor will be better equipped to work with you if they have a clear understanding of your needs. It helps your counsellor to know your objectives for therapy, but also, it can provide insight as to who you are as a person.
As you participate in counselling, aim to implement some of the homework (sometimes called “between-session interventions”) agreed upon in counselling. Counselling homework usually consists of experimenting with new behaviours, making cognitive shifts, acknowledging feelings in specific moments, or keeping track of a combination of all three during the time you are not with us. Homework, at its best, enables integration between the counselling hour and the client’s regular life. Ultimately, homework can be a meaningful way of facilitating healing and growth outside of the time spent with your counsellor.4 As my supervisor, Andrew Neufeld, sometimes illustrates – if you go to see a physiotherapist for your knee and the only work you do is with the physio in session, your knee will likely eventually get better but it will be a long, drawn-out process; whereas, if you do exercises in between sessions your recovery will likely proceed exponentially faster. The same is true for counselling – the work you do between sessions will significantly influence the speed at which you recover and heal.
Last, and perhaps most significant, try to practice self-compassion as you enter and proceed with therapy.5 Counselling can be exhausting, and emotional, and it always requires bravery. Your counsellor knows this and appreciates this about you. Try to be especially gentle with yourself during the process, and treat yourself with tenderness, care, and grace.
Shaw, S., & Murray, K. (2014). Monitoring Alliance and Outcome with Client Feedback Measures. Journal of Mental Health Counseling, 36(1), 43–57. https://doi.org/10.17744/mehc.36.1.n5g64t3014231862
Duff, C. T., & Bedi, R. P. (2010). Counsellor behaviours that predict therapeutic alliance: From the client’s perspective. Counselling Psychology Quarterly, 23(1), 91–110. https://doi.org/10.1080/09515071003688165
Murphy, K. P., Rashleigh, C. M., & Timulak, L. (2012). The relationship between progress feedback and therapeutic outcome in student counselling: A randomised control trial. Counselling Psychology Quarterly, 25(1), 1–18. https://doi.org/10.1080/09515070.2012.662349
Cronin, T. J., Lawrence, K. A., Taylor, K., Norton, P. J., & Kazantzis, N. (2015). Integrating Between-Session Interventions (Homework) in Therapy: The Importance of the Therapeutic Relationship and Cognitive Case Conceptualization: Therapeutic Relationship and Homework. Journal of Clinical Psychology, 71(5), 439–450. https://doi.org/10.1002/jclp.22180
Galili-Weinstock, L., Chen, R., Atzil-Slonim, D., Bar-Kalifa, E., Peri, T., & Rafaeli, E. (2018). The association between self-compassion and treatment outcomes: Session-level and treatment-level effects. Journal of Clinical Psychology, 74(6), 849–866. https://doi.org/10.1002/jclp.22569
Winter is coming, and so too are shorter days and longer periods of darkness. For a sizable percentage of people (~3% of the Canadian population1), this change to our environment can bring about a seasonal form of depression called Seasonal Affective Disorder, SAD. Those who experience SAD experience an onset of clinical depression in the fall season, which spontaneously improves in the summer, a cycle that usually repeats for at least two calendar years in succession. Interestingly, the symptoms of SAD are not typical of non-seasonal depression.2 Depressed mood, loss of interest in activities, and withdrawal from social interaction is common to both, but where typical depression usually includes insomnia, anxiety and reduced food intake, SAD is characterized by hypersomnia, carbohydrate craving and increased body weight. The symptoms look superficially like seasonal rhythms in animals as they prepare to hibernate.
In fact, many of the same biological mechanisms which prompt the onset of hibernation in animals like bears are similar to the processes which give rise to SAD in humans. This is because most organisms have internal body clocks which track daily and annual cycles in the external world. Our body clocks, for example, are capable of tracking how long the sun is present each day. While we don’t yet fully understand why this process affects mood, we know that SAD is associated with day length because data from different American states reveal that the incidence of SAD are higher in more northern states.3 This is also true of the ‘winter blues’, or sub-clinical SAD. We also know that the issue is in terms of day length and not the amount of sunshine a location gets because Calgary (~51° N) has much more winter sunshine than Vancouver (~49° N) but similar daylengths and population rates of SAD. This is particularly important information for us Canadians who live north of the 49th parallel. We may get plenty of sun, but we still experience shorter days.
So, as we get less daytime during these seasons, is it possible to trick our body clocks into thinking the days are longer?
Remarkably, one of the most effective remedies for SAD is bright light treatment. Introducing bright light in the Fall and Winter can prevent or reverse SAD, with roughly 2/3rd of SAD patients responding to the treatment4. The research indicates that it is as effective an antidepressant as any pharmaceutical used to treat SAD and when used correctly is accompanied by relatively few possible side effects. Importantly, however, bright light therapy may trigger mania in individuals with bipolar disorder5, so please consult with your doctor before considering the treatment. The minimum effective dose is approximately 2500 lux, which is about the intensity of sunrise outdoors.6 Bright light treatments, however, will often exceed 10,000 lux. Indoor, room lighting typically emits 500 lux and is thus an ineffective treatment. Those susceptible to SAD can purchase bright light-emitting visors or, alternatively, there are bright light lamps which allow one to sit or work in an environment containing ambient day-time levels of light. These devices can also be used strategically to ease certain sleep disorders and help realign one’s body clocks during jet lag.7
Because many of the symptoms of Major Depression and SAD are shared and the two disorders are often comorbid, traditional psychotherapy is also a highly effective treatment for seasonal depression.2 Research using group-based cognitive-behavioural therapy (CBT), for example, has demonstrated antidepressant effects which nearly mimic 30 minutes of 10,000 lux bright light treatment.8 Health professionals who utilize CBT teach skills to those suffering from various forms of depression which help to change their perceptions of the world.9 Cultivating emotional regulation, developing personal coping strategies, and learning to disrupt patterns of negative thoughts and actions are key constructs of CBT. Bright light treatment and psychotherapies like CBT may be used alongside one another, as well as in conjunction with other therapies like medication or mindfulness practices. Research also suggests that people whose depressive symptoms look more like the ‘winter blues’ than seasonal depression should improve their diets by limiting starches and sugars, exercise frequently, manage stress (especially around the holidays), increase social contact and connection, and spend more time outdoors.10
Finally, vitamin D, an essential building block for our bones and muscles, is in short supply in the Canadian Fall and Winter months. A deficiency of vitamin D has been associated with depressive symptoms and some research suggests that taking vitamin D before winter darkness sets in may help prevent symptoms of SAD.11 During the winter months, those living roughly 33 degrees north or 30 degrees south of the equator synthesize very little, if any, vitamin D.12 People beyond these latitudes rely primarily on eating fish and egg yolk or taking nutritional supplements to get the vitamin D needed.13 It is important that most of us, and perhaps especially people experiencing SAD, ensure that we have sufficient levels of vitamin D during these darker months. Thankfully, the Canadian government acknowledges this problem and mandatorily requires that products like cow’s milk, margarine, and calcium-fortified beverages have vitamin D added to them.14 Planning a mid-winter vacation may be valuable for its increased light exposure and onset of vitamin D synthesis, and who doesn’t like taking a vacation as a form of treatment?15
Thankfully, there are multiple options for Seasonal Affective Disorder which allow for more personalized treatment plans. If you’re feeling blue this Fall and Winter, Alongside You offers an abundance of counselling and well-being services that can help you if you identify with any of the discussion above regarding SAD.
If we can be of help to you, please don’t hesitate to ask. This is why Alongside You exists – because we believe that everyone is worth it. Feel free to contact us to see how we can help!
Adam Manz recently graduated from Simon Fraser University with a Bachelor of Arts majoring in Psychology. He is currently pursuing a master’s degree in clinical psychology while maintaining a love for meditation, podcasts, and hiking. Adam is volunteering with us here at Alongside You and we’re glad to have him on board!
1Body and Health Canada. (2019). Seasonal affective disorder. Retrieved from https://bodyandhealth.canada.com/healthfeature/gethealthfeature/seasonal-affective-disorder.
7Burgess, H. J., Crowley, S. J., Gazda, C. J., Fogg, L. F., & Eastman, C. I. (2003). Preflight adjustment to eastward travel: 3 days of advancing sleep with and without morning bright light. Journal of Biological Rhythms, 18(4), 318–328. doi: 10.1177/0748730403253585
9Canadian Mental Health Association. (2013). Seasonal affective disorder. Retrieved from https://cmha.bc.ca/documents/seasonal-affective-disorder-2/.
5Chan, P. K., Lam, R. W., Perry, K. F. (1994). Mania precipitated by light therapy for patients with SAD (letter). Journal of Clinical Psychiatry 55:454
4Golden, R. N., Gaynes, B. N., Ekstrom, R. D., Hamer, R. M., Jacobsen, F. M., Suppes, T., … Nemeroff, C. B. (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. American Journal of Psychiatry, 162(4), 656–662. doi: 10.1176/appi.ajp.162.4.656
13Health Link BC. (2019). Food sources of calcium and vitamin D. Retrieved from https://www.healthlinkbc.ca/healthlinkbc-files/sources-calcium-vitamin-d.
3Horowitz, S. (2008). Shedding light on seasonal affective disorder. Alternative and Complementary Therapies, 14(6), 282–287. doi: 10.1089/act.2008.14608
14Janz, T., & Pearson, C. (2015). Health at a glance: Vitamin D blood levels of Canadians. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11727-eng.htm#n2.
11Kerr, D. C., Zava, D. T., Piper, W. T., Saturn, S. R., Frei, B., & Gombart, A. F. (2015). Associations between vitamin D levels and depressive symptoms in healthy young adult women. Psychiatry Research, 227(1), 46–51. doi: 10.1016/j.psychres.2015.02.016
10National Health Services. (2018). Treatment of seasonal affective disorder (SAD). Retrieved from https://www.nhs.uk/conditions/seasonal-affective-disorder-sad/treatment/.
8Rohan, K. J., Mahon, J. N., Evans, M., Ho, S.-Y., Meyerhoff, J., Postolache, T. T., & Vacek, P. M. (2015). Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: Acute outcomes. American Journal of Psychiatry, 172(9), 862–869. doi: 10.1176/appi.ajp.2015.14101293
12Stewart, A. E., Roecklein, K. A., Tanner, S., & Kimlin, M. G. (2014). Possible contributions of skin pigmentation and vitamin D in a polyfactorial model of seasonal affective disorder. Medical Hypotheses, 83(5), 517–525. doi: 10.1016/j.mehy.2014.09.010
6Tam, E. M., Lam, R. W., & Levitt, A. J. (1995). Treatment of seasonal affective disorder: A review. The Canadian Journal of Psychiatry, 40(8), 457–466. doi:10.1177/070674379504000806
15Targum, S. D., & Rosenthal, N. (2008). Seasonal affective disorder. Psychiatry (Edgmont), 5(5), 31–33.
2The National Institute of Mental Health. (2016). Seasonal Affective Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml.