by Juliana Fruhling | Aug 18, 2016 | Counselling
Part 1:
Reducing Your Children’s Anxiety
Recently, we have noticed a rising trend of anxiety in young children. This is particularly troubling as anxiety onset at a young age can lead to behavioural problems in the future. Thankfully, there are many tools and approaches designed to help your child cope with his/her anxiety.
Anxiety in young children come from their incapability of processing anxiety that fits under the norm of effective emotional regulation. Children don’t learn to effectively process multiple emotions until they are approximately 8 to 12 years old. Kids who are under the age of 8, are incapable of identifying or seeking relief from complex emotional experiences. This inability to process emotions in a healthy way will often lead to anxiety in children and prompt them to act out in different ways.
Often parents will come to therapy to seek answers for these tough questions: how can I help my child reduce anxiety, or (more commonly), how can I stop my anxious child from acting out? Clearly, this is a problem that carries much weight. Thus much attention has been devoted in the therapeutic world to teaching parents effective tools for helping their child to cope with complex emotions. It is our hope these tools will help prevent an anxiety that can easily overwhelm children.
Non-Directive Play Reduces Anxiety
One tool proven to be effective in reducing anxiety in young children is Non-Directive Play, also known as Child-Centred Play. Non-Directive Play is a soothing approach of play where the child is given ultimate freedom of expression to play however they want to. Basically, the child is free to choose the items they want to play with, without getting judged or evaluated by the parent or caregiver. Children are given this freedom in a pre-determined play structure and pre-established timeline. The theory is a child’s anxiety will decrease when they are allowed freedom to play as they wish without any evaluation or scrutiny by a parent.
During a Non-Directive Play session, a parent will sit with their child and give the child plenty of space to engage in that world freely. There are instructions given beyond the predetermined parameters. The parent will engage by simply learning to notice and describe what their child is doing during the play. These statements are free of judgement or evaluation. This means parents should refrain from giving any signs of approval or disapproval while the child is playing. The parent is present only to observe and reflect a genuine interest in the child’s exploration and activities. This can be expressed in a warm manner, gentle voice, and other clear indications of positive regard. Non-Directive Play allows the child to bask in the attention of his or her parent without having to give any explanations of justifications. In this framework, the parent gets to be the opportunity to be a warm and acknowledging presence for the child.
Improving Coping Skills for Those With Anxiety
Research has shown that engaging in this type of play semi-regularly can improve a child’s ability to cope with anxiety as well as increase their self-confidence and independence. In the study of effects of teaching parents to engage in Non-Directive Play with their children, Wilson & Ryan (2001) found that children showed improvement in terms of becoming “more manageable and accept(ing) adult control more readily”. In addition, Wilson & Ryan (2001) found the self-esteem and social skills of children may increase through continued use of non-directive play, making them more amenable to discipline. In a 2008 study, Ray also spoke of the positive impacts of Non-Directive Play, noting improvements in children who were exposed to this technique. You see improvements in their anxiety symptoms, markedly better social skills, and a decrease in any clinical behavioural problems.
References
Lin, Y. & Bratton, S. C. (2015). A meta‐analytic review of child‐centered play therapy approaches. Journal of Counseling & Development, 93(1), 45-58.
Ray, D. C. (2008). Impact of play therapy on parent-child relationship stress at a mental health training setting. British Journal of Guidance & Counselling, 36(2), 165-187.
Wilson, K. & Ryan, V. (2001). Helping parents by working with their children in individual child therapy. Child & Family Social Work, 6(3), 209-217.
by Andrew Neufeld | Aug 12, 2016 | Counselling
Dialectical Behaviour Therapy (DBT) was developed by Marsha Linehan, a Professor of Psychology, Psychiatry and Behavioural Sciences at the University of Washington. She was struggling to find solutions for her patients in hospitals and clinical practice who came in repeatedly with chronic suicidal thoughts and suicide attempts. Through her work with DBT, she went on to become the Director of the Behavioural Research and Therapy Clinics at the university. Her primary research focuses on developing and evaluating evidence-based treatments for those with high suicide risk and multiple major mental health issues. All of this information can be found in the “About The Author” section of her book, “DBT Skills Training Handouts and Worksheets” which is also the book we use in our Dialectical Behaviour Therapy Groups at Alongside You.
Now, let me tell you in her own words why Marsha Linehan developed, and is passionate about her own work in DBT. I happened to have the pleasure of doing some training with Marsha last year in Seattle and she summed up the goal of DBT and her work with clients in one sentence: “To have a life worth living.” I can’t think of a better way to explain the goal of DBT. So many of the people I work with, particularly those who struggle with chronic suicidal thoughts and actions, and multiple major mental health issues have ceased believing that it is possible to have a life worth living. This is my job as a therapist and the job of DBT – that is, to help the people I work with see that it is possible to have a life worth living.
How Does DBT Help Clients?
DBT focuses on four major skill areas: Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. The core of DBT begins with an analysis of each client’s behaviour through chain analysis, and missing-links analysis to find the causes of the behaviours and come up with a plan for problem-solving around these causes. Chain Analysis addresses when we engage in the ineffective behaviour, while Missing-Link Analysis addresses when we fail to use effective behaviours. This allows my clients to be aware of their struggles and plan accordingly in a proactive way.
- Mindfulness skills help clients reduce suffering and increase happiness and control of their own mind. Linehan is a Zen Master and incorporates mindfulness into DBT throughout. However, we don’t have to be Zen Masters to make use of mindfulness skills! There are many ways to practice mindfulness and I encourage my clients to try many different methods and find the best fit for themselves.
- Using Interpersonal Effectiveness skills can help clients develop new relationships, improve current ones and deal with conflict. Many of us struggle with asking for what we want or need in relationships, as well as struggling with how to say no to things we need to. Effective relationships is a core need for all of us in building our support systems and our resilience.
- The goal of Emotion Regulation Skills is to reduce emotional suffering. We’re not saying you should try to get rid of emotions because emotions play a very important role in our lives. Rather, we emphasize working on our skills and ability to manage, regulate, and change our emotions when we have a desire or need to.
- Distress Tolerance is described by Linehan as having the skills to tolerate and survive a crisis situation without making the situation worse. This is important for two primary reasons: pain is a part of life that we cannot avoid, and the ability to tolerate distress is a necessary step in making any changes in our lives. Without distress tolerance skills, the stress of making changes will circumvent our attempts to move forward in a different way. Through Crisis Survival Skills and Reality Acceptance Skills, clients learn to tolerate their distress and make lasting changes in their lives.
Conclusion
While DBT was originally developed to help highly suicidal clients, and those meeting the criteria for Borderline Personality Disorder, DBT is also able to help with other issues. For those struggling with Depression, Anxiety, Trauma, Stress Management, Anger Management, Conflictual Relationships, DBT can be a good choice. If you’re struggling with any of the above issues, using these four core skills of DBT can help you build the core mindfulness skills necessary to remain present in our lives. DBT helps you better manage your emotions and reactions to situations, be more effective in your interpersonal relationships, and tolerate the distress involved in making changes in your life. If you’re dealing with any of these issues, I hope this gives you hope. DBT is not the only solution, but it is a proven, effective solution that produces results!
by Brenna Jacobson | Jul 20, 2016 | Counselling, Group Therapy, Therapeutic Yoga
Revolutionary Treatment for Trauma
Ongoing studies are being carried out in the field of women’s health, which is exciting. I am hopeful that the psychological community will continue to become more open and curious about this “new 2000 year old revolution,” as a positive addition to the traditional treatment for the broad spectrum of traumatic stress injuries. Many practitioners in the field of psychology are embracing Trauma Sensitive Yoga because they are witnessing its positive effect in the treatment of trauma. They see their clients re-connect their physical body to their mind and witness their patients’ previously blocked channels opening up due to Trauma Sensitive Yoga. Clients who were previously unable to articulate their traumatic experience can now do so, allowing the whole treatment process to move forward.
I am inspired and optimistic about the federal government’s involvement through its funding on research regarding the efficacy of Trauma Sensitive Yoga. One of the big obstacles in this process is the stigma around the word ‘Yoga’. In truth, Trauma Sensitive Yoga is the opposite of traditional yoga. The facilitator’s role is to guide the client. The client is in control, free to make his/her own choices every step of the way. It is not about when, but how. Over time through a process that combines yoga interaction, communication, and collaboration, the yoga facilitator and therapist lead the client to a place of inner strength. This all results from the individual’s work that she/he does on him/herself. This is not from what we do for them, but what they do for themselves. Our clients who have survived trauma learn that their body is not the enemy nor is their body at fault. First, they rediscover the body they may have become numb to. Then they befriend their body by learning how to self-regulate. At the end of it, clients rediscover their true self and their inner wisdom.
Clients First
The priorities for Trauma Sensitive Yoga facilitators include putting the client first, providing a safe environment, facilitating appropriate types of exercises (not poses), NOT assisting, teaching qualities, supportive language, and the client’s ability and freedom to make choices.
Yoga facilitator training focuses on working on oneself first – practicing the techniques on yourself, before trying to guide someone else. Empathy is when we come from a place of our own inner power and we can use that to focus on serving others. Yoga facilitators are known for doing this. By bringing into focus our own biases and stigmas, we arrive at a place where we have true empathy for the other person. Being around others that have been through a similar situation can be a life changing experience for trauma survivors. Human beings are complex creatures who find incredible comfort in not being alone. By connecting all the pieces, working as a team, and embracing the inner strength within each of us, we can pull through it. We invite our clients to play a key role in their own healing as this is the whole concept behind holistic healing.
by Brenna Jacobson | Jul 13, 2016 | Counselling, Group Therapy, Therapeutic Yoga
Everywhere I look, Trauma Sensitive Yoga is the hot topic currently in the spotlight. Why the sudden interest in this topic you may ask? The federal government is contributing 1.2 million dollars to a research pilot-project in British Columbia for women in transition, and people are wondering if the costs are going towards a viable solution. The feds are headed in the right direction. After decades of relatively stagnant structure and programs, the federal government is finally realizing there has been a vital missing link in past approaches to ‘holistic’ healing in western society. We have been ignoring an essential part of the healing process, the physical body.
Treating trauma involves treating the whole person. Specifically in the treatment of trauma, Registered Yoga Therapist (RYT) David Emerson and Dr. Bessel van der Kolk, renowned researcher in Post Traumatic Stress Disorder (PTSD), have collaborated since 2003. They have been developing the Trauma Sensitive Yoga program in the Trauma Centre at Justice Resource Centre, Brooklyn, MA.
A Solution for Many Traumatic Conditions
Trauma Sensitive Yoga is designed to help heal women who’ve been through domestic violence as explained in the recent article from CBC, Wednesday June 22, 2016. However, Trauma Sensitive Yoga has been known to help a broader audience. Those who benefit from Trauma Sensitive Yoga include: survivors of rape, childhood abuse, neglect, mental abuse, war vets, and at risk youth just to name a few. This process is even able to help people in other areas we might not usually think of as trauma, such as women with fertility problems.No trauma is more important than another. All traumas are alike where we feel disconnected from our true self. People with trauma feel a sense of powerlessness and lack of control over their outcomes
Although we may not like to admit it, we are all victims of circumstances in life. Our misfortune could be caused by certain events such as trauma, the ‘Frustration Cycle’, or our inner wisdom being clouded by buried false beliefs about ourselves that are negative and self-destructive. According to the International Journal of Yoga Therapy, No. 19 (2009):
Traditional trauma therapy is talk-based and focuses on the mind, the story, tending to neglect the physical visceral and body-based dimension of trauma. An essential aspect of recovering from trauma is learning ways to calm down, or self-regulate. For thousands of years, Yoga has been offered as a practise that helps one calm the mind and body. More recently, research has shown that yoga practices, including meditation, relaxation and physical postures, can reduce autonomic sympathetic activation, muscle tension, and blood pressure, improve neuroendocrine and hormonal activity, decrease physical symptoms and emotional distress, and increase quality of life. For these reasons, yoga is a promising treatment or adjunctive therapy for addressing the cognitive, emotional and physiological symptoms associated with PTSD specifically.
In a pilot study done at the Justice Resource Centre on the effectiveness of yoga on PTSD symptoms, there were findings that state some of the findings state that,“After eight weeks, the yoga participants showed improvements in all dimensions of PTSD, an increase in positive affect and decrease in negative affect, and an increase in their physical vitality and body attunement.”
According to Dr. Jeff Morley, a registered psychologist for the Canadian centre for Police and Emergency Resilience, PTSD is no longer being classified as a mental ‘disorder’ but will be recognized as an involuntary injury. This gives rise to a more expansive umbrella for the injury. New more inclusive terms such as Post Traumatic Stress Resilience (PTSR) and Post Traumatic Stress Injuries (PTSI) are more accurate at describing what people are going through.
by Andrew Neufeld | Jun 16, 2016 | Counselling
In part 1 of this post, “The problem with the lack of governing body in counselling,” shows why it’s important for all counsellors to meet the professional standards and ethical requirements for counselling. People have the right to know the counsellor they’ve chosen come from a background of qualified counselling. These qualifications can come a degree, or some form of proof attendance and completion of school. Clients can then rest assured the counsellor of their choice sufficient knowledge in their field. All counsellors should have proof that they’ve spent sufficient time in researching and learning the methods of clinical practice.
What To Watch Out For When Choosing a Counsellor in British Columbia
Understanding what to look for when choosing a counsellor is super important. The emerging trend of something called “competency based counselling” is incredibly troubling. “Competency based counselling” suggests that life experience and a little bit of training is an adequate substitute for years of schooling, ongoing professional development, and clinical supervision. There are a number of organizations being formed right now based on this idea. The scary thing is these organizations look every bit as official and professional as their authentic counterparts. Especially to those who don’t know the counselling profession that well. It is very important to know that these organizations aren’t regulated for meeting standards that the BCACC, CCPA, and BCAMFT do.
Here’s a question for you: would you be comfortable going to seek medical advice or treatment from someone who hasn’t gone to medical school? Most likely not. Based on the “competency based” approach, someone who has worked alongside doctors and completed a few courses on medical issues would be equal to someone who has completed medical school. This is precisely what some of these “competency based” organizations are suggesting you should do for counselling. This is not okay. It is completely unethical.
Counsellors are specially trained to work with people who are going through some of the most difficult experiences in life. Further, our work has a direct impact on thought processes, social relationships, daily functioning, and a lasting physiological effect on the brains of our clients. There are quite literally thousands of studies documenting brain changes based on psychotherapy. This is not something to be taken lightly – working with a counsellor has the potential to affect your brain chemistry. This is why it is so important that your counsellor has proper training and experience before you allow them to significantly influence your life.
What To Look For In A Counsellor
The first thing I would look for in a counsellor is that they are a member of one of the three organizations mentioned previously (BCACC, CCPA, BCAMFT). If you are seeing a Psychologist, make sure they are part of the College of Psychologists of BC. This will assure that they have met the minimum requirements set out by counsellors and/or psychologists who have been practicing in the field. It also protects you because they are under obligation and held accountable to meet ethical standards.
If a counsellor is not a member of one of these organizations, I would question their qualifications. Sometimes, a fresh graduate with a Masters degree or Ph. D may be waiting to hear back from their application or have to take additional courses to meet criteria differences between countries. Aside from these reasons, every counsellor or psychologist should be part of one of these three organizations.
Questions To Ask Your Counsellor
Sometimes it is hard to know what type of questions to ask. You might want to find out if a counsellor’s training is adequate. Or what their experience is. Or if they are going to be a good fit for you as a client. Here are a few sample questions you can ask any counsellor. These are designed to help you get information on their training, clinical background, and whether they are what you are looking for:
- Where did you get your training? What were your undergraduate and graduate degrees in?
- Where were your practicum / internship placements?
- What professional training have you completed after graduating?
- Do you currently have a Clinical Supervisor? If not, why not?
- What is your experience in professional practice? What settings have you worked in (Hospitals, Outpatient Clinics, Private Practice, Other)?
- What experience do you have working with the issues I am dealing with? How long do you think it will take to see change?
- What made you decide to become a counsellor and what are you passionate about in your work?
The last question may seem strange. However, so much of effective counselling relies on the personhood and humanity of the counsellor. Always ask your counsellor questions that relate to their education, training, and clinical experience. The most overlooked but equally important question is “Why are they doing this? Are they in it to help clients move forward in life?” In my experience, clients who ask these questions gain a better insight of whether or not the counsellor-client relationship will be a good fit.
Closing Thoughts
I hope this article helps you in choosing the right counsellor. It’s important to know what to look for and what to be careful of in order to be a wise consumer. Registering body like the BCACC, CCPA, BCAMFT, or College of Psychologists of BC help professionals stay on top of their profession, education, and ethics. It also provides clients with reassurance that the professional has met certain standards and are reliable professionals. “Counsellors” who don’t meet these standards, or believe in “competency based” may have the good intentions but they lack the expertise of someone who has spent years in school.
You want a professional that has gone through adequate learning, practice, and who complies to the regulation of a professional body. A professional who meets these requirements have your best interests at heart. Not someone who claims to but does not want to go through the necessary schooling or training for the profession. It is my hope that this article helps clients feel confident in their ability to make wise decisions in their counselling journey. As well as encourage professionals to maintain the highest standards of professional practice in our desire to help others.
To learn more about the professional bodies, please check out their respective websites.
BC Association of Clinical Counsellors (BCACC)
http://bc-counsellors.org
Canadian Counselling and Psychotherapy Association (CCPA)
https://www.ccpa-accp.ca
British Columbia Association for Marriage and Family Therapy (BCAMFT)
http://www.bcamft.bc.ca
by Andrew Neufeld | Jun 9, 2016 | Counselling
Two of the most frequently asked questions I get from people is, “How do I choose a counsellor?” and “How do I know what to look for when I’m choosing a counsellor?” These are very important questions I’m always happy to answer. Nowadays it’s critical to be a wise consumer of mental health and other counselling services. Especially since not all services or service providers are the same. Be careful of the options in the community that look “official” but the counsellor is not actually professionally qualified.
The Problem with the Lack of Governing Body in Counselling
One of the biggest problems in British Columbia is that there is no College for counsellors. A College is a regulatory body, established in the province of British Columbia to regulate a profession. The College abides by the Health Professions Act, or in the case of Social Workers, the Social Workers Act. The lack of a College for counsellors is a problem that counsellors have been trying to fix for over a decade but have not been able to for many reasons that are beyond the scope of this article. Doctors, social workers, nurses, and psychologists all have a College that is regulated by the province with specific entrance requirements, ethical standards and ongoing training requirements. These requirements ensure that anyone calling themselves a doctor, social worker, nurse, or psychologist have met these requirements (assuming they can prove registration with the college). While no system is perfect, you can at least be assured that certain minimum standards are maintained in professions that are regulated under a College.
Not having a College for counselling profession in British Columbia is a major problem. Think about it. You could literally drop out of high school, put up a sign, and call yourself a counselor. There is absolutely nothing illegal about this, and quite frankly, this happens far more frequently than it should. This is why it is very important to know what degrees and credentials to look for when you’re choosing a counsellor.
The Current Solution – Self Regulation
Thankfully, we have a solution called self-regulation. It’s not a perfect solution but it’s the best we can do for the time being. There are three major registering bodies for counsellors in BC that are responsible for self-regulation in counselling. They are: the BC Association of Clinical Counsellors (BCACC), the Canadian Counselling and Psychotherapy Association (CCPA), the British Columbia Association for Marriage and Family Therapy (BCAMFT). These organizations were created by counsellors in the profession who wanted to ensure a minimum level of professionalism was met. The minimum level of professionalism includes meeting mandatory education requirements and ethical standards. Self-regulation means there is a complaint process for the public that ensures accountability. The regulating bodies also require ongoing education where counsellors continue their education on the latest research and treatment methods.
All of these organizations require a minimum of a Masters degree in the field of psychology, completion of practicums/internships, and guidelines for ongoing supervision while in clinical practice. Certain requirements must be met to be covered under professional liability insurance which acts to protect the interests of both counsellors and clients.
How Does This Affect You?
Just as in any other profession, it is necessary that counsellors meet professional standards and ethical requirements. Our clients should have confidence that their counsellor has gone through proper training. Proper training includes time spent at school learning counselling theory, conducting research, and practicing the methods of clinical practice that have been shown to be beneficial to clients. Counsellors should have gone through professional training via internships where they were supervised by counsellors who have been in the field for many years. Training under such guidance can enhance their learning and practice so they become effective at helping others.
It is essential to have professional standards for ongoing supervision and accountability. These standards validate a counsellor’s commitment to ongoing learning. They also serve as a source for counsellors to seek help from when they need additional insight into the difficulties of their clients. Professional standards and regulations help ensure counsellors are always acting in the best interests of their clients and always doing so in an ethical manner.
Finally, it is important to have a process in place for complaints. This provides clients with a method for recourse if they feel a counsellor is not acting ethically. This insurance helps protect both clients and counsellors. Especially in cases of legitimate claims or false allegations. Without a governing body, there is no oversight for these very important areas.
Our next article will explore what to look for when choosing a counsellor. There are certain things you need to watch out for and specific questions you should be asking. There is a lot at stake. Your mental health and the mental health of your loved ones can be deeply affected by the counsellor you choose to see.
Update: Continue to Part 2 of the blog – The Difficulties with Choosing A Counsellor in British Columbia – Part I
To learn more about the professional bodies, please check out their respective websites.
BC Association of Clinical Counsellors (BCACC)
http://bc-counsellors.org
Canadian Counselling and Psychotherapy Association (CCPA)
https://www.ccpa-accp.ca
British Columbia Association for Marriage and Family Therapy (BCAMFT)
http://www.bcamft.bc.ca
