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.
It can be difficult for a parent to watch their child struggle with big worries. As parents, we want to be able to fix our child’s problems – preferably this would happen quickly and easily. If we can’t fix what concerns them (which we often cannot), we are left to support the child through their anxiety. This may sound simplistic, but I assure you, it’s not. Parental support is vitally significant for the child, and often, empowering for the parent. As the saying goes — a good parent prepares the child for the path, not the path for the child. Approached with gentleness and kindness, encouraging support can be a great gift to their developing identity and self-confidence.
Practical Ways Parents Can Support Their Anxious Child’s Wellbeing
Children require consistent, predictable routines in order to flourish1. These don’t have to be rigid or excessive, but a general structure for the course of a day allows a child to predict what comes next, and to prepare for it. For example, create a rhythm to the bedtime routine that becomes so predictable and soothing that it lulls the child to sleep (figuratively speaking). When a child knows what time they go to bed, and the events that lead up to it, they can begin to gear down and relax, knowing that the adult in charge will be helping this process the same way every night. Avoid screen time two hours prior to bedtime as the emitted blue light inhibits the release of melatonin (the hormone responsible for sleep cycles and circadian rhythm).2 Instead, read books together, discuss a moment of gratitude, ask questions about their day, or speak words of affirmation to your child.
During daytime hours, a child’s pace of life should be slow and sustainable. Children need plenty of time for play and quiet exploration.3 Children who are expected to run at a pace that is beyond their capacity may experience an increase in anxiety. As an adult, you may have a clear perspective on what is manageable for your child. They may be excited to join five different sports teams this fall, but you are the one with the foresight to understand that, within a short time, this may lead to them feeling overwhelmed. This, of course, evolves as children get older, and every child is truly unique in what they can tolerate – much like their adults!
Lastly, create space in your day (or week) to connect with your child. Follow your child’s innate interests and spend one-on-one time enjoying what they do.
Some ideas to get you started:
If they’re interested in food, bake cookies
If they love sports, kick a soccer ball around, just for fun
If they enjoy physical activity, go on a bike ride or for a walk
If they’re into music, listen to a new song they’re excited about and show them what you know on the guitar or piano
If they’re interested in mechanics, have them help you change the oil, or open the hood of the car to look around together
Intentional investment of time spent with your child will pay dividends when it comes to their behaviour, but more importantly, to their sense of belonging and connection. The attachment that is formed from these positive connections bolster a child’s confidence to face the world, and increases resilience to stress.4,5,6
Ways Parents Can Emotionally Support Their Anxious Child’s Wellbeing
Emotional support is an extension of practical support. A parent may become overwhelmed by their own feelings (of guilt, or frustration, or panic) when they see their child in the throes of anxiety. It may be important to take a moment to check in with yourself before running to the aide of your child. First, accept that your child is feeling anxious, and notice your own feelings about this. Give yourself some time to regulate your own emotions. When you feel ready, approach your child to validate their feelings, and to name what you see happening for them. For example, “I see that your fists are clenched and your eyes are wide. These must be big worries for you.” Sit with them as they feel the weight of their worry without trying to rush them, or brush it off. Once the child has walked through the experience of their big feelings of worry, re-direct them to calming activities.
Some ideas to get you started:
run a warm bath
go for a walk together
somatic breathing exercises
progressive muscle relaxation
Lastly, show your child that you, their hero, can make mistakes, do hard things, go on to survive the experience, and thrive. It can be very helpful to practice self-compassion in a way that is visible to the child.7 For example, if you find yourself running late at the school drop-off, model taking a few deep breaths, smile, and acknowledge, “Wow, we sure are running late today! I can’t get it right every day though, and that’s okay! Today we might be late, but maybe tomorrow will be different.”
It can be soothing for a child to observe their parents set boundaries that guard their own time and self-care in fact, it reinforces that it is acceptable for the child to do the same.
If you or your child would like to come in to discuss their big worries, or yours, please contact us and we would be happy to help! I’d love to work with you while I complete my internship. We also have a whole roster of Registered Clinical Counsellors available to work with you as well.
Spagnola, M., & Fiese, B. H. (2007). Family Routines and Rituals: A Context for Development in the Lives of Young Children. Infants & Young Children, 20(4), 284–299. org/10.1097/01.IYC.0000290352.32170.5a
Fletcher, F. E., Conduit, R., Foster-Owens, M. D., Rinehart, N. J., Rajaratnam, S. M. W., & Cornish, K. M. (2018). The Association Between Anxiety Symptoms and Sleep in School-Aged Children: A Combined Insight From the Children’s Sleep Habits Questionnaire and Actigraphy. Behavioral Sleep Medicine, 16(2), 169–184. https://doi.org/10.1080/15402002.2016.1180522
Mrnjaus, C. (2013). The Child’s Right to Play?! Croatian Journal of Education, 16(1), 217-233.
Neufeld, G., & Maté, G. (2004). Hold on to your kids: Why parents matter.
Priest, J. B. (2013a). Anxiety disorders and the quality of relationships with friends, relatives, and romantic partners: Anxiety disorders and relationship quality. Journal of Clinical Psychology, 69(1), 78–88. https://doi.org/10.1002/jclp.21925
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books
Neff, K. (2013). Self compassion. London: Hodder & Stoughton.
Last week, Andrew wrote a blog about the logistics of getting counselling for your child, I would like to provide some insight into what happens inside the counselling room. I absolutely love working with children. I find it challenging, inspiring, rewarding and unique. Often folks ask me “So, does the child just sit on a couch and tell you how they are feeling, does that even work with kids?” I chuckle and assure them that counselling with children is going to look very different than counselling with adults.
Enter PLAY therapy.
What Is Play Therapy?
I believe that play therapy is the most developmentally appropriate therapeutic approach for children. I feel that it is doing children a disservice if we ask them to communicate their inner world the same way we ask adults, which happens primarily through talk therapy. Children do not have the same cognitive ability as adults, therefore, play therapy bridges the gap between concrete experience and abstract thought.1 Play therapy provides the opportunity for children to express their feelings and thoughts in a way that is familiar to them because typically children love to play.
To this, some might question, “Are you just playing then?” The answer is unequivocal, “No, quite the opposite.” There is much meaning in play; Froebel says, “children’s play is not a mere sport. It is full of meaning and import.”2 Play is the natural language of children. Play is the way children communicate. Garry Landreth says, “toys are used like words by children, and play is their language.”3 While engaging in play therapy, the child uses the toys in the room to communicate thoughts, experiences, situations and feelings.
My Approach To Play Therapy
Each counsellor who works with children has a different way of engaging with the child through play therapy. For myself, I adopt a posture of curiosity; I want to see the child’s world through their eyes. Typically, the first session is about establishing trust and rapport, just like a session with an adult client. Personally, I find sitting on the floor and meeting the child at their level is helpful. I have a box of fidget toys that I have available on the floor or table, these are for the child to squish and fiddle with as we talk and play. Often if a parent is in the initial session, I will encourage the parent to use a toy too.
In order to help facilitate the sometimes awkward first meeting jitters, we play Getting to Know You Jenga. This is a tower building game with a twist – each block has a question. The child is encouraged to answer the question and this helps establish a rapport and points of connection. One of the things that never ceases to amaze me is the child’s ability to direct the conversation to the areas that are needed to be focused on. This is modelled in the way that child answers the questions and, in turn, ask me questions. When I have my initial meeting with the parent, I often share that my trust needs to be earned. Often a child might share a small piece to “test the waters” and see if I am paying attention. Like playing pass with a ball, I need to catch what they have shared with me and convey to the child that I have heard them.
What Is A Play Therapy Session Like?
Each play therapy session can look different. For me, I am all about the feelings. It is vital for children to grow up with a greater understanding of their feelings and learn healthy ways to express their emotions. I try to incorporate as many different modalities as I can. Sometimes it might be colouring pictures of feelings and emotions, other times it is outlining their body and drawing where they feel that emotion. Other times it is playing in the dollhouse and sharing about their family. There are incredible books that provide wonderful language for children as they process their feelings. One of my favourites is In My Heart, which beautifully describes some of the many emotions that are found in our hearts. For the more active children, we can play catch and answer questions back and forth. I really try to tailor the activities to the likes of each child.
One of my favourite ways to work with children is through the use of the sand tray. Picture a mini sandbox complete with figurines to play with. The child is encouraged to use the sand tray to create a scene. The child can build a magical world or perhaps create a scene that is more realistic. The beauty of the sand tray is that often it is a way to visibly show what a child might be feeling internally. As the child creates, depending on the preference of the child, I am asking questions and gaining insight or silently attending to what they are sharing with me.
How Can Play Therapy Help My Child?
Just the same as adult counselling, when I am in the room with a child, it is my desire to provide empathy, congruence and unconditional positive regard, as these are the core conditions that help to facilitate change.5 I truly believe it is the relationship with the therapist that helps to promote growth and healing. However, that does not negate the important role the parent plays in the relationship. When a child has shared something significant or created something powerful, I encourage the child to invite the parent into the room to see and learn together. As I remind the child, we only see each other during sessions, but you see your parent more. I want the parent to be well equipped to take the themes and language that was spoken during the session and translate that to home. I want to thank you, parents, for trusting me with the most precious gift: your child. I want to work with you in order for a child to learn, grow and develop into a confident and healthy person.
Although the mediums used in play therapy are often very fun, many times, the work that is done in play therapy is difficult – children work hard at expressing and understanding their big feelings. It is my role to help facilitate these discoveries through conversation and play. Play therapy can be a powerful experience where great changes can happen for our kids – changes that may not happen without the freedom and safety of the play therapy sessions. Play therapy is a place where children get to be who they are at their core and have that be ok and celebrated. A place where they can explore difficulties in life in a safe, supported way.
Working with children is a privilege and one I do not take lightly. If you are interested in learning more about play therapy or setting up an appointment for your child, please do not hesitate to contact me through our website.
Bratton, S. & Ray, D. (2000). What the research shows about play therapy. International Journal of Play therapy, 9, 47-88.
Froebel, F. (1903). The education of man. New York: D. Appleton.
Landreth, G. L. (2012). Play Therapy: The art of the relationship. Third Edition. New York: Brunner-Routledge.
Piaget, J. (1962). Play, dreams, and imitation in childhood. New York: Norton.
Rogers, C. (1951). Client-centered therapy, Its current practice, implications, and theory. Boston: Houghton Mifflin Company.
We’ve been receiving more questions about counselling appointments, and particularly appointments for children with a Registered Clinical Counsellor. So, we thought we’d write another article to address some of the things that are unique about counselling appointments for children. I won’t repeat the details of the last article, so you may want to read that one first, and continue here.
Consent and Confidentiality in Counselling for Children
Consent to Counselling
One of the questions we get asked is, “Who can consent to treatment, and can my child consent?” This is a bit of a tricky question in some situations, particularly around parental separation and divorce. I’ll save the intricacies for another article, but in general, one or both parents need to consent for their child to see a Registered Clinical Counsellor. If there are no court orders involved, either parent can consent but we always like to get both parents to consent, and also to provide history and input because we believe it’s in the child’s best interests to operate this way in most situations. The more information we can get and the more support the child can get, the better off everyone is.
In terms of when a child can consent to their own counselling, there is no black and white line drawn in BC in terms of the age at which a child can consent. One of the most commonly-used ages is 14 and is generally accepted by most service providers. If, however, you can make an argument that the child is what is called a mature minor, the child can consent as early as age 12, or possibly earlier as long as they understand what they are consenting to. In most situations, we use the age of 14 as a guideline here at Alongside You.
Confidentiality in Counselling for Children
Many parents find it unnerving to send their child to counselling when they are not in the room to witness what is happening and being said. As a parent, I can easily understand this anxiety – I know I want to know what is happening for my kids all the time! Here’s the challenge – counselling relies on a safe, secure relationship between the client and the counsellor built on trust. If the child thinks the counsellor is going to turn around and tell the parents everything they are saying, what are the chances the relationship of trust will survive? Probably not very high.
Every Registered Clinical Counsellor at Alongside You is responsible for their professional practice and so there may be some variability in how much input from parents is sought. What I would suggest is that most counsellors will seek to collaborate with parents as much as possible, with the best interests of the child in mind. The degree to which information is passed, however, is going to depend on the comfort level of the child and the strength of the therapeutic relationship with the counsellor. It will also depend on the counsellor’s judgement of what information would be helpful to pass on. If there is a suspicion of imminent risk to the child, confidentiality can be breached without consent, but this is a judgement call on the part of the counsellor and up to their professional discretion. I know this involves a great deal of trust on the part of parents, and it is not lost on us as professionals. We want the best for your kids and will hope to strike the greatest balance between these needs to help your child.
Who Comes To The First Appointment?
The answer to this question really depends on the age of the child, or what the child wants. For younger children (i.e. approximately 12 years old or younger), it’s quite common for the first session to be with the parents alone to get some history and background and answer any questions or concerns. This first appointment can also be split between the parents and the child, at the counsellor’s discretion.
For older children, it’s likely going to come down to what the child wants. If the child wants the parents to come into the first session, then that’s likely what will happen. If, however, the child wants to come in alone, it’ll likely be just the child in the session. This is to build trust between the counsellor and the child and allow them to establish boundaries around safety and trust.
How Can I Help My Child While They Are In Counselling?
Encourage Your Child
Going to counselling can be scary for anyone, and it’s a lot to take in for a child. One of the best things you can do is to be encouraging. Let your child know that this is a time for them to have a safe place to talk about what is happening for them. Emphasize that this is an opportunity to work through some of the difficult things in life, it’s not a place to go to get fixed because there’s something wrong with them. They are wonderfully made human beings who sometimes need a little extra help.
It may also be helpful to let your child know that you’ve gone to see a counsellor before and share how it helped you, in as much detail as you’re comfortable with and as is appropriate for the age of your child. Common experience and reassurance can go a long way.
Avoid Interrogating Your Child After The Session
I get it – you want to know what happened. We all do as parents. But, it’s not going to support the process if the child then worries about being interrogated after coming out. Instead, a helpful question can be, “Is there anything you’d like to tell me about your time with the counsellor?” Realize that answer may be, “No,” and this needs to be okay. You want to give your child the opportunity to share their journey with you, not make a demand that they let you in if they’re not ready to do that yet.
Understanding The Reports You Get Back
We all love our children, and we want to believe everything they say. I remember when my parents would ask me what I did at school, invariably, my answer each time was, “I played and had a snack.” I, of course, didn’t do this, and this only every day at school. I was a very forthcoming child apparently. I also know, that what kids report back to parents isn’t always accurate (the same goes for adults), or the full story. This isn’t intentional necessarily, it’s just how our communication patterns work. I remember a client that I was doing EMDR with one time had gone home and told their parents that we had been doing ECT. Yes, that ECT that involves significant electrical charges to the brain in a hospital setting. Thankfully the parents called me to clarify and assumed that something got lost in translation. I’ve also heard clients tell parents, “All we did was talk about boring stuff,” or, “All we did was draw a picture.” While some of this may be true, there’s usually a lot more to the story.
It’s helpful if we all start with the assumption that the counsellor has the best interests of the child in mind and that we may not be getting the whole story when we get it from our child. Be curious, ask general questions, and if you have any concerns, contact the counsellor to clarify.
Trust The Counsellor and Your Child
I know it’s unnerving to trust someone else with the care of your child. I get that on both sides, as a Registered Clinical Counsellor and as a father of two young girls. Again, trust goes a long way and goes both ways in the relationship between parents and therapists. We want what’s best for your child, and we’ll do whatever is possible to help. Sometimes this involves us not divulging information you may want to know, and sometimes that may be unnerving for you.
We want to include you in any way we believe will be helpful for your child and your family. This sometimes takes time to develop, understand, and plan for. Your patience is much appreciated, as is your commitment to a process that may have you feeling like you’re standing on the outside at times.
Thanks for reading to the end! I hope this helps with some of the questions you may have about the first appointment with a Registered Clinical Counsellor for your child, and a bit about the ongoing process. Sending your child to a counsellor for the first time can be nerve-wracking, and challenging at times. Please feel free to ask any questions you like as you’re booking, we’ll answer them as best we can!
I remember my first counselling session. I was pretty freaked out. I didn’t really want to be there. I didn’t know what to expect. I think that last part was what made the situation difficult – I’d never been before, I didn’t know anyone who had seen a counsellor before, so I was completely lost and anxious about it.
I saw a new client yesterday and this reminded me of my own first experience seeing a counsellor. This client had never been to counselling, had no idea what to expect, and I could see that there was definitely some anxiety about the whole situation.
While every counsellor will be different in their approach, I thought I’d write an article about what to expect and how to make your first session as successful as possible when you meet with your Registered Clinical Counsellor for the first time.
Here at Alongside You, your first interaction will be with our front desk staff who will explain much of the administrative details that you’ll need to know, give you recommendations on which of our counsellors might be the best fit, and help to book your first session. After that, they will send you our online intake form to fill out prior to your appointment. This helps us take care of the necessary paperwork ahead of time, and also helps our counsellors get an idea of what you’re coming in for and some details before you arrive.
When you arrive, you’ll enter the waiting room to wait for your appointment. We have a self-serve waiting room, so please feel free to help yourself to water, coffee, or tea and take a seat. We want you to be as comfortable as possible! If you have any questions before your appointment and it’s during our reception hours, feel free to wander toward the back and speak with our office staff, they’ll be happy to speak to you.
Once your appointment time arrives, your counsellor will come greet you in the waiting room, and invariably, probably offer you another drink. Feel free to get a refill, they’re free! Now it’s time for the main event. Your first appointment with a Registered Clinical Counsellor.
Each counsellor will have a bit of a different interview process to start out your work together, but remember, they need to get to know you and also, you need to get to know them for the relationship to work. The first appointment will be about building the relationship and getting to know each other.
Here are some areas that I usually ask clients about at our first session to get to know them and how I might be of help. Again, every counsellor will be different but a lot of these questions are fairly common to ask new clients.
Things A Counsellor Might Ask You At The First Appointment
Personal and Family History
I like to know what life was like growing up, and how clients got to where they are today. This can be a short or lengthy discussion. As a marriage and family therapist by training, I believe that our personal and family history have a strong influence on our development and I like to know how people came to be where they are now. I usually suggest that clients tell me their story – however, they want to tell it – in as much or a little detail as they feel comfortable.
Mental and Physical Health History
I like to know the history of a client’s mental and physical health. What has your health been like throughout their life? Do you deal with any chronic mental or physical health conditions? Does anyone else in your family deal with any of these conditions?
Another question I often ask is, “When is the last time you saw your family doctor? When is the last time you got a checkup and bloodwork done?” This may sound overly-medical for a counsellor to be asking, but it’s important. If you’re coming in because you’re feeling depressed, anxious, or otherwise, I want to make sure that there isn’t a physiological problem at the root of your symptoms. There are many physiological issues that have symptoms that can masquerade as psychological or psychiatric issues. If you are dehydrated, have a thyroid imbalance, your blood sugar is off, iron is low, etc., these can all cause symptoms that look like a mental health issue. The last thing I want for you is to treat something as psychological if there’s a physiological cause.
Now, these areas not mutually exclusive conditions either. You may have a physiological issue and also be struggling with a psychological issue. We want to cover all of our bases.
What Brought You To Counselling
This may seem like an obvious question, but it’s also an important one. We all struggle with various things in life, it’s the joy of being human. I want to know what it is that brought you in today, what are the challenges, how did they start, and my favourite question, “Why now?” What made you decide to come get some help now, particularly if this has been an ongoing thing for a while. This question is important because it clarifies what is the key issue that you are experiencing, and what your motivation level is, and what is specifically motivating you to get help now.
How To Measure Success
I often ask clients, “If this works, what will be different?” I want to know what your goals are and how they’ll gauge if counselling is a success. This both handles the goal setting, and how to find out if the counselling process working. My goals and metrics may not be what my client is going to use. I want to know what your gauge is. This doesn’t mean I don’t have my own tools and metrics for the process (I do), but it gives us a common language to monitor the relationship and the process on an ongoing basis. It helps us answer the question I ask pretty regularly with clients, “How’s this going for you? Is this helpful?”
What Do I Need To Know About You For This To Work
We are all special little snowflakes. We have our idiosyncrasies, oddities, preferences, hot button issues, and more. I’m no different. I want to know what is going to help you in the process, help us build the relationship, and help you feel safe and supported while trying to avoid things that do the opposite. Some people need a very gentle approach, others need a straight shooter. Some are very wary of a particular gender because of past experiences, others aren’t. I want to know these things so I can be the best help I can be for you.
I remember my first appointment with my current counsellor about 7 years ago. As you might imagine, I can be picky about my counsellors, and I’m also pretty headstrong and assertive. I know what I need in a counsellor. So, I sat down in his office and said, “Here’s what you need to know about me if this is going to work. I need someone who isn’t afraid to call me out on my crap. I need that, and I respond well to it. If you can do that we’ll get on famously, and if you can’t, no harm or foul, I’ll give you your money for today and be on my way.” I know myself and know that if I’m matched up with a counsellor who is softer and non-confrontational, I’ll be able to get away with things and manipulate the conversation easily and this won’t help me. I need accountability.
Things To Know About Counselling As A Client
As a Registered Clinical Counsellor, I want your experience to be as positive and helpful as possible and I know I can speak for the whole team here at Alongside You on this one. It’s important to know, however, that counselling is a team effort. Counsellors aren’t magicians with a magic wand that can fix all that ails you. The process works through the development of a safe therapeutic relationship and a joint effort to move forward. Here are a few things to keep in mind as you start your counselling journey.
Your Counsellor Cannot Read Your Mind
Some of you who have been to counselling before may laugh at this, and I know that I’ve had clients who were relatively convinced I had this magical power based on some of my interactions with them. We have intuition, not mind-reading powers. What this means is, it takes two active participants in a counselling session to get to where we’re trying to go. If you’re not an active participant, the process is very difficult if not impossible.
Being Open and Honest Are Important
We know this is a big ask of you. It’s not easy to sit down with a stranger and talk about the difficult parts of life. The counselling process needs this, however. If we can’t be open with each other, we can’t work together and create a safe space to wrestle with life. It’s not all-or-nothing, however. It takes time, and you don’t have to be an open book from the first minute. Build the relationship, and share as you do so. We’re in this together.
Try To Know What It Is You Want From The Session
This is sometimes a difficult one. I know that I often struggle to know what I want out of a session with my counsellor, but part of that is because I have a standing appointment that I go to every month regardless of how I am feeling that day because that’s what works best for me. Some of the questions I’ve outlined above can also be used on an ongoing basis to figure out goals and focus points, but it’s always helpful when clients know what they want to focus on in the session. It helps keep the process on track.
Ask The Counsellor Questions
Sometimes clients are surprised when I turn the tables and ask them if they have questions for me! As I mentioned above, counselling is a two-person endeavour and process. If I need to get to know you, it only stands to reason that you should get to know me as well. Ask away! The fit between a counsellor and client is important and getting to know each other helps us figure out if we’re the right fit. I always encourage clients to ask whatever questions they want, with the caveat that I may choose to decline to answer questions of a personal nature if they go beyond what I choose to reveal to clients about myself or my personal life. Every counsellor is different in this area but feels free to ask. You may want to ask about experience, qualifications, approach, personality, or things like hobbies, etc. It’s up to you and your counsellor to navigate how best to get to know one another.
Give The Counsellor Feedback
I always tell my clients, and then remind them periodically, that I need their feedback. Going back to my inability to read minds, I need feedback to know if we’re on the right track, if I’m focusing on the right things, and if things are helpful. Sometimes clients are afraid to tell the counsellor if they feel the process isn’t going in the direction they want or isn’t working. I absolutely want to know these things. I’d rather find out that something is off than continue believing all is well only to find out after the fact that it wasn’t helpful. I also want to know what is working so we can do more of that!
Counselling Is A Journey
I know that going to see a Registered Clinical Counsellor for the first time can be anxiety-provoking. I promise it’s not as scary, and we’re not as weird as you might think. We’re just regular people too, who have some training and experience to help you through some of life’s challenges. If we keep some of the above in mind and are open with each other, we can find a path through the challenges and help you thrive!
Feel free to give us a call or send us an email through our contact form if you have any more questions. We’re happy to answer them! Have you been thinking about taking the first step in seeing a counsellor? There’s no time like the present – take the first step, that’s the hardest part. It gets easier from there.
I never thought that I was a perfectionist growing up. The state of my room at any given point in time seemed to be an indication of my lack of perfectionism. As I grew older, however, I started wondering about it. At the same time, I also didn’t really know what it was. So, I continued on and forgot about it.
Fast forward to the present day, and again I’m wondering about it. Anyone close to me knows that I’m pretty particular about things, and often have a specific idea of how things need to be. If you visit our office, you’re likely to see some of that in action. As I worked on my car this morning, I noticed it creeping in. My fun car, a 1997 BMW M3, is now 22 years old. It has squeaks and rattles. It’s well maintained, but even so, if I’m working on the engine and I notice a sound that doesn’t seem quite right, it’s incredibly easy for me to obsess about it, rather than accepting that it’s a 22-year-old car that is going to have some strange sounds at times.
It even creeps into work. Shocking, I know. When we first started, we set out to fill gaps in services, particularly in counselling in Delta. The reasonable person would know that we were flying by the seat of our pants many times, trying things that didn’t work, and revamping again. Truth be told, as we’ve expanded and branched out far beyond counselling, we’re still figuring it out as we go along. I think this is actually a good thing because we’re trying to figure out how to help people in new, creative, and needed ways. It just doesn’t sit well with my perfectionism most of the time, and as I’m writing this, I also think this has a lot to do with the anxiety I often feel around work.
My counsellor and I were talking about this last week, and he gave me a really helpful handout on perfectionism that he’d come across, which you can read here. Addressing the full topic of perfectionism would take far longer than this blog post, so I want to give you some bullet points that I’ve noticed in my own life with perfectionism, and also what has helped me – and I hope that it helps you!
Three Signs That You Might Be A Perfectionist
You care deeply about everything, even things that really don’t matter much.
Don’t get me wrong, caring is a good thing. Particularly as a counsellor, caring is important! Here’s the thing though – we need to care about things at an appropriate level. The difficult part is knowing what that appropriate level is, especially if you’re a perfectionist.
You have unrealistically high standards, in almost everything you do.
High standards are a good thing. It’s something that I actually appreciate about myself, and usually, something people appreciate about me. The problem comes when our high standards become impossible One of my battles is that it is impossible for me to know about, account for, and control all of the details in a rapidly growing clinic. It was much easier when it was just me, Meg, and a couple others at the beginning. If it goes on for too long, it’s easy to get frustrated and just stop caring about anything, which doesn’t help either!
You have a difficult time with criticism.
I don’t know anyone that likes criticism and coupled with the fact that most people suck at giving constructive criticism, it’s a difficult thing for many people to handle. It’s very difficult for perfectionists because it flies in the face of their standards, their view of themselves, and their views of their accomplishments. How do you feel when someone offers constructive criticism? Does your body respond in revolt? Do you immediately go to justification and finding ways to fight back?
These are only three of the many signs of perfectionism you may notice in yourself if you’re indeed a perfectionist. If you’re interested in getting a quick sense of whether this might be a thing for you, you can try this screening tool as a way of finding out if perfectionism should be on your radar.
So, what if you are indeed a perfectionist? What do you do? Here are three things that help me keep my perfectionism in check, and I hope they’re helpful for you!
Three Ways To Combat Your Perfectionism
Question your level of care about things.
If you are caring about everything very deeply, then there’s something goofy in your meter. This one can be difficult, especially for something high on the emotional spectrum. Caring deeply about fellow human beings is a wonderful attribute, although it too needs to be kept in check. Caring deeply about whether the Kleenex boxes match the wall colour, or the specific noise your car is making is exactly as it should be when everything is running fine, or other such things may be an indication that your level of care is off.
One question I ask myself frequently is, “What is my level of care on this one, and is that reasonable?” I find this question to be especially helpful if my stress, or anxiety levels are high – because if they are, then that lovely limbic system is going to shut off our frontal lobes, which is the area of the brain that helps us determine reasonability.
Question your standards and expectations.
Working hard is a good thing. Being disciplined is also a good thing. Having no boundaries on either of these is not. It was pointed out to me when I did my Birkman assessment during my certification training that I will never expect anyone else to do something that I wouldn’t do myself. I’ve found this to be very true. The problem is, I expect extremely high standards from myself, and thus, it’s easy for me to pass all of those onto others. My own standards are often impossible to meet.
A question I use to keep myself in check on this one is, “If someone else were doing this, and it had nothing to do with me, would I think this standard was reasonable?” This integrates a little bit of the mindful self-compassion that Kristin Neff has developed and I find very helpful. We often expect things of ourselves that we would never expect from others. It also helps us give our brain a break, reduce anxiety, and increase the chance of having a reasonable perspective.
Have key people in your life whom you trust.
This is perhaps the most important of these three. I cannot overstate the value of key people who know you well, care about you, and are able to speak truth into your life, even when it’s hard. The trust part is key, because you’re going to have to trust that they’re doing it for your benefit, and it’s not because you’ve failed.
I’m fortunate to have a number of key people like this in my life who keep me in check. First and foremost is my wife, Meg. She knows me better than anyone else in the world, loves me despite my inadequacies, and also isn’t afraid to speak the truth to me when I need to hear it. I know that when she calls me out, she’s doing it for my own good, and I need that.
I also have my Registered Clinical Counsellor that I have a standing appointment with each month. I’ve been seeing the same counsellor since 2014, and I still remember our first appointment. I sat down and said to him, “Here’s how this works. I have impossible standards, I care deeply, and I don’t always have perspective. I need someone who isn’t afraid to call me out when I need it. If that isn’t you, that’s ok and I’ll thank you for your time. If it is, awesome, and we’ll get on famously.” He said he had no problem with that, and true to his word, he’s still supporting me, pushing me, and calling me out when I need it 5 years later.
Perfectionism can be a difficult thing to manage. It’s part personality, part anxiety, and wholly exhausting at times. I’ve been dealing with it for many years, but through some of the strategies above, and thanks in great part to some key people in my life, I have learned to manage it well, most of the time.
I know that my counsellor has played a key role in my ability to manage this part of myself. If you’re struggling with perfectionism and would like some help, we’re here. We’ve all got our stuff, and sometimes that outside perspective can be really helpful.