Author Archives: Denise Hall

Dream Work: A Guide to Your Inner Voice

Posted by: Denise Hall on août 24, 2017 11:50

Dream analysis is an ancient practice that Shaman, healers, sages, and therapists have used to help their patients. Visions and waking dreams are part of many cultures for foretelling the future, healing a disturbed or sick person, searching for animals for food, or preventing or strategizing wars. Some people believe that dreams themselves are prophetic at times and can foretell coming events. Dreams can be a helpful tool in understanding your inner workings and help you make changes in your life.

Jung believed that our dreams were a direct communication from our unconscious. He also believed that our unacknowledged shadow or dark side was represented in dreams and he suggested that we “befriend” our dreams and let them inform us. Images in the dreams can represent parts of our self that are largely not given a voice in our waking life. Freud believed that dreams were a direct representation of our waking life issues and concerns and they primarily problem help resolve our struggles and fears.

Adlerian dream work has origins in a psychoanalytic approach and the focus is on dreams having a purpose in our life, mainly to inform us and heal our psychological self. Dreams can also emerge as childhood conflicts for example when authority figures appear or we dream about the family home or family members. Sometimes images can represent existential-spiritual issues and relate to the person’s relationship with a higher power. Dreams that have images and experiences that elicit questions of values, connection with others, freedom or death and life relate to spiritual-existential themes.

James Hillman, a devotee of Jung’s analytical psychology, believes that dreams are owned by the psyche and the psyche confronts its death in dreams. As we grow and evolve our old beliefs, fears, and conflicts die in the psyche and we reinvent ourselves evolving into a new understanding, essentially a new psychological self. He is against interpretation of dreams because he wants us to live the experience of the dream and to let it inform us as it grows and evolves.

One of the ways to get the most out of dreams is to keep a dream diary. Most people do not remember all of their dreams however even small snippets of the dream can be informative. Over time patterns emerge and can tell us much about our waking life and inner self. Keeping a dream journal near our bed and priming ourselves to remember our dreams helps. When we wake from a dream we should try and stay in the atmosphere of the dream and write down our thoughts immediately. Here are some categories to frame and understand our dream with:

The Dream

Main Characters

Main Features of the Dream

Action, Scene, and characters

Symbols in the dream

Personal and archetypal significance

Type of dream

My feelings in dream and at waking

Later thoughts or feelings

In dream work with a therapist the work is highly collaborative. In the model that in which I was trained, the Hill Cognitive-Experiential model, the emphasis is on eliciting the dreamer’s images, associations, and insight allowing a lasting understanding of their self and processes. I also use the Jungian model of dream analysis.

Therapy can be challenging for some people and tackling life issues through dream work is less deep and more creative and enjoyable. The model has an action component that takes the insight gained and operationalizes it into practical and realistic goals. Dreams then become change oriented.

There are many dream books with definitions for the symbols that emerge however the dreamer is the best judge of the meaning of the dream images. These books offer suggestions but the dreamer is free to decide what they mean. Collaborative work with a therapist helps bring deeper meaning to dreams and can allow opportunities for insight and action in waking life.

If you want a dream work session to explore your dreams call Denise @ 604-562-9130




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Our Social Brain and Interpersonal Relationships

Posted by: Denise Hall on juillet 11, 2017 2:55

What we thought we knew about the brain is shifting rapidly because of the research of the past 10 years. Daniel Siegel (2008), Allan Schore (2009), and others have gathered recent neurobiological research, interpreted it, and transcribed it into common language. Therapists and others have brought the information into the counselling room and books such as David Doidge’s The Brain That Changes Itself have made their way to mainstream bookstores and television.

I have just finished a course on interpersonal neurobiology and I would like to share some of the knowledge that I believe can change your life. First our memory and what we take in from the world is a much more nonconscious process then we earlier believed. Apparently in one second we take in 10,000.00 bits of information of which only 16 are conscious (Gihooley, 2008). Further, this author maintains that cognitive research suggests that the unconscious is the main component of mental processes and that this realization has turned the psychological community on its ear (Gihooley (2008). He states:

“We’ve come to realize that there is an enormously complex mental apparatus working independently of, and largely invisible to, our conscious mind. These unconscious processes form the actual center of mental life; they are the origin of motivations and initiator of actions, and conscious thought. It may be all we know—plays a comparatively minor and peripheral role in mentation” (Gihooley, 2008 p. 93).

The author is, in effect, stating that our explicit memory and what we know is, in effect, more peripheral to our human experience than, as we thought, the other way around. He gives an example of speech suggesting that we are really not aware of our speech because it is orchestrated and delivered unconsciously. We, in effect, are only aware of what we speak after it is spoken. Implicit memories and knowledge underpin this process and consciousness is not a part of what we are continually perceiving and interpreting. Information processing is an involuntary process (Gihooley, 2008).

Many researchers and clinicians have agreed that in child development the first 18 to 24 months are crucial for a healthy mental and physical life later in life. We know that the child’s right brain is the main part of the brain that develops during this time and the memories are largely nonconscious. In order to develop the brain properly the child’s caregiver needs to create a secure attachment with the child. Attuned communication is also needed for the development of self-regulatory processes and the pre-frontal cortex, which is the centre of logic, reasoning, and executive functioning. Attachment experiences are independent in their influence of genetics and temperament.

Dr. Siegel 2009) presents nine functions that are required for the pre-frontal cortex to develop: balance of the body, attunement with others, emotional balance, response flexibility, ability to calm fears, insight and self-knowing, empathy, morality and larger social good, and intuition. He also focused on the importance of parents being attuned and present with their children in order that their pre-frontal cortex links with them. He suggested that a healthy loving secure attachment is important and that it is estimated that 65% of Americans are securely attached and 35% are insecurely attached.

Dr. Siegel recommended three requirements for developing the nine functions for healing and integrating the brain: loving relationships, internal reflection, and the functions of the brain itself. Practices that assist with the tasks are mindful awareness, prayer, Ta Chi and Yoga. The goal of healthy brain development is integration of the emotional centre of the brain (limbic area) and brain stem (reptilian or old brain) with the pre-frontal cortex or new brain.

Chaos and/or rigidity, Dr. Siegel suggests, becomes the state of being when the brain is not integrated. The presenter suggests that an integrated brain is harmonious and is able to manage separateness and togetherness from others and individuation and connection. He defines the mind as a “process that regulates the flow of energy and information”.

Childhood trauma, and poor attachment experiences produce a brain that is disorganized. The emotional brain is disconnected from the thinking brain and the physical regulation system resulting is chaos or rigidity in behavior and mental health issues. Because this is largely nonconscious it is challenging for the person and others to figure out what is not working.

The good news is that the brain is plastic and a disorganized system can be healed and integrated. Loving secure relationships and self-reflection is the key to healing. This can happen in love relationships and in therapy. Trauma experiences can cause an otherwise integrated brain to disorganize and cause havoc in a persons life creating depression, anxiety, and post traumatic stress symptoms. Again healing can occur with therapy and being surrounded by loving family and friends. The difference in healing through a trauma is most often the support a person seeks and gets.

These advances in knowledge are helping people realize that their difficulties in life stem from early experiences and/or traumatic life events. They begin to view their issues as experience dependent and, for many, caused many years ago not as a result of them being a bad person whose life is hopeless. They also realize that they can change their life if they get help and reach out to others. The key here is awareness and bringing many of the memories and knowledge that motivates and drives their lives to conscious awareness. Those in pain and struggling can have control over how they deal with the information and then they can begin to heal and integrate their brain.

The key points of brain research are that the focus is now on unconscious processes and early childhood attachment. The growth of the brain in the first 2 years is in the right brain and its health is experience dependent. Poor attachment and trauma experiences result in a disorganized brain and behavior that is chaos or rigid, however the brain has neuroplasticity and can heal and integrate with therapy and loving relationships.

Books that are recommended are Daniel Siegel the Developing Brain and Parenting from the Inside Out.




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

WHAT YOU NEED TO KNOW ABOUT TRAUMA AND PTSD

Posted by: Denise Hall on juillet 11, 2017 2:48

Do You Have Trauma Symptoms?

If you have any of the following you might have post traumatic symptoms or even a firm diagnosis or PTSD:

  • nightmares and sleep disruption,
  • not feeling safe or have a general feeling of unease in your surroundings or body,
  • have panic attacks,
  • unable to concentrate on reading material, work activities or household tasks,
  • over the top anger and strong responses to minor things
  • avoid certain places and people,
  • isolate and are very uncomfortable with groups of people,
  • anxiety about even minor life tasks is very high,
  • an unreasonable fear of authority figures, the police or institutions,
  • an exaggerated response to loud noises

If you think that you have not experienced a potential traumatizing event, surprisingly most people have had at least one traumatic event in their life whether it is witnessing one or being in a car accident, breaking a bone in an accident or in a sports activity or losing a family member (estimated 70% in the US). Trauma is as old as humanity, however the field of Traumatology is relatively young with its origins in the 1990’s. The study and treatment of trauma incorporates biological, social, psychological, economic and political factors. Trauma is an exceedingly complex subject and my intention in this article is providing important information about Trauma and PTSD for my clients, colleagues, and readers. Understanding trauma and the profound affects it has on individuals and communities is essential in providing the resources for those people struggling with the effects.

Background

During my Masters training in Chicago I was introduced to Dr. Colin Ross’ work, a Canadian born and trained psychiatrist, whose book The Trauma Model (2006) profoundly influenced my practice and my understanding of trauma and psychological disorders. Dr. Ross suggests that trauma is usually the factor underlying most mental illness diagnoses and that using this model helps in dealing with the issue of co-morbidity. The Colin A. Ross Institute (www.colinross.com) contracts with psychiatric facilities in Texas, Michigan and California providing treatment for psychiatric disorders.

Another of my instructors in trauma work is Dr. Bessel van der Kolk whose work at the Trauma Institute (www.traumacenter.org) in Brookline MA is at the forefront of trauma treatment. His recent publication The Body Keeps the Score (2015, Penguin books) is an excellent resource for practitioners and clients. The research he conducted on Eye Movement Desensitization Reprocessing (EMDR) and incorporating Yoga in treatment for trauma is important work.

The Definition of Trauma

Posttraumatic Stress disorder (PTSD) is the term for the clinical diagnosis that meets the criteria for the disorder after a trauma event or an extreme stressor such as:

  • Serious accident or natural disaster
  • Rape or criminal assault
  • Combat experience
  • Child sexual abuse or physical abuse or severe neglect
  • Witnessing a traumatic event
  • Hostage/imprisonment/torture/displacement as a refugee
  • Sudden unexpected death of a loved one

The first month after a trauma event or an extreme stressor, if distress is present, a person could meet the criteria for an Acute Stress reaction that may or may not lead to a diagnosis of PTSD. Not everyone develops a diagnosis of PTSD after an extreme stressor. If they do not meet the entire criteria they can be diagnosed as having an Adjustment reaction.

Symptoms and manifestations

Symptoms fall in three categories:

  • Re-experiencing of the traumatic event or intrusive thoughts and images including nightmares and exaggerated responses to triggers and avoidance of reminders of the event;
  • Avoidance and emotional numbing including detachment; and
  • Another affect is increased arousal including difficulty sleeping, hypervigilance and difficulty concentrating.

PTSD is difficult to diagnose as it is often masked by other symptoms and people can be asymptomatic for months or even years. Often clients are misdiagnosed with depression, high anxiety, bipolar disorder /or psychotic symptoms when at the root of their distress is a traumatic event that more than likely is forgotten or repressed. The memory, likely in a fragmented state, of the trauma is located, at least partly in implicit memory, the very large repository of unconscious material in the brain. This area governs most of our decisions and actions however for most people it lies beyond their conscious awareness.

Often the person develops panic attacks without a connection to a trauma event. Untreated trauma could also be indicated in suicidal thoughts or high-risk behaviours. Other possible symptoms include anger and irritability, feelings of alienation, betrayal, mistrust and isolation. Sometimes the trauma is manifested in psychotic symptoms such as paranoid and/or delusional thoughts. Another complication is when people distract or self medicate with substances such as alcohol or drugs. Generally the person feels on guard with a general feeling of unease when outside of their home.

Political and Social context

Tragically, there is a widespread blind spot where trauma is concerned and the treatment of trauma is mixed in part due to the fact that there is organizational and cultural amnesia and denial of the symptoms of PTSD and the reality of trauma. Both Judith Herman (1997, 2015) and van der Kolk discuss the political implications of addressing PTSD. Perhaps it is as Van der Kolk, Weisaeth & van der Hart (1996) suggested, in their view of psychiatry’s historical approach to trauma. They are highly critical of psychiatry and the medical profession as a whole, stating that it has amnesia about the reality of trauma and its affect on the human psyche, and that there is periodic denial and minimization of the fact (and impact) of trauma.

Herman and van der Kolk suggest that the acknowledgment of the reality of trauma has gone through periods of discovery and periods of invisibility, closely mirroring the public and political appetite to address its importance. Compassionate lay observers tend to be the only people who keep the importance of trauma in their awareness. The biggest concern is that valuable knowledge and time has been lost in the process of denial (van der Kolk et al.). People do not get diagnosed or treated appropriately.

Herman (1997, 2015) also delineated the political aspects of trauma and she asserts that trauma cannot be understood without examining the social context surrounding the situation. Essentially, the recognition of psychological trauma is a political issue. In order for trauma to be considered, the issue of war itself needs to be addressed, as does the inequality of minorities, and of women and children in domestic abuse and violence in society. Unless human rights are a priority, and oppression is challenged, there is minimization, denial, and “forgetting” in the minds of individuals as well as society when it comes to trauma. The affects of trauma and perpetual war are profound in society and rarely acknowledged.

Clinical examples

Examples that I often deal with in my practice are traumatic injuries, assaults and bullying and harassment in the workplace. Other examples include veterans who have long fought for recognition of traumatic stress in combat and vicarious trauma and secondary traumatic stress of police, firefighters, paramedics, frontline workers and health care workers. In addition, trauma dramatically changes the brain and often the worldview of the recipient. When examined under a functional MRI the brains of trauma recipients show scattered activity whereas the brains of non-recipients show focused activity.

With symptoms, tolerance for stress, much like a physical injury’s tolerance for physical activity, is decreased and people are easily triggered into a stress response. They can exhibit fear behaviours such as the flight/fight/or freeze response likely not in keeping with the situation. I remember General Romeo Delaire speaking at conference I attended. He is a vocal proponent of the military’s recognition and support for PTSD.  General Delaire said he was in a marketplace in Africa when a fruit vendor used a machete to cut a large watermelon. He said when he noticed this happening he just “lost it”. He knew then that he had PTS symptoms and needed help.

Longevity of Symptoms

An important piece of information to consider is that the affects of trauma do not disappear overnight even with prolonged treatment, they linger in some form for years. Treatment such as EMDR and desensitization certainly help reduce the emotional impact but symptoms remain. We also know that if someone has had PTSD symptoms once, they are at high risk for developing them again, especially with subsequent trauma experiences.

People with trouble concentrating, disorganized thinking and sensitive nervous systems, hair-trigger reactions often with anger, depression and anxiety, and somatic symptoms such as chronic pain are likely suffering from residual symptoms and often their condition is misdiagnosed. Another symptom of trauma is dissociation, a condition where the person feels like they are outside their body. They never appear grounded and in the present. This is survival technique that over time causes dysfunction in everyday life. In more severe forms it can develop into separate egos or “alters”, and dissociative identity disorder.

Treatment Approaches

Treatment varies depending on the treating professional. I tend to take an integrative approach, using the following:

  • Mindfulness-based stress reduction,
  • Eye Movement Desensitization Reprocessing (EMDR),
  • Emotional Freedom technique,
  • Acceptance and Commitment therapy
  • +Dialectical Behaviour Therapy,
  • Cognitive Behavioural approaches
  • Client centered approaches
  • Psychodynamic therapy.

Grounding and containment are very important in making a person feel safe again because people often feel unsafe and a sense of betrayal and the trauma has changed their lives significantly. Their core self seems no longer accessible and they have difficulty trusting that life will be manageable and safe again.

Newer training approaches suggest that reliving the trauma or in vivo-desensitization is not necessary to heal from a trauma and some practitioners warn about the potential of traumatizing the person unnecessarily if they are pressured to revisit the original trauma event. EMDR performs desensitization without specifically revisiting the original trauma and body–centered approaches are helpful in helping clients feel grounded and secure in their body an essential component of feeling safe again.

Most treatment professionals have adopted a trauma-informed practice, which recognizes trauma as a component in diagnoses and that certain practices can re-traumatize. They recognize the need for helping people transform feeling helpless to empowering people to take back their lives from the effects of trauma.

Medication or Not

Medication is a personal choice and many people express concern about taking psychoactive medication. In severe responses to trauma, medication is generally indicated to assist people to be able to function again. Sleep is an important component of healing both physically and psychologically and if a person has severely disrupted sleep they will have difficulty stabilizing and beginning to heal. If a person is actively thinking about suicide medication is also warranted. Research supports psychotherapy along with medication is more beneficial than medication alone. If a person’s response is moderate then psychotherapy may be sufficient to alleviate the symptoms.

Summary

In summary, the study of trauma is relatively new and appears to be politically and socially situated. It is often misdiagnosed or missed altogether and is often an underlying component of psychological distress. PTSD and Acute Stress Disorder are the diagnoses and the affects are cumulative. Treatment approaches vary and new approaches focus on empowerment and treating the affects and feelings around the trauma not reliving the trauma or extreme stressor. There are a number of treatment choices and it is not necessary to relive the trauma to heal. Medication along with psychotherapy is indicated in severe symptoms but with moderate symptoms psychotherapy alone might be sufficient.

Your feedback about this article and to contact Dr. Denise about psychotherapy Email [email protected] or phone 604-562-9130




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

“The Quickest Way to the Truth”: Confronting Sexual Harassment in the Workplace and Beyond

Posted by: Denise Hall on juin 22, 2016 3:47

From the plea bargain and previous acquittal of Gian Ghomeshi to the sexual harassment class action suit against the RCMP and other high profile cases, sexual harassment is definitely in the news but are we seeing justice done? Christy Clark said recently that sexual abuse, assault and  harassment are a part of women’s everyday lives. These acts of violence and abuse continue to occur at alarming rates. A CBC guest Rebecca Solnit on the Sunday Edition’s  June 19, 2016 discussion on violence in the US  indicated that a rape occurs every 107 seconds and spousal abuse every 17 seconds. Why are we not doing enough to protect women in their homes and their workplaces?

The CBC executive whose quote I have used in the title was abused at work while a male coworker stood by. She agreed to an apology and a peace bond from Ghomeshi instead of enduring a trial. She may be quite right in stating that the truth can get tangled up in the justice system and the court of human opinion. Forgoing her anonymity, she felt the truth would best be served by making a statement about the abuse. Perpetrators seem to be able to continue harassing and abusing and evade responsibility for their actions. Gian Ghomeshi was acquitted of six charges in the first court case and PeasandHammerbarely offered an apology or took any responsibility for his actions in the second.

In the memoir “No One To Tell” Janet Merlo, a former RCMP officer in British Columbia, outlines the abuse and gender inequality she endured during her time with the force. Merlo was named as the representative plaintiff in the class action suit of over 100 women against the organization. Going through the courts is not working very well for the victims, mostly women. So what can be done to stop the rampant abuse and bring the perpetrators to account?

As a therapist I work with victims of sexual harassment, rape, physical assault and violent acts mainly perpetrated by men, many unreported. Discussing this issue with other therapists they tell me that the women they work with state that if they had a chance to go back they would not report sexual harassment and sexual assault. They say it is just too horrendous an experience to report. Furthermore many victims report losing their jobs while the offender(s) keep(s) their position. Women in male dominated occupations tend to fare pretty badly in the places they work.  I have heard reports directly from women in construction jobs, police forces, and the military.

Politics aside, Christy Clark, BC Premier, recently disclosed being a victim of an assault when she was 13 years old. She said she never told anyone because of the shame associated with being a victim. Some people are cynical and say that her report was politically motivated. I am thinking this is not the case.  Most women feel a high degree of shame associated with being a victim and I question why women and, specifically our premier, would talk about a traumatic and highly intimate situation for political purposes? Claims from perpetrators that women report for financial or other reasons are usually way off base. There is no amount of money in the world that would make up with the horrific circumstances, terror and public scrutiny involved with disclosing sexual harassment or assault. Also, research on recanting suggests that many victims recant because of the consequences of going through with the accusations for their families and the community.

I watched a Norwegian movie last week called HEVN (“revenge”) and the heroine of the film was bent on revenging the rape and subsequent suicide of her younger sister who was in her teens when the rape occurred. Initially she was going to kill the perpetrator but settled on setting him up and stripping him of his family and stature in the community. If the court system does not provide justice then must victims take retribution into their own hands? The problem with doing so as an “eye for an eye” suggests, will leave both parties injured, most likely badly. More succinctly, violence is not the answer.Violence is the problem.

The women in the RCMP have initiated a class action suit to settle their grievances around sexual assault and sexual harassment. Maybe civil action is better for compensating victims. Civil actions have a lower burden of truth and they can provide compensation for suffering and loss of positions the victims aspired to and felt proud of.

WorkSafe BC now accepts sexual harassment and bullying under their mental stress provisions if the abuse if work related. It is also incumbent on employers to have a system of regulation and protection in place. Certainly the criminal courts did not appear to serve Gian Ghomeshi’s victims well. Many victims just keep quiet and perpetrators continue to harass, abuse, and rape because they believe they can and they believe THAT THEY WILL NEVER GET CAUGHT.

Another high profile example is the Stanford sexual assault case where the perpetrator’s father wrote a letter decrying the six month sentence for his son, Brock Turner, stating it was too harsh for “20 minutes of action”. What if he got 20 months for each minute of action? Legal experts have said that this sentence was more in line with a “first offence of burglary or auto theft”. Another comment from Danielle De Smeth, a California based criminal attorney, was that “it emboldens those of privilege or an athletic background”. Sure does! Two young black men were hung in the 1942 on a bridge on the Chickasawhay river for being within 10 feet of a white teenage girl.

So what is the quickest way to the truth and how are we going to stop perpetrators from sexually abusing? Sexual assault and harassment is a technique of power as is withdrawing reproductive services for women. Rape is used by soldiers in war zones to totally control the vanquished. Racism is more of an issue in economically stressful times. Maybe, sexual assault and harassment is like racism where the perpetrators objectify and dehumanize their prey because they feel they are losing power economically and politically. Mark Lepine killed 14 women in Montreal for just that reason. In spousal abuse perpetrators keep their partners powerless so they will not leave. Sexual abuse and assault are the tools that perpetrators use to subjugate women and children.

Maybe the solutions to stopping abuse lie beyond the criminal courts in changing workplace culture, economic inequality and societal attitudes. As long as women remain unequal economically and societally along with ethnic minorities and are kept powerless to bring the abusers to account, the abuse will continue despite the criminality of the acts. Even if we have regulations that prohibit sexual harassment in the workplace, many victims will not speak up because of fear of losing their jobs, being ostracized for speaking up, and concern about the onerous process of going through a system that is fraught with difficulties. This is a challenging issue and we must do a better job of protecting women in the workplace and in the community.

Your comments are welcome




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Thera-spraining Psychotherapy: What it is and What it is not.

Posted by: Denise Hall on juin 13, 2016 12:34

This blog post is meant to unravel the puzzle that is therapy. In the past therapy was considered only for people with serious
mental health issues. Therapy has become much more accepted as a way of changing one’s life,
recovering from grief and trauma, relationship breakups and family and parenting issues. In
fact, there is evidence to suggest that it can be very beneficial in relieving depression and other
issues. It also is effective in reducing the need for pharmaceutical intervention in some
situations.

What does the therapy process look like? Contrary to what some people think, therapy is an
active process requiring work, openness and cooperation on the part of the person seeking
therapy. The therapist does not change you, they are, in effect, a facilitator of change. How
much you change (or even whether you change) is up to you.

Well what does therapy do? Therapy changes the brain as Norman Doidge the author of The
Brain That Changes Itself” aptly illustrates. Having a skilled person validating your experience,
listening with nonjudgement, and focusing on your strengths does wonders for most brains that
have a tendency to focus on the negative side of any experience and produce emotions such as
shame and guilt. Therapy can help you think differently about your situation and with
understanding comes clarity. It also helps you remember who you truly are and encourages you
to accept your strengths as well as your human flaws.

Knowing you are not alone and that someone really understands what you are going through
has immense therapeutic value. Family and friends can be supportive too but most of us would
rather not burden friends too much and usually most people just keep their feelings to
themselves.

Therapy is also preventative. It prevents and/or mitigates conditions such as high stress,
depression, anxiety, chronic pain and PTSD that left untreated can cause associated physical
conditions such as stomach ulcers, cardio/vascular events, panic attacks, isolation, suicide,
physical deterioration, musculoskeletal challenges and debilitating pain, and addiction
to opioid medication.

What therapy does not do? Most of us in our ever increasingly complex and fast-paced world
are looking for a magic bullet or a quick solution that will alleviate or solve a difficulty. Therapy
is not a quick fix for many reasons including that situations are usually complex and accrue over
time. Healing takes time. Untangling the many factors in a situation is a process and our
defense mechanisms often get in the way. We usually need a safe place to freely explore the
landscape around issues causing frustration and pain. Many people have never had a safe place
to do this.

Another thing therapy costs money, upwards from $100.00 to $200.00 per hour. Depending on
the qualifications of the therapist. Most psychotherapists have a Master’s degree and are certified by
provincial or national bodies (for more information on practice requirements for psychotherapists
across Canada, please see https://www.ccpa-accp.ca/profession/regulation-across-canada/).
Psychologists are regulated provincially as are registered social workers. I definitely would
recommend counselling or therapy with someone who has had rigorous education, training and
supervision.

The good news is that it might not take a lot of sessions to get you feeling better about your
situation and feel like you are gaining more control over your life. For complex issues involving
trauma it can take much longer. I remember a therapist telling me that if personal growth was a
priority then I would find the money to pay for therapy. I do not see it as simple as that now
that I have been a therapist for years. Most people have competing priorities these days and
therapy is usually put on the back burner. Although it is likely to be beneficial, managing a
household, paying rent and food costs are a high priority in most everyone’s life.

Although there are some options for therapy with psychiatrists that practice therapy, employer
funded programs and government and community organizations, there are usually wait lists,
number of sessions is time-limited, and acute conditions take priority. The Globe and Mail
published an article last fall that made the case very well for government funded mental health
services accessible to everyone. Many countries do provide therapy and the cost to taxpayers is
outweighed by the reduction in cost in the general health budget and employer funded
disability plans.

A word of caution about therapy though; growing as a person can change your life priorities
and the relationships with those around you. It also can be challenging! Opening yourself up to
someone maybe for the first time is scary. We are afraid usually of being judged by others. The
evidence for addressing issues rather than suppressing them is strong. Unexpressed feelings
can manifest themselves in health conditions, chronic pain and addictions. Many people have
tried self-medicating when issues have become too much leading them into a dangerous
trajectory.

I am hoping this blog post helps you understand what therapy can do for you. Remember you
are the captain of your own life when you take part in psychotherapy. What you get out of it is
up to you and I encourage you to shop for a therapist that fits for you and that you feel safe
with. In case you would like to speak to me further about your situation, I am available for free
30-minute telephone consultations if you would like to explore it for yourself at 604-562-9130
or email [email protected].




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Expressing Anger Constructively

Posted by: Denise Hall on mars 2, 2016 4:31

Expressing anger in a constructive way is challenging and in many situations almost impossible. First we need to locate the source of our anger then determine whether we actually are angry with others or ourselves. Is it righteous anger or displaced anger and is this a battle that is wise to wage? Is it way beyond the particulars of the situation?
Another question is are we using anger as a defense? For example, anger can keep you from dealing with:anger

* the source of your fear.

* the critical voices in your head.

* personal values that create guilt.

Anger can:

* prevent you from examining the losses in your life.

* stop you from communicating your hurt.

* keep you immobilized and not able to problem solve.

* keep you angry & not moving forward.
Let us discuss the wisdom of choosing our battles. Some of the questions that would be helpful to ask are:

* How important is this relationship?

* What are my personal costs if I keep quiet?

* Is there a power imbalance (e.g. Employer – Employee) and what are the costs of speaking up? (e.g. will I lose my job, will it be difficult in the long term if I speak up?)

* Will I put myself at risk physically if I speak up?

* Can I express myself clearly and constructively?

* Will this person understand if I speak up?

* Is this battle worth fighting?

* Would letting go and not taking the situation personally be a better strategy in this situation?

 

The point in asking these questions is that it makes us pause and better define the situation and decide whether to go ahead with expressing our feelings. Choosing not to proceed in any of these situations does not mean we stuff our feelings. There are other constructive ways of expressing feelings of anger without confronting the person directly (e.g. writing an « unsent letter » to them). Sometimes, knowing that we will not win with someone who is unapproachable and/or has more power than us and instead taking care of ourselves in the situation is a better route than confronting the person and being much worse off.

This does not mean we should accept bullying or sexual harassment. There are other better ways to deal with such problems rather than confronting the person directly. Analyzing the situation is rather tricky. Our feelings sometimes prevent us from perceiving the situation accurately and that is when I believe it is time to bring in a trusted friend, colleague, family member, or counsellor.

When using our feelings to help us direct our lives, we definitely need to give them more than a glance. They are there to guide us to more authentic and healthy ways of being. Strong feelings indicate that we have to take notice and that there could be underlying and long-term issues fighting for uncovering and expression.

Not expressing feelings constructively has the potential to really get people in trouble in their relationships, at work, and with the law. However, not giving them expression is destructive as well because they can erupt at any time in the most inopportune places or wreck havoc on our health. Road rage is a good example of this. Unexpressed feelings seek out opportunities to vent. It can happen on the road or with service personnel who have done some small thing to irritate you.

When you decide it is time to express your feelings, an anger script can be helpful. Write something like what follows before you talk to the person:

In making an assertive statement use the following:

« When you___________ I feel_______________ and the consequences are that I___________________. »

It is important that you are specific about the situation and your feelings and the consequences are realistic. An example:

« When I ask you to empty the dishwasher and you ignore my request, I feel angry and disrespected and as a consequence, I don’t want to make dinner for you or help you with anything ».

Another area where we can feel angry is when others cross our boundaries and/or we agree to things we don’t really want to do. We can then feel resentment, a real sign we need to set limits.

It is surprising how many people have a difficulty with saying a simple « no ». We really don’t have to justify a no answer. Making excuses is not being honest or authentic. Often, just a simple « No I am unable to pick you up this evening » is justifiable. Other times, we may have to give the person more information. The following guidelines are adapted from McKay, Rogers, and McKay (1989):

* Acknowledge the other person’s needs

* Advise them of your position, preference, feelings etc.

* Say « no »

« I know you were counting on me to have dinner with you this evening but I would prefer not to go and stay in instead. So I am unable to come to dinner ».

When setting limits, it is important to spend time thinking about the situation and the best way to go about it. Over apologizing and putting yourself down is not helpful; positive « Self-talk » is important!

Beware of guilt feelings getting you to agree to something you don’t want to (see my Blog on Guilt). Also, make sure your body language is assertive not passive or aggressive.

You can also negotiate with the person.

« I am unable to drive you home however I can drive you to the nearest bus station and provide you with bus fare if needed. »

The « broken record » is a good strategy when people are persistent. Repeat your assertive statement.

« No, I would not like another drink. »

Being specific is key. If you are vague and the person is trying to persuade you, it will give them an opening.

I have used two books as references and the title of one says it all: Don’t be Nice, Be Real. Most reasonable people appreciate your realness and willingness to be clear and assertive. Avoiding and making excuses tends to be disrespectful and leaves most people with an uncomfortable feeling. Being assertive takes some work. However, expressing your feelings, wants and needs is being honest, authentic and respectful to others even if they disagree with you. They likely will respect you for it.

 

References:

Bryson, K. (2004). Don’t Be Nice Be Real: Balancing passion for self with compassion for others, Santa Rosa CA: Elite books

McKay, M., Rogers, P. & McKay J., (1989). When Anger Hurts: Quieting the storm within, Oakland, CA: new Harbinger Publications, Inc




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Finding Compassion Within

Posted by: Denise Hall on février 2, 2016 5:11

self-careBy Denise E. Hall Psy.D CCC MCVP

Every part of us that we do not love will regress and become more primitive – Carl Jung

I have been thinking for a long time about writing about Self-Compassion. In my work as a psychotherapist and with my friends and family, I am constantly struck by the lack of self-compassion people convey in their words about their work and life. They are constantly saying things like “I am so stupid”, “I should have known better”, “how could I have missed that”, “who would notice or like a _____”. “I am just a ________” etc. etc.

No wonder we have high levels of depression and anxiety in our culture. Western society is high on guilt and judging individuals. It also encourages people to have unrealistically high standards for themselves and sometimes their standard is pure perfectionism. Their failings are seen as a panacea for everything that is wrong. Not only are individuals judged and blamed, parents, in particular, are one of most heavily blamed group in society. Some people believe that Individual blame conveniently shifts the responsibility from organizational, corporate and /or institutional/governmental culpability.

What is self-compassion? I think we confuse it with selfishness if we tend to spend time on caring for our self. Self care and self-compassion, I suggest is an afterthought, something we do when we have time and when all our responsibilities are taken care of. What happens usually is there is nothing left to give to self. We turn to other things like alcohol or drugs, food or other dependencies that hook us quickly but do not provide the profound and positive effect of simple self-compassion.

Self-compassion is the act that states “I am human; I am fallible and it is OK to make mistakes to change my mind, to pursue my passion.” It is not judging our actions as good or bad, just viewing them as part of learning and growing, part of being human. How can we be compassionate of others if we do not practice it with ourselves? The Green Cross Standards of Care state that we cannot perform our work as a caregiver unless we take care of ourselves. There is also the metaphor of the airplane oxygen mask, putting it on first before we put it on others.

The driver of this judgemental approach is our critical voice or voices that are internalized from the Media, and the dominant stories in our culture about who is valued and who is not; from our parents and school experiences. Awareness is the key to self-compassion and the more we understand these influences, the more we have control over our actions. When we judge ourselves harshly it demeans us and often drives our self-esteem into the black hole of constant recrimination, fear and helplessness.

There is a Buddhist sutra that is called Metta or lovingkindness that blesses ourselves and others. It is a meditation similar to the following:

May I be safe
May I be healthy
May I have ease of body and mind
May I be at peace

The practice goes on to bless others, dearest ones, benefactors, neutral ones and those we are in conflict with. Compassion starts with the self and it encompasses our work, our friends and family, relationships with others and those that are sick, troubled or difficult to deal with. The whole world looks and feel different when we practice self compassion. The native Hawaiians have a practice called Ho’oponopono which is a forgiveness ritual that starts with loving, accepting, and forgiving the self and then others. They call it the miracle healing practice.

Self- compassion is a simple concept however it is not easy to practice. It takes accepting ourselves and all our parts warts and all!!!

Your comments are welcome! Please contact me at 604-562-9130.




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Fostering Self Acceptance Part -1

Posted by: Denise Hall on septembre 9, 2015 3:04

 

The issue of self- acceptance is a complex one and there are a number of components to consider. First though, the negative affect of non-acceptance of one’s self can be dangerous to one’s health and well being. Non-acceptance of self leads one to be highly self-critical, denying of their emotional needs, inability to learn from past mistakes, inability to set realistic goals, isolating and unable to form positive relationships, and being unaware and/or unappreciative of their strengths and positive qualities. It keeps a person in a negative space, could lead to depression and social anxiety and colours everything we do. Non-acceptance is addiction’s tool that serves to numb the feelings associated with negative feelings about self and behavior.

Self-acceptance is about accepting the self unconditionally, negative parts, and all. Now that is a large order and generally self-acceptance is a “work in progress”. It is challenging to be fully self-accepting and maybe in order to continue to grow as person, a person needs to accept the challenging parts but see them as things they are willing and able to change. Jung called the dark part of self, the shadow side. Knowing and accepting the shadow side is the work of personal growth. Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Reflections on Time Management

Posted by: Denise Hall on juillet 17, 2015 8:06

A common complaint from my friends and colleagues is that we should manage our time better. We think it is just a matter of “getting organized”. I would like to reflect on what I think managing our time actually involves and why it is important that we address the issue of our time constraints.time-608876_640

“Time is money” and the thinking goes if we are more efficient with our time the more money or benefit we will accumulate. Also being “on time” is a quality that some people get obsessive over and it is considered a major affront if someone is late for a meeting or event.

Managing time is illusive, sometimes the more we pay attention to it the more it slips away, the more we ignore it sometimes the more we actually have “control” over. It is the worry rule; the more we worry about managing time the more likely we are to not accomplish our goals in that area.

In our technology crazed world we are constantly accessing our phones, Facebook pages and You Tube videos. These devices are tools, not masters and instead of us managing them and using them to manage our time more efficiently, they tend to manage us. And when these gadgets consume every waking moment, there is no time left for creativity, interpersonal connection, and just plain “veg’ing out”.

In hunter/gatherer societies food gathering was an intensive short-term activity and there was a great deal of time to feast, relax, play, and socialize. In so-called “modern” society work consumes a great deal of our time whether it is household tasks, childcare, volunteer work or paid work. We tend to be consumed by work with little time for thinking, reflecting and creating let alone socializing and developing solid relationships with others. The reasons for this are not something for this article.

Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

Critical Thinking: A Key Career and Life Skill

Posted by: Denise Hall on juillet 8, 2015 2:00

Have you ever said to yourself “What was I thinking?” You realize that you ignored all the red flags at the beginning when you went for the job interview and took the job or you have somehow forgotten that you have tried that route before and now you are here in a similar setting that did not work before. We sometimes do not do the analysis before we agree to a situation or have come to some faulty assumptions that we wonder how we could be so confused and make a poor decision.

Faulty thinking is one of hazards that we, in our humanness are prone, to. What I am meaning is that simply going by our intuition can send us down the wrong track. An article title133d the “Pitfalls of Doing What Comes Naturally” by Diane Cole (2011) in the Psychotherapy Networker provides a counter to the “extraordinary influence wielded by the intuitive mind” in current thinking (p. 1). The author references Blink: The Power of Thinking without Thinking by Malcolm Gladwell as a popular work that suggests the decision making power of the intuition is stronger than rational and logical reasoning.

Cole (2011) suggests that the cognitive research cited in The Invisible Gorilla by Chabri and Simons (2010) and On Second Thought by Herbert (2010) provide counter arguments to the “overly positive” view of using intuition as a guide. Their take on cognitive psychology is that our intuition is sometimes helpful and sometimes not. What we remember intuitively largely from our unconscious is influenced by heuristics, “hard-wired mental –shortcuts and cognitive “rules of thumb” that we use in our daily decision-making. The study of heuristics is on the forefront of cognitive research today.

Coasting along on autopilot making decisions, the authors suggest, can cause serious errors in judgment. In this case the information we remember and use for our decision-making sometimes can be considered a “heuristic distortion”. The article suggests that because our mind simplifies and categorizes information it produces these distortions. The premise of the article is that this sometimes erroneous automatic process must be over-ridden by more conscious processes. We need to “tune-in and decipher our brain chatter” (p. 2). What we remember and attend to gets simplified and categorized into schemas or mental maps and they need to be reprogrammed according to the author. Continue reading




*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA