Imagine with me for a moment, a world where your conscious and unconscious minds are subjected to think on your past mistakes. Day in and day out, you are bombarded by the clanging symbols of your personal errors in life. To society, your mistakes may be considered of an egregious nature or they may be relatively harmless, but you are now incarcerated. The outside world sees you as a menace and you are no longer welcome to roam among the living. It’s a
world that has been intentionally designed to break you, as a person. It’s a world invested in making you pay the ultimate price, for your crimes against humanity.

Prisons are a dichotomy of rules and lawlessness. As a clinical psychologist and chaplain, I have had first hand experience of what it is to be behind the walls of a prison. I have spent an untold amount of time within the confines of both prisons and jails. Deep within these barbaric fortresses, there are few amenities and definitely no luxuries. It’s undeniably a surreal and a deplorable environment. Many of the facilities are considered to be “state of the art,” yet the advancements are seldom intended on improving the prisoner’s life, but rather they are focused on the containment.

Prisons are institutions unlike few others. These correctional facilities are designed to incarcerate and rehabilitate. It’s within the confines of these walls that these institutions frequently fail to rehabilitate and restore an individual, but rather they perpetuate an environment unfavorable to growth and maturation.

As a prisoner, you have no individual autonomy. Your freedoms have been vanquished and you are, for all intensive purposes, a ward of the state. You have no freedoms, no rights, no ability to make personal decisions. Essentially, you have no stakes in this thing that we call life. You are reduced to an animal in captivity and nothing more. It’s a deranged way of treating someone and it is inhumane. There is seldom any compassion, any empathy, and most commonly, a lack of a healthy community. It may not surprise you to learn that the rate of recidivism is an ever-growing population of people who offended and reoffend. Often, these individuals are at odds with life outside of the prison.

The psychological impact of incarceration can leave a dire impression on an individual’s life. These dire impressions are often invisible, but commonly witnessed through negative shifts within an individual’s personality. The severity of these shifts increases the longer the individual is confined within the walls of a prison. Prison life not only has an ability of transforming an individual’s personality, but it has a tremendous impact upon the wellbeing of the person. Research has clearly shown that the longer an individual is incarcerated, the greater the probability that they may develop significant mental health issues. Institutionally, prisons have been designed to isolate, punish, and of course, ideally rehabilitate, but they are the perfect breeding ground for psychological conditions. These issues are exacerbated by the environment with which this population lives. It is common for a majority of prisoners to feel stress and anxiety related to their personal safety and wellbeing. The longer someone is imprisoned, the more profound the psychological stress.

Prison life alone can exacerbate any underlying condition, but separate an individual from their primary social support system and you will add fuel to the fire. It’s the lack of healthy relationships and social support that will often do in an inmate. According to the Centers for Disease Control and Prevention, CDC, “Social isolation and loneliness have been linked to increased risk for: heart disease and stroke, type 2 diabetes, depression and anxiety, addiction, suicidality and self-harm, dementia, and earlier death”. Remove an individual from their sense of community and you deny them the right to bond, connect, and commune with others. Undeniably, not all social support systems are healthy nor are they ideal ingredients for improving an individual’s life, but seldom are these perspectives even considered. Research has repeatedly shown that social isolation in itself, can prove the gateway to a number of psychological conditions.

While social isolation is one of many key risk factors behind inmates developing mental health conditions, it’s the individuals with which they are isolated from, that makes all the difference. As you can imagine, the level of intimacy and the relationship itself, can play a significant role in the feelings of separation. For some, they may have very little feelings of distress or anxiety about being separated. For others, they may feel a heavy burden related to the absence of significant relationships in their lives. Likewise, it is important to mention that one’s psychological diagnostics, can have a tremendous impact on how they relate to such a separation.

Social isolation maybe one of the key factors, but it’s the lack of personal autonomy, that can leave an individual with feelings of helplessness and utter despair. It’s the inability to declare oneself an independent thinker, that can prove the most intolerable aspect of prison life. When you compound the social isolation with an individual’s inability to prove autonomous, you create the perfect environment for a mental health condition. Personal autonomy is more than making individual choices for one’s life, rather it is also about having the freedom to think, ponder, hope and dream. It’s important to understand that prisons serve a purpose within our society, but remove an individual’s ability to think, ponder, hope, and dream and you ultimately remove their ability to thrive.

Prison systems are complex environments brimming with a plethora of negative consequences including: social isolation and lack of social supports, inadequate physical and mental healthcare, lack of meaningful and lasting relationships, the feelings of being constantly watched by guards and the eye in the sky, mandatory solitude, constant violence and the probability of violence occurring, overcrowding, the uncertainties about the future, and even the inhumane aspects of a prison, can create havoc with one’s perspectives and worldviews.

According to research by Timothy G. Edgemon and Jody Clay-Warner, “Not only do many prison inmates suffer from mental health difficulties, but incarceration itself increases the risk of certain mental health disorders” (Edgemon & Clay-Warner, 2019). Prisons are institutions of depravity, instability and a lack of opportunity. Research has clearly shown that the longer an individual is incarcerated, the more likely they are to develop a significant psychological condition. Unfortunately, prisons are less about rehabilitating and more about confinement.

Inmates are not only faced with a barrage of issues on the inside, but once out, they face countless challenges and hurdles that they’ll need to overcome. Just in case you were unfamiliar with the outcome, post-incarceration is a continuation of an inmate’s time served. Many will find it difficult to obtain a driver’s license, housing, financial assistance, and employment prospects. Therefore, many inmates fall back on a life of crime, because they feel as though they have no skills or options to live their life. As a natural consequence of living in prison, they may have obtained new tricks of the trade and may utilize these assets to survive and often provide for their own. Let’s not forget, that a countless number of inmates were exposed to the most egregious side of life, thus it is not uncommon that they may have developed a severe mental health condition. Sadly, they are seldom rehabilitated or granted an opportunity to move beyond the life that they are familiar with. As such, the rate of recidivism will remain high and prisons will often be their second home.

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

[War] strips us of the later accretions of civilization, and lays bare the primal man in each of us. It compels us once more to be heroes who cannot believe in their own death; it stamps strangers as enemies, whose death is to be brought about or desired; it tells us to disregard the death of those we love.

Sigmund Freud, 1915

In recent years, conversations about wars, and rumors of war, have increased exponentially. The water cooler conversations are no longer saturated with dialogue about the latest game, family or friends, rather they are conversations that involve discussions of war and the probability of war. As a global community, we are no longer sheltered by the convenience of being off in the distance, rather we receive our news instantaneously. We receive such egregious messages and are expected to digest them in the same breath. We are well aware that our ideological perspectives vary drastically from one corner of the world to the next. We have leaders who are pro-war and pro-armament; then there are the leaders who are antiwar and advocate against such drastic actions. The psychological ramifications of these conversations have been taking a noticeable toll on our society. As a society, it is difficult to avoid conversations about war, warmongering, antiwar and the very real possibility, that our children may one day become involved in such an unfavourable conflict.

What is it that drives war? Obviously, there are a variety of reasons and rationales behind a country entering war. Wars are seldom fought over insignificant issues, but most commonly occur because of geopolitical and religious ideological perspectives. Ironically, you seldom hear of wars being fought to defend race, sex, gender or economic hardships of the downtrodden. For the majority of wars, they are often fought over political, economic, and religious ideologies.

As a global community, we have become immersed with the 24 hour news cycle. As such, war is ticking away every moment of the day. War is on the minds and hearts of nearly every person that you encounter. Whether they are pro-war or antiwar, the psychological ramifications of being so deeply entrenched has had a dire effect on the mental health and wellbeing of our society.

In the 1945 Charter of the United Nations, there were decrees and resolutions drafted declaring what justifies a declaration of war. The UN was desperate to create measures to prevent future catalysts of hate and tyrants from ruling countries in the future. The UN had created a number of guidelines divulging what they consider appropriate and inappropriate in a time of armed conflicts. Most of all, they were concerned about protecting the wellbeing and health of all global citizens.

Undoubtedly, the effect of war has a way of fracturing the very fabric of our collective mental health. When there is war, we all suffer. War knows no victors and has no allies. Yet, there are times that war must proceed and conflicts must escalate.

The impact of war on mental health has only begun to be fully understood. War does not only impact the soldiers and those leading such operations, but it has an ability of vicariously impacting the mental health of all who are directly and indirectly associated with the war. Notably, you may not be even living in a war torn country to be affected. Research has shown that the more media that you consume of a war or a hostile action, the greater the likelihood that you will be severely impacted. The vicarious implications may creep up on you subtly, but the long-term effects have a way of mimicking firsthand experiences.

According to the World Health Organization, the United Nations has suggested that “there are more people living with mental disorders in areas affected by conflict than we previously thought – many more. One person in five is living with some form of mental disorder, from mild depression or anxiety to psychosis. Worse, almost 1 in 10 is living with a moderate or severe mental disorder” (World Health Organization, 2023). For far too long, a shadow has been cast over the egregious affects of war. For those directly and indirectly impacted, war has a way of injecting itself into the lives of its victims. The physiological and psychological repercussions of war should always be considered when entering a conflict.

The implications of war on soldiers has been well-documented since the early 1900’s, but the implications on the noncombatants and civilians has been lackluster. We know that war has a way of severely impacting an individual’s sense of self. The cognitive implications are indisputable. The physical ramifications are incomprehensible. Furthermore, it has been well-documented that soldiers are traumatically effected by a number of variables, including: witnessing friends and comrades being killed; the death of noncombatants and civilians; and witnessing an enemy combatant being killed. As soldiers, you are not only witnessing wartime casualties, but there is extensive research that proves you will be impacted by what you have witnessed for years to come. Furthermore, research has clearly indicated that the health implications for a soldier are often masked by their own ideological perspectives of the job. Similar to first responders, soldiers have a difficult time expressing a need to be helped. For many, it is a sign of weakness and many refrain from expressing their personal vulnerability. For others, they may fear losing out on a promotion, if something is placed on their military record.

As a society, we must remember that war knows no allies. We seldom consider the outlying implications of war, but these implications have a direct bearing on an individual’s ability to thrive and survive. When a country has endured a war, the ramifications last long beyond the final battle. The economic repercussions alone can cripple a nation. The evidence is clear, when a country that has endured a war, the ramifications trickle down to those who are most vulnerable.

The most vulnerable are seldom considered when the rumblings of war occur. According to the National Institutes of Health, “The direct correlation between the degree of trauma and the amount of the psychological problems is consistent across a number of studies. The greater the exposure to trauma – both physical and psychological – the more pronounced are the symptoms.” Psychologically, trauma leaves an impression upon the mind and physiological makeup of each person it encounters. Regardless of one’s age or intellectual quotient, we know that the ramifications of being exposed to a traumatic event can leave a deep and lasting impression.

There is consistent evidence that indicates that those involved in a conflict can improve. The implications of war does not have to be the endgame for an individual. Whether you are, or you have served as a soldier, there is hope on your horizon. Moreover, studies have indicated that those who are, or were, victims of war are capable of minimizing the consequences of trauma. The truth is, the greatest obstacle in minimizing the effect of exposure is the lag time between the event and the care. Please do not avoid asking for help. The immediacy of care is of the utmost importance. There are a variety of treatment interventions that are capable of helping individuals recover from a traumatic experience. Please do not delay seeking advice or care.

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

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

I recently read an article entitled “What Horses Teach Us About Systemic Oppression” by Julia Alexander that resonated with me as I work on this article.

Funnily enough, I was going to write the article yesterday, but it was a freezing cold -26 degrees outside so my own agenda morphed into blanketing the equines rather than writing about them. It was after I chased them around trying to convince them that the blanket was a good thing that I came back to write the article and had to laugh out loud. Here, I was going to write about the need for being fully aware in AAT that animals have their own agenda – not our agenda nor that of our clients. I was going to write about the ethics of considering and equally weighting all three agendas to avoid our human agenda of leading the session against the animal’s will. At this same moment, I found myself chasing my mini donkey around the property and half lassoed him to get his blanket on. I gave up on my Shetland pony because it refused to be caught so I allowed it to make the choice to go blanket-less despite the prediction of a steep -30 degree temperature overnight – so whom did I do right by?

In reality, it can be argued that systemic oppression does not apply to forcing someone to do something that is for its own good if it is in your care.

When I think of this in the context of AAT, I think of it on two levels: One level includes the need to ‘force’ an animal to undergo things it may not want to do to ensure its health while the other level regards our therapeutic agendas in the context of AAT. When we bring animals into our AAT practices, we become their ambassadors and we are responsible for all tenets of their welfare. If we do not conduct wellness checks (despite their protests) or give first aid when needed, then we are not meeting our ethical obligation to provide care. However, what if they simply refuse to work the day your client chooses them in your AAT practice? Are they allowed to say no?

This is where the three agendas come in and possibly animal oppression. Let us do this through an example:

Josh is attending therapy because his mother has died. Josh has attended traditional counselling but it has not been effective. Josh is an avid animal lover and his father is hoping that by working with the animals and an AAT trained mental health therapist, Josh will get the help he needs.

You are that therapist and you have a horse who is very gentle by nature. Josh has no experience working with horses and this horse is perfect for him to begin sessions with. Josh is excited to brush this horse. When you and Josh go toward the horse, it turns away to graze. Here are 3 possible agendas at play: 1. Your agenda is to build rapport with Josh through working with your horse, 2. Josh’s agenda is to brush the horse, 3. The horse’s agenda is to eat. What is the best ethical approach to helping Josh in this moment?

There are many ethical options. Firstly, you could help Josh understand that the horse is a sentient being with its own feelings, wants and needs. You can ask Josh what he thinks you both should do. This would give you a good indication of Josh’s awareness, depth of empathy, and many more important social skills. In doing this, you would be meeting your agenda, which is to get to know Josh and you would be meeting the horse’s agenda, which is to eat but you would not be meeting Josh’s agenda, as he wanted to brush the horse. Secondly, you could catch the horse and bring her back to brush her, meeting both your and Josh’s agendas but not the horse’s.

So how can you meet all three agendas? Perhaps you can suggest to Josh that he get some food to offer your horse. If she comes to him, then it gets to eat while you teach Josh to brush and build rapport. All three agendas will have been met!

As a psychologist who has been working in the medium of AAT for 18 years and who offers a certification in AAT to helping professionals, it is my professional opinion that we should always strive to meet the three agendas when working with animals in practice. Our animal partners are helpers in our work with their own wants and needs. For ethical reasons, we must acknowledge and meet these needs as much as is possible.

I might go so far as to say, now that I read Ms. Alexander’s article, that we may be ‘oppressing’ our therapy animals if we ‘force’ them to do what we want them to do in AAT whether it be because of our personal agenda or that of our client.

It often takes more work to meet our agendas when working with animals, as it is imperative to work around or within their agendas. Many people have much pre-knowledge of working with animals before collaborating with them in professional AAT practice. It is our due diligence to ensure that we are checking in on our beliefs and values about animals before we practice with them and during every single AAT session. There is a very good chance that our pre-lived experiences will influence the agenda of the session. If in fact, we are moving ahead with our human agendas without consideration for our therapy animals’ agendas, then we are most likely practicing animal oppression rather than animal assisted therapy.

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

TW: Sexual Violence

Being a Human-Centred, multi-cultural relativist and feminist informed, Emotion-Focused Therapist, working with an Integral Psychotherapy perspective means walking closely with clients on their path of trauma recovery, trying to keep in-step and sensing where they are going.  With what they feel they need, can manage, want to explore further, and when safe and ready all act as signposts along the journey.  But what happens when they go deep into the varied experience of their fellow women who upwards of 1 in 3 in the U.S. have suffered sexual violence.

            She is a client that I have known for nearly 8 years and the first session after a COVID summer began with a short list of new developments. Firstly, we explored her feelings of uneasiness surrounding her young son who now walked by himself to school.  There was some reference to a feeling of a growing distance to her long-distance boyfriend which had been previously mentioned.  Then the work of the day appeared. She was looking for her blueprint within which to place her own experience.  She hadn’t yet found it, but she definitely had explored the possibilities through a range of soul destroying examples, as I was about to find out.  My flinching inside warned me!

            Three years prior, she woke up to being sexually assaulted by a boyfriend.  The week before the session had been the anniversary of the awful violence, and troubling memories, the rest of her PTSD sequelae, along with a mounting distress that it was overtaking her ability to work were all re-emerging from their mind-body dormancy.  She had been looking high and low for a blueprint, figuring this might help.  I was there to bear witness and share like I always did with this client, what was coming up for me as she processed her way through the things.  By the way, she is longstanding client of more nearly 8 years and we’ll we have a very great working relationship – she knows that I will just be myself as therapist and it is ok.  This is by now, one of the elements that is helpful, she keeps telling me, in one way or another.  But what do I do about my internal flinching?

            Hers wasn’t as she read in the memoir of woman who at 12 years old was led out to a forest by a boy and was gang raped. Hers wasn’t like the woman in that wartime novel – raped by a Nazi soldier. Hers wasn’t any of the brutal rapes in various series she’d followed on Netflix. I wondered how she was managing such exposure and shared that I was feeling ‘my own’ anxiety, listening to her and could only imagine what was stirring in her experience.  ‘I admire your empathetic research.  But are you ok, it is enough?’

            “I am ok, but it is hard!”

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

The world is currently at a crossroads. Many of us are growing tired of the “new normal” that has required us to have varying levels of shelter in place, though we understand the need. As things progress, we are coming out of our cocoons, testing the waters of leaving our homes while still taking the precautions that make sense based on the available data. Masks and hand sanitizer are the new black. We are indeed fashionable.

            So many clinical professionals have moved to telehealth platforms in order to provide much needed care. Some have been doing so for years, while others, like me, avoided it to no end until the pandemic hit our shores. I was pleasantly surprised at how quickly I as a practitioner and my clients adapted and thrived using this technology. I will admit to still doing that “weird wave” at the end of most sessions but even that has brought cheer.

            Some have reopened their physical offices while taking all available precautions. Many have felt the data did not support this (and this will not be a debate on that issue I assure you). I too would like to reopen, especially since we had been finishing a 1600 square foot addition to our offices as COVID – 19 hit. The offices have sat empty, longing for service for many months now.

            There is however a third option (besides in office and telehealth) that some have started to try. Others, including some colleagues I work with, have been doing it for years but are expanding greatly due to the pandemic. This third option is utilizing nature’s offices.

            Nature’s offices are outdoor offices where clients can meet with their clinical professional outdoors, thus mitigating as much risk as possible. These offices when used correctly, offer privacy, comfort, safety, and so much more.

            A “typical” nature’s office can be set up and used in the following ways during the pandemic:

• Client and clinician meet in the car park wearing masks.
• Client and clinician do their best to follow physical distanced requirements in place at the time, as recommended by experts in the field of pandemic response.
• If available, clinician gives the client a choice of offices.  Ideally there are many offices in differing settings with different designs.  If this is not possible, any nature office will work.
• Seating is spaced as far apart as practical, exceeding minimum suggested requirements, without being seated directly across from one another.
• Once seated, client and professional can remove mask if desired but will put them back on at the end of the session as the client returns to the car park.
• Each nature’s office offers privacy though the clinical professional discusses the possibility that someone could presumably walk into the area in the context of confidentiality. Should that occur, the session pauses until the area is clear.

While not every office has outdoor space, particularly in big cities, the offices that do may find that the transition is easy enough. However, it is important to have a back-up plan such as telehealth, should weather pose an issue. Some nature offices include an option of a roofed structure such as a gazebo that allows air to pass freely while providing shelter from rain or excessive sun. Some have a heating source for cooler temperatures though few will be utilized when full winter cold sets in.

In this setting, clinician and client need not worry about recycled air as you are breathing the air found in nature. The furniture though often used and cleaned regularly, is further “cleaned” by being outdoors, as rain and sunlight (via UV rays) provide natural disinfectant though it is wise to follow the latest Centers for Disease Control and Prevention and World Health Organization recommendations for cleaning, mask wearing, etc.

When the pandemic passes, these offices can still serve programs regularly. You need not look at this as a temporary investment; on the contrary, these may well become some of your favorite spaces.  

Case Study: Pillwillop Therapeutic Farm, Wolcott Connecticut USA

            Pillwillop Therapeutic Farm’s slogan is “Nurture in Nature” and has utilized fields, woodlands, gardens and other areas of its property for therapeutic services for years. When the pandemic hit, it closed down its physical offices and switched to telehealth pending clear data and understanding of how the pandemic spread. As information became clearer after months of global data collection, it appeared that an important stage between telehealth and in office care would be to utilize existing nature’s offices and build additional ones. Face masks, hand sanitizer and other safety measures would continue while the main building would remain closed to all but essential staff (due to animals that needed care as the farm program could not be run totally from home).

            Taking consideration of folks that have varying levels of mobility and health concerns, a half dozen areas were set up for outdoor sessions. This was made more difficult by a shortage of benches and outdoor seating in the state.  Items were purchased, and existing stock was moved as needed, to ensure that sessions would be able to be offered for those that telehealth was less than ideal for. All clients were pre-screened prior to being offered the opportunity to use this service option. Some were declined due to a lack of safety protocols or other high risk behaviors.

            As the pandemic has continued, nature’s office expansion has continued. Several areas will have or already have had a heat source installed to help in cooler weather.  Options will be explored as winter sets in to determine if in-building sessions are practical and safe or if a move to telehealth only will be needed for the coldest months.

            Nature’s offices currently include areas of sun, shade, flowering plants, stone benches and other options. Some offices are within feet of the car park while others require a short walk. All will continue to be used post pandemic so the costs associated with building, furnishing and maintaining them is considered an investment in improving the infrastructure of the program and not as a drain on funds.

            For more information and photo examples of nature’s offices, please visit this link. https://www.docwarren.org/nature-offices

Be safe, do good

-Doc Warren

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, clinical & executive director of Community Counseling of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). He is internationally certified as a Counsellor and Counsellor Supervisor in the USA and Canada (C.C.C., C.C.C.-S, NCC, ACS). He can be contacted at [email protected]  His program has also been featured on NBC

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

I had originally written this article prior to the outbreak of Covid-19. The pandemic however has put a spotlight on this topic and has added some urgency to the discussion.

The internet offers us many conveniences. From online banking, to ride sharing and food delivery, the internet is not only making things more convenient for us, it is also providing us with life changing opportunities that previously did not exist. During a global pandemic, the internet has allowed many services to continue functioning in a way that would not have otherwise been possible. Virtual or digital service platforms have allowed clients to access mental health care services without interruption/with minimal disruption. This has no doubt provided a lifeline for many people who are experiencing challenges with their mental health that may have been exacerbated by the pandemic.

As a therapist, I have spent a large part of my career providing services to clients over the phone and using digital technologies (email-based counselling, live chat and video counselling). The demand for mental health services that are more accessible is growing steadily, as is the recognition by therapists that not all clients are well served through in person counselling.

There are a few reasons why clients request online services:

• In a country as large as Canada, location can often be a challenge. Most mental health services tend to be concentrated in urban areas. If services exist in smaller communities, waiting lists can be long and often the service provider is personally known to clients, making them feel uncomfortable with accessing service and disclosing personal things.
• Convenience is also an important consideration. The need for a client to travel to a therapist’s office can pose significant challenges including cost, time and physical barriers for clients with mobility issues
• Demographics: there is a generation of people who have grown up doing almost everything online. The online world is their comfort zone and being able to access mental health services online can significantly increase the likelihood of them doing so.

Even prior to the pandemic, there was demand for online services, but many therapists were resistant and or uncomfortable. This resistance to digital services could be attributed to a few different thought processes.

• Some therapists believed that therapy at its core is a process that must occur in person. Physical presence is vital, and without it the therapeutic process cannot be effective.
• Some therapists also held the view that online services can be complementary to but cannot replace the in-person experience.
• Lastly, some therapists do not feel sufficiently skilled with technology to deliver quality therapeutic services effectively.

Since the onset of the pandemic, I have spoken to many therapists who have had to confront and have successfully overcome the aforementioned criteria and are themselves surprised by how much they enjoy a virtual medium and how effective it is for clients. Many therapists have advised that even when they are able to resume in person practise, they will likely devote some portion of their practise to online service delivery.

Outside of the restrictions placed on us by the pandemic, virtual therapy is not about replacing the traditional in-person experience. Rather it is about increasing accessibility for clients who may not be able to engage in person. Providing digital therapy is not about simply replicating the in-person experience in another medium. Successful digital therapy requires planning for the benefits and challenges of each medium.

As an example, let’s consider video counselling. There are numerous benefits to the client and therapist as location does not pose a challenge. The client and therapist can be in two different locations with hundreds (or thousands) of kilometers between them. This helps a therapist avoid the cost of renting an office and affords them some convenience. This also enables a client to access good quality therapeutic care that may not be available in their geographic location. The client may also feel more comfortable/safe in their own physical environment and may be more engaged in therapy as a result. While the benefits are undeniable, we also must be mindful of some of the challenges.

• What does the therapist’s regulatory college/association say about providing online therapy?
• Do the client and therapist have enough knowledge about the online platform which is being used?
• Do both the client and therapist have a private space in which they can engage in the therapeutic process?

None of these issues are meant to be deter a therapist from offering digital services. Rather, being aware of these issues, helps one plan accordingly. For example, many insurance companies who provide professional liability insurance now explicitly list digital services as something that is covered within the policy. Additionally, there are a number of secure digital platforms through which therapy can be conducted. elivering online services might require us as service providers to behave differently but this method of service delivery can be beneficial to clients and therapists.

Offering digital therapeutic services even after the pandemic restrictions are lifted, is going to be essential if we want to ensure that everyone who needs mental health services can access it. We are seeing an increase in academic and professional coursework that aims to equip therapists with the skills to effectively deliver digital services. Regulatory bodies and insurance companies are also recognizing the efficacy of digital services. It is now up to us as therapists to understand and explore whether incorporating digital services in our practises would be suitable for us and our clients.

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

When I first started practicing counselling with my peers in graduate school, I was surprised at how much energy it took to be fully present with another person’s story and carefully weave in emerging counselling skills. I came out of practice sessions feeling both excited and drained. Thankfully, my counselling skills and energy regulation have evolved since those early days. There are specific, quick strategies that help me to remain centered and grounded during sessions and between clients, and I’d like to share them here with you.

1. Hydrate. This was one of the best pieces of advice that I heard in my graduate degree courtesy of Dr. Dawn McBride – she recommended drinking plenty of water during sessions to remain hydrated. This helps prevent literal headaches for me, which makes life easier! Taking a thoughtful sip of water can buy a moment of reflection to respond to an unexpected client statement. As a bonus, the act of getting up after a session to refill a water bottle allows for a quick physical break and sense of movement between sessions.
2. Imagine. I work with clients on creating containment imagery to help them feel safe, and I use my own mental container when I need to disengage from a persistent thought or story after a session. I reserve this for the “big stuff” that would otherwise affect my ability to be fully present with my next client. Alternatively, I might visualize thoughts as clouds that are drifting by or another similar image to gently detach from them.
3. Sense. After a heavy session, I often like to do a quick act of self-nurturing with one or more of my senses. I keep a little self-care first aid kit in my office with things like mints, lip balm, hand lotion, a peppermint essential oil roller, and river stones. I can use any combination of these to anchor and nurture myself in the brief space between two clients.
4. Write. In a perfect world, I complete my notes in the 10-minute space between clients -when this happens, I feel like a rockstar. Realistically, my notes are usually done at the end of the day. Concisely distilling 50 minutes of work to capture progress and plans helps me to clearly mark a boundary between one client and the next. At the end of the day, it helps me to draw a line in the sand between work and home, the professional and the personal. Either way, I feel that my work is safely (and ethically) contained and I am free to move along with the next part of my day.

Well, there are a few quick strategies that I use throughout my workday to refresh and stay regulated. What are your favourite ways to care for your needs between clients? Feel free to reflect or post in the comments below.

Annelise Lyseng is a registered psychologist at MacEwan University in Edmonton, Alberta.

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

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