Tag Archives: Andrea Cashman

Insights and Take-Aways From The Polyvagal Theory for Trauma Clients

Posted by: Andrea Cashman on September 25, 2015 8:49 am

I recently attended Stephen Porgues workshop in Ottawa called Social Connectedness as a Biological Imperative: Understanding Trauma through the eyes of Polyvagal Theory. If anyone is interested in pursuing a specialization in trauma or expanding their trauma learning repertoire, I highly recommend attending a workshop with Stephen Porgues. He is a great speaker that can break down the science of Polyvagal Theory so that you can apply this knowledge to helping your trauma clients. It was a very informative and even inspiring workshop to attend. I cannot say all workshops in the past have given me more fuel for the passionate work that I feel I am doing. I thought I would share some insights and learning points that I took away from this workshop. By all means, it would be wise to look into Polyvagal Theory in its entirety to full understand its scope and application for treatment. I will not be going into it in full as that would take up a lot of blog space and it is not the purpose I intend on in my blog. I recommend either attending a workshop or purchasing Stephen Porgues book on Polyvagal Theory.

First of all, Polyvagal Theory specifies two functionally distinct brances of the vagus nerve, the tenth cranial nerve, that serve different evolutionary stress in mammals, including us humans. The less evolved vagus nerve branch serves as a more primitive branch that illicits immobilization behaviors (ie feigning death) whereas the more evolved vagus branch is linked to social communication and self soothing behaviors (wikipedia). You can check out YouTube for more explanations on Polyvagal Theory – here’s another brief definition in relation to trauma https://www.youtube.com/watch?v=8RKC3Ga6shs Polyvagal Theory claims that the nervous system employs a hierarchy of strategies to both regulate itself and to keep us safe in the face of danger. In fact, it’s all about staying safe. Our highest Strategy involves social engagement which is regulated by the myelinated vagus nerve. Our next strategy is fight or flight, regulated by the sympathetic nervous system when social engagement is not an option. Our last option is to freeze, to immobilize when fight/flight is not an option in the face of trauma(Garland, 2013). Continue reading →

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

Helping Clients See Past Their Diagnosis:

Posted by: Andrea Cashman on September 8, 2015 9:01 am

As psychotherapists, we use diagnoses to categorize mental illness to assist us in developing and implementing treatment plans based on current up-to-date research. A diagnosis serves as a guiding tool for treatment purposes. It is imperative for us psychotherapists to see our clients for who they are – genuine and unique human beings struggling to stay afloat in the midst of their personal storms. Clients come in struggling with issues pertaining to their mental illness with impacted relationships and consequently the burden of stigma that many endure with their diagnosis. It is helpful to unpack stigma to help you and your client understand it fully. The World Health Organization in 2001 also recognized that it is the largest barrier to treatment engagement.

Jones and colleagues outlined stigma, in it’s full scope, to have 6 dimensions that include:

Peril – Otherwise known as dangerousness. Clients can be perceived as frightening, unpredictable and strange.
Conceal-ability – The visibility of a mental illness which parallels with controllability. Mental illnesses that are harder to conceal are more stigmatized.
Course – How likely the person is to recover and/or benefit from treatment
Disruptiveness – Measures how much a mental illness effects relationships or success in society. If the mental illness is seen as less disruptive, more stable, it is less stigmatized.
Origin – Mental illness can be either biological or genetic in origin.
Aesthetics – Or the displeasing nature of mental illness in its social cues and perceived behaviours that fall out of the norm.

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

Helping Young Clients Transition From Post-Secondary School

Posted by: Andrea Cashman on August 26, 2015 5:00 am

Many of the young clients that come into my office seem to be struggling with making the transition from post-secondary school into the real world. They are the young adults who have just successfully graduated from their College or University programs but struggle to make the next step. The reason behind their hesitation is not what you may think it is initially. Many of them struggle to even get past putting in applications for job postings. The job search terrifies them not because there is a lack of jobs necessarily but because they do not feel good enough or they completely feel lost on what career is for them. Struggling with self-identity or self-esteem issues is what holds them back. I’ve even seen clients who have entered into programs that their parents have picked out for them. These young adults feel trapped in a world that doesn’t hold true to themselves. Regardless, the question remains the same: why are these young adults suffering a transitional crisis so early on? We mostly hear jokes and passings about mid-life crises. We hear frequently about empty nest transition crises. However, we rarely hear about young people suffering a crisis in their 20’s. This is often referred to as a quarter life crisis. Continue reading →

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

Is goal-setting essential for a good marketing and learning plan?

Posted by: Andrea Cashman on August 20, 2015 5:00 am

It’s important to establish goals and goal-setting in your private practice to maintain a marketing and competency plan in order to grow or maintain your practice. Without goals, it’s easy to fall within a rut or status quo and this lack of growth will affect your practice in minor or major ways. Goals allow you to achieve certain objectives to fulfil your practice vision or dreams. These visions or dreams can include building your clientele or advancing yourself through specialization or expertise in the psychotherapy field. Sit back and ask yourself – What do I see when I envision my dream practice? Then ask yourself – How can I get there? What goals do I need to make?

Examples of some goals related to competencies may include ones that centre on delivering effective client care and establishing trust in the therapeutic relationship (which may be examined in client feedback and supervision etc.,), developing more sound knowledge of medical and psychiatric illnesses (through courses and reading), developing a learning plan that includes specialization or furthering your competency level based on the client population you counsel, developing your communication skills through learning basic counselling skills (if you are a new psychotherapist), or goals centred on professionalism or referral networking. Each of these goals listed above can be broken down into specifics and tailored to meet your preferences and desired outcomes. It’s important to list your goals as either short term or long term goals and to be easy on yourself if you do not meet a deadline in time. Goals can always be altered. Continue reading →

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

The Importance of Incorporating a Holistic Approach Into Your Practice

Posted by: Andrea Cashman on July 21, 2015 12:44 pm

I’ve always gravitated to looking at someone in their whole form so when I heard that I could utilize this to market and found my practice on this approach, I decided that that was what I wanted to do. The business name I chose was Holisitic Counselling Services and I chose this in part to reflect my values and to let clients know that I am open to viewing them as a whole person and practice in this manner.

The word holistic comes from the word “whole” and examines a person (or client) in terms of their mind body associations that also tie into their emotional and spiritual well-being. Mental Health, or health in general, depends on all these factors working together in the environment. The environment around the person can alter these factors. Your role as a psychotherapist is to not only focus on the client’s presenting problem but to see the client as a whole person and determine how the problem is affecting all aspect’s of their day to day life as well as what other positive or negative influences promote or diminish their well-being or mental health. No client wants you to focus on their issue exclusively. They also want to be seen as a person and validated as such.

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

Yoga as a Form of Trauma Therapy

Posted by: Andrea Cashman on July 8, 2015 4:00 pm

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There are many trauma therapies that focus on the body such as sensorimotor therapy and EMDR. Exercise itself is a healing modality for depression, anxiety, stress and especially trauma. Many therapists may turn towards CBT or exposure therapy or another form of psychotherapy, forgetting that the body may be a source of healing. I specifically want to talk about the effects of yoga on trauma as this is a great trauma tool to encourage clients to engage in. Yoga therapy has been understudied; however, has been shown to be an effective adjunct treatment for psychiatric disorders (Cabral et al.,)

Trauma and its effects on the body cause disregulation. In PTSD, the fight or flight system is broken causing prolonged symptoms of re-experiencing, avoidance and hyperarousal. Hyperarousal symptoms are the main embodiment of the physical symptoms within the body of a PTSD client. Clients may feel easily startled, hold tension within their bodies and have difficulty sleeping and exhibit angry outbursts (nimh.com). The body will hold onto that tension and not be able to regulate back to a calm state compared to someone who does not have PTSD.

Yoga has many physical benefits, one of which is retraining the body to be calm. The National Institutes of Health Center for Complementary and Alternative Medicine defines mind-body interventions as “a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms.”Yoga practice enhances the connection between the mind and body, and it is used as a therapeutic intervention in a variety of diseases. The mechanisms that allow for the potential therapeutic effects of yoga involve the autonomic nervous system, especially a reduction in sympathetic tone, as well as activation of antagonistic neuromuscular systems and stimulation of the limbic system (Cabral et al.,)

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

Sensorimotor Psychotherapy

Posted by: Andrea Cashman on June 4, 2015 9:35 am

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My thoughts and a brief introduction on Sensorimotor Therapy for Trauma Clients

In April, I attended a workshop on Trauma and the Body – The Theory and Practice of Sensorimotor Therapy presented by Anne Westcott on behalf of the Sensorimotor Psychotherapy Institute (SPI). I’m particularly interested in theories designed to implement treatment on trauma clients. This particular workshop opened a new realm of possibilities for me. I had my sights on becoming specialized in EMDR in the future but perhaps SPI’s three level certification program is another avenue to explore for me and for anyone seeking to work exclusively with trauma clients. I don’t necessarily believe that one theory is better than another; however, I do believe it is about what works for you the therapist and your clients. The Sensorimotor Psychotherapy Institute was founded by Pat Ogden in the 1980’s out of her interest in the correlation of client’s disconnections from their bodies/their physical patterns and their psychological issues. Before PTSD appeared in the DSM, Pat recognized that treatments in that time seemed to trigger traumatic reminders in a detrimental way. Sensorimotor Psychotherapy (SP) is drawn from somatic theories, attachment theories, neuroscience, the Hakomi method and cognitive approaches. Pat Ogden quotes “most human behavior is driven by procedual memory – memory for process and function – and is reflected in habitual, automatic responses and well-learned action patterns: movements, postures, gestures, autonomic arousal patterns, and emotional and cognitive tendencies.” This SP workshop explores the processes of memory and how this information can be utilised to change procedural learning in a window of tolerance for the client with PTSD. Specific skills such as tracking and attuning the body are taught. Dysregulation is noted with trauma responses of fight, flight or freeze and how the neuroscience behind the sympathetic and parasympathetic brain structures play a role in these trauma responses. SP uses movement to move the client in a state of active mobilizing defenses into a state of triumph.
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*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA

How to Deal With Cancellations and No-Shows

Posted by: Andrea Cashman on May 27, 2015 9:14 am

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I knew going into private practice I would have to expect some clients to cancel or reschedule. I certainly did not account for the high amount that did. I had planned for it before opening my practice by adding a cancellation fee to my consent form and by talking to clients about it. I find this to be quite effective in and of itself. However, there are some other tips I can share with you.

First of all, why do clients cancel or reschedule last minute? Is it that life gets in the way via personal illness, personal and family emergencies, a death in the family etc.? Or is there something a bit deeper to these last minute cancellations? Some clients may cancel their first appointment for fear of the unknown; however, this type of cancellation seems, at least in my opinion, to be rare. I find that mental illness itself may impede the client from making their appointment, especially when anxiety and depression come into play. If they can barely meet their activities of daily living, like showering and getting out of bed, how can they make it to your office? Other reasons people may cancel are due to a breach of some kind of the therapeutic alliance perceived by the client, a change of financial situation, having a phobia to come in or having some form of avoidance especially when diving into deep topics etc.,

Having a cancellation policy set up in your consent form, like I mentioned above, is a great first step to avoiding or cutting down on cancellations. Clients will think twice about cancelling last minute because a cancellation fee will apply. You can always give a first time warning as well if you are worried about breaking the therapeutic alliance. I believe that if you set the boundaries early about cancellations, clients will respect that and reschedule/cancel ahead of time to respect both your time and money. It is up to you what you will charge for cancelling last minute and what time frame you set. I tell clients that I prefer a 24 hour notice by email or phone but the fee will be applied if less than 12 hour notice is given. I personally charge half of my actual fee. At first, I wrestled with this notion of charging people for last minute cancellations. Then I began to realize that it is my time and my source of income and it’s a professional courtesy. If you are new to practice and you have a last minute cancellation – you may already have gotten ready for the day and be in the office and that may have been your only client. Can you justify the fee then? Many clients may not be aware that you pay for office rent, supervision, advertising, business supplies, etc., all out of pocket. This is a business decision that you need to decide is right for you. If you do decide to have a cancellation fee, will yours be flexible in certain circumstances?

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

Important Lessons From Vacation Time

Posted by: Andrea Cashman on May 4, 2015 2:38 pm

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It has been almost four years since I took a real vacation (and not a stay-cation). The stress had taken its toll from working as a psychotherapist and a nurse over the last few years so when I finally decided to take a vacation this year to de-stress and unwind, I truly felt the positive gains from it and saw its benefits. I had decided I needed a beach vacation to be able to de-stress and self-reflect. It’s always important as therapists to schedule in these much needed breaks to reconnect with ourselves as human beings and recharge for ourselves and for the benefits of our clients. Yes, it’s hard to leave knowing some clients might feel abandoned or have difficulty coping without having their therapy sessions readily available during the week(s) you are away; however, not taking a vacation for yourself does harm to all parties. It not only can cause you burnout which will affect your clients but it also sends the message to your clients that they have to depend on you and that you are not a model of self-care yourself. Being well attuned to your own needs sets a good example. If you have a full case load and have complex clients that you feel may need some potential support while you are away, you can always designate a back up therapist to look after your clients as need be. This is at your discretion. Don’t hesitate to let your clients know you are away by preparing them in session and by changing your voicemail message and email vacation reminder.

So, here I was in Cuba last week, enjoying the beach and the sun. I was able to relax, meditate and reflect on myself as a person and a therapist. I recharged myself. I was away from all social media and email/phone correspondence and it was liberating. I was able to take in the culture and be humbled by my surroundings and took on a new appreciation for my life and felt true gratitude. I noticed how happy Cuban people are and how they use music, dance and song to express their happiness. I noticed how much they smiled and laughed and revelled in simple things. I wondered how disconnected we were compared to them and how much we take for granted. My take-aways were humbling and grounding for me. Even just taking care of my basic needs of sleep, food, water and sunshine/fresh air did a world of good. How many times do we have sleepless nights or don’t get enough vitamin D from the sun? – and how these factors lack in our daily lives and effect our work ethic. I even have heard of therapists who don’t schedule in a proper lunch break in between clients. How can you truly be effective and available when your concentration is off with your stomach rumbling? Not only did I think of these things, but I also had time to reflect on where I would like to be in a year’s time from now and where I hope my private practice will be as well. I hope you take the time to have a self-reflecting and recharging vacation time this year because you will not regret it.

Andrea Cashman is a private practice psychotherapist who has founded Holistic Counselling Services for individual clients seeking therapy in Ottawa, ON. She also practices at the Ottawa Hospital as a registered nurse. Feel free to comment below or contact her at [email protected] or visit her website at www.holisticcounsellingservices.ca

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

Non-Verbals in Session

Posted by: Andrea Cashman on April 23, 2015 10:21 am

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Approximately 90 per cent of communication is exchanged non-verbally and most of that is done in an unconscious way. We use 30 of our 90 facial muscles to convey non-verbal communication (www.counsellingconnection.com) The body’s innate intelligence is an untapped resource in psychotherapy (www.sensorimotorpsychotherapy.org).

You have learnt about non-verbal communication in your counselling graduate studies. It is an essential skill to be able to pick up on subtle non-verbal cues your clients exhibit in session. Most times, a client may not be able to put into words or articulate how they really feel. Non-verbals can speak for them. These non-verbals demonstrate a client’s status in their eye contact, facial expressions, their body movements and in their posture. For example, a depressed client may exhibit a slumped body posture, with their head mostly down, shoulders down, eye contact limited and they may seem to reflect a body posture that turns inward and makes them appear smaller. Most times a client’s non-verbals will match what they are conveying to you verbally about their situation and sometimes there will be an incongruency between what is verbalised versus expressed in body language. It’s an important skill to notice non verbal communication and another skill to be able to incorporate that into therapy by reflecting back what you have observed. Often times client’s are not even aware of the messages their bodies are conveying. Helping them become aware can facilitate body awareness in times of relationship conflicts where others may perceive their body language as threatening or in any other negative fashion.

There are many theories and therapies that utilise nonverbals. Sensorimotor psychotherapy, developed by Pat Ogden in the 1970’s, correlates the disconnection trauma victims feel in their bodies with their physical patterns and their psychological issues. Sensorimotor psychotherapy joins somatic therapy with psychotherapy (www.sensorimotorpsychotherapy.org). Somatic therapy is another holistic therapy that studies the relationship between the mind and the body in regard to psychological past. The word “soma” is a Greek word that means living body. Somatic therapy shows how trauma symptoms and their effects on the autonomic nervous system and how these effects can fester into prominent physical symptoms, digestive issues, hormonal imbalances, sexual dysfunctions, depression, anxiety and addictions (http://psychcentral.com/). In addition, other therapies utilise non verbal communication to some degree. Emotion focused therapy relies on body language to convey emotions and work directly with them. Biofeedback is another therapy that tracks specifically body language by use of monitors or biofeedback machines to ease anxiety and stress. There are many more, of course. Can you think of one that has intrigued you or one therapy that you use specifically in your therapy sessions that utilises the body/body language?
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*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA