Cap Psych Pod Episode 8: Grounding Techniques

Today we’re joined by Tracey Eisenberg. Tracey is a registered psychotherapist and has been with us here at Capital Psychological since 2020. Tracey’s diverse career as a lawyer, coach, and now therapist has offered her an opportunity to treat both individuals and teams in crisis, as well as individuals facing mental health challenges. Tracey’s practice focuses primarily on supporting individuals aged 12+ to address issues such as anxiety and depression, stress management, trauma, compassion fatigue, self-esteem related issues, and other mental health challenges. Today, Tracey will be discussing the importance of utilizing grounding techniques in everyday life, as well as how to prepare yourself for holiday situations that can be tricky to navigate for some.

What are grounding techniques?

I get that question a lot in session when I’m suggesting to clients that it’s something they can benefit from, especially if they’re anxious. In the simplest form, grounding exercises are things that you can do to help bring yourself back into the present moment. So, if someone’s super anxious or if they’re having a panic attack or they’re in their head, grounding will bring them back into the room and back into the environment. There are many different kinds of exercises, some of which I will describe for you today, and they range in both complexity and time spent. Some grounding techniques are as simple as getting in touch with your breath- hearing it, feeling it, sometimes counting it. It’s similar to mindfulness; you have probably heard a lot about mindfulness – the act of staying present in your environment. There is a great deal of overlap here but whereas mindfulness is a grounding practice that can be done daily. When we talk about grounding it is usually done when we are feeling overwhelmed, anxious, or stressed.

What sort of situations in everyday life can call for grounding techniques?

I think, especially right now in a… I’d like to say post-covid but I’m not quite there yet.  In a “getting to post-Covid world” there are many things that can being us to a place of heightened emotion – anger, anxiety, fear, etc. Whether the emotion comes from a flashback from a previous incident (common for those suffering from PTSD), or we are faced with difficult situations at work or home, these techniques are helpful. For example, if you suffer from panic attacks (this is a formal diagnosis provided to you by a health professional) or you are having trouble coping with a difficult person or assignment at school or work, you might find yourself in a place of distress. Maybe you had a confrontational conversation with someone, and you are activated by it and worried. You might be replaying events over and over in your head, or your heart rate is up, your palms are a little sweaty, you are having trouble concentrating and you might feel a bit panicky. These are all typical situations in which grounding can be helpful. Or maybe you have a really confrontational conversation with someone and after the conversation you’re really revved up and worried about it and maybe you’re replaying it in your head over and over again multiple times, these are situations where someone can feel panicky and they’re all situations where grounding can really be helpful.

How will the grounding be helpful? What can I expect to feel?

That’s a good question. Let’s get into the nuts and bolts of grounding. Grounding will help because, essentially, it brings you out of your head and back into the room or environment. It is like the cog in the wheel that is spinning around and around in your head. It helps to stop the spinning and it’ll slow you down, reconnects you to the “now” and helps to slow your breathing and your racing thoughts. Some people report that when they’re in the middle of a grounding exercise, they find that they are not thinking about anything else but the exercise which is something they find very helpful and relieving. The exercises are underrated because they can bring you to a place of increased peace and tranquility, without the need to solve the problem or figure anything out – in other words, grounding allows you to just “be”. You can expect to feel different things when you ground – depending on the type of exercise.

You’ve probably heard of the term adrenal fatigue. Grounding techniques can help us to address this issue which can leave us feeling depleted for most of the day. Our adrenal glands excrete hormones like cortisol. These levels usually peak in the morning and fall as we near bedtime. For those under stress, this hormone level may become unsynchronized. Grounding – and especially earthing – can help to resynchronize the levels of cortisol and provide more energy.

A simple grounding technique is to walk barefoot on the ground (grass is an amazing place to try this). The exercise reconnects you to the earth, to where you are, and to nature. When we reconnect with the earth we feel more solid, and calmer. Another nature-based grounding technique is hugging a tree. Trees are so solid that hugging one can remind us of how they have weathered so much over so long a time and are still there, rock solid. Otherwise referred to as “earthing”, the idea is to connect to the energy of something living. For the non-tree-huggers, I will go through some other easily accessible exercises.

Other grounding exercises that you might find helpful are:

·       Connecting to your breath (breathing slowly up to ten times until you both feel and hear your breath and the breath stabilizes to a consistent rhythm. When you do this exercise, count each breath, and focus on both the inhale and exhale. When possible, extend the exhale for a bit longer.

·       Hold something cold in your hand and notice the object (a canned drink from the refrigerator will do the trick). Feel the cold, the shape of the can. Take a sip and notice the feeling of the drink as you swallow, the bubbles, the fizzy sound.

·       Pick up your pet if you have one, and notice how they feel – the beat of their heart, the feel of the fur/hair, their smell.

·       Use all of your senses. Try to name 5 things you can see, 4 things you can touch right near you, 3 things you can hear (eyes closed are best on that one), and 2 things you can smell, and then think of one thing you are grateful for. This is a particularly effective technique that I use often with clients.

·       Splash your face with cold water and notice how it brings you back into the room.

·       Jump up and down for a moment and then clap your hands. These movements will help to release some anxiety and also bring you some body awareness.

·       People who experience frequent bouts of anxiety use both the breath and the senses exercise, and some will even wear a hair elastic on their wrist that they can flick gently. This helps to bring them to the present.

I would like to elaborate a bit on the extended exhale breathing. This exercise is the most readily available as you always have your breath with you. It is an extremely useful grounding tool. Breathe in through the nose to a count of 4 and then exhale very slowly through the mouth until you are empty. Then stop and notice how you feel. You will likely feel calmer. You can do multiple rounds of this exercise.

As we approach the holiday season, how can someone use grounding techniques in a situation such as a stressful event like hosting a big dinner or attending a large family gathering?

Holidays can be stressful at the best of times. We are usually overwhelmed with a long “to-do” list. There may be individuals with whom relationships are strained but who will be present. It is a great idea to start (before the holiday season) by focusing inward. Notice how you are breathing. Is your breath feeling tighter than usual? Are you taking shallower breaths? Do you find your mind distracted or racing? Begin now to practice the extended exhale breathing. If you can, combine 2 of these exercises and sit on a chair with your feet solidly on the ground (earthing element) and then use your breath. Notice how you feel after. Does your chest expand easier? Is your mind calmer?

Before guests arrive, ground yourself. Take the time to be present. Practice some gratitude (another podcast for sure) for everything that you have and that you are and take a moment to yourself to do a 5-4-3-2-1 exercise in private. So much preparation goes into the holiday gatherings, and we want to be present (mindfully) to enjoy them. Don’t feel awkward if you need to leave the room for a few minutes to ground if you are beginning to feel heightened. Take a mindful walk before everyone arrives...it will settle the mind and prepare you for the arrival of others into your space. What is a mindful walk?

How are mindfulness and grounding related?

Mindfulness is a type of meditation that, like grounding, is aimed at reducing stress and anxiety. It gets you in touch with your feelings and senses (like the 5-4-3-2-1 exercise) and heightens your awareness of the environment (similar to earthing). There are many different ways to practice mindfulness. The mindful walk I mentioned is one. Take a walk (without earbuds if possible) and notice everything in your path – what do you see, what can you touch (leaves, trees, grass)? Pay attention to everything – what do you smell, hear, etc.? Other mindfulness exercises include doing a body scan where you try to focus your attention on each part of your body. Notice where you are tensing up and where you are not. Stay aware of any sensations, emotions, or thoughts that you notice as you scan your body. YouTube has many guided body scans that you can listen to and follow along. Simple mindful exercises such as sitting and breathing or walking can be practiced at any time. For the body scan, allow more time and a quiet space.

Can anyone do these exercises or do you need to be professionally trained?

The exercises I have mentioned today – both the mindfulness ones and the grounding techniques do not require professional training. However, if you are in the care of a therapist, he or she can walk you through these exercises and may even practice them in session. Feel free to ask questions if you feel you need more guidance.

Cap Psych Pod Episode 7: Psycho-Educational Assessments

Today we're joined by Sarah Mackrell. Sarah is our head psychometrist. Today she will be sharing some information on the different types of assessments that we offer as well as when to tell if you or your child may need an assessment and what to do once the assessment is complete.

The first question that I think we should start with is how to tell if you or your child may need an assessment?

S:  Signs that a child might require an assessment often depends on the age; so early on, it can often be prompted by family physicians. For example, are kids meeting appropriate developmental milestones for things like motor skills or speech, are they developing expectedly in terms of their social skills from things like eye contact, social play, etc. Once kids are older in the daycare and in school years, it can be prompted by teachers or daycare providers who may express concerns about their behavior or learning skills, especially compared to their peers. Also, parent intuition; are you concerned about something in their developments? Are you seeing them struggle more than expected in terms of their development or academic skills? And if you're not sure, talking to a doctor or friends or teachers can be helpful.

Typically, what age do children need or generally complete an assessment?

S: So, often when we're looking at assessment timing, important transitions in developmental can help prompt us for when we might look at when we want to do those. For example, as I mentioned, starting daycare or elementary school are big transitions for kids so it's common for kids to have some trouble with that adjustment as they’re settling into a new environment or new routine. Think about “Is there difficulty excessive” so, are you seeing a lot of behavioral challenges? Is it causing them a lot of mental health difficulties for a longer period than expected? Are they having a lot of social challenges that, again, are not typical for the usual adjustment trouble that they might have a new environment? And a big part for that is thinking about where they are developmentally, so is anyone else concerned? Again, as I mentioned, we expect some adjustment difficulty, but is it above and beyond what’s typical in terms of the intensity and duration of those challenges and where are they at relative to their peers? For example, when we're talking about starting school, you might have a child who's born in December versus a child born in January and we would expect some development variation there in terms of their adjustments. Keeping in mind, is it appropriate for where they’re at for their age and where they are relative to their peers?

As far as teacher prompting that's a big one from learning disabilities and attention issues as those tend to be noticed in the classroom. Academically, around grades 2/3 is usually when we do assessments the first time around for reading, writing, and math challenge. Attachment issues tend to come out more then too as kids are in a more structured academic environment. Sometimes, we see those troubles more often because there’s greater demands on staying seated or listening to instructions. For kids who do relatively well in earlier grades, we often do assessments around that middle school- high school range as there's more demands on attention skills like planning, organization, homework, increased independence that tends to be a time were especially bright kids they can't really coast by anymore on their intellect, they start having more demands that look for more of those higher order skills versus their aptitude for a task. Then the final time for kids is usually that reassessment often needed for college or university to maintain supports.

K: Okay that makes sense, so it really just varies depending on every kid, really.

S: Yeah, and there's expected transition points where there are shifts in the curriculum and that can make things more or less difficult for different kids depending on the areas they struggle with.

Right, okay. So, so far, the focus has been on children but adults sometimes also require an assessment. What are some signs that an adult may want to seek out an assessment?

S: For adults typically, the main prompt is difficulty in the workplace. For people finding that they’re having a lot of trouble focusing on their job tasks, people who are consistently having trouble meeting workplace deadlines, mental health challenges can also prompt needing an assessment done. For adults, the mental health challenges might be also an issue in the workplace but often it’s prompted by physicians who want a formal diagnosis to help guide pharmacological treatment to see what's the diagnosis they fit best into, what medications might help, or if there's multiple diagnoses because that can affect the combination of medications and might be important information for a physician.

Another type of assessment often done for adults is for people have been in some type of accident. For example, car accidents, or people have had some have injury from activity like a concussion. In that case, someone might need an assessment to formalize support for workplace or for accessing services through their insurance company.

Okay, perfect. Starting the assessment process can seem like a daunting task for some people. Can you explain the different types of assessments that there, are and how each type of assessment can be helpful?

S: Yep, so as I mentioned, psychological assessments are one type of assessment and that's usually then formalized a mental health diagnosis; that can be used for guidance for physicians. It could also be used for guidance for therapist, so if someone's working with therapist and feels that a formal diagnosis can help guide treatment, that can be useful. Also, this can be used in the workplace and people need accommodations around their condition or support or things like extra time for work or any time off, things like that.

ADHD assessments are another type of assessment. Again, often those are used for accommodations in school and the workplace, formalizing supports, also for physician guidance for medication if needed.

Psycho-educational assessments are used in the education world especially, so school accommodations for things like extra time, access to technology for students, and formalizing supports in the workplace too. If someone might have a long term academic challenging for things like reading, you might need accommodations in the workplace for things like technology.

Gifted testing is often used just to confirm a student meets criteria for entrance into gifted programming offered through the schools because that tends to be limited, so that's more confirming that they meet criteria in that case.

For Autism Assessments, again providing guidance from parents, teachers, physicians just best support the child for other practitioners who involved in care. Assessments are also often required in order to access funding services available. So, the assessment can help open up access to services and provide more information on how to best support children and adults.

Neuropsychological assessments again guidance for physicians, accessing funding through insurance, workplace and for children also in the school.

Okay perfect! Can you tell us about the process of getting a child in for an assessment and just kind of some general timelines that people can expect?

S: The first step is calling the main office to see what the wait times are. Unfortunately, there's a lot of demand right now and wait list can be extensive at a lot of offices. So, calling the office, getting your name on the wait list and see what the expected wait times are, which can vary depending on the time of year and demand at the time. The next step is to speak with your family doctor and insurance companies; check if you have coverage and if you need a doctor’s referral letter. We don't need a doctor’s referral letter for you to access our services, but some insurance companies do require a doctor’s letter saying that you require an assessment to provide coverage for the process.

Once you come up on the wait list, someone from the office will call you to set up an intake meeting. For parents of children, that meeting’s done just with parents to review the child's medical history, social, emotional, and academic history. For adults, work history is also applicable. After that, we will book times for you to come into the office to do testing; the assessment measures are completed in the office. After that's completed, we will score all the test materials and prepare a draft report. This is written by the Psychometrist and Psychologist involved in the assessment. Once that's done, we complete a feedback session where we review any diagnoses and then talk about recommendations which is the most important part in order to see how to help with areas of challenge. Finally, we send you a copy of the report to review and that's an opportunity go through it in more detail and ask us any follow up questions.

What kind of information is included in the final report?

S: The final report typically involves a review of background history that we get at the intake meeting, the second part of the report is looking at the testing results, so a summary of all the testing completed in office, and then the final, most important part is the recommendation section. The way the report’s broken up for that part is it's usually in headings for the areas of difficulty, and in that section, we’ll talk about accommodations and recommendations for what can be done to address those challenges. For students, it could be in class support (classroom modifications, technology access) it can be referrals for other professionals that might be able to help work with those areas more specifically like an occupational therapist or a therapist for emotional challenges, and adjustments for evaluations in the workplace or school setting.

Okay, and then once the final feedback appointment is completed and parents have the report with all those recommendations, what should they do with it?

S: The first thing parents should do is contact your child's school and let them know that you have completed an assessment, you have the report, and would like to set up a meeting to review the recommendations and set up an Individual Education Plan (IEP) and that's just to formalized supports in the school. [The IEP] is basically a condensed document that summarizes any diagnoses, areas of strengths, areas of challenge, and then has required supports for environmental accommodations in the classroom, assessment accommodations required for tests and exams, and instructional accommodations required by the teacher as far as how they communicate your child for their needs. Once a feedback appointment is completed, another thing that might be required too is additional paperwork. This depends on the case; for the majority of people, the report is enough for school, but in some cases if you're looking at things like funding access there might be additional paperwork that we need to fill out. At that point parents can also let us know if there's any documents they need us to complete to help support an application for funding support.

Just a couple more questions and these are questions that we typically get from parents or from people that are having assessments done. One is how to explain the process to a child – for some it can be kind of scary and if you tell a child they are going to see a doctor, I know a lot of the time they expect to be getting needles at our office, which is not accurate. How would you suggest that people explain the whole process to a child?

S: Often, we’ll recommend using the child’s own words. Usually by the time people are looking at an assessment, kids are aware of what they're struggling with so whether it be reading or attention or difficulty with their peers, they’re usually expressing to their parents that they're struggling either if they’re [feeling] more sadness, they’re more anxious about things, or they're just really frustrated. We usually recommend using their own language back to them, so “Remember when you mentioned you were having trouble?” or “You're feeling left out and you're not really sure why.” or “That reading homework we've been doing, you’ve been getting really frustrated.” or “Do you feel like you're listening in class but people are telling you that you're not paying attention or you're not working hard enough?” Using their own frustrations and saying, you know “You've expressed that you're really having a challenge in this area. We want to make it easier for you.” Using their experience can be useful because then it makes sense to them why, and it’s also validating their experience and explaining that this is supposed to make your life easier and that's why we're doing it.

One last question: is the outcome of this going to limit them from being successful in the future?

S: Yeah, so that’s often a common concern from parents is if they do meet criteria for some kind of diagnosis, whether it be learning or attention or something else. The fear that this identification is going to hinder them in some way or that their challenges are going to stop them from achieving your goals or being successful and this is not true at all. It’s not uncommon for students have the biggest difficulty in these areas in the school-age time, so elementary school to high school. Unfortunately, there's not a lot of flexibility at this age; you have to be in school for a set amount of time, you have to sit at a desk for a certain amount of time, you're taking courses that are required despite your interest level in some cases, and this tends to be less of an issue overtime. Towards the end of high school students get a lot more choice, they're picking things that they're interested in, they naturally will self-select into a skill area and especially as they go into the college or university time, they’re picking something they’re going to be doing as a career- something they're motivated to do, something they’re interested in, something they’re good at, and they’re going to be surrounded by peers who have similar interests. So, the impact tends to be less and less overtime. It's not to say that their challenges won’t affect them in those careers, but the motivation and their skill will compensate in a lot of ways, and people don't have to pick a job if they're not good at it. You can pick a job that you're interested in, you can pick careers that are on a topic you’re related to that minimize impact your challenges. Someone with attention issues might not want to sit at a desk all day and be staring at a computer screen; they might want something more dynamic where you're talking to people and they’re able to change what they're doing day to day. There are ways to be successful in careers that were going to minimize the impact as an adult and that's something that's going to improve overtime.

I think that was all the questions that we had. Thanks so much for joining us today Sarah that was very helpful. I'm sure I'm sure it'll be great for a lot of people who are questioning where to get started with assessments.

S: It can be a daunting process but it's really helpful I find, for a lot of people having some type of information about why they're struggling and guidance on how to overcome [it].

Thank you so much again to Sarah Mackrell for joining us today. If anyone would like more information on assessments within our office, please feel free to call us at 613-599-7709 or visit our website at www.capitalpsychological.com.

Cap Psych Pod Episode 6: Gender Identity

  Today we’re joined by Melissa Flatla.  Melissa works with individuals (ages 9+) who have questions and concerns related to anxiety, depression, self-esteem, neurodiversity, trauma, and identity. In particular, Melissa specializes in working with the trans* and gender diverse population. Melissa works with clients to co-create a space wherein they can feel empowered to share their stories and move toward wellness through a lens of self-compassion. In honor of June being Pride month, today we’ll be speaking about all things gender identity. 

For anyone listening who may not be familiar, can you please explain what being transgender is, or what questioning your gender identity means?

M: Yeah, absolutely. I’ll give a bit of a brief overview. So really, I'm going to start by giving some terminology. When we think about transgender we also need to think about cisgender. These are often the terms that folks might hear most often. Cisgender is essentially an individual whose sex assigned at birth and their gender - so their identity - align. Transgender, again I’m putting this very simply just for the sake of doing so, is someone whose sex assigned at birth and gender, so their identity, do not align. Now, there's a whole wide range of identities and terminology that I won't delve into today- I'll just give you sort of a scratching at the surface, but there's a lot more so if folks want to do some reading or watching some videos there's a wealth of info on out there.

When we talk about gender, we need to also talk about sex. I'll be saying sex, biological sex, sex assigned at birth, I might use them interchangeably today. Essentially what that is is it's a categorization that's based on somebody's external presentation at the time they're born; so, the baby is born and the doctor or the nurse looks at the baby- they look at their external genitalia and they place them in a category. Typically, it's either male or female although there is a third sex- intersex, and folks may be put in that category if it's not clear where they might fall. Now, this categorization- this assignment that's made for us really sort of shifts this trajectory for the child. This changes their socialization, it gives us a little letter to put on our birth certificate or on our passport, but it also changes, sometimes, what kind of opportunities somebody has access to, or how they're spoken to. It really dictates a great deal, and all of this happens before we have any idea how somebody feels or what their identity is because babies don't talk, so they can't tell us.

When I think of gender I also think okay, let's talk about sex at the same time so we can understand that those two pieces are in fact separate from one another. In terms of questioning our gender identity, everybody is going to define this in a very different way and I'm sort of prefacing the conversation with that because I think it's important to honor the fluidity of life, the fluidity of identity. We’re all on various journeys at any given time and that's the beauty of it; that's the beauty of being alive and being human. So, whether we are looking at, you know, any aspect of our identity there's really no one way to be someone. There's no one way to be a sibling or parent or a teacher or therapist; we get to decide that for ourselves we get to define that for ourselves, and I very much think that gender is the same. We are the ones who can determine what language feels most authentic, what expression feels like it truly brings us to the forefront, you know, how we want to be seen, how we to be received in the world. I think we do that with more than just gender, so it's a process we’re familiar with but when we start talking about gender, I think this is a place where people feel particularly vulnerable especially in the current climate. A questioning of gender identity to me is really something that I define as a personal journey you know, an aspect of our lives that that many of us may go on at various points and we may, you know, start and return to it as many times as needed but it's a place of curiosity and inviting ourselves to listen to our own voice and to me I really think that as moving towards authenticity. Who am I? How do I want to be seen? How do I want to present myself to the world? What feels right? And then really kind of stepping into that place if vulnerability but also liberation as they move towards feeling authentic.

K: Okay, that’s great. It’s nice to mention too that once you kind of figure out who you are like how you identify it doesn't always stay the same, right, later in life it can change.

M: Exactly, it's so fluid and I always make the same cheesy joke. For people who don't know me, I'm very cheesy I don't hide that, but I often think about how when I was younger, you know, I was really invested in in Pokémon- I was really into it. Now, I don't know anything anymore but for me you know, that was a big part of my identity in a very different way of course than gender, but that was a big part of my world -my identity. It's something that I moved away from overtime. Every part of us is constantly in a state of shifting so we assess and reassess overtime. The same can be said with gender and some people may feel very firmly set and established in something whereas others may move in and out of it at any given time and both are valid, and both are beautiful.

Often times, it can feel important to put a label on yourself with regards to your gender identity or even your sexual preferences.  What are some tips you would give to someone who is feeling that pressure?

M: I love this question. I really appreciate you asking this, it’s something I feel like I’ve talked about so often. My first inclination here is to really want to invite folks to explore the origin of that pressure. What would having a label offer them? Where are they feeling this pressure most? Really sort of unpacking that in a sense to get a feel for whether this is something that is a value of theirs whether it's something that holds importance in their lives versus is this sort of the social obligation? Do I feel I “need” to have a label for one reason or another, and then really wanting to explore from there. We live in a world that often values concrete ways of categorizing people. This is a very human thing that we do- we like to put everything neatly into boxes that conceptualising and easily articulate, but this doesn't really align with that fluidity of life and identity so we can come up against this this resistance or this friction of sorts. I often really want to invite folks to be curious about the origin of that pressure and if possible, to remind them that labels are for us; They don't need to be for other people and we're really in the driver’s seat with regards to the language we use, the labels that will resonate with. Some folks will feel that it's very important to them to have a label and others might be on the other side of that spectrum or somewhere in between. I think being able to work towards an understanding of where is the value for us, what is important, and how can we move toward that, I think supports that general sense of authenticity and really engages us in this process of being curious about ourselves and making space for and bring your own voice to the forefront.

We have a lot of power in determining the language that we use to talk about ourselves and our experiences and even our relationship with others, so we can sort of re-offer that as many times as we need or want, so you know reminding ourselves that there are really no rules here so why not have some fun and try things on. In doing so, can we shift that to a lens of curiosity rather than maybe a lens of obligation- perhaps it takes some of the pressure off.

Sometimes it can feel awkward to ask someone what their preferred pronouns are.  How do you suggest someone can bring this up in a conversation? 

M: I want to just preface this by saying I think this is something that is definitely a big part of conversation right now especially as we talk more about trans rights, and as we really further our own understanding from social and community perspective. I will just say, you know, there certainly are many times where we feel uncomfortable, or we feel maybe we don't have the awareness or the understanding to really engage in a conversation. If possible, I will sort of invite folks to step into that discomfort and to ask. We can ask questions; we can be curious and sometimes that capacity to really step into that space and ask someone in the same way that we would ask their name really helps to essentially normalize asking for pronouns and sharing pronouns within a space. It is nice in particular when cis folks can do some of that work as well instead of feeling like it often has to fall on the trans person’s shoulders.

If we are feeling uncomfortable or if it is something that doesn't feel accessible in that moment, there are few things we can do: one thing is we can start by using sort of gender-neutral language if we're not sure of someone’s gender or if we're not sure or their pronouns, this can be relatively subtle signal that we are safe that we are aware enough to kind of hold that space so someone may offer up their pronouns once there is that so initial sense of “okay, this might be a person I can share this with”.

Another thing we can do is focus on visibility- so having our pronouns in our e-mail signatures, our website bios, social media accounts, again that's an indicator that we are aware, that we're engaged, that we are safe, that we’re allies and to me that's sort of one of these lists of simpler, more subtle things we can do to just hold that safety for others.

For me personally, I like to just start by introducing myself with name and pronouns so I would often say “Hi my name is Melissa, and my pronouns are they and she.” By doing that not only am I offering that information to another person but I'm also inviting that in return if they're comfortable sharing. I think something like that could be very helpful, so when we're introducing ourselves, we can start by stating our own pronouns as an invite to the other person. Those would be my suggestions on the surface, but I will really invite folks if they’re able to step into a bit of discomfort to try asking, I mean there's no harm in asking a question, it’s certainly something that is not offensive in nature. It's the same thing as asking someone for their name, so really wanting to get to know someone- showing them that we care and that were present and that it's important to us that we refer to them in a way that honors who they are.

K: It is nice that social media has started adding pronouns to people’s bios as well, I find that very helpful.

M: Yeah, I was just seeing it on Instagram not too long ago. I was really excited to see that that's finally coming around and thankfully that's having this this impact and spreading out into other areas, whether it's the software we use or creating an account online it prompts us for it. I love seeing it and I'm so appreciative all the folks who have gone ahead and filled theirs out.

Another question we get from parents a lot is how to talk to their kids about their gender identity if they are questioning it and struggling with figuring themselves out.  What advice would you have to parents of kids who are questioning their gender identity?

M: What a rich question. I have the benefit of working with number of young folks, so I'm hoping that this will be a space I can offer a bit of insight here. One of the most common remarks that I often hear coming from young folks, but sometimes parents too is that they can feel the discomfort around the subject coming from the other person. So sometimes my younger clients will say “I can kind of sense my parents tense up” or “I can feel that they're not sure what to say or how to navigate this” and so they almost want to rescue their parents from that space. Sometimes they might interpret that as an indication of the subject is maybe something shameful or embarrassing and they might step back somewhat. I want to be clear that the discomfort is not inherently good or bad, it is a human experience, and I don't think it's something that we should feel we have to hide either. I actually offer the same suggestion to anyone who asks, and you’ll probably hear me say these words again today but being curious and honest I think really strike me as important elements of any conversation, but especially one around something like identity or gender. Historically, there has been a great deal of shame and perhaps many of us are still kind of on our own journey of learning and engaging with ever-evolving language and ever-evolving information, I think just being really up front, being clear and sort of naming or feeling confident in naming where it is that we’re coming from and being clear about our desire to be present and to learn alongside our loved one.

I think it's really beautiful, and it could be very beautiful to know that you've got someone who wants to accompany you along that space, who wants to be there with you and is willing to say “yeah, you know, I don't have all the answers, I have questions of my own and I've got places where maybe I have concerns or I want to explore something with you, but I'm also here. I mean I want to learn from you I want to hear the language that you learn I want to hear what you resonate with.” I think it's the same thing that parents are doing with their kids around any other topic, you know, being present, being honest about what it is that you know, what it is that you don't yet know and just being really clear about what your desire is and what your intention is in having that conversation with your kid- it goes a long way. Often, I tell folks when in doubt, go back to the basics. Sometimes we overthink it a little bit and truthfully what you're doing here is probably the same thing you're doing in so many other areas and that's being present, being honest, being curious, showing all of that love that you have for your kiddo in a really direct way. I think that's a very beautiful thing and I can tell you I hear a lot of wonderful things about it in session from kids who feel really loved and supported. You don't have to get everything right, you don't have to know all the answers, they’re going to tell you.

One last question for you: How can we best support our loved ones in the LGBTQIA+ community?

M: I knew I was going to come back to some of these words I'm glad I said earlier! Again, I think just being curious and being present with folks is going to go a long way. Like I said, sort of coming back to the basics- the tendency we have to overthink is really, to me, an indication of how deeply we care. So, you know, being patient with ourselves as we navigate this journey alongside a friend or family member or colleague. We may be engaging with the material that we have had no exposure to before, we may be engaging in it when we've had exposure to material that maybe isn’t the same language that the person we love is using. To me, I think what we can do here, and what often goes a long way is listening very closely, you know, what kind of language do I hear my loved one using, and can I allow them to be my guide in terms you know what I might want to do some learning about, the questions I might have, what language I'm using. This is a tricky one I think that I often invite folks to try and acknowledge, if present, that fear of saying the “wrong thing.” You know, try not to fear slipping up. To me, those moments where we may say something that isn't quite the right fit, or we may reflect back a concept and perhaps we're not exactly on the right page, these are really critical for learning, for growth and they're also incredibly humanizing. When we’re sitting with another person that we love and we're engaged, we’re curious and we’re present, we're already extending all of that care to them. I think they can see us there; they can feel that genuine connection. The world isn't going to explode if we say a word that they don't resonate with or if there's a gap in our knowledge. We all have places to learn- even for myself, as someone who works primarily with the trans community, and I consider myself quite well-read in terms of the material that's available and I'm learning new things everyday from my clients. The beauty of that is we've all got our own journey and we're going to be intertwined at some point but at the end of the day, everyone uses different language for any part of their own self identification whether it's gender otherwise. What we do in other situations is we listen; we listen carefully [and we] we ask questions. To me it's really the same thing here and I certainly appreciate and recognize that this can be a topic that can feel threatening or overwhelming at times. I think it comes back to that almost fierce and intense love that we have with people in our lives, and we want to do right by them. I think the truth will just coming back to the basics in a sense would be curious and being honest are going to going to make a really profound difference in that person's journey and in our own. It will maybe take the pressure off a little bit too.

I think that's all the questions that I had for you today. Is there anything else that you wanted to add?

M:  I think there's one thing that I hope that folks will take away from today, and it's really to be kind to themselves, whether you are navigating a gender journey of your own or you’re navigating one alongside someone you love and care about, you're not going to have all the answers- none of us ever do. I mean sometimes we don't even have all the questions and to me that's part of what makes life engaging and interesting, and certainly there are moments where that is uncomfortable and overwhelming, and I imagine it is also liberating. There are so many different boxes that we sort of squeeze ourselves into and that can be such a profound task to unravel some of what we've learned or some of what we know. The world is a whole lot more expansive than we might think and the beauty is that we're learning more and more about it everyday. Listen to the people that are around you, be curious, utilized resources if you can, or ask for some if you're not sure where to go. It doesn't have to be this is daunting task. You don't have to know everything; you're just being present in the same way that you’ve done all along, so I hope that we can turn the dial back a little bit on the pressure for ourselves and for other people.

Thank you so much again to Melissa Flatla for joining us today!

Cap Psych Pod Episode 4: Grief and Loss

Today we’re joined by Selena Ladouceur. Selena is a Registered Psychotherapist (Qualifying) here at Capital Psychological. Selena received her Master of Arts Degree in Counselling & Spirituality from a joint program with the University of Ottawa and Saint Paul University. Her therapeutic intention is to focus on working with individuals and families to help them heal and process emotions in a supportive, non-judgmental, and safe environment. She typically takes an empathetic approach to treatment, concentrating on theoretic lenses best suited to Humanistic, Person-centered, and Emotion-focused therapy.

Today we’ll be chatting about something most everyone has experienced or will experience in their lives, grief and loss. Selena, thanks so much for joining us today.

S: Thank you Kristin for having me and taking the time to share this topic.

Many of us have likely heard of the stages of grief- can you walk us through them and how you would recommend coping with each stage?

S: Sure, so I think first it’s really important to discuss that losing someone or losing a pet, a relative, a loved one- it is never easy to lose someone or experience the grief that’s associated with a loss. So, it’s important to learn how to cope with it and eventually get to a place of being able to accept what has happened.  I’d like to start off by sharing a little bit about grief and what some definitions of grief and loss look like and can include. Grief is very much an emotion generated by an experience of loss and it’s not really stable- it’s not something that once you reach it, it just stays there. It’s something that can change, it’s something that can be felt stronger on specific days. It’s a process, and one that’s never ending. It’s continually manifesting. We can think of grief as a stranger living with us or as something that can be experienced and then accepted but not overcome.

I have a definition of grief and it states “it is the response to loss, particularly to the loss of someone or something that has passed away to which a bond or affection has been formed. Although conventionally focused on the emotional response to the loss, it also has physical, cognitive, behavioural, social, cultural, spiritual, and philosophical dimensions.” I took a grief workshop and that was something that was explained to us in that workshop, so I thought it was important to state that.

Some other definitions explain it as there’s a grief period, a mourning period, a bereavement and then the grief work. Grief Is the natural response to the loss. Mourning is the external or public expression of the loss or of the grief. Bereavement is the stage of having suffered it, and the grief work is the work of dealing with the loss. One thing that I think is really important to talk about is the Kubler-Ross model for grief: it’s the 5 stages of grief. It described 5 primary responses to the loss. These stages are not a linear process, nor do they require completion.  An individual can retreat backwards at any time, and they can also move forwards. It’s back and forth, it’s not kind of that one pathway. For example, a person may feel that they’ve fully moved past something and then the next moment it can jump right back at them. This occurs because grief is insidious and demands to be felt. These stages include denial, anger, bargaining, depression & acceptance.

Denial is the first stage and this stage the reality of the loss is questioned. A person may believe that there was some sort of mistake or mix up or an incorrect diagnosis; especially with cancer victims for example, this is when they’ll try to hold that hope that maybe it’s not as bad as it sounds, maybe there’s a way that with proper treatment we can cure it- kind of that stage.  They may cling to this false reality and prefer to kind of stay there.   

With anger, those who are grieving may begin to cast blame or ask questions like “why me?” They may become angry with the deceased person “they left me” or in the case of a suicide, they can say “it was selfish of them”. They can turn to that kind of resentment.

Bargaining is the next stage and this stage the individual will attempt to bargain away to avoid their cause of the grief. For example, after receiving a terminal diagnosis, they may plead to God “I’ll eat healthier, I’ll quit smoking, I’ll do anything and everything right just so I can get better.”

The fourth stage is depression. During this stage, they’re grieving enters a period of darkness and sadness. They may lose motivation for living, act like themselves and enter the mourning. So sad, why bother with anything.

The next stage would be acceptance. In this stage, they come to accept the loss, although there may still be pain, we like to refer to this as “open wounds” or “raw wounds, raw feelings”. During this stage, there’s a sense of calmness and a resumption of normal activities. It’s okay, going to be okay, things like that.

One thing I also wanted to mention was there’s a lot of myths vs realities around grief and loss. Some myths are things like we only grieve deaths, where in reality, we can grieve every loss. Another myth could be grief is an emotional reaction- grief is not that- it’s actually manifested in many ways. Another myth could be that we should grieve at home- in reality we cannot control where we grieve; it may hit us in a store, triggered by a memory, those kinds of things. It could be physical, spiritual, and emotional and it can occur at various times and places. You can kind of think of it like an ebb and flow.

K: Okay, that makes sense. I’m glad that you mentioned that it doesn’t have to be a death because I know a lot of people think of death when they think of grief and loss, but it could be like a job or anything really. 

How do you recommend helping a friend or family member who may be experiencing a loss?

S: So, mourning a loss like we had previously kind of said is not linear. It’s something that I would try to help them understand. I would share with them what the stages of grief are and how complicated they can be, and when we’re looking at the task associated with mourning, how can we observe that they may be revisited many times over before they’re able complete that mourning stage.  I think I would look at it almost like tasks; I would say the first task would be to accept the reality of the loss or get them to accept the reality of the loss. Often after death, survivors struggle to accept the reality of what’s happened. They also may deny the significance of the loss, accepting that the reality of the death means that coming to terms with the loss both emotionally and intellectually will be necessary.

 Another thing you could do would be to help them process their grief. This task would involve confronting emotions, even the painful ones, encouraging them to express it, recognizing when they are experiencing the pain, naming the emotion, and learning how to cope with [the emotions].

Another task could be to adjust to a world without the deceased. After a loss, many survivors face a world without their loved one and this can be where that wound hits you, you wake up in the morning and your partner’s not there or going into a room where a loved one used to sleep and they’re not there or seeing a dog bed on the floor where your dog used to sleep, anything like that.  This task would involve making internal, external, and sometimes spiritual adjustments to the loss. For internal adjustments, these are going to change one’s identity- survivors must ask themselves “who am I now without this loved one”. External adjustments can include taking on different roles and responsibilities, for example a spouse who was responsible for childcare may now have to seek employment outside of the home. Spiritual adjustments involve changes to a person’s world view, the beliefs, and assumptions. For example, someone who believes that the world is a fair and kind place may no longer feel this way after the loss, and they may start to resent everything around them and have that external blame.

Task four I would say would be to find a way to remember the deceased while still moving forward in life. This means keeping a place in your heart for that person that you lost while being able and willing to move on with your own life. You know how when people always say “carry a piece of me in your heart” it’d be that sentiment- that person is always there with you. This may also mean allowing yourself to be happy and to love again which can be sometimes very difficult, especially after you know, you’ve had the same partner for 40+ years, it’s easier for people to say move on than it is to actually move on. So just holding the space of the person.

K: I know a lot of the time people feel a lot of guilt with that as well.

S: Yeah, so for the four types of loss, to explain too would be the anticipatory grief, delayed grief, disenfranchised or ambiguous grief or loss, and complicated loss. To explain these, the anticipatory grief is a grief that is experienced in advance or impending, so this would be for example a cancer patient finding out it’s inevitable that they’re going to pass or someone who was hit by a car and maybe there’s internal bleeding, etc. or there are complications due to this injury. There may be that anticipation that that could be the outcome. I think that the biggest difference there is knowing it could be coming vs not knowing, vs the sudden. Delayed grief- this emerges if not given time to process an emotion, so it’s expressed at a later time than maybe when the loss was experienced.  Disenfranchised or ambiguous grief can occur when others do not recognize of honor the loss. These terms can be used interchangeably, and it’s surrounding a loss [when] reason of the death is unknown.

Complicated grief can be debilitating, it can be intense, it could be an intense longing for the deceased, parental bereavement, risk factors along with support system not being there anymore. This grief refers to grief that is so severe and long lasting that it significantly impedes the persons ability to actually function. To help support someone through grief too, I think there’s’ a couple planes I could kind of touch on there:

Acknowledging what they’ve been through, so validating what they’ve been through, supporting them. Using terminology- “that sucks, that’s horrible, I can’t imagine how much that hurts”. You want to offer that solace but also that comfort of sitting with them and it’s uncomfortable- it’s hard. Allowing them time to mourn, but giving them space, and letting them mourn without judgement. There’s not a timeline that they have to meet, it’s okay to take 20 steps backwards if they need to, just give them that space to do that.

Creating an environment that facilitates openness. Being there, sitting with them even if it’s just in silence. And acting normal, maintaining a normal because a lot of the time the worse thing someone can do is treat someone differently.

K: right, like tiptoeing around them.

S: Exactly, yeah.  And then, you know check ins too. How are you doing? Do you need anything? Can I bring you food? Things like that. Check-ins that aren’t always considered a “check-in” if that makes sense. And then suggesting professional help I think is really important, you know. Losing someone can be incredibly difficult and there’s so many different types of loss. It can be the loss of a spouse through death, it can be maybe a heart attack or a stroke that can cause changes in the person, there’s so many different ways to lose that connection with someone. I think being able to reach out for help is something that’s really important.

So, obviously grief and loss is a difficult subject for anyone but how would you suggest speaking to a child about a loss?

S: When a loved one dies, children often do not know how to react to the news in the ways that we, as adults do. Their reactions can be very different than ours, and their emotions are not always understandable to them. Emotions are BIG and sometimes the children just don’t have the ability to kind of recognize or understand what it is that they’re feeling. This can often be due to barriers like I said, their age, maturity, understanding of what happened, the understanding of what death is, the fact that they have been sheltered by death possibly and having never experienced a loss before. This can be really difficult too especially if you think of it in the way of spirituality- do they have a belief? Do they believe that the person went to heaven? Can you talk about it in that way? Do they not have that belief? So, religion and spirituality will definitely kind of come into play there as well. 

I think younger children (preschool age) see death as temporary. Sometimes they still believe that it’s reversible, and that that person can come back. Once a child reaches the age of 5-10, then they start to think more like adults do, so they still have the belief that it will not happen to anyone they know, but when it does happen, they’re able to understand the severity of it; they kind of don’t have that belief that they can come back anymore.

Three key things to remember when explaining death to a child are being honest & encouraging questions, listening to them and keeping it age appropriate. I think those are the three key things to remember when you’re explaining this to your child. During your explanation, let the child know that it’s okay to ask questions, anything that comes to mind for them- be open, be supportive, be validating and then sharing it in a way that they can understand it. For example, explaining it to a five-year-old would be very different than explaining it to a twelve-year-old. Making it age appropriate, I think that’s going to be really important.

You can also let the child guide the conversation- how are YOU feeling? What do YOU understand about it? Being curious, asking them what they understand. Children who are having a serious problem with grief can start to show signs and that’s something I think is really important to watch for. If they have an extended period of depression in which they lose interest in daily activities or events or things that they would engage in previously could be concerning. Having a loss of appetite or a change in appetite, change in sleep patterns, a prolonged fear of being alone. They can also become anxiously attached, meaning that they don’t want the parent or loved one that’s left behind to be away from them for long periods of time, or even at times be out of their sight. That can be something that can cause a lot of stress to them. Acting much younger for an extended period can be another one, withdrawal from friends, not wanting to do things, not wanting to act out socially, and believing that they’re talking to someone or seeing he deceased family member for an extended period of time can be something to watch for as well.

One other thing to note is long-term affects of bereavement on children. Children who are bereaved early are more likely to develop psychiatric disorders in later childhood. This was found from a study by The National Library of Medicine in 1998. It found a fivefold increase in children’s psychiatric disorders in bereaved children compared to the general population. Something else to watch for too is denial of the death or avoidance of the grievance. Acting like nothing’s happened- that can be something that can be concerning as well.

You kind of touched on it a little bit but grief and depression can often go hand-in-hand. What are some signs that someone might be falling into a bout of depression and that they may need some professional help?

S: That’s a really good question because they do, they definitely go hand-in-hand and there are definitely some symptomologies that overlaps or cooccur. First, I think it’s going to be important to know some symptoms of depression. If you look at the DSM5, fatigue or loss of energy, feelings of worthlessness are all classed under depression. It diminishes an ability to think or concentrate, it can include indecisiveness, recurrent thoughts of death, suicidal ideation without a specific plan, or possibly even a suicide attempt or plan for committing it. Those are some things to really watch for in depression.

Grief is more the reaction to a loss and it’s more that natural sadness that occurs. When you’re experiencing depression on the other hand, it has a component of negative self focus- guilt, worthlessness, internal self negative talk, I guess you could say.  It tends to be accompanied by feelings of apathy and hopelessness. If a person feels that it’s hard to move, get up, motivate themselves, or they feel that their sadness is persistent or ongoing, never changing, depression is likely the cause. With grief, these moments of moving forward beyond those difficult ones will more ebb and flow so they become less frequent and will offer pleasantries with friends and family afterwards. Unfortunately, with depression, it will take away those pleasantries and this is usually caused because of loss of perspective. That indecisiveness comes up there, or that difficulty concentrating or thinking of anything but the sadness. Depression can sometimes advocate for permanent measures to be taken, as I said before, it talks about it in the DSM5, when there’s significant emotional pain and wanting to just end that pain, suicidation can occur so that’s something where if you’re talking to someone and see the signs and they start talking about “why am I here” or “maybe it would be better if I wasn’t here” that would be a really important time to encourage that person to seek immediate help before engaging in any type of self harm behaviour.

Something that people often talk about is survivor’s guilt.  Can you kind of explain what that is?

S: Yes, survivor’s guilt is huge. I worked with a client who was grieving a loss and it wasn’t until we hit this connection for her that it was like wow, that’s what I’m feeling.  A lot of people don’t know about it. Survivor’s guilt is a particular type of guilt. It may develop in people who survived a life-threatening situation or witnessed a traumatic or catastrophic event.  Even someone who had been the caregiver for a loved one with cancer- watching the disintegration of the person. They can go from being who they are to a very fragile state before impending death. That can be extremely traumatic to witness and to go through. Individuals believe that it’s unfair that they survived when the other person dies, and this can lead them to thinking that they did not do enough to save the life of that person. It’s going to be really important to talk to them about how they’re feeling, what they’re feeling, and explaining to them- especially when we’re talking about an impending death, there is nothing we can do.  The fact that they survived doesn’t make them a bad person. I think it’s important when you’re discussing that with someone to make that very clear to them. It’s okay that they survived, and they don’t have to feel that guilt.  Some symptoms of survivor’s guilt can include nightmares, difficulty sleeping, flashbacks to the traumatic events, and a lot of times too they’ll be almost a suppression of it, so when these triggering moments happen, it’s reliving it all over again because they’ve suppressed it, they’ve tried to forget it.  It can also include loss of motivation, irritability, a sense of numbness and thoughts about the meaning of life. They can start to question “what is the meaning” It’s important to know in times of that to rethink back to Viktor Frankl, what is the meaning of life? What is the purpose for you? What’s meaning making for you? It’s really important to explore what that person’s vision is for themselves moving forward. I think it’s important, kind of like when you’re helping a friend go through losing someone, it’s also important to talk about how to help someone going through survivor’s guilt. They’re much the same- acknowledging what they’ve been through, allowing time to mourn, being kind and patient, creating an environment that facilitates openness, normalization, checking in, and of course suggesting professional help as well.

Some coping strategies for dealing with survivor’s guilt can include things like seeking help, talking to someone, getting that professional perspective, self-care routines are also considered to be a very important part of emotional healing, and that goes for any type of grief or loss- making sure you’re taking care of YOU- you’re taking care of yourself.

Grief can lead to both physical and emotional symptoms, as well as spiritual insights and confusion. While grief is a very natural an inevitable part of life, it’s also one for the most part that can be neglected and misunderstood. Having this experience, it’s really important to allow yourself the time to grieve. Allow yourself to go through that loss, allow yourself to experience the feelings. And then you get to a place of acceptance, and like we said before it’s not linear- it’s going to be something that’s continual, it’s going to be a process. It’s something that you’re going to take 20 steps forward and then 20 steps back and that’s okay. I think it’s important to say that.

Thank you, Kristin, for having me, I hope I was able to shed some light on the grief process, and what affects and impacts it may cause on the individuals who have lost a loved one. I think it’s also important to remember that our job as therapists is to hold space and provide validation and support for our clients as they go through the stages and ultimately just help them get back to what an everyday life can look like for them.

K: Absolutely, thank you for joining. Grief isn’t something that people tend to talk about very openly, so I think it’s important that we open the doors to this conversation and get people talking about it, because it definitely can be very helpful.

S: Absolutely, I have some resources too that I wanted to share.  One of them was the Bereaved Families of Ottawa Group It’s a volunteer-run group and it offers drop-in sessions and also sign-up sessions, so you can do smaller groups if you prefer and it depends on what your needs and preferences are, they kind of cater to that which is good.

Also, there’s another group called Grief Shares it’s a grief recovery support group where you can find help and healing for the hurt after the loss of a loved one.

Thank you so much again to Selena.  If anyone would like to book an appointment with Selena or any of our other therapists, please call the office of visit www.capitalpsychological.com

Cap Psych Pod Episode 3: Alcoholism and Addiction

Today we're joined by Matthew Champ, Registered Psychotherapist. Matthew studied criminology and psychology in university with a focus on addictions and substance abuse. He has been involved in the mental health counseling field since 2010 and has been at our clinic for just about two years now. Matthew has worked with people from all walks of lives, ages, and backgrounds including both institutional and private settings. Today we'll be covering some specific questions on the topic of addiction, including the stages of addiction as well as the 5 D’s of alcoholism. Matthew thanks so much for joining us today!

M: Thanks for having me.

K: No problem! So, just before we jump into some specifics, can you tell us what exactly addiction is?

M: Yeah, that's a big question- what is addiction, right? Because there's so much that goes into addiction. Addiction for the most part is a chronic relapsing disorder characterized by compulsive drug seeking; its continued drug use despite harmful consequences, and it has long lasting changes in the brain. So it’s a little bit of a brain disorder as well as a mental illness at the same time. We have these intense cravings but we lose our control over our ability to moderate how much we're using. That's the textbook definition of addiction, but there's so much more that can go into addiction.

There's a journalist by the name of Johann Hari and he did this amazing Ted talk called  “Everything you think you know about addiction is wrong.” Have you heard of that Ted Talk, Kristin?

K: I haven't, no, but that's definitely something that I can link if anyone’s interested.

M: Perfect, because it's fantastic. He talks about addiction being a lack of community, a lack of support, a lack of resource because addiction often times is steeped in shame; it's steeped in stigma, avoidance and isolation so ultimately whether we're talking about addiction to substances like cocaine, alcohol or indamines, he would be looking at this [and] going “well let's talk about addictions to things like sex or screen time on our phones.” You know, for some people it's addiction to food or to working out and exercise 'cause we can technically become addicted to almost anything. Ultimately, addiction is when we separate ourselves from our community so it's a really interesting concept that he talks about there. He kind of takes the textbook definition of addiction and he expands on it by bringing community and our need as a society to really help each other out into the the picture and it's a really interesting Ted Talk to explore what addiction is past that textbook [definition].

K: It's interesting, whenever I hear addiction I never think of phones or anything like that. In my head, it's always drugs or alcohol- so it's interesting that you bring that up. I'm sure a lot of people probably feel the same way.

M: Absolutely, you know, we live in a world now [where] our phones are so important to us, right? We go everywhere with them- when I leave the house it’s always like “OK, I’ve got my phone, I’ve got my keys, I’ve got my wallet.” Ten years ago it was like “I’ve got my wallet and my keys.” In the last ten years even, we've gotten to the point where we're so dependent on having our phones where when we get into situations where we're bored, we pull out our phones. We will sit on a bus and we'll sit there on our phones rather than engage with the world around us. You go to the mall (well, not in the last two years obviously with Covid), you go to the mall and go to a food court and you see people off in their little corners at their tables and they just all on their phones. So yeah, addiction ends up becoming that compulsive seeking for that dopamine release, and we can get that through any time phone goes off, we get that through that burn that we get at the gym, we get that through anything really that's not just alcohol or drugs. I'm glad we were able to actually touch on that because it wasn't really until the last 10 years that we started seeing people being flagged as having screen addictions and phone addictions. Even over the last 20 years, pornography addictions with the access of the screen and the internet, that's made those types of addictions even more prominent in our day-to-day society.

K: Definitely! So, can you walk us through the different stages of addiction?

M: Yeah, absolutely. Let's not actually call it the stages of addiction- let's call the stages of use because addiction is only one stage in the stages of use. If you were to Google “what are the stages of of use” or “stages of addiction,” you're going to find people will often say that there are four stages. They'll say experimentation, regular use, high risk use, then addiction. I think that we should actually be breaking it down into about 6 steps.

There are six stages, really, I think that are out there because we have to recognize that not everybody is a user, right? So, for talking about stages of use we have to start with the first stage: non-use. Some people don't drink alcohol, some people don't smoke marijuana, lots of people don't smoke cigarettes or use cocaine, so we do have to start off with that non-use stage because that is number one. From there, the first reason that people typically start to use is they experiment with something, right? So, you know, they either hear about it from a friend or they see it whether it's in media or with marijuana recently being legalized in Canada suddenly it's like oh, well there are now stores on every single block that I can go and try this.

K: Multiple stores on every single block.

M: Not everybody here might be living in the Ottawa area but it’s so funny if you go down Richmond St through Westboro, there is literally a block where there are four pot shops within a block and a shop where you can go get your bongs, rolling papers and vape stuff across the street. How do you all stay in business when you're in direct competition with each other?

K: Yeah, even close to our office, on Hazeldean Road there are three strip malls in a row that have a shop in them.

M: It’s funny because you’re now driving past more pot shops than you are beer stores or liquor stores. But, seeing all those pot shops leads to that curiosity, right? So, why do people start to use? They start to use because they’re curious. No one ever picks up a substance or a drug and says  “I can't wait to be addicted to this,” right? So we start with that idea, “I’m just going to try and see how it makes me feel.” Usually experimentation then, before even leading into regular use, it goes into social use. A lot of times, you go and you try a substance; maybe for a teenager it’s trying alcohol, maybe for someone else it's trying pot, or you know, maybe even trying MDMA or cocaine or speed or another street drug. At first, it starts off as kind of a ‘fun’ thing to do. When is it fun to do? When we’re being social, so drinks at parties, smoking weed with your buddies, when you're at a party, cocaine is sometimes that bump that people use just to get them through the next hump of “I can now go and have five more beers.”  and so well that might be a binge, someone might actually just put that binge into social use. They're only using or only bingeing when they go to parties, and that might be very rare.

There are some people that I’ll work with who go to parties every single week, and that's where their main drug use is, so it’s no longer “social” as much as it is the next stage of habitual use. Now it's “anytime I go to a party I'm using it, and I'm going to parties all the time,” or “I'm having a drink every single night with dinner,” or “I'm smoking weed every single night before I go to bed.” Habitual use doesn't necessarily mean that we're using it to get intoxicated. A glass of wine at dinner or a beer at dinner is not going to lead to intoxication for the average person. Smoking a joint before going to bed may be more medical than it is drug seeking. We can look at that habit and [see] that there's a habit, but that habit doesn't necessarily mean that we are over using or indulging to do damage. Once we realize that there is a habit forming, we have to be very wary of it because it's very easy for habit to slip into abuse.

Abusive use is our next stage. Abusive use is ultimately “I am using to get intoxicated.” I may not necessarily be chemically dependent on this substance, but I'm now drinking three or four beers every single night to get a buzz, or I am now smoking weed to be high, or I am using to feel that rush- to get that dopamine release. This is also an interesting stage because you can be in abuse stage while you are experimenting, while you're in a social stage, or while you're in the habitual stage because of binges. If we're saying that someone is a social user and they only go out to a party once every two or three months, and they use then; but when they do use, they get rip roaring drunk or high out of their minds, we would then say in this moment of use, you are in the abusive stage because you're doing this to be intoxicated.

Now, there comes a fine line of abuse leading potentially to addiction. Not for everybody, but it can for some people because the biggest difference between abuse and addiction is the need. The abuse is the the want.  “I want to be intoxicated” versus addiction becomes that need. “I need to be intoxicated; I work more at my baseline when I am high or when I am drunk” and it becomes that idea of abuse may be impacting our lives with harmful consequences because of hangovers, but addiction would be “I need to get through my day by being drunk,” or “I can't go to work without being drunk,” “I can't sit with a family without being drunk,” “I can't take care of my kid without being drunk.” It starts to take over that person's life and it's no longer a choice. It becomes that necessity and that dependence part.

The biggest thing here is acknowledging that when we're in an abusive stage of alcohol use or substance abuse, we really want to be checking in to make sure that “I don't actually need this.” Once we hit that need, well then it becomes hard to stop; now our brain has started to change, our body has started to change physiologically to that response, and now we're only getting our big dopamine or serotonin releases when we use our substances and not when we are doing the things that would normally release dopamine for the average person.

 I used to do these prevention presentations and I built a curriculum a few years ago that was working with a lot of grade seven and eight students and when I was explaining the difference between substance abuse and addiction to them, I would often talk about things that normally produce dopamine. If we go back in evolution days to caveman days, dopamine was released when we did something to survive. You drink some water, you survive. You eat some food, you survive. You have a good sleep, you survive. That’s what allowed our brains to release dopamine to make us feel good, like “Hey, you're surviving! Have some of this ‘feel good juice’ and feel good.” But as our brains have evolved and as our world has become a world of stimulation, everything kind of releases dopamine- just different levels of it. Living in Ottawa, we've got a lot of Ottawa Senators fans here and if you're watching a Senators game and they score, your dopamine gets released and you feel good. If the Senators win, you feel even better because you get a lot more dopamine. We have so many more food options; we don't have to eat the same thing over and over again so if pizza is your favorite food and you sit down and have pizza your brain explodes with dopamine and it feels fantastic. Maybe you love to travel, so going to a new place you've never been before, your brain explodes with dopamine and we feel good. Where addiction comes in is addiction takes down that dopamine release for everyday things and ultimately makes us dependent on getting our dopamine from our substance use or abuse. It's a really kind of interesting thing that our brain does there, when we hit that addiction stage.

I know that I've already thrown one YouTube video at at y'all to take a look at, but if you want a really good picture as to the stages of use that lead up to addiction, I would highly encourage you to watch this video by Film Bilder. It's a very sad, depressing little cartoon but it's so fascinating in its simplicity that I encourage pretty much anybody to watch it if they want to have a good understanding of what addiction looks like.

K: I've heard you talk about the 5 D’s of alcoholism- can you walk us through what those are?

M: Yeah, absolutely. I’ve talked about the 5 D’s lot with clients because the 5 D’s are simple. A lot of times when we're doing recovery work with addicts, it seems very complicated and complex, because ultimately the emotions are complicated and complex, the state of mental wellness is complicated and complex, so I like to do something very simple to start which is to acknowledged five different ways to manage cravings without it being too hard. Having them all start with D is fantastic because it makes it a little bit easier to remember. If you're a client of mine,  I'm sure you've heard me mention the 5 D’s before.

The first one I actually want to focus on is not usually the first one I talk about with clients but it’s deep breathing. The reason that I bring up deep breathing first is [because] I believe that therapy is a huge piece of learning mindfulness for oneself, and I think that mindfulness is probably one of the biggest things that our society has kind of thrown behind because we're all either future oriented or past focused. Mindfulness is ultimately bringing ourselves back into present; bringing ourselves back into the “now.” When it comes to addiction, a lot of times there's a lot of shame built around it and there's a lot of stigma and taboo around it where people automatically assume the worst thing about someone when they hear the word addiction. By deep breathing, it allows the person not to be focusing on the past or the future but to be focusing on the present. It helps us slow down our hearts, and when we slow down our heart what we're doing is we're slowing down how fast the blood is rushing through our body; we’re slowing down our stress response. Taking the time to sit down, close your eyes, do that deep breath in through your nose for 5-6 seconds, hold it for a couple of beats, and then exhale through your mouth for about 5 seconds as well, and then a hold before repeating is going to allow us to focus the mind, focus our energy for actually managing the cravings. Deep breathing is very important.

 The second D that we need to kind of then put into play is delay; can we delay our craving? Perhaps you're someone who is what we call a “functional alcoholic.” A functional alcoholic would be someone who can go to work; they have a job, they have a family, they've got other things going on, but when they're not doing those priorities they are drinking and drinking to a state of intoxication. Maybe it's that they get home from work everyday at 4:00 PM and their first beer is cracked at 4:05 PM. The big thing is the delay- how long can I delay the start of my use, because by delaying the start of our use we actually do reduce the amount of harm that we're ingesting in that day. Maybe it’s a reduction of a grand total of 1 beer in the long run, or one use. Maybe it becomes a reduction of two or three, and if that still leads to intoxication, that tipsy feeling or that buzzed feeling that the individual is looking for, we do know that simply reducing the amount that we ingest means that we've reduced the amount of harm that we are potentially facing. I always encourage people to start with 5 minutes or 10 minutes. If you get that craving right away, you say “I'm going to wait 10 minutes.”

That's where we can throw in our third D which is distraction; what can I do to distract myself for the next 10 minutes or 15 minutes? The hope is that come the end of 10 minutes, the cravings have dropped a little bit and maybe the distraction has kicked in so that way we're not necessarily as tempted to go straight to the fridge and crack open the drink or it allows us to reset that delay for another 10 minutes. I encourage people to find useful and productive things as distractions- for some people it might simply be sitting down and watching something on Netflix- if we sit down and watch something for 25 minutes, hey, we’ve delayed that use for 25 minutes and we’ve distracted our mind for that time. Perhaps it’s distracting ourself by going for a walk, maybe we’ve got a kid in the house so we’re going to do some colouring with the kid and distract ourself with our other priorities. Maybe it’s distraction through music or taking a hot shower or a hot bath and pampering yourself a little bit. Maybe it’s simply going upstairs and reading for a little bit or doing a workout or an exercise; anything that’s going to allow you to get a little bit of a dopamine release without necessarily feeling like you need to continue using.

From there, we go into drinking water- drinking cold water. That's going to help calm down our heart as well. It's going to kind of come back into us and go ‘we are consuming something.’ For some people that I work with, I’ll tell them to keep a tub of vanilla ice cream in the freezer and anytime they get a craving, going take a scoop of vanilla ice cream and let that cold, sweet ice cream kind of trickle down the back their throat. It's going to help slow down the heart rate with how cool it is, it's going to slow down our thoughts, and it's also going to just allow us to feel a little bit better. It’s a nice way of having another distraction or delay in play.

The fifth D, which is probably the most important D is discussion. This allows us to have some semblance of accountability and community. If we go back to that “what is addiction” [question], and we say “well, addiction is the absence of community.” How do we combat addiction then? It’s when we build ourselves up with a support network, we build ourselves up with people who aren't going to judge us for having a substance abuse problem or an addiction issue . We have a support network [for when you say] “I've got a big craving I've just tried distraction, delay, deep breathing and drinking water or eating a little bit of ice cream and I'm still feeling this intense urge or this craving” Who do I have that I can call? Who do I have that I can send a text message, or send an email to and say “Hey, I'm struggling right now and I could just use an ear or use someone just to know what I'm going through”? That gives us that little piece of accountability so that other people are invested in our wellness as well. This is why, if you think about resources like Alcoholics Anonymous for example, the sponsor program is such a huge part of that program because it's about “hey- you have a craving, it's hard to deal with this on your own, you've now got someone you can call, you’ve now got someone who can help talk you off the ledge and you’ve got someone with that lived experience to be able to help talk you off the ledge.”

 Very simply put, we do deep breathing, we delay, we distract, we drink cold water and we have discussion. Those are the first really simple steps in managing our cravings when it comes to substance abuse and addiction.

K: That's a great start -I'm sure we could circle back and talk about this for hours.

M: Absolutely. I know that that was the big last question you had for me, but I do want to give some resources around addiction or substance abuse issues.

You can obviously reach out to Capital Psychological- I'm not the only person here that has a background in working with people who are living with addictions. There are some therapists that can take people on pretty soon.

 We also have to recognize that therapy is expensive and usually going hand in hand with addiction is financial issues as well. Actually, side note- when we were talking about all the different things that people can become addicted to, we totally forgot gambling which is huge. It's hard for someone who might be living with a gambling addiction to be able to go “well, can I afford therapy?” [or] to focus on therapy when all of their money has gone into their gambling addiction, so there are a lot of other resources that I want to give that are out there. I believe that our duty as therapists or mental health workers is to ensure that our clients are better off after we've talked to them than before we talked to them, and part of that also means understanding the financial pressures.

Ottawa has a number really great resources for people who are living with addictions. Outside of Alcoholics Anonymous or Smart Recovery, which are both support groups. AA does the 12 step program, which is highly steamed in Evangelical Christianity, so that really pushes some people away from wanting to get into it. Smart Recovery has become a very good alternative to that.  I always joke that Alcoholics Anonymous was made by middle class, middle aged white dudes for other middle class, middle age white dudes (that’s a generalization of AA). Smart Recovery has been a really good diverse counter to AA for a lot of people and I've seen a lot of good success with Smart Recovery groups. I believe that there's a good one that's being run out of the Royal Ottawa right now.

Speaking of the Royal Ottawa Hospital, they have an amazing concurrent disorders program that is 100% free- all you need to do is call up the Royal Ottawa, ask to be transferred to the concurrent disorders program and they will have you go in, do an intake and you can either do inpatient or outpatient there, but it is an intensive program- it's usually four to six weeks and it's every day all day.

We in Ottawa have as well OARS, I guess it's now called SAR which is the you know Ottawa Addiction Referral Services, so if you don't know where to go, you can call up SAR- they’re attached the Ottawa Withdrawal Management Clinic down on Montreal Rd. What they'll do is they'll do a long assessment with you. After that assessment, they will provide you with options that fit within your budget or fit within where your addiction actually currently lies.

They might recommend something like Rideauwood Addiction and Family Services, which have programs for pretty much anyone between the ages of 8 and 98. They've got programs for family, for children, teenagers, they've got a school based program, they've got an adult program, they've got a drug treatment court. They also have a gambling program, which is why I wanted to bring them up because there aren't a lot of gambling programs in Ottawa, but they are one of the few gambling programs that is completely covered by the government.

They might refer someone under the age of 24 to the Dave Smith Treatment Centre. That's an inpatient treatment centre for youth and young adults who are struggling.

We also have the Mental Health Crisis Line. The Mental Health Crisis Line (613-238-3311) is a 24/7 line and they will be able to connect you with other resources as well.

If you're looking at going into actual in-person treatment rehabilitation, Merrickville has an amazing program called Newgate 180. That one is not free, unfortunately, but it's just a spectrum of different resources available.

A big one for parents who might have youth or young adults in the family who are living or struggling with substance abuse is  The Parent’s Lifeline of Eastern Ontario. This is such a fantastic organization; it is run by other parents who have had children with either serious mental health issues or serious addiction and substance abuse issues. They have a 24/7 crisis line- I believe the number is 613-321-3211. They also have a youth group for these youth who might be suffering from substance abuse issues or mental health and mental wellness issues. They have one-on-one counseling available as well. A lot of great resources there at PLEO.on.ca.

That's just a start of some resources that are available. If anybody doesn't see their demographic being met in any of those resources, feel free to reach out to Capital Psychological and let us know and I will always be able to provide you with more resources along that path as well.

K: Perfect, that's awesome. Thank you for sharing those. I'm sure that's going to be super helpful.

M: I hope so. And if you're listening to listen you're like “I don't have a problem with substance use or abuse or or addiction” that's fantastic, my one big take away for you would be don't judge those that are living with it. Like I said off the top, nobody wakes up one day it goes “I can't wait to become an addict.” Addiction takes time to formulate. We look at the criminalization of drugs and the war on drugs and there are a lot of political reasons as to why drugs have been criminalized, and not a lot of good health reasons as to why drugs have been criminalized.

It's really important to remember that these are people who are living with health issues. It's interesting, I've used the word “addiction” and “addict” a lot today, but I'm usually very hesitant to use that word because of the stigma that comes with it. I don't like using the word relapse either, because relapse is a word that ultimately means “okay, well we're back to zero.” When I think about addiction or life as a race, I think of it like a marathon; if you're running a marathon and you happen to stumble at mile 11, you don't go back to the beginning and start over again- you stand up, you pick yourself up, you dust yourself off, and you keep running. When you finish the marathon, you go “Hey, I ran an entire marathon and I only fell one time” or “I only fell four times.” Even if you fell 10 times, you still completed that marathon and that's a huge thing to be supportive of rather than going “Oh, well you've just thrown away a year sobriety by making a mistake.” I try to be very careful around my language when I'm working with clients one-on-one. I used the words “addiction” and “addict” today because we are talking about addiction as a whole but it is something to kind of check ourselves around how we speak and the words we use. The words we use really do have a lot of power when it comes to managing the stigma of substance abuse.

Thank you so much again to Matthew for all of the information on alcoholism and substance use/ abuse. Like Matthew said, if anybody needs any more information, they can definitely reach out to our office through the “CONTACT US” page on our website. There, you can also reach out if you would like to book an appointment with Matthew or any of our other therapists.

Cap Psych Pod Episode 2: Self and Co-Regulation in Parenting

Today we’re joined by Sandra LeBlanc. Sandra is a Registered Social Worker with 25 years experience and has been with our clinic for just over a year now. Sandra works with children, adolescents, adults and families to navigate through a wide range of mental health issues such as anxiety, depression, attachment issues, trauma and grief.

Today we're going to dive into a topic that many people can relate to: parenting. Sandra is going to provide some guidance on self and co-regulation, specifically utilizing the P.A.C.E approach.

First, let's talk about self regulation and co-regulation. What does self regulation mean?
S: So very often, parents will come in and ask me if I can teach their child self regulation skills, or the teachers want them to have self regulation skills in the classroom. What self regulation means: it's the ability to manage your big feelings, your impulses, to think before you act, using self control, managing yourself, managing your anger and impulse control so that you're not bopping Johnny on the head in the classroom or doing things that parents or teachers don't like our kids to do.
However, the problem with self regulation is that it can be really really hard for children when they are young and their brains are not fully developed. That's one thing we're really becoming a lot more aware of; their brains are still quite young, so they need our help- so that's where the co-regulation comes in.

Perfect, so what is co-regulation? How would you describe that?
S: So because our brain is already fully developed, or at least we hope it is- most of the time it is but sometimes we have our off days too, and our off moments- so we need to help the child to regulate and calm what we call their fight/flight/freeze responses which is kind of like the bottom half of the brain where we don't think rationally. If a child is not thinking clearly, the bottom half of their brain is going into that fight/flight/freeze response so then they can't access the thinking part of their brain (the frontal cortex)- that's where maybe they know that they should be using their words, not hitting or not throwing, those kinds of things, but they forget in that moment because they're in that fight/ flight/freeze response and the bottom half of their brain is activated.
What we need to do is to engage and nurture them first through emotional co-regulation. So for example, being with a child comes first before we teach them.

Okay, that makes sense. So what is the P.A.C.E approach? Can you explain that?
S: Sure! P.A.C.E was first developed by Psychologist Dan Hughes who developed dyadic developmental psychotherapy. P stands for playfulness, A stands for acceptance, C stands for curiosity, and E stands for empathy. If you'd like, I can go into them in a little bit more detail for you.
K: Yeah, sure that would be great.
S: P, being playful- play is really the key to a child's world and their way of learning about the world. When we engage in playfulness with them, we are showing them an interest in them, or showing that we care about them and that we want to have fun with them. We also have to make sure that we're not totally plugged into our devices like out phones or electronics when we're playing with them- we need to be there with them.
K: That's very hard nowadays.
S: Yes, exactly- we get very distracted by all those things. If we can also use humour with them, that can help us go a long way as parents- we just have to make sure that we're not using sarcasm instead of humour because sarcasm could certainly have an impact on them and they could find that hurtful.
A stands for acceptance, which is one of the harder ones, I find, to use. What we're doing here is we're accepting the child's feelings and behaviours, and we're just accepting them in that moment. So the parent can accept the feelings, but not necessarily agree with them or condone the behaviour. For example, they may be super angry and throwing something or a toy or maybe even calling us names- that's hard as a parent to sit there and listen to that, but the acceptance part is saying "okay, wow I can really see that you're really really angry right now" or "you're super frustrated" or "you're really angry with mom/dad."
It's not to be confused with accepting that it's okay to throw that toy, or it's okay to call me names- that's not what we're saying here. We're just really validating their feelings in that moment.
C is where we're using curiosity. At this point, we're not trying to assume that we know what they're feeling or why they're doing something. An example might be if you see your child laying on the couch and you think "oh, they're just being lazy." What we need to do here is just be curious and ask questions like "oh, I see you've been on the couch more often than usual- I wonder if you're feeling lonely, or your sad- what's going on?" Just be curious, and don't assume that it's laziness. Even going further such as "with this pandemic, I wonder if you're missing your friends and maybe you're just really bored, what's that like for you that you can't see your friends right now?"
K: Right, I feel like for a lot of parents it's hard to remember that yes- they're a kid, but also they're just a small human. Kids have the same thoughts that we do.
S: Yeah, exactly. They don't always want to tell us what they're feeling, because sometimes they don't know what they're feeling either- maybe they have a feeling in their stomach but they're not really sure what's going on.
The last one is empathy- this is where we're trying to understand and be sensitive to what they're feeling and experiencing and trying to understand their thoughts; basically putting ourselves in their shoes. So "oh, wow that sounds really hard for you- of course you're bored, of course you're missing your friends, I totally get that. It's okay for you to feel sad and lonely and like you're missing out, especially during Covid." It's been so hard for all of these kids who have been home for longer periods of time or maybe they're not able to play with friends or peers because they have an immuno-compromised family member so they have to be really careful about socializing, so that could be really tough for them.

For sure! Can you tell us a little bit about the ideal outcome of adopting the P.A.C.E approach with regards to parenting?
S: The idea of using the P.A.C.Eful approach is to build a safe, trusting and meaningful relationship with children and for young people who have experienced trauma. This is what Dan Hughes was doing when he developed it, and I've found that you can use this approach with any child whether they've experienced trauma or not, or even with yourself. That's one thing I encourage parents to do is to try to be accepting of their own feelings and be empathic towards themselves. I encourage teachers to use it with their students at school, and hey- you can even use it on your husband if you want.
K: It's always good to improve any kind of relationship.

Can you walk us through a scenario when this might be applicable?
S: Yeah, so one example I can give you is this: let's pretend there are two children who are stuck at home, isolated with their parents because of Covid and one of them starts to express some anger, throwing a toy and says something like "I'm really tired of playing with these toys all the time, I'm so sick of being with my brother all the time, I don't like this anymore." As a parent, you might be feeling like "wow, my child's really ungrateful- she has all these toys, and a roof over her head, a brother to play with, why is she being so [ungrateful]." I need to check myself, I need to take a moment and breathe and try to not pass my judgement on them. This is where I use the A in P.A.C.E. being accepting- so "oh my, you seem so angry right now." "I wonder if it's really hard for you not to be able to see your friends right now." (That's the Curiosity) "here you are, you're stuck at home with mom and dad and your little brother, wow that must be so hard for you."
Then it's kind of wrapped up- I didn't really use the P in there- there's no Playfulness in that scenario exactly, but I really tried to use Acceptance and Curiosity and really try to figure out what it is [that was bothering them]. Your child might say "Yes! Yes! I miss all my friends, I don't get to see them anymore and I'm tired of playing with my brother." In this situation, the child might still yell, they might still cry, they still might have a temper tantrum, and it might still last for a while, but the hope is that the child's feelings are being heard and they're feeling validated. As a result of that meltdown, the child will diffuse in a more timely manner. If the parent is able to come alongside them and offer them support in using this approach vs something like a time out where they get sent to their room or sit in the corner, which is more of a punitive nature, this will help them become more regulated and calm down faster. It doesn't change the outcome, because they still can't play with their friends, but at least they're feeling heard and validated by their parents and they're learning how to manage big feelings.

Okay, so is it beneficial for parents to learn how to utilize P.A.C.E on themselves before applying that technique when dealing with their kids?
S: I think so, because again, like I said in that scenario- you might be thinking "wow, my child is so ungrateful and not using the toys that they have." So we really have to accept our own views and our own values and feelings and this way if we're accepting "this is what I'm feeling right now, I'm feeling really triggered by their reaction" then it's going to help me stay calm, and I'm going to use a little self-compassion on myself, or Empathy on myself. Maybe later on, I might be curious as to why I'm so upset about them with that [situation]. It might be something that goes back to when I was younger about when my parents told me I really need to be grateful for toys because we only got one toy for Christmas- that kind of thing. So it's good to use it on yourself, and to be empathic with yourself, as well as your spouse too if you're finding that you're upset with how they've dealt with a situation with the child.

What benefits do you see in using P.A.C.E vs other parenting approaches?
S: I think the biggest benefit of this approach is that you're not trying to change or negate the child's feelings. By using the acceptance, the child feels heard and understood. It doesn't mean that you're condoning the behaviour, and the temper tantrum may still happen but it will not last as long.

In what ways does the coronavirus affect the use of P.A.C.E? Do you think it makes it more relevant given all the changes that everybody has experienced over the last 2 years?
S: Definitely, as in the example I used earlier- I think that because of this global crisis, parents need to be more accepting and empathic towards themselves and to each family member, and accepting that it's really hard for us to be isolated, for us to work online, to miss friends, to feel anxious about going in public again which is something that some people might be dealing with as well, especially as mandates or restrictions start to lift. By being able to use curiosity to wonder aloud "Gee, I wonder what you guys are feeling right now- are you missing your friends? Is there anything you're worried about at school right now? Are you worried about the masks or not wearing masks?" Each child deals with the situation in a different way; we just need to figure out how they're feeling. I find using P.A.C.E very helpful for any scenario, really.

Right, perfect. Okay, so switching gears a little bit- let's talk about meltdowns, which is literally every parent's nightmare. Something you talk about is looking for signs of stress in children. Can you walk us through some potential behaviours to look out for?
S: Yes, so some things you want to look out for is things like toileting accidents, aggressive behaviour, defiance, when they're seeking power in other ways- so some children right now may be seeking control in a lot of different ways because of all the uncertainty that we've been experiencing due to the coronavirus. Another one you might see is baby talk and asking to be dressed, even though they already know how- they already have that skill, so they're kind of regressing in their behaviours. In this case, it's really important to provide the child with a connection if they're looking for that at that time. If they want to be dressed and it's just once in a while that you need to help them with that, then you're meeting their emotional needs and they're feeling safe. Once they feel safe again, then you will probably see the baby talk disappear. But if you use comments like "use your big boy/ girl words" then you might be shaming them and you won't be meeting their emotional needs.

That makes sense. What advice can you provide to calm a child when they seen inconsolable?
S: One thing I often suggest is just seeing if you can offer them a hug or a touch or to help regulate them in that moment and just listen to their cues of what they need at that time. Other things that might be helpful are providing them with space, distraction, or with sensory activities- some kind of physical activity that is obviously safe such as jumping on a trampoline if you have a small trampoline in the house, playing with a ball. And then finding things that they find soothing and calming for themselves like fidgets or bouncy balls, or a rocking chair- lots of kids find that soothing, colouring books, puzzles, bubbles. Doing deep breathing with bubbles can be really helpful.

How do you suggest a parent close out a meltdown? Is there an approach that you've found useful to reconnect with a child after the fact?
S: Definitely I would suggest going back later and talking to the child once they're calm. We want to be looking for the teachable moments once you're both calm. So together, you can also discuss what they might want or need when they're feeling upset. This is going to help you with that calming down space or calming down basket, so you might ask them "do you need space?" or "do you need a hug?" or "what would you like in your calming area or basket?"
K: That makes sense. I feel like almost everybody's been in the position whether they have a child or niece or nephew and they're just like "ahh, I can't talk to you right now" because you get so flustered and upset, it's hard to be the parent in that situation.
S: Mmhmm, and sometimes if you need to walk away yourself, that's okay. You can tag team somebody else in that might be around- hopefully someone else is around that could take over for you so you can go and become calm and collected.
Lastly, parenting's not an easy task and we all make mistakes. I'm a parent myself and I've made lots of mistakes. We need to practice self care and we need to try and stay regulated ourselves when we are dealing with our children's big emotions. Let's say we don't stay cool, then it's okay for us to go back later on and repair the relationship. Just say "Hey, I'm really sorry mommy yelled" or "I didn't handle that situation as best as I could have and I'm really sorry and I love you." Making sure that the child knows they're still loved and cared for, and the fact that you're able to apologize and show that you're human is really really helpful.
K: Right, and that too, maybe not if they're super young, but it also shows them that they're allowed to have emotions because even their mom, dad or parent does, so that's good.
S: Yeah, and I think because of Covid, everybody's emotions are running high right now so even parents are struggling a lot lately, so it's is even harder for us to self regulate and help to co-regulate our children.

Thanks so much to Sandra Leblanc for taking the time to provide some information on self and co-regulating in parenting. If anyone is interested in speaking with Sandra, please feel free to reach out to the clinic at www.capitalpsychological.com

Cap Psych Pod Episode 1: Starting Your Therapy Journey

Today we’re joined by Brenda Weaver, our Practice Manager. Brenda has been with the clinic since 2015 and manages everything from intakes and payment to keeping the office running day to day. Today we’ll be covering some FAQs pertaining to taking the first steps in finding a therapist, information you may need to research before reaching out to a clinic of a therapist and how to go about getting that first appointment booked.
​
How do you suggest someone begins their journey to finding a therapist?
B: The first step is probably to talk to your GP; let them know your concerns, let them know what’s going on with you. They may have a referral source for you. If they don’t, just start doing your own research on therapists in your area, ask friends and family if they have any recommendations. A good resource that I sometimes recommend is the Psychology Today website- there you can filter by location [and] specialty in order to find a therapist that might be able to help. Some will note if they’re accepting new clients or not.

K: Oh, that’s good- that’s helpful so you don’t just randomly reach out to a bunch of people and if they’re not taking any new people, it’s not just wasting your time.

B: Exactly. It’s hard enough to take the first step without being turned down 100 times… maybe not 100, but you know what I mean.

So, when you do go about reach out to someone, what is some information should you include in your initial message for them?
B: So, we need to know if you’re looking for an assessment or if you’re looking for therapy- we can touch on that a little bit more later. We need to know if you’re looking for yourself or if it’s for a family member; if it’s for a child, we need to know the custody arrangements- if parents are together or not. If they are together, great! If not, then we need to know who has decision making [authority]. It’s a good idea to come into this open book so everybody is on the same page. We need to know if you’re looking for a certain type of therapist: Registered Psychotherapist, Psychologist, Social Workers- there are so many different kinds. It’s important to let us know if you are looking for a specific modality- CBT, DBT, something like that. And of course, we want to know the reasons that you want therapy. Give us as much information as possible so we can find the best therapist to suit your needs. We have to speak to the therapist to be sure that they can work with you on your concerns, but everything is confidential to the office, so you don’t have to worry about that at all.

K: Right, that’s good. So, just about the different modalities, typically, do you think that a GP, if they’re referring you to a therapist, would specify “I think EMDR would be helpful” or “CBT would be helpful” or anything like that?

B: Sometimes they do, but sometimes they just say “you need talk therapy” or whatever, which could be a bunch of different ones. Kind of depends.

K: And I guess you could just ask your therapist too, once you are set up with someone.
B: Exactly.

Touching on the therapy and assessment aspect, what’s the difference between therapy (or treatment) and an assessment?
B: Okay, so a lot of people think that you need to have an assessment before you can have therapy- that’s not the case. The definition of therapy is a treatment intended to relieve or to heal a disorder. It’s generally an hour-long session where you speak with your therapist about your mental health concerns or issues in your life and they can help you through. An assessment is an evaluation using testing measures to determine a diagnosis and to give recommendations. Assessments have to be done with a Psychologist and a Psychometrist (in our office anyway) to do the testing for them. Once the testing is completed, scoring and data interpretation is done, a draft report is written, and we set a feedback appointment at which time you’ll get a diagnosis and recommendations. Often times, the recommendation is to seek out therapy, but it all depends on what is found in the scoring and data interpretation.

K: Right, and I’m sure a lot of people don’t know about the fees too, so that’s probably something that they need to check in on before they go ahead and book.

B: Fees are definitely something that you need to discuss with your therapist or admin before you go in to do an assessment.

K: Never good to have surprises like that.

B: No, definitely not, and I mean they can be pricey so you definitely wan to make sure that if you have coverage, that the coverage will cover specifically the assessment as well.

Can you explain the difference between a Registered Psychotherapist, Registered Psychotherapist Qualifying, Registered Social Worker, Psychologist and Psychiatrist?
B: Well, there’s a lot of different types out there. Psychotherapy is kind of like an umbrella term for anyone who does therapy. A Registered Psychotherapist belongs to their own college, they can work with individuals and/or families depending on their training.

Qualifying Psychotherapists are in the process of completing their clinical hours, and still have to write their final exam to become *autonomous. They are able to provide counselling services while under supervision.

Social Workers often times have a master’s or a bachelor’s degree. They provide support to people with mental health issues as well. Depression, anxiety and PTSD are some of the issues that RSWs can offer support with. They also belong to their own college, and they can work with different age groups depending on their training. At our office, everybody is under the supervision of a psychologist.

Psychologists have a doctoral degree; they focus on emotional and behavioural aspects of mental illness using different techniques of psychotherapy. They can treat, as well as complete testing to see if a psychological diagnosis is present. They are governed by the College of Psychologists.

Psychiatrists also have a doctoral degree, and they have the ability to diagnose patients through testing. Psychiatrists are also medical doctors, so they have the ability to prescribe medication to their patients. Essentially, if you need medication for depression, for example, you’d need to see a psychiatrist, however you could see a psychologist or a psychotherapist for treatment and they can refer you to a doctor for medication, or back to your GP for medication if needed.

How do you suggest someone finds a therapist whose background aligns with their specific concerns?
B: Well, connecting with your therapist is really important- I would say to read the therapists’ bio from all the clinics around you. Be sure to read them and choose a few possible ones, then you can kind of narrow it down. Also, in an office where there’s an admin, when you give your information, they can often match you up with the best therapist to fit your needs.

K: Okay, that might kind of just speed things up a little bit if there is [an admin].

B: It does, yeah. And once you’re talking to somebody you can get more of a feel as to what they need, and kind of match up personalities too with the therapist which is kind of nice.

In that regard, what would happen if a client isn’t connecting with their therapist? Would it hurt the therapist’s feelings if they try to find someone new?
B: That’s a really good question. Your therapist is going to have your best interest at heart. If there isn’t a good connection for you, there probably isn’t a good one for them either so they would definitely want you to move on to someone else that would be able to help you. Just be honest with yourself if things aren’t working out and start looking for someone new. It isn’t beneficial to anyone if you continue seeing a therapist and you aren’t getting anything from the appointments. It’s best to just move on if the services aren’t quite for you.

K: Right, and if you do have coverage, it’s just kind of a waste of your coverage if you aren’t actually getting anything out of it.

B: It absolutely is, yeah, for sure.

What would happen if you share custody of a child who needs to meet with someone? What’s that process like?
B: So, this can be tricky sometimes. In cases of shared custody, it’s preferred that both parents are on board for therapy for the child. Often in the case of younger children and adolescents, the therapist will meet with parents to get some background and to discuss possible treatment. Having both opinions is really helpful. If the parents prefer not to be together for the session, a split session or two totally separate sessions can be arranged. Fees would be charged for both sessions though.

K: So, it’s best just to be honest if you don’t get along with an ex and you don’t think it’s going to be beneficial, then just do it on your own.

B: Absolutely. The majority of people try to put the best interest of the child first, but sometimes there’s so many hurt feelings that parents just cannot be in the same room or on the same computer screen together, and we understand that. We’ll do our best to make everybody comfortable.

K: And then it would be in the kids’ best interest too, if they know that and they can just do things separately.

B: Absolutely. The other thing that I should mention too is quite often adolescents aren’t on board with therapy, so make sure if you’re seeking out a therapist for your child/ teen that they really are on board. I usually tell people to have them read the bio with you to make sure that they think that they can connect with the therapist.

K: Right, they need to be open to actually talking to someone because if you just put a kid in a room, they’re not going to just start talking to someone with no desire to.
​
B: For sure. [If they] go in cold and “I don’t really want to talk to you” it’s hard for the therapist as well- it’s like pulling teeth to get them to talk. Obviously, they’re not in a place where they’re ready to talk.

Can you explain the consent process for if a child comes to see a therapist?
B: So, legally a child 12 years old and above can sign for consent for therapy. What we do in our office is we have both the child and a parent sign consent in order to rule out any issues when it comes to confidentiality and to billing; I mean, let’s face it, these sessions cost money- you need to know the prices. The best thing to do is to ask your clinic or your therapist about procedures.

Also with billing, can you explain the insurance process? How to tell if you’re covered for a specific therapist, etc?
B: The best thing to do, obviously if you have a handbook, look it up. If not, you can call your extended health benefit company to find out if they will cover [and] what type of therapist they will cover. We usually send out the wording, so it’s whichever type of therapist “Under Direct Supervision of Dr. Garcia” in our case. Some will cover Registered Social Workers, some won’t. Some will cover Psychotherapists, some won’t. It’s definitely best to have a little conversation with them first just to make sure they will cover.

What is the difference between direct billing and submitting a claim to your insurance company?
B: Direct billing is when the office bills the insurance company directly. Not all offices do this- we don’t, so basically, you pay us after the session and then you submit the claim yourself. Quite often you can do it online- we’ll send you a receipt and you can just upload it directly to your insurance portal.

You had mentioned that the therapists in our office are supervised by Dr. Garcia- can you explain what that means?
So, the supervision is for insurance purposes, so extended health benefits cover [sessions]. The other reason is so the therapists have someone to discuss a case with; find additional ideas, additional resources to help their client. It’s always kind of nice to have somebody that you can bounce some ideas off and to get some advice in helping with their treatment. It’s also possible that they need a signature of the supervising psychologist for a form or a letter; quite often it would have to be from a doctor, so the psychologist, then, would be the one to do as well as the treating therapist. So, the supervisor needs to know at least parts of the case before signing.

Thanks so much to Brenda Weaver for answering some of out FAQs about starting a therapy journey. If anyone has additional questions about seeing a therapist at our office specifically, they can give the office a call or they can submit a form through our website.