You are Getting Very… Misinformed? The Truth About Clinical Hypnotherapy 27 August 2021 Bliss Team No comments Categories: Book Recommendations, Communication, Events, Grief, Individual Therapy, Inspiration, Life Coaching, Self Care, Therapy In your classic portrayal of hypnosis, you might find yourself staring intently at a swinging pendulum, and listening to a series of repetitive phrases until you are lulled into a state of suggestibility. In this state, a hypnotist could make you sing opera or cluck like a chicken. This isn’t a new idea – hypnotherapy has a long history of being falsely represented as a form of mind control. Clinical hypnotherapy, however, is quite different. Clinical hypnotherapists use hypnosis as a therapeutic tool. Hypnosis, a state of deep relaxation and heightened awareness, opens up the unconscious mind to suggestions. Unlike pop culture hypnosis portrayals, in clinical hypnotherapy, the client is always in control. The client’s brain is just more receptive to imagery, creativity, and new ideas. Clinical hypnotherapy can be a valuable tool for breaking habits, promoting relaxation, and even relieving pain. Hypnotherapy has a long history, and in the 1960s, it gained medical recognition as a legitimate form of treatment. Hypnotherapy is currently not regulated by a medical board, but most clinical hypnotherapists are well-trained and hold Master’s degrees or higher. I sat down with one of our practicing hypnotherapists, Stacey Fernandes (she/her/hers), who discussed with me the roots of clinical hypnotherapy, its applications, and misconceptions. What is Clinical Hypnotherapy? Like all legitimate therapeutic approaches, clinical hypnotherapy is grounded in scientific research. Clinical hypnotherapy has been proven to improve anxiety and depression, with or without adjunct treatment. It is thought to be most effective when combined with other talk therapy approaches such as Cognitive Behavioural Therapy (CBT). Hypnotherapy can be used in an individual or group setting. In both settings, hypnotherapy can be used to gain insight into one’s life, habits, and values. When hypnotherapy is done in an individual session, it is more tailored to the client, and parts can even be recorded and played back after the session is over. Often, participants in hypnotherapy groups will pursue individual hypnotherapy later. The typical trope of a client getting very sleepy before slipping into a trance is misguided and misinformed. In fact, Stacey notes that clients often feel re-energized following a session. Depending on the goals of the client, a clinical hypnotherapist can tailor the session to renew energy or restore peace. Each clinical hypnotherapist has their own style. Stacey shares that her own is very imagery- and nature-based, often involving meditations of forests, hammocks, or beaches. Some clinical hypnotherapists have more colour-based hypnotic scripts. Each hypnotic script is designed to evoke a feeling, action, or emotion. How Does One Become a Clinical Hypnotherapist? Stacey obtained her Master of Social Work degree before furthering her education as a hypnotherapist. It was through her college that she learned of a hypnotherapy training course in Costa Rica. The course was centred around “Breaking the Worry Trance” and was revelatory for Stacey. It was imagery-based, and has since informed Stacey’s own practice. To become a clinical hypnotherapist, Stacey did over one hundred hours of clinical training in Ericksonian hypnotherapy. Ericksonian hypnotherapy uses techniques such as metaphor and imagery to alter behavioural patterns. There are other types of hypnotherapy, which combine other therapeutic approaches, such as psychoanalysis or solution-focused therapy. How Does Clinical Hypnotherapy Work? Clinical hypnotherapy taps into our subconscious mind, moving us away from our analytical brain and into our receptive, creative mind. Often, our brain can meet new ideas with resistance or skepticism. Clinical hypnotherapists ask us not to ignore or avoid these feelings, rather to observe and normalize them. Stacey borrowed a metaphor from renowned hypnotherapist, Grace Smith, to describe how hypnotherapy works: “Picture a bouncer (conscious mind) at a nightclub (subconscious mind). Inside the club all the people are smoking cigarettes and a non smoker approaches the bouncer stating ‘I can help, I’ve read lots of books on wealth.’ The bouncer denies the request because they are unfamiliar, despite this person being safe and offering valuable information. Everyone in the club is very familiar with each other despite it being an unhealthy behaviour. Anything new gets blocked. The non smoker tries to tip the bouncer $100 and gets into the club. The person interacts with everyone by speaking on the microphone and engaging them to drink water instead and providing the benefits of hydration. Eventually everyone starts drinking water and feeling much healthier. Now if a person who smoked tried to get into the club the bouncer would deny them – they are unfamiliar!” This helpful metaphor illustrates how clinical hypnotherapy can be helpful for opening up and expanding our minds. Clinical hypnotherapy can be effective where other therapeutic approaches are not, and can be used to calm and alleviate anxiety. However, it is often met with resistance due to preconceived notions as well as unconscious biases. Yet, with an open mind and commitment to heal, clinical hypnotherapy can be incredibly effective. What Should I Know Before Seeking Clinical Hypnotherapy Treatment? I asked Stacey the question, “What would you tell someone who is thinking about starting clinical hypnotherapy?” and she had some great ideas. First of all, do your research. Since clinical hypnotherapy is not regulated the same way social work and psychotherapy services are, literally anyone can claim to be a hypnotherapist. You want to seek out someone who has other credentials, such as a Master’s Degree in Social Work, or Registered Psychotherapist status. Ask questions about your potential clinical hypnotherapist’s background, training, and experience. Many training courses have a required number of hours of practicing the craft; ask if your therapist has completed these, how many, and where. Inquire about their specialties, style, and interests. Book a consultation with the clinical hypnotherapist to see if you two are a good fit. Like any therapeutic relationship, you want to ensure you have similar styles, goals, and interests. If something feels off, or you don’t feel comfortable opening up to this person, consider looking elsewhere. Remember that clinical hypnotherapy is scientifically-backed, and evidence-based. Your clinical hypnotherapist should be adequately trained and qualified. Treat this like you are finding a new healthcare provider; you want to be confident that the provider has the skills and expertise you are looking for. If you are a beginner to clinical hypnotherapy, consider looking for a practitioner trained in Ericksonian hypnotherapy; this is listed as one of the therapeutic modalities in Ontario, along with Cognitive Behavioural Therapy (CBT) and Internal Family Systems Therapy (IFS). This means that it is recognized as effective by the regulatory board of Ontario for psychotherapy. Most importantly, approach clinical hypnotherapy with curiosity, open-mindedness, and willingness to learn. Embrace and question your skepticism, and move towards healing with patience and wonder. Interested in partaking in clinical hypnotherapy as part of your healing journey? Bliss is offering a virtual hypnotherapy group workshop this Fall, with the aim to Re-Charge and Re-Energize after a year and a half of pandemic life. Run by Bliss therapists, Stacey and Lindsay, it is an excellent opportunity to engage in clinical hypnotherapy. Are you interested in joining the workshop? Sign up today! . Contact community@blisscounselling.ca or call us at 226-647-6000. __________ Written by: Catiyana Adam and Stacey Fernandes Catiyana is Bliss Counselling’s Office Strategist, a music enthusiast, and avid writer. She has a keen interest in mental health, illness, and treatment, and is aspiring to be a therapist. Catiyana graduated from McMaster University in 2021 with a Honours Bachelor of Arts in Sociology. She focused on courses in health and illness, as well as families and feminist studies. She hopes to pursue a Master of Social Work at Wilfrid Laurier University next year. Stacey is a Registered Social Worker, traveller, and adventurer at heart. She is dedicated to learning and advancing her knowledge through workshops, courses, and travel. Stacey uses EMDR (Eye Movement Desensitization Reprocessing) as well as Hypnotherapy and other therapeutic methods in her sessions. She believes in communication, reflection, and slowing down.
New and Trending Research on Autism 28 June 2021 Bliss Team No comments Categories: Book Recommendations, Communication, Individual Therapy, Life Coaching, Relationships, Self Care, Therapy What is Autism Autism is hard to define. Not only because the definition itself changes all the time, but because it affects our perceptions, communication, social experiences, learning and behaviour; essentially, everything you need in order to get through the world. Any information that is being processed by the senses can easily over-stimulate an individual who is on the Autism Spectrum. On the other hand, an individual with Autism can also have difficulty processing input from their senses. This is why we discuss Autism, as a spectrum, and say,“If you’ve met one person with autism, you’ve met one person with autism.” How to diagnose ASD In order to be diagnosed with ASD, you need an assessment from a professional who can provide an assessment. This professional can be a doctor, social worker, psychiatrist, or psychologist, who are able to provide a screening using certain tools. In Canada and the United States, we use the DSM-5 as our tool for assessment and diagnosis of Autism Spectrum Disorder (ASD). The DSM-5 essentially is like a take out menu; you pick three criteria from column A, two from column B, and 1 from column C, D and E. The DSM-5 also uses a process called, scaling, where the person being assessed is also rated from 1-3 in terms of severity. This is more subjective, as diagnoses are not applied consistently in clinical practice, and as such are less useful from a treatment standpoint. However, the rest of the world uses ICD-11. The ICD-11 uses 3 subtypes or possible diagnoses: (1) Childhood, (2) Aspergers, or (3) Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). IDC-11 includes profiles such as Pathological Demand Avoidance (PDA) , a profile where those on the spectrum may avoid demands that would even be pleasurable for them. Since there are different tools that could be used in order to assess a person for ASD, it means that we aren’t all communicating or understanding ASD from the same reference point, or speaking the same language, and as a result, researchers are finding it difficult to collaborate and synthesize common or generalizable patterns. Another big concern in trending research is the discrepancies between the age of concern (i.e., when behaviours and traits become apparent) and the age of diagnosis. Parents and teachers alike are noticing behaviours such as missed milestones and other common traits in children quite young that could indicate ASD. But, it takes years for the diagnosis. This is an unfortunate reality when it is expected (across all neurodiverse people) that the earlier the diagnosis, the better. As a result, we are losing critical time. Currently, we aren’t really sure how to screen more effectively, although researchers are doing their best to try to close this gap. What is the importance of an assessment Sometimes, when we are faced with a number of challenges, we need support. Some people may wish to receive support without a formal ASD diagnosis. For others though, an assessment may help an individual with accessing additional therapy or support programs such as, disability credits (for the adult or family & caregivers of a child or teen), an Individual Education Plan (IEP), or workplace accommodations. What is it be included in an IEP The best IEPs should be a living document that is changed and updated regularly and follows the person with ASD throughout their educational career. IEPs are mandated to be updated at least once a year, in the Fall when the academic year begins. However, the most effective IEPs are updated throughout the school year, as new information becomes available (i.e., new assessments, new interests, new motivations for goals, etc). It’s important that it also be reviewed regularly with the child’s teachers to ensure that they are up to date on all of the important details. IEPs should also include information on practical supports and longer term goals. For instance, you can ask yourself or your child if they are struggling with processing reading, emotional self-regulation, or other daily tasks and brainstorm ways in which they will be able to receive support in these areas throughout the day. When considering long term goals, such as establishing greater independence and/or self-advocacy, you’ll also want to consider whether it is achievable. Basically, we don’t want to give somebody with an ASD diagnosis a tool they are unable to use. Some goals, like self-advocacy, are quite lofty for a person on the spectrum and need to be broken down into smaller skills or parts in order for there to be incremental progress and success. Legally, IEPs are also to include a transition plan, by the age of 16. This is a very integral part of planning the next steps, as this person reaches the end of high school. IEPs may integrate strengths-based approaches. Typically IEPs have focused on the student needing support, or to be assimilated in the classroom, rather than focusing on where the student is already demonstrating success. A strengths-based approach views neurodiversity as a normal variation of the human genome that doesn’t need to be fixed. When incorporating this approach, we are working to maximize the students strengths, talents, and interests as well as their deficits and restricted interests. This process is collaborative and includes the student’s goals so that it is a helpful resource and tool for the student. When we aren’t collaborative in this process, the student isn’t invested or engaged, and why would they be? They didn’t contribute to the creation of the IEP or share their perspectives, experiences, goals or interests, which may be vastly different from those being provided by the parents, caregivers or teachers. This approach also considers the functions of the behaviour, not just the problem behaviours. In doing so we are pulling back the outer layers, the outward reactions, in order to understand what is happening for this person and why. If, for instance, a student relies on behaviour for regulation, then what are we going to do to support them? What is something else that could fill that same function or regulation piece? There’s value in setting the bar high. But, it’s also good for students who struggle to feel success, even if it means breaking a goal down into its most elemental parts, so that the student can attain it, feel success, and improve their self-esteem. How to navigate transitions Transition strategies are used to support individuals with ASD during changes or disruptions to activities, settings, or routines, by planning ahead (front loading) before the transition occurs. Transition plans are used to create predictability and positive routines around transitions. They can be presented to the individual verbally, auditorily or visually such as: Visual schedule planning (e.g., a white board, paper, excel spreadsheet); Electronic (e.g., timers, calendars, colour coded schedules and spreadsheets); Social stories; Visual memory may be higher than audio, verbal or written memory. By providing a visual schedule of the plan, the individual will be better able to remember and regulate the progression of how things are going to go. You may also want to include different colours to distinguish the events and the individuals favourite activities into the schedule. This way the individual can see that these rewards or interests are coming too. Electronic transition tools are great indicators that there will be a transition as well. Using an app on a phone or tablet, also allows them to take ownership of the transitions. When presented well in advance, social stories can help with preparing for a new transition, such as going to the airport for the first time. In this example, you can write a story of what happens when we go to an airport and walk the individual through the series of transitions (e.g., when we arrive to the airport, we will have to park, then we will have to get our bags from the trunk, then we will have to walk across a bridge to the planes, then we will have to wait in line to weigh our bags, then we will have to show our passports to get our tickets, then we will have to go through security, etc.). You can also add to this by finding resources online such as written, audio or video stories, as well as photos, that explain why we are following these steps. What is the difference between meltdowns and burnout Meltdowns and burnout both occur when the demands of a situation exceed the individual’s coping skills. Meltdowns are brief, they last for minutes to hours. The function of this behaviour is to indicate to the individual that they have just crossed a threshold, and offers them a chance to withdraw or regain their sense of control. In order to fully understand the reason for the meltdown, we need to understand the motivation behind the behaviour so that we can make a plan for managing it in the future. ASD burnout is a newer topic in research. It was identified as a new ASD experience when individual participants described the experience to researchers, and it was found to be a common trait. Burnout lasts approximately 1-3 weeks. If this time is exceeded, that’s when professionals begin to question if there are concurrent challenges being experienced, such as depression and anxiety. Burnout is brought on by an extended period of masking. We see it in those with ASD, who have higher social skills who are camouflaging their autistic behaviours. This process can be emotionally, mentally and physically taxing, and ultimately leads to losses in function. These skills, that they use to manage, end up getting lost or reduced. Burnout is present in teens, young adults, and adults at any age. It can amplify stimming behaviours or sensory sensitivity. Burnout is usually seen during transition stages, when expectations and behaviours have to change. The individual usually has no idea that the burnout is about to happen, until it does. Repeated meltdowns can also result in burnout. One resource, “No More Meltdowns” by Jed Baker, provides practical solutions for structuring and managing meltdowns and burnout. Video modelling (e.g., we are going to go to the doctor, then to the playground, etc.) also helps the individual to understand the expectations. Social narrative power cards and comic strips also help. The individual can make their own and manage their own emotions, by for instance, giving themselves a power up, when needed. Whichever method is chosen, the most valuable aspect is to ensure that the individual with ASD is buying into the tools. Other supports include offering choice (e.g., to wipe the table now or in 10 minutes or choice boards) as it helps the individual move toward the activity or goal, and provides them with supportive lessons in terms of limiting choices and power over the decision making process. As rule oriented people, individuals with ASD may also appreciate systems that incorporate rules and offer explanations as to why the rules are the way they are. How does ASD impact sexuality and gender There is a lot of research that is coming out quickly, that is related to sexuality and gender among individuals with ASD. But, it is limited because such individuals are such a proportion of our population. What we do know from the research however, is that only 50% of students with ASD are receiving the same level of sex education as their neurotypical peers. These individuals are sharing the same physical and sexual experiences as their peers, but are receiving less education on the topic, have fewer social supports, as well as a reduced understanding and application of social skills and awareness of social aspects. As a result, younger individuals with ASD are at a higher rate of sexual exploitation, especially online. The most common and fastest growing areas of vulnerability and exploitation are those who are in their tweens and teens. People online will ask them to do and say sexual things. They are then recorded, threatened, blackmailed, and bribed into doing more sexual things online. This is especially dangerous for neurodiverse individuals, because of the combination of lacking: (1) theory in mind, that is, they don’t understand that people would have a different motivation than theirs; (2) social skills, which prevent them from finding support or finding their way out of these situations; and (3) any preventative legal protections. Research has also been finding a strong connection between ASD and gender expression. For instance, studies have found that there is a higher prevalence of ASD in trans-individuals. There is also an overrepresentation of Individuals with ASD in gender clinics reports. There’s debate as to what the connection could be. For instance, when there are assessments being done, there are some ASD specific assessment concerns such as research which was exploring sensory factors of restrictive interests. In this study, the researchers noticed that young boys with ASD who were interested in sparkly, silky things and long hair. This finding aligns with social scripts of femininity or feminine interest. As a result, this interest could be a behaviour exhibited by somebody whose is questioning or considering their gender, but it could also be a sensory factor. Issues related to gender and sexuality are typically ignored when overlapping with a disability, generally, whether it’s physical or invisible. There is an assumption that the complexities that accompany gender and sexuality cannot exist, once somebody is diagnosed with ASD. These issues that are related to gender and sexuality, end up being treated as an obsession or transient phase. But there is some question around whether or not this is an issue of perception. For instance, a person with ASD may think, “I am a man, but I love baking… maybe I am a woman.” By assigning baking as a women-only interest, there may be an issue with being unable to distinguish a gender identity through the ambiguities of social scripts. This is why it is so important to discuss topics of sexuality and gender, as well as the assumptions of categorization or black and white thinking (i.e., that it has to be this or has to be that). Individuals with ASD also place less importance on social norms and don’t necessarily read social cues so they may not conform to gender binaries or scripts, as they feel less social pressure to follow these norms. Where to receive additional support and resources If you are interested in: Updating your tools and strategies for working with individuals with ASD; Creating an effective and strengths-based IEP; Learning more on the functions of ASD behaviours and regulation strategies; Mastering skills like advocacy, goal setting, and independent living skills; Exploring sexuality and gender as it relates to ASD; Understanding the rights for accommodations as an ASD person at school or in the workforce; Finding ways to connect with self and others Then, book an appointment with Josh and receive support that is uniquely tailored to your needs. CLICK HERE to view his online schedule and find a date/time that works best for your schedule. ___________ Written by: Josh Rinz Josh Rinz (MA, RP, AAT) has a Bachelor of Science in Biology from the University of North Carolina and a Masters of Theology, specializing in Spiritual Care and Psychotherapy from Wilfrid Laurier University in Waterloo, ON. Josh is a leading expert in the mental health field, especially when it comes to working with neurodiverse children and adults, as well as their caregivers! He is committed to quality, evidence-based therapeutic practices that work in collaboration with his clients to improve their emotional, cerebral, spiritual, and relational wellbeing. Josh brings an enthusiastic and innovative approach to therapy. Working with diverse individuals, families, and caregivers, he believes in the importance of creating a safe and engaging space where clients can explore their personal stories and discover their sense of hope within. Josh has the training, the experience, and a very special interest in working specifically with adolescents on the autism spectrum, as well as neurodiverse people and those with additional special needs and considerations. He strongly believes in supporting the whole ecosystem of an individual, which includes providing specialized support to the families and caregivers.
Understanding Borderline Personality Disorder 12 March 2021 Bliss Team No comments Categories: Book Recommendations, Individual Therapy, Therapy, Uncategorised Please note that every person’s experience of borderline personality disorder (BPD) is different. The symptoms and ranges of BPD run both vertically (the number of symptoms experienced) and horizontally (the intensity of how they are experienced). If we also consider other factors that layer and intersect, such as life events (e.g., t/Trauma) and social positions (e.g., financial security, colour of skin, sexual orientation, gender, etc.), our end result is a very unique tapestry of experiences. “People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” Dr. Marsha Linehan What is Borderline Personality Disorder? BPD is the most common personality disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). This manual is used by physicians and psychologists to make mental health diagnoses. Someone with a personality disorder typically faces unique challenges in: Relationships and social situations; Managing emotions and thoughts; Understanding how certain behaviours are creating problems and/or; Recurring difficulties in changing a mindset to suit different contexts. 75% of people with BPD self-injure one or more times. 10% of people with BPD take their own lives. What are the symptoms of BPD? The DSM-IV-TR lists 9 categorical criteria for BPD. A person must present with at least 5 of the symptoms in order to be diagnosed with BPD. The 9 symptoms can be summarized as: Frantic efforts to avoid real or imagined abandonment, significant fears of being alone; Unstable and intense interpersonal relationships; Lack of clear sense of identity; Impulsiveness in potentially self-damaging behaviours, such as substance abuse, sex, shop lifting, reckless driving, binge eating; Recurrent suicidal threats or gestures, or non-suicidal self-injury such as cutting, burning with a cigarette, or overdose that can bring relief from intense emotional pain; Severe mood shifts and extreme reactivity to situational stresses; Chronic feelings of emptiness, loneliness and neediness; Intense, frequent, short-lived and inappropriate displays of anger, depression or anxiety; Transient, stress-related feelings of unreality or paranoia. Inconsistent symptoms are the hallmark of BPD, which makes it difficult to define a single set of criteria for a diagnosis. This is further complicated, as research has shown that about 90% of folks with a BPD diagnosis, share at least 1 other major psychiatric diagnosis. What is it like living with BPD? “Prick the delicate ‘skin’ of a borderline and she will emotionally bleed to death.” Kreisman and Straus BPD has been described as emotional hemophilia. In the case of BPD, the client will have difficulties with moderating their feelings. Mood changes can come and go quickly and can shift from extreme joy to the deepest despair. A person with BPD may be filled with anger or despair one hour and then calm the next, with little understanding as to why. This then leads to feelings of insecurity, lower self-worth and inner criticism, which brings about more self-hate and depression. Symptoms, such as dissociation, can also interfere with concentration making it very difficult for folks with BPD to complete their tasks. Feelings of emptiness makes a person with BPD feel as though they have to do anything to escape, such as impulsive and self-destructive behaviours, so that they may feel something. People with BPD may also feel as though they do not have a core identity and to overcome their mostly negative self-image, they will create characters or codes. People with BPD may also experience splitting. Splitting can happen at any time, if they are under enough pressure, stress, anxiety, or anger. Splitting is when a person only thinks about a situation or person in binaries. It is the rigid separation of positive and negative thoughts and feelings about oneself and others. For instance, a person with BPD may only consider a context to be right or wrong, good or bad, or in black and white terms without any room for grey. A person with BPD may struggle to accept human inconsistencies or ambiguities, and as such favour predictability. When there is a miscommunication or when somebody they idealize eventually disappoints them in some way, or acts in a way that they did not predict, a person with BPD may look at them as though they cannot be trusted. When this occurs, the person with BPD has to make a decision to either restructure their strict and inflexible conceptualization of this person or to isolate themselves in order to preserve the “perfect” image they had created. Research shows that there is no definitive cause for BPD, rather it is a combination of genetic, developmental, neurobiological and social factors that contribute to its development. People with BPD may come from family backgrounds with parents who were indifferent, rejecting or absent. They may have also received little to no affection and/or experienced chronic abuse. A person with BPD will also seek out new relationships (i.e., partners and/or friendships) quite often. Once in a close romantic relationship they will both crave and become terrified of intimacy; fearing abandonment, they will cling to their partner, which will then lead to fears of enmeshment, so they push away. Because of this, they end up pushing away those they want to connect with the most. Of all the major mental health diagnoses, BPD is the most stigmatized. Stereotypes include viewing folks with BPD as dramatic, manipulative, unfeeling or lacking emotion, attention-seeking and/or narcissistic. They are consistently suspected of wrongdoing, carelessness, anger, and difficulties with building a regular routine. This leads folks with BPD to hide this part of themselves from others. For a person with BPD there are significant fears of abandonment and they will attach to a favourite person and rely on this person for emotional validation and security. Their favourite person becomes the source of their comfort and devotion. A BPD person’s favourite person can be anybody: a relative, parent, best friend, lover, or somebody they just met. The difference between a best friend and a favourite person, is related to the intensity of the thoughts that surround this person. A person with BPD requires compassion, understanding, acceptance, honesty, patience and love. They may not have grown up with either receiving or learning how to share these characteristics with their formative relationships, so accountability for behaviours that are challenging a relationship and empathy, are key. Of course a person with BPD will need to learn how to give themselves the love and compassion that they crave from others, as well. What can you do if you or a loved one is experiencing BPD related symptoms? It is important to recognize that there is no “cure” for BPD, rather somebody who experiences these traits and is receiving treatment may just have more time between self-harm episodes and/or coping strategies to support emotional regulation. Kreisman and Straus have described a structured method of communication, known as SET that can be used when communicating with a person who is in a BPD related crisis, or emotionally spiralling. Support – Use a personal “I” statement of concern to demonstrate a personal pledge to try to support the person in emotional crisis. For example, “I am really worried about how you are feeling.” Empathy – Acknowledge their chaotic feelings with a “You” statement. For example: “You must be feeling awful/scared/hurt/etc.” Truth – Emphasize that this person is accountable to their own life and that others’ attempts to help, cannot avert this primary responsibility. In this statement, you must acknowledge that there is a problem that exists and offer a solution for what can be done to solve it. This must be done in a matter of fact tone. For example, “Here’s what happened…These are the consequences…. This is what I can do… What are you going to do?” It is possible to have a healthy relationship with a person with BPD, especially if you are the favourite person. You can do this in 5 easy steps. Step 1 : Communicate The first step is to have a discussion, to acknowledge that you are their favourite person, and to determine if the relationship is mutual. Questions to reflect on and consider during this discussion are: What are each person’s needs? Are they currently being met? Has there been an instance where either person’s needs weren’t met, why might that be and how might you both be able to overcome this in future interactions? What are both of your feelings regarding space and emotional boundaries? Step 2: Avoid Assumptions BPD folks generally think in black and white (e.g., “they don’t love me anymore”). In order to avoid this assumption and the potential for an emotional crisis, or “testing” the favourite person to make sure they still do love them or won’t leave them, the BPD person should feel comfortable with being direct and asking for reassurance from their favourite person (e.g., “Is everything alright? I’m just worried because I haven’t heard from you in a while”). Step 3: Develop More Friendships It is comfortable and easy for a BPD person to give all of the love and everything they have to their favourite person, but it’s a lot of pressure to receive and also reciprocate as a single human being. This is why it is important for both the favourite and BPD person to have friends of their own that they enjoy spending time with. This will help the BPD person with the intensity of putting all of their emotional needs on one person, and will also help the favourite person to have other outlets and their own support. It’s important that the BPD person avoids scheduling their plans around their favourite person. Step 4: Limit Expectations This is one of the most difficult ideas for a BPD person to incorporate into their worldview, but it is to cultivate a mindset in which their favourite person may leave, by choice or not, and this is okay. This requires a mindful appreciation for enjoying the day for what it is. No matter what happens. It is not possible to control a person or to demand that they be committed to your relationship or friendship forever. Thinking of the future and the possibility that they could leave, may generate anxious thoughts and feelings of being abandoned. Instead, the BPD person can try practicing gratitude for the current state of their relationships. Step 5: Therapy & Medications Treatment for both the BPD and favourite person usually begins with education; discussing what is known about BPD and its causes, as well as how the BPD person can self-manage and prevent relapses. Therapy and counselling may also be offered at the individual or group level for both the BPD and favourite person. The BPD person may also wish to take prescription medications that align with their specific symptoms (e.g., mood swings or anxiety). There are a number of therapeutic tools that can be used in the treatment of BPD symptoms. The 2 major tools are cognitive behavioural therapy (CBT), which focuses on the present and on changing negative thoughts and behaviours, and dialectical behaviour therapy (DBT) which uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and the client’s emotional state. DBT helps clients to regulate intense emotions, to reduce self-destructive behaviours and to improve relationships. It’s important to remember that like any relationship, the connection you build will be at it’s healthiest if it is constructed on a foundation of trust, friendship, mutual respect and care, honesty and accountability. At Bliss, we want to help our clients navigate the complexities of BPD and help them live balanced, happy, fulfilling lives. If you need additional guidance, please book an appointment with one of our therapists who specialized in this area and will guide you through the therapy process in a safe, non judgemental atmosphere: Sheila Mcdonough Sergius Semuyeh Valentina Messier Josh Rinz Marni Moss You do not have to go through this alone. Bliss is here to support you. Written By: Jess Jess is our amazing office strategist at Bliss Counselling. Jess is a Master’s graduate from the University of Guelph. During this degree, they focused on aging and end-of-life, communication, human sexuality, LGBTQI2S+ health, inclusive practice and policies, knowledge mobilization strategies, research methods, and program evaluation. I would like to learn more about BPD, what other resources exist? For more information and support, please consider the following resources. Books Beyond Borderline: True Stories of Recovery from Borderline Personality Disorder by John G. Gunderson (edited by Perry D Hoffman) Building a Life Worth Living: A Memoir by Marsha M. Linehan Coping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder by Blaise Aguirre I Hate You – Don’t leave me: Understanding the Borderline Personality by Jerold J. Kreisman and Hal Straus Loving Someone with Borderline Personality Disorder by Shari Y. Manning Mastering Adulthood: Go Beyond Adulting to Become an Emotional Grown-Up by Lara E. Fielding The Dialectical Behaviour Therapy Wellness Planner: 365 Days of Healthy Living for Your Body, Mind, and Spirit (The Borderline Personality Disorder Wellness Series) by Amanda L. Smith The Mindfulness Solution for Intense Emotions: Take Control of Borderline Personality Disorder with DBT by Cedar R. Koons This is Not the End: Conversation on Borderline Personality Disorder by Tabetha Martin The Dialectical Behaviour Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation and Distress Tolerance by Matthew McKay, Jeffrey Wood, and Jeffrey Brantley Online Documents Borderline Personality Disorder: An Information Guide for Families by CAMH https://www.camh.ca/-/media/files/guides-and-publications/borderline-guide-en.pdf?la=en&hash=69DE097DD9DC16A66440FCD4573E73358AEEECEC Borderline Personality Disorder by the National Institute of Mental Health https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml DBT Skills Training Handouts and Worksheets by Marsha M. Linehan https://projecticee.files.wordpress.com/2018/12/lin-c-dbt-handouts.pdf The Overlap Between Autistic Spectrum Conditions and Borderline Personality Disorder by Dudas et al., (2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590952/
To my Quaran-tine: How can we navigate our relationship during a pandemic? 14 February 2021 Bliss Team No comments Categories: Book Recommendations, Communication, Self Care, Sex Therapy, Sexual Wellness Due to the restrictions on dating activities that would normally happen during Valentine’s Day, couples may feel like it’s going to be just another day. Which can be disappointing to those who enjoy taking a break from the repetitiveness of everyday life relationships. This is a universal conflict for all couples, new or old, healthy or strained. COVID-19 did not just impact how people meet, but also the exploration of romance and even how much time people spend together. For partners who are living together and are spending more time with each other at home throughout COVID-19, emotional connection has improved; physical connection on the other hand has not. The amount of time spent with partner(s) does not necessarily equate to “quality time”. For instance, more time together could mean more conversations about things each person isn’t happy with within their relationship or changes they might like to see. Some partners may realize they aren’t as compatible with each other and may be starting to realize that they want different things. Some relationships may be trying to work through betrayal, such as infidelity, and are finding it difficult to not be able to take space from their partner(s), as they try to figure out what they want. If we layer in those relationships who have children, it’s even more difficult to have privacy and to take time to grieve aspects of the relationship when the kids are around and people are isolated from their support systems, like family, friends, co-workers. For those who are dating, there is also a lot more communication and negotiations of boundaries during COVID-19. For instance, folks may be asking themselves: Is it safe to be discussing COVID-19 related precautions with this new person? How do we discuss and navigate consent? Should I be isolating after sharing a physical connection, and if so, for how long? Are relationships that came to fruition during the pandemic going to last past the pandemic? A list of common challenges people have felt in their relationship during COVID-19 includes: Experiencing Low sexual desire and desire discrepancy Sharing less physical intimacy or avoiding sex Overcoming infidelity Finding ways to effectively communicate feelings and listen to alternative perspectives Managing erectile dysfunction & rapid ejaculation Exploring sexuality Reconnecting sexually Wanting to open up the relationship Sometimes when there is a crisis, it can either connect and bring partners closer or it can have the opposite effect. It’s important to remember that relationship bumps are inevitable, pandemic or not, No matter the situation, great new things will come from this, even though it’s hard right now. At Bliss, we want to help our clients through these challenging times. Navigating relationships during COVID-19 can be hard, but not impossible. Here are some tips from our very own therapists who specialize in sexual health and wellbeing in relationships: Have separate time You’re not going to desire someone when you spend all of your time with them. Do what you can to separate yourself. That could mean, self-care, taking up jogging, biking, connecting with friends, and having outdoor hangouts in safe ways. Do not feel guilty for taking time for yourself. Increasing pleasure and fun Figure out target specific activities you can do at home, or outside, these can be brainstormed with your therapist. Some activities you can discuss with your partner(s), or date are: Exercising Board Games Movie Marathons Puzzles Planning Future Fun Events Cooking Together DIY Spa Dates Bubble Baths Colouring Dressing Up For A Date Night In Reading To Each Other Paint Night Online Classes Yoga Stargazing Create a Photobook Of Memories Long Drives Bake Off Share Your Favourite Stand-Up Specials Streamline a concert together Make (chocolate) fondue together Make breakfast in bed Recreate your first date, from home! Make your own valentine Ask conversation starters, or quiz yourselves on your love maps! Write each other a poem or haiku Write each other love or gratitude letters Cook a romantic dinner, with candle light and all (some of these ideas are great for an COVID friendly Valentine’s) Open Communication Anxiety about COVID-19 leads to stress and irritability in the relationship. Effective open/transparent communication around what you are going to do is key. Whether it is with your partner(s) or someone you’re dating. If you have the same perspective, it’s okay. If you have two different perspectives, or pre-existing anxiety and OCD, it will affect the relationship. So, discussing boundaries and negotiating “dating terms” should be at the forefront of conversation. Managing Stress If you find yourself being hypervigilant in managing emotions, minimizing conflict, protecting kids from the tension or outburst, you may be giving yourself additional unnecessary stress. In managing stress levels, remember that you cannot control anyone else’s emotions except your own. You must let your partner(s) regulate themselves. For those in couples or individual therapy, this is something you can talk to your therapist about. Finding ways to regulate your own emotions will help in figuring out how to move forward with your partner(s) with no resentment. It’s really important to normalize your experience and your partners’ relationship concerns. Our therapists here at Bliss validate client’s emotions and experiences while supporting them in reframing thoughts, changing habits, breaking patterns, and getting out of cycles they may be stuck in. Navigating relationships during a pandemic can be hard. Give yourself more credit, and Happy Valentines Day! Resources: Come As You Are by Emily Nagoski, for desire/arousal in women. Better Sex Through Mindfulness: How Women Can Cultivate Desire by Lori Brotto Not Always In The Mood by Sarah Hunter Murray, for low desire in men and myths around male sexuality Esther Perel – Infidelity Written By: Raman Dhillon Raman Dhillon is the office strategist & digital content manager and helps assist our clinic/operations manager Jess. Raman has a background in Psychology & Literature from the University of Waterloo, and more recently a Post Graduate Degree in Mental Health and Addictions from Humber College. Raman has experience with client-centered intervention as well as holistic assessment. She’s very interested and well versed in different therapeutic approaches such as mindfulness, naturopathy, and art therapy. Raman loves merging her two passions, mental health, and art to convey messages, psychoeducation, and awareness to the masses.
Book Review: The Whole-Brain Child 17 April 2019 Bliss Team No comments Categories: Book Recommendations If you enjoy reading, it is likely that you already understand the therapeutic nature of a good book. At Bliss Counselling, we also recognize the power of reading and the numerous benefits that books provide for us. Reading can encourage individual growth, develop or strengthen empathy, teach us better ways of interacting with the world, or provide much-needed support in difficult times. Below is my review of a recent book recommended to me from Bliss therapist Jenna Luelo! Book Reviewed The Whole−Brain Child by Daniel J. Siegel M.D., and Tina Payne Bryson, Ph.D. What It’s About The book provides 12 revolutionary strategies to nurture a child’s developing mind. Why You Should Read It I think this book is great for any parent, caregiver or anyone who has an interest in learning more about the developing brain! As a parent, it can be challenging when we are confronted the strong emotions from our children. I enjoyed this book because I believe that it helps us to interpret what is happening in a child’s mind when they are experiencing extreme emotions such as fear or anger. It is a fantastic reminder that sometimes a child is not able to connect their “upstairs brain” (reasoning skills) with their more intense emotions. Each chapter in the book describes twelve revolutionary strategies that can be used with children. Below is a link to a quick guide outlining each strategy mentioned in the book: A Quick Guide of Strategies Favourite Quote “Imagine a peaceful river running through the countryside. That’s your river of well-being. Whenever you’re in the water, peacefully floating along in your canoe, you feel like you’re generally in a good relationship with the world around you. You have a clear understanding of yourself, other people, and your life. You can be flexible and adjust when situations change. You’re stable and at peace. Sometimes, though, as you float along, you veer too close to one of the river’s two banks. This causes different problems, depending on which bank you approach. One bank represents chaos, where you feel out of control. Instead of floating in the peaceful river, you are caught up in the pull of tumultuous rapids, and confusion and turmoil rule the day. You need to move away from the bank of chaos and get back into the gentle flow of the river. But don’t go too far, because the other bank presents its own dangers. It’s the bank of rigidity, which is the opposite of chaos. As opposed to being out of control, rigidity is when you are imposing control on everything and everyone around you. You become completely unwilling to adapt, compromise, or negotiate. Near the bank of rigidity, the water smells stagnant, and reeds and tree branches prevent your canoe from flowing in the river of well-being. So one extreme is chaos, where there’s a total lack of control. The other extreme is rigidity, where there’s too much control, leading to a lack of flexibility and adaptability. We all move back and forth between these two banks as we go through our days—especially as we’re trying to survive parenting. When we’re closest to the banks of chaos or rigidity, we’re farthest from mental and emotional health. The longer we can avoid either bank, the more time we spend enjoying the river of well-being. Much of our lives as adults can be seen as moving along these paths—sometimes in the harmony of the flow of well-being, but sometimes in chaos, in rigidity, or zigzagging back and forth between the two. Harmony emerges from integration. Chaos and rigidity arise when integration is blocked.” Written by Jill Stroeder
A Review of Brené Brown’s “Rising Strong” by Heather Stuart 1 July 2016 Bliss Team No comments Categories: Book Recommendations Book: Rising Strong : The Reckoning, The Rumble, The Revolution (Random House, 2015) By: Brené Brown Reviewed By: Heather Stuart What I liked about the book: I listened to the audiobook version of Rising Strong, as I think that Brown’s writing style lends very well to this format. What I really enjoy about Brené Brown is her ability to speak to her audience honestly and with a narrative voice that makes you feel like she is talking with you over coffee. Rising Strong is full of personal anecdotes and insights on the difficult and vital task of picking oneself up after a painful setback. As is always the case with Brown’s writing, the book contains lots of great take-aways (e.g. the handy acronym BRAVING), and reminders that she has plenty of her own vulnerability triggers. For Brown to admit how humiliated she felt after mispronouncing the name of a public figure while giving a talk demonstrates a level of courage and openness often lacking in people who achieve a certain level of notoriety. She also speaks candidly about her own ability to escalate arguments with her partner instead of managing her anger and bidding for connection. What I didn’t like about the book: While I appreciate much of what Brown discusses in Rising Strong, I also got caught up on a couple of snags. The first one is that she runs the risk of becoming name-droppy in a way that is grating. When the Pixar studio became an integral part of one of Brown’s examples of getting through difficult experiences, I had to roll my eyes. By and large I think that it’s an incredibly positive thing that Brown’s ideas have resonated with such diverse audiences, however, she runs the risk (in my humble opinion!) of pandering to the wealthy and famous. Secondly, and more importantly from a therapeutic perspective, Brown’s examples of coming through difficult circumstances and experiences are more limited than I would have expected. As Brown herself claims towards the end of her book, people who have experienced serious trauma will likely seek more intense and specific support than the book offers. People who have experienced serious setbacks can certainly use much of the bedrock of ideas in Rising Strong (again, “BRAVING” comes to mind), but I would caution that Brown’s illustrations of her concepts might feel far too inconsequential to some readers. Some favourite quotes: “The opposite of recognizing that we’re feeling something is denying our emotions. The opposite of being curious is disengaging. When we deny our stories and disengage from tough emotions, they don’t go away; instead, they own us, they define us. Our job is not to deny the story, but to defy the ending—to rise strong, recognize our story, and rumble with the truth until we get to a place where we think, Yes. This is what happened. This is my truth. And I will choose how this story ends.” “There are too many people today who instead of feeling hurt are acting out their hurt; instead of acknowledging pain, they’re inflicting pain on others. Rather than risking feeling disappointed, they’re choosing to live disappointed. Emotional stoicism is not badassery. Blustery posturing is not badassery. Swagger is not badassery. Perfection is about the furthest thing in the world from badassery…People who wade into discomfort and vulnerability and tell the truth about their stories are the real badasses.” “Just because someone isn’t willing or able to love us, it doesn’t mean that we are unlovable.”
A Review of Paul Coelho’s “The Alchemist” by Tammy Benwell 27 March 2016 admin No comments Categories: Book Recommendations Book: The Alchemist By: Paul Coelho Reviewed By: Tammy Benwell What the book is about: The Alchemist is a book about following your dreams, and the struggles that one often faces when attempting to do so. While sleeping under a sycamore tree Santiago has a recurring dream where a young child tells him that a treasure awaits him at the Pyramids in Egypt. After consulting an elderly gypsy woman, who confirms his dream, Santiago sets out on his journey to Egypt. Along the way he encounters people and circumstances that cause him to doubt his dream, but he also meets people like the Alchemist, who continue to inspire him and renew his faith in the journey. Why I think you should read it: I love this book because it touches on one of my core beliefs about the nature of life. I believe in following your dreams, no matter how big or small they might seem. I think that we allow fear and feelings of unworthiness to dictate a lot of our choices in life, therefore limiting our growth. Bad things will happen to us all at some point, and sometimes the bad things can feel quite frequent and overwhelming. Santiago certainly faced his fair share of challenges. But if we can continue to push forward, I whole-heartedly believe that good things can happen. I have witnessed it firsthand, working with mental health patients, their families and my clients at Bliss. Favourite quotes: “It’s the possibility of having a dream come true that makes life interesting.” “People are afraid to pursue their most important dreams because they feel that they don’t deserve them, or that they’ll be unable to achieve them.” “People are capable at any time in their lives, of doing what they dream of.” “The fear of suffering is worse than the suffering itself… no heart has ever suffered when it goes in search of its dreams.”