Category Archives: therapy

goals, learning and contracts

after my post about small and SMART goals on garfield’s blog, i got inspired to write another one at brainblogger about the pitfalls and benefits of goal setting, this time taking a bit more of an academic slant. larry ferlazzo took up that post and talked about goal setting in the classroom. it made me think about learning goals. i won’t get much into this right now but i found it interesting that when i was googling around a bit about the topic, pretty much everything i saw were not really learner-directed goals. they were either goals clearly set by the teachers, or contracts that were not really contracts, i.e. they don’t meet the criterion of containing mutual promises. a lot of learning contracts (and contracts in counselling, too, by the way) are of the mafia sort: if you don’t pay up, we’ll break your leg. fortunately, there is usually little leg-breaking involved in learning or counselling contracts but they tend to be one-sided. the promises by one party (e.g. the learner) are numerous and clearly laid out, and often there are no promises made by the other party, or they are not specified.

depression and exercise

exercise – it works for depression is the title of a post i wrote for brainblogger the other day. it is about a large-scale study, the SMILE study (standard medical intervention and long-term exercise, conducted at duke university), which found that vigorous exercise three times a week for half an hour or forty-five minutes reduced symptoms of depression as effectively as antidepressants. there is the beginning of an interesting discussion in the comments about how to discuss findings like with people who are in the midst of depression.

any thoughts on this?

psychologists, mental illness and stigma

today please visit over at brainblogger, where i talk about research on how some psychologists view people with mental health issues, especially those with schizophrenia and borderline personality disorder.  interesting points that are being discussed in the comments are the place of diagnosis and the importance, or limits of, of objectivity.

mental health advice: tell me what you think

the other day i received a phone call from william (not his real name), very distressed. he was in the psych ward, on his third week now. “i gotta get better, i gotta get better!” he kept saying. his hospitalization had been preceded by a good six weeks of progressively worsening mental health. anxiety, depression and borderline personality disorder were only some of the diagnoses that had been with him for many years. when he is healthy, he is funny and quirky, a dedicated stay-at-home dad who enthusiastically shares his two daughters’ passion with field hockey. when he cycles into his illness, his thought patterns quickly become more and more one-dimensional until all that is left is a looming preoccupation with how bad of a father he is and a clinginess that becomes almost unbearable to his partner, especially since it tends to be laced with hurtful sarcasm.

my involvement with william is only at the margins. when things get bad, though, we often spend a lot of time on the phone. he finds our phone calls comforting; i think it’s because i treat him like a normal human being, because i, too, have personal experience with mental illness, and also because i keep pointing out my boundaries, gently but firmly.

when william called and kept saying, “i gotta get better, i gotta get better”, my instinct made me blurt out, “you gotta make a choice here. either force yourself to get better – the old pull-yourself-up-by-the-bootstraps method – or accept that you’re sick right now, and that this could be a slow process. but if you keep going back and forth between the two, it’s going to drive you around the bend.”

in my observation, one of william’s major problem seems to be that he is stuck in a painful, very tight loop of thoughts and feelings, a cage of unrelenting self-talk of self-loathing, control and neediness (“i’m a failure!” “no-one wants to spend time with me!” “jean bought the wrong kind of potatoes again!”) my blurting and telling him what i think he needs to do – not exactly according to the textbook of counselling – was at least partially informed by this observation. perhaps i was trying to say, “get out of your cage!”

over to you, readers. what do you think? was my exclamation to make a choice clumsy, too directive? if you were william, how would you have reacted? would you feel connected because i simply followed my instinct and therefore related on a real level?

therese borchard: the pocket therapist

earlier this year, you heard me rave about therese borchard’s book beyond blue a few times. she has a new book out, the pocket therapist. i just received it and haven’t opened it yet. because i have so much trust in therese, i’ll do this: i’ll look at three random pages, tell you what i see there, and give you a few thoughts. ready?

page 50: imitate an eagle

that’s a great start. this being a pocket therapist (what is this? the sub title is: an emotional survival kit. maybe it’s a-tip-a-page?) maybe it’ll suggest to glide, let the winds take you, without resistance. maybe it’ll talk about being super protective of your little ones (little what? creative urges, perhaps?) ok, let’s see.

an eagle knows that a storm is approaching ling before the storm comes. he will hoist himself way up high and wait for the winds to come. then, when the storm arrives, he steers his wings so that the wind will raise him up and lift him above the storm. while the squall thunders below, the eagle is gliding above it. he hasn’t dodged the storm. he has simply used the fierce winds to lift him higher.

interesting! totally reminds me of norm amundson’s book on metaphors that i discussed a few days earlier.

how might this help someone with, say, bipolar disorder? we could say the storm resembles a manic episode. honing one’s sensitivities so that the “storm” can be anticipated is a very important skill to learn. how might one glide above it? that’s an interesting question. perhaps possible only for people with advanced meditation practice.

perhaps this is not what therese was referring to. how do you think this metaphor could help?

page 161: pin the anxiety on the unrealistic expectation

makes me think of pin the tail on the donkey. that involves tapping around in the dark (makes me think of the times we look around in the jungle of medication and techniques, hoping to stumble on one that might eventually work, at least for a while). it also involves trust – that there is someone who will make sure you don’t fall down the stairs or fall into the flower pots while you blindly stumble around. here’s therese:

i jot down irrational goals like “penning a new york times bestseller in my half hour of free time in the evening” … [or] “training for a triathlon with a busted hip.”

then my therapist and i arrive at some realistic options, like “writing an adequate blog” [or] “swimming … a few times a week but saving the triathlon for after retirement.” these goals don’t sound as sexy on paper as the overachievers’ but they are friends with sanity, and that’s all i care about.

aah! i get it. she separates the realistic from the unrealistic, and as she does that, the anxiety stays behind with what’s unrealistic.  can you see yourself using this techniqe?

page 71: bawl your eyes out

not much interpretation needed here, is there?

in a recent new york times piece, writer benedict carey refers to tears as “emotional perspiration.” …

for one, they remove toxins from our body. emotional tears (those formed in distress or grief) contain more toxic by-products than tears of irritation, like when you peel an onion, indicating that weeping is surely nature’s way of cleansing the heart and mind.

second, tears elevate mood. crying lowers a person’s manganese level, and the lwoer the better because overexposure to manganese can cause anxiety, nervousness, irritation … and the rest of what happens in your brain when you or your spouse are in a foul mood.

finally, crying is cathartic.

you’ve felt the same release that i have after a good sob, right?

it’s as if your body has been accumulating hurts and resentments and fears … until your limbic system runs out of room and then, like a volcano, the toxic gunk spews forth everywhere.

what’s crying like for you?  does it offer you release?

once again, therese borchard didn’t disappoint me. in fact, i already have someone in mind to whom i will give a copy of the book.

let the wizard of oz help you!

i just finished reading norm amundson’s new book metaphor making. it is written to assist counsellors in making better use of metaphors and includes theoretical foundations and intervention exercises. the most interesting part (for me) were the forty metaphoric images that offer an in-depth practical and personal opportunity to experience working with metaphors. i’d like to give you a taste of it. this one is about the yellow brick road. since i’m thinking of using it with my immigrant clients who may not be familiar with the wizard of oz, and since some of you may have forgotten the story, here’s a short intro, adapted from amundson’s version:

once upon a time there was a young girl, dorothy, and her dog, toto.

one day they were swept away by a cyclone and carried away to the land of oz. dorothy was determined to get back home and found out she should get help from the wizard who lived in the emerald city.

on her journey there, she was joined by three companions: a lion who needed courage, a scarecrow who needed a brain, and a tin man who needed a heart. the foursome met traveled on a road paved with yellow bricks and they met many adventures, and good and bad witches.

in the end they found the wizard and it turned out he was no real wizard after all! still, they managed to reach their goals through the magical encounters they had had along the way.

amundson’s thoughts on this story:

sometimes we are unexpectedly blown away by strong winds that knock us off the ground and take us to new places. when that happens, we get confused and we have to create new plans.

in the story dorothy has silver slippers that have the power to take her home but she does not know that. instead she goes on a journey to get help from an expert who, it seems, has all the answers.

dorothy’s companions all have lost confidence in their natural abilities. together they represent passion, intellect and the courage to act – all essential elements of a happy life. they, too, are seeking to find help from the wizard.

when we are in transition (“on the road”) we often feel uncertain. there can be confusion and doubt that we are smart (the scarecrow’s missing brain) or emotionally strong enough (the tin man’s missing heart). we can feel fear, and that can take away from our courage to take risks (just like the lion).

still, it all gets resolved because of persistence, problem solving and help that comes in the midst of all the difficulties – often from unexpected sources.

the wizard in this story has maintained power through lies and illusion. maybe that’s similar to some job seekers who feel that there are negative forces that exert control over them (e.g. a bad economy). in the end, the wizard is unmasked. however, no-one kills or punishes him – he only is allowed to show his true, human face now – and it turns out that without his mask, he also can be helpful.

the morale?

the answers for many of life’s problems lie within us rather than in the hands of an all-knowing expert. there are also many ways in which people can support each other to reach their goals.

things to think about:

can you see any similarities between your situation and the story of the wizard of oz?

can you see some areas of your life where you may have more strengths than you are using right now?

if you were in this story, what would you be looking for: courage, passion, intelligence, a home – or something completely different?

can you think of another story that might have similarities with your situation right now?

depression screening on blue monday, january 18

the CMHA (vancouver-burnaby branch) will be holding a depression and anxiety screening the evening of monday, january 18th 2010, which they call ‘blue monday.’ blue monday is traditionally the third monday in january, a date chosen because it occurs after the holidays but when the days are still dark and dreary, new year’s resolutions may have already been abandoned, post-holiday bills are coming in, and it will be a few more months until another holiday occurs. as a result, people may be feeling sad and overwhelmed. blue monday is therefore an excellent opportunity to take stock of one’s mental health, to acknowledge when things are tough, and take steps to improve it.

participants fill out a depression or anxiety questionnaire, which is then scored anonymously by volunteers. the participant then discusses the results with a clinician, who will make suggestions based on the results. this is not meant to be a counselling session, but an opportunity to have participants think about their mental health, and see their own medical doctor if there is reason to believe s/he should.

the blue monday depression and anxiety screening will take place between 5 and 8 p.m. on january 18th, 2010. space is limited, so interested individuals are asked to register in advance by calling 604-872-4902 or contacting

the CMHA will also have information and resources on mental wellness, and will be showing a series of films by award-winning film-maker, gary ledbetter.

journaling – what works for you?

today, please visit marie at coming out of the trees.    about her blog she says

i’m passing along a collection of excerpts from my personal and therapy journals to whomever needs to read them. i’m sharing my story so that those of you who are on a similar journey can know that you aren’t the only one – and so you can know that there is a way through. it is my intention to tell my story with both authenticity and dignity.

the title of my blog comes from a phrase i penned in the fall of 2007:

“i feel like i am walking through a thick forest and i don’t know where i’m heading, i only know to follow the compass. i believe someday i will come out of the trees and into a clearing. i believe that, when i enter the clearing, i will finally know my primary life’s calling. until then, i have to walk in faith.”

marie gave me the great honour to comment on one of her journal entries what works for you?.  in that entry, she talks about her relationship with god; i concentrate mostly on the journal writing process – a topic, as you may know, that interests me quite a bit – see journaling for healing, creative writing: waking up from our routines,
women, therapy and blogging, journaling: a dialogue or blogging yourself home.