Sometimes we are the teachers, sometimes we are the students but to me the best times are when we are both. As a wise person taught me many years ago, we have two ears but only one mouth so we should make it a point to listen twice as much as we talk. If we do that, we can discover that there is so much to learn in and from life and those around us.

Years ago, when working at a health food store, I met an interesting man. He smelled of a mixture of what seemed to me to be pipe tobacco (very sweet blend) and a machine shop. He wanted a container of freshly ground peanut butter and we were happy to oblige. He spoke of how much healthier this was than the jarred stuff that was packed with extra oils, preservatives, etc. If it was not sweet enough for you, he suggested simply adding farm fresh honey. I swear I never tasted a peanut butter sandwich so fresh and delicious. To look at him he would not be your first choice for health advice: well worn and stained hands that held deep cracks and splits, a beard that appeared to have had little contact with scissors and would not know what a razor was. He also had well worn clothes. He spoke of an undying love of his mother, who he continued to live with and take care of well past the year’s most of us move on (then again, Nana, my mom still lives with us, or is it we still live with her? Who knows and who cares whose name is on the deed).

People talk about what makes a good person. Sure some pick out the bazzillionaires that occasionally write out a big check to their pet project and while those checks are greatly needed, there is so much more to being a good person. I can’t speak for financial riches, nor can I speak of big checks as I have never experienced either but I have been blessed with good people. For that I will always be thankful.

I was at a meeting a while ago and the person running it asked me what my worth was. I replied that “I try to always leave things better than I found them.” He was not amused and asked what my net worth was; he was interested in and defined one’s value by the amount of assets one had. Now, to be honest, I knew what he was getting at but I didn’t think it was any of his business and I honestly don’t know. I’m not a money guy and hope to never be. When pressed I said “I’ll tell ya what, you know that expression about not having a pot to pee in or a window to throw it out? Well, I’ve got the pot and the window and that’s really what concerns me most. I’m not concerned with nor do I value someone by the money they have. Hell, in my experience, those that have the least have tended to give the most…” It was about that time that I excused myself; this was not my crowd.

If I had a million dollars (sorry if I got that barenaked ladies song in your head) I’d likely donate it to the charity I founded and we’d do some really nice things with it. We’d finish the unfinished offices, get that septic system installed so we could open the community kitchen and we’d buy ourselves a nice but older farm sized tractor with a front scoop and backhoe attachment. Nothing too fancy but something that could help us clear the fields, dig the septic and improve the trails as well as do other projects. We may hire a helper as well; there is always a need for more hands. What we wouldn’t do however is ask what our new worth is.

Sometimes folks can be like the moth, easily transfixed by a flash of light, that something sparkly that entertains us to the point of peril. How many moths have met their demise because they focused on the lights and not on the swatter? As people we can tend to get overly involved with our electronic devices even at our own peril. This past weekend I was nearly hit by a few different cars that motored into my lane while they were texting or surfing on their phones. One did not even look up when the horn sang loudly.

In our word of therapy, more and more I see counsellors getting into the latest invention or technique for counselling, some of which cost hundreds or thousands of dollars. Some are going to get trained by self-described XXXXXX masters who will teach their “secrets” to you for the “small price” that is more than I paid for my last few cars (I’m cheap when I buy cars, but still). Sure the certificates are printed at home on their own computer but the PDF workmanship is amazing…

As for me, well call me old fashioned but while I love to research and write and to stay up on the latest and greatest, I am never the moth. I can’t offer my clients the latest “light therapy” that syncs to their favorite music. Nor can I serve them a latte, match my office scent to the emotion they are seeking to embrace and sorry, but you will not find a warmed towel unless it is currently sitting on top of a leaking radiator on one of our tractors.  What I can offer you in an attentive ear, an inquisitive mind, a humble but learned opinion and the compassion that will help you feel connected in the moment with another soul.

My leather couch has seen fancier days and the French doors on my office sport a skeleton key lock and lace curtains. My car park is compressed gravel and there are signs of post and beam construction in my walls and hand forged nails in some of my molding. We may sit in the office for our session or roam the many acres of woodlands, fields, or sit by the brook. Nothing high tech to be sure but soothing and grounded.

Years ago, I was working on an old car and was stuck on how to repair it without a super fancy electronic device. I toiled for hours, days, all to no avail. Finally, I spoke to a man with a thick French accent who knew more about cars than any trained mechanics I’ve ever met. I shared my frustration and feeling it was hopeless unless I could rent that machine. He offered to take a look. He said he knew how to fix it and he had the proper tools. I was very appreciative and we set a time to meet.

A week or so passed and he showed up at my driveway just as he said he would. He had an old beater truck that looked like it never knew an easy day. Every panel on that van had a story it could tell. It was something to see but ran like a top. He opened the side door and reached in for his tools. I was imagining this great piece of high tech equipment but instead he pulled out a hand made tool caddie and a coffee can or two that had been fitted with a copper wire handle. My heart sank and I thought he was a nice man but had wasted my time. He pulled out a few basic hand tools and asked me to start her up. As it ran I asked him what he thought and he replied “I don’t know. She hasn’t told me yet. We need to listen…” (His voice trailing off).  Alone with the silence of the world other than that poorly running engine, he set about making many an adjustment until finally he looked at me with a big grin and said “let’s try her out.”

Driving, we talked a bit but also listened to the engine as it sang its humble song. He had fixed it! He didn’t use anything fancy, just an attentive ear, a few basic tools, a learned mind and the compassion necessary to want to help his fellow man. He left without payment, having refused my attempts. Packing his tin cans and homemade caddie he got into his panel van and headed home. I have no idea what his financial net worth is but he is among the richest men I know.

Sometimes it’s the little things…

Last year I wrote a piece I called “The Unintended Benefits of Counselling” (April, 2015) in which I explored the “collateral” positive aspects of developing a counselling skill set and the impact it can have on our personal  lives as counselors.  The basic premise of that blog was that counselling can have a personal benefit for the counsellor as well as the client. (And it would follow of course, that when the counsellor improves, the results are inevitably beneficial for the client. Counselling truly is “the gift that keeps on giving.”) ­­The focus of this blog is an exploration of how counselling can have a positive impact on our capacities as professionals in other realms, and especially in professions where a counselling skill set may not be considered as a necessary tool in the performance of our duties.  A recent example in my daily work was the genesis for this idea. Although I am a CCPA Certified Counsellor, my day job is that of a high school administrator. To be honest, I have always maintained that the counselling skill set can be incredibly effective in the daily work of a school administrator.  In my capacity as a school leader, I employ effective listening skills, utilize re-framing techniques, conduct solution-focused therapeutic interventions and facilitate mediation in areas of conflict. All before 10:00 A.M.  As a Certified Counsellor, I believe that EVERYONE can benefit from counselling; the parents, students and staff that come into my office are no exception. And in fact, many of the people who come into my office are normally in some type of crisis that requires resolution or at the very least an intervention. (In fact, there is a movement afoot in British Columbia to empower teachers to act as mental health advocates and “front-line workers” since teachers enjoy a unique and increasingly significant position as professionals who see kids every day and are thereby able to establish baseline data for behavior.)  A case in point: I recently had a young woman referred to me for poor attendance. She was 13 years old and in the critical transition year of Grade 8 as students move from elementary to secondary school. She had missed about 25 of the first 35 days of school and as you might expect, her marks reflected her sporadic attendance. Now, under normal circumstances, most vice principals are going to suspend students (as counter-intuitive as that may seem) in order to reinforce the importance of daily attendance as it relates to school success.  The meta-message being, “Jane Smith, you need to attend our school on a regular basis if you wish to remain a student in my bureaucratic institution.” But, as I’m also fond of saying, “Don’t just DO something, sit there..” It takes a lot more effort and care to look beyond the behavior to find its etiological root. In other words, moving from the “what?” to the “why?” Obviously, this student isn’t attending regularly. That’s the “what” but “So what?” The real question is “Why is this student not attending?” And the answer is not, “Because she doesn’t like school.” In fact, as with many of the behavioral issues I deal with as a vice principal, the problems in school aren’t because of school, they have just manifested themselves at school. Extra-curricular issues tend to manifest themselves at school because school for the most part is a “safe space” where children can” act out” and the professionals in school notice these behaviors because “they care.”  So, back to the young lady in question: she was missing school because she was depressed about her parents’ recent divorce.  She was “creating a crisis” in the hopes that Mom or Dad would act, would “make her go to school” and thereby” demonstrate” their love for her.  How many times have we as therapists helped our clients make the connection between their unmet needs and their behavior? What I have found as a school administrator is that a little CBT can go a long way to helping students not come back to your office. With respect to this student who was missing school, my therapeutic intervention did not include discipline for truancy. It did include efforts to build a relationship with this student by demonstrating care for her, it included asset identification, self-esteem building exercises and homework, it included normalizing this student’s experience, it included identification of triggers, it utilized extra-therapeutic factors as a means of self-help, it included personal network reification. It was the antithesis of what a person would expect if they were referred to the vice-principal’s office for violation of the code of conduct. It was brief, solution-focused modality with an emphasis on psychoeducation.  And it worked! In the 30 school days since this intervention, this student has missed 2 days. As therapists, we can’t wave a magic wand and make everything all better, but we do possess a very powerful set of skills and clinical acumen that enables us to help. And that’s why we got into this “business” right? We are called to this vocation to use our time, skills and energy to help others, to improve their lives, to enable them to live a more meaningful, satisfying existence. And fortunately, this is a transferable skill set.

Peter Persad

Dream analysis is an ancient practice that Shaman, healers, sages, and therapists have used to help their patients. Visions and waking dreams are part of many cultures for foretelling the future, healing a disturbed or sick person, searching for animals for food, or preventing or strategizing wars. Some people believe that dreams themselves are prophetic at times and can foretell coming events. Dreams can be a helpful tool in understanding your inner workings and help you make changes in your life.

Jung believed that our dreams were a direct communication from our unconscious. He also believed that our unacknowledged shadow or dark side was represented in dreams and he suggested that we “befriend” our dreams and let them inform us. Images in the dreams can represent parts of our self that are largely not given a voice in our waking life. Freud believed that dreams were a direct representation of our waking life issues and concerns and they primarily problem help resolve our struggles and fears.

Adlerian dream work has origins in a psychoanalytic approach and the focus is on dreams having a purpose in our life, mainly to inform us and heal our psychological self. Dreams can also emerge as childhood conflicts for example when authority figures appear or we dream about the family home or family members. Sometimes images can represent existential-spiritual issues and relate to the person’s relationship with a higher power. Dreams that have images and experiences that elicit questions of values, connection with others, freedom or death and life relate to spiritual-existential themes.

James Hillman, a devotee of Jung’s analytical psychology, believes that dreams are owned by the psyche and the psyche confronts its death in dreams. As we grow and evolve our old beliefs, fears, and conflicts die in the psyche and we reinvent ourselves evolving into a new understanding, essentially a new psychological self. He is against interpretation of dreams because he wants us to live the experience of the dream and to let it inform us as it grows and evolves.

One of the ways to get the most out of dreams is to keep a dream diary. Most people do not remember all of their dreams however even small snippets of the dream can be informative. Over time patterns emerge and can tell us much about our waking life and inner self. Keeping a dream journal near our bed and priming ourselves to remember our dreams helps. When we wake from a dream we should try and stay in the atmosphere of the dream and write down our thoughts immediately. Here are some categories to frame and understand our dream with:

The Dream

Main Characters

Main Features of the Dream

Action, Scene, and characters

Symbols in the dream

Personal and archetypal significance

Type of dream

My feelings in dream and at waking

Later thoughts or feelings

In dream work with a therapist the work is highly collaborative. In the model that in which I was trained, the Hill Cognitive-Experiential model, the emphasis is on eliciting the dreamer’s images, associations, and insight allowing a lasting understanding of their self and processes. I also use the Jungian model of dream analysis.

Therapy can be challenging for some people and tackling life issues through dream work is less deep and more creative and enjoyable. The model has an action component that takes the insight gained and operationalizes it into practical and realistic goals. Dreams then become change oriented.

There are many dream books with definitions for the symbols that emerge however the dreamer is the best judge of the meaning of the dream images. These books offer suggestions but the dreamer is free to decide what they mean. Collaborative work with a therapist helps bring deeper meaning to dreams and can allow opportunities for insight and action in waking life.

If you want a dream work session to explore your dreams call Denise @ 604-562-9130

Sue Johnson (2008) well-known emotionally focused couples therapist advised that the Freeze and Flee “tango” between a couple, can follow the Protest Polka [see previous article]. As a couple’s therapist, noticing this “tango” usually indicates the couple has shut down on all levels. Most likely this couple has been struggling for years to reconnect and has given up. Johnson states this dance is seen when the couple has both shut down and are frozen in either a defense or denial state (2008). The couple is encapsulated in a self-protection mode denying they want or feel anything for each other (2008). For couples’ therapists, this will be challenging energy to slowly and gently peel through.

The couple may not be fighting as before, but show a politeness that screams coldness. This awkward kindness towards each other is actually an evolving detachment and withdrawal state. The default button for this couple is to deny, detach, and withdraw at all costs. If this maladaptive coping behavior continues this couple can come to believe the problem lies within themselves. The couple can get into a cycle of self-loathing and a rumination of negative core self beliefs. Johnson also points out this cycle of self-hatred is different than the other two demon dialogues (2008).

Fleeing the emotional aspects of the relationship is also a behavior that causes disconnection and distance. When a partner moves from feeling emotions to fleeing into reasoning and logical analysis or distractions it becomes a mechanism of denial. Couples who are distressed can revert to old maladaptive behaviors as a child who is holding on to a parent. Fears of loosing the attachment to a mate can conjure up the same feelings as when a child.

The “dance of distance” is surmised with avoidance of feelings, a sense of giving up, rejection and self-loathing (Johnson, 2008). An Emotionally Focused therapist can break through this “dance of distance” by helping couples understanding their behaviors and uncover how they impact relationships. Behavioral patterns (flee and freeze) need to be broken and a sense of hope instilled, as this couple journey back to re-establishing a bond. The therapist must also uncover negative self-talk, challenge the negative thinking by refuting and assisting the replacement of positive thoughts. The couples need to continue this work of refuting and reinforcing positive statements so the negative cycles do not restart.

The freeze and flee behaviors will stop over time as it is replaced by an emotional bond. The couple will need to continue to work together to be responsive, emotionally attuned, and safely connected. The therapist needs to carefully monitor signs of the freeze and flee pattern and if noticed immediately help the couple engage in exercises of emotionally connected dialogues. As an emotionally focused therapist there is always hope for every relationship as long as the couple is willing to do the work and want the emotional bond back.

www.daniellelambrecht.ca

I would be happy to engage in comments with you following this article. Thank you kindly.

One of the most common questions I get when I am lecturing on private practice related issues pertains to marketing. Many folks appear to think that they need a budget the size of Wal-Mart or Canadian Tire in order to “break into” the business of therapy in their area. The truth is that it is not the size of the marketing budget but the quality of the plan that makes the most impact on a new practice.

It is really not that hard to break into an area provided you have done some homework first. How many places offer services in your area to your target area of specialty? What do you offer that is different (if anything) than the other offices? Do you have any contacts at potential referral sources? Will you open an office under your name or will you use a company name? Either way, is the name memorable, easy to remember and spell?

While I speak at this at length in a book I contributed and on my website; below are a few things that I have found to be the most effective for my practice. I would love to hear what has worked best for you and know more about your area as there is no one set of practices that work. Sometimes something will work wonders in one area but fail in another.

Spending a few hundred bucks on a basic website can give you the best bang for your bucks in many cases. It does not have to be fancy nor complicated. So long as it has basic information on the practitioner, office location, contact information etc. it can do much to help bring in referrals. I have never paid to be listed on the top of searches but I do update my page regularly as that can have an impact on the search engines ability to find and classify you. You can even add features such as payment and scheduling options as well, depending on the service you use.

As a practice gains clients; word of mouth from these clients, provided that they are happy with the services, can be one of the best ways to attract new clients and it is FREE! Free is usually good, it becomes bad only if you have had people that have a negative view of you and or your services.  This goes for other practitioners as well. If they feel they can work well with you and have some good results with your services they are more likely to start referring people to you should they be full or unable to take that client themselves.

Things like google maps and similar programs can be good as well. They are typically free but in the growing internet society can be worth more than their weight in gold. I also live for brochures, pens and business card size magnets; having business cards of course is a no brainer. As for pens shop around for good quality products that are low cost. I get my pens from a company that makes them right and prices them fairly. I spend a bit more for click pens instead of ones with caps as some research has shown that once the cap is lost the pen is often tossed. I have recently seen some of my office pens from 2005 still floating around the area. Brochures can be a simple and relatively straightforward way to market a practice. You can design your own on your pc and print it out as needed to keep costs low.

One of the ways that really helped me get started was what I referred to as “Rapid Response Packs.” Rapid Response Packs were packages that I assembled that had a stack of brochures, 250 cards (they typically can come from the printer preboxed in 250 lots so they are easy to package), a handful or so on pens and some magnets. These packs were given out to potential referral sites who indicated an interest in making referrals. I developed these packs in part through an observation of my peers who often make referrals. I noticed that when they had something that they could easily hand to a client they were more likely to make the referral than if they had to take the time to write the information down. While most people only give 5-10 card at most when requested, giving them a bunch ensures that they will be able to make the referrals should they need to. In some cases they will be more likely to give some of the products to other referral sources that they may know.

When considering marketing on a small budget let me offer this humble advice: RELAX. The reality of the situation is that in our field marketing is less and less vital as we become known to an area. Unless your model calls for rapidly expanding the office by adding clinical professionals, you will likely find yourself feeling overwhelmed with referrals that you cannot handle. This can happen in as little as 6-12 months (providing you are offering ongoing counseling services and not just assessments or evals). Try to treasure the time when you look at your medical file cabinet and only see a few charts. While you may fill with dread that they will never have friends to hang out with, these charts will not be lonely for long. In time you may learn to dread not the files but the sound of the phone ringing because you just cannot fit another client in your schedule. Who knows, you just may find that like me, you prefer to have your office number unlisted and never run an ad (we did relent and list the number of our second office and even considered running a cheap ad as we planned on adding several people at once.). The point is, we are not in retail where everything is cut throat and advertising is a must. Let your work speak for itself and everything should work out in short order. Also, remember that we as clinicians are part of a team, if we are employed by the same folks or not. Work well with one another, work friendly. There is enough work for everyone, lets enjoy it.

-Doc Warren

Sometimes you need a fancy logo, long explanation and a media event to get a point across, other times a few will suffice. I love history and try to repeat the good while avoiding the mistakes, though life likes to give us plenty of opportunity to make our own mistakes anyway. I listen. I listen to the trees, to the people and I read as often as possible (daily) a mixture of old and new work in order to keep pace with today and learn from yesterday in order to provide a well rounded tomorrow.

Sometimes it takes a thousand pages to convey a thought, others a few paragraphs. Still, there are times when a look or a hand gesture speaks volumes both within and without a session. Smiles can mean many things beyond happiness but mostly they tend to be positive. A person once told me volumes by just letting me see his hands. They were weathered, withered but large, scarred, stained, callused and stiffened through years of manual labor. You knew where he had been.

A bumper sticker that a school I attended had two large words “Do Good” and in the corner in very small writing it had the college name and contact information. I knew from reading those two words that this was the program for me and those of my ilk. I completed five programs there before finishing to open my not for profit. I am sure many others who walked though those halls have done the same, many have done it bigger and better, but we all try.

I once had a school send me a large package of swag designed to sell me on their program. I almost signed up especially after I read a book they sent that listed them as the best school for my type of program.  A few years later I learned that the owner was being featured on a news program; the government and many people alleged that he was a crook and run a degree mill. It turned out that he had written and published that book himself. All hype, no substance other than greed. Last I read he was on the run with all the money he had collected.

I find myself attracted to older people with broken bodies; they seem to have the best stories. One such gentleman that I will call Cecile as I didn’t think to ask his permission to share his story, talked about his adventures during the depression as a young man, earning a living with his hands, body, sweat and blood. He never made much money but his hands made many things that helped build this country. He shared his glory days when he “could fix any machine with a few wrenches, an oil can and a little persuasion.” I came to learn that persuasion was what he called a hammer like hunk of steel that he made in the factory.

Now feeble bodied but sharp in mind, he resides in a local “rest” home, retirement and our tax dollars paying the rent (it bothers me so much less when I pay my taxes knowing that it helps folks like him). He never made much money, had no pension and never got that gold watch that people used to talk about that capped their years of service. Instead when asked about his retirement he said “they said I was getting slow, either get faster or stay home. Then the foreman stopped giving me a choice of the two, I grabbed my lunchbox and went home.” He made a swiping gesture with his hand as he said it. It was there that I noticed one and a half digits missing from his hand. When asked he simply said something along the lines that sometimes the hand wins, sometimes it is the machine.

I asked him if he had any regrets and he stated he did not, he did wish he had seen the ocean a time or two but otherwise he was ok. He mentioned that his broken hands and broken body enabled his children to get “educated and be a better man than I ever could have been.” That part I highly doubted but did not want to interrupt. His kids never worked a factory job that I know of. They all got jobs as clerks in offices or some such work; a few went to college and “got themselves important jobs with fancy names and everything.”  He never had much of an education, “poor people just didn’t do that back then” he advised.

He did not see his kids that often the last few years of his life. They had moved away to bigger cities, they saw the ocean that he never did and made a good life for themselves.  He said he was proud of every one of them and that if their success meant he had to live in the home, it was worth it knowing that they were safe. He loved telling people to be safe. He never was heard by me at least, to say goodbye. Instead he would simply wave his hand and say “be safe.” I am not sure if he ever noticed how ironic it was that he waved the hand with missing digits when he wished people to be safe but it always warmed me when he said it to me.

I find myself closing more and more correspondence to those that mean something to me with the words “be safe and do good.” I did not consciously decide to do this mind you; it just came from my love of learning from the “now” and from the “then” of time.

I wonder what has rubbed off on you, from your studies, clients, friends and family etc. As for me, I learned to go to the ocean so that if I live as long as he did I will not have to say that I wished I had. No regrets, just a life well lived…

Be safe and do good.

-Doc Warren

”Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, clinical & executive director of Community Counseling of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). He can be contacted at [email protected]

What we thought we knew about the brain is shifting rapidly because of the research of the past 10 years. Daniel Siegel (2008), Allan Schore (2009), and others have gathered recent neurobiological research, interpreted it, and transcribed it into common language. Therapists and others have brought the information into the counselling room and books such as David Doidge’s The Brain That Changes Itself have made their way to mainstream bookstores and television.

I have just finished a course on interpersonal neurobiology and I would like to share some of the knowledge that I believe can change your life. First our memory and what we take in from the world is a much more nonconscious process then we earlier believed. Apparently in one second we take in 10,000.00 bits of information of which only 16 are conscious (Gihooley, 2008). Further, this author maintains that cognitive research suggests that the unconscious is the main component of mental processes and that this realization has turned the psychological community on its ear (Gihooley (2008). He states:

“We’ve come to realize that there is an enormously complex mental apparatus working independently of, and largely invisible to, our conscious mind. These unconscious processes form the actual center of mental life; they are the origin of motivations and initiator of actions, and conscious thought. It may be all we know—plays a comparatively minor and peripheral role in mentation” (Gihooley, 2008 p. 93).

The author is, in effect, stating that our explicit memory and what we know is, in effect, more peripheral to our human experience than, as we thought, the other way around. He gives an example of speech suggesting that we are really not aware of our speech because it is orchestrated and delivered unconsciously. We, in effect, are only aware of what we speak after it is spoken. Implicit memories and knowledge underpin this process and consciousness is not a part of what we are continually perceiving and interpreting. Information processing is an involuntary process (Gihooley, 2008).

Many researchers and clinicians have agreed that in child development the first 18 to 24 months are crucial for a healthy mental and physical life later in life. We know that the child’s right brain is the main part of the brain that develops during this time and the memories are largely nonconscious. In order to develop the brain properly the child’s caregiver needs to create a secure attachment with the child. Attuned communication is also needed for the development of self-regulatory processes and the pre-frontal cortex, which is the centre of logic, reasoning, and executive functioning. Attachment experiences are independent in their influence of genetics and temperament.

Dr. Siegel 2009) presents nine functions that are required for the pre-frontal cortex to develop: balance of the body, attunement with others, emotional balance, response flexibility, ability to calm fears, insight and self-knowing, empathy, morality and larger social good, and intuition. He also focused on the importance of parents being attuned and present with their children in order that their pre-frontal cortex links with them. He suggested that a healthy loving secure attachment is important and that it is estimated that 65% of Americans are securely attached and 35% are insecurely attached.

Dr. Siegel recommended three requirements for developing the nine functions for healing and integrating the brain: loving relationships, internal reflection, and the functions of the brain itself. Practices that assist with the tasks are mindful awareness, prayer, Ta Chi and Yoga. The goal of healthy brain development is integration of the emotional centre of the brain (limbic area) and brain stem (reptilian or old brain) with the pre-frontal cortex or new brain.

Chaos and/or rigidity, Dr. Siegel suggests, becomes the state of being when the brain is not integrated. The presenter suggests that an integrated brain is harmonious and is able to manage separateness and togetherness from others and individuation and connection. He defines the mind as a “process that regulates the flow of energy and information”.

Childhood trauma, and poor attachment experiences produce a brain that is disorganized. The emotional brain is disconnected from the thinking brain and the physical regulation system resulting is chaos or rigidity in behavior and mental health issues. Because this is largely nonconscious it is challenging for the person and others to figure out what is not working.

The good news is that the brain is plastic and a disorganized system can be healed and integrated. Loving secure relationships and self-reflection is the key to healing. This can happen in love relationships and in therapy. Trauma experiences can cause an otherwise integrated brain to disorganize and cause havoc in a persons life creating depression, anxiety, and post traumatic stress symptoms. Again healing can occur with therapy and being surrounded by loving family and friends. The difference in healing through a trauma is most often the support a person seeks and gets.

These advances in knowledge are helping people realize that their difficulties in life stem from early experiences and/or traumatic life events. They begin to view their issues as experience dependent and, for many, caused many years ago not as a result of them being a bad person whose life is hopeless. They also realize that they can change their life if they get help and reach out to others. The key here is awareness and bringing many of the memories and knowledge that motivates and drives their lives to conscious awareness. Those in pain and struggling can have control over how they deal with the information and then they can begin to heal and integrate their brain.

The key points of brain research are that the focus is now on unconscious processes and early childhood attachment. The growth of the brain in the first 2 years is in the right brain and its health is experience dependent. Poor attachment and trauma experiences result in a disorganized brain and behavior that is chaos or rigid, however the brain has neuroplasticity and can heal and integrate with therapy and loving relationships.

Books that are recommended are Daniel Siegel the Developing Brain and Parenting from the Inside Out.

Do You Have Trauma Symptoms?

If you have any of the following you might have post traumatic symptoms or even a firm diagnosis or PTSD:

• nightmares and sleep disruption,
• not feeling safe or have a general feeling of unease in your surroundings or body,
• have panic attacks,
• unable to concentrate on reading material, work activities or household tasks,
• over the top anger and strong responses to minor things
• avoid certain places and people,
• isolate and are very uncomfortable with groups of people,
• anxiety about even minor life tasks is very high,
• an unreasonable fear of authority figures, the police or institutions,
• an exaggerated response to loud noises

If you think that you have not experienced a potential traumatizing event, surprisingly most people have had at least one traumatic event in their life whether it is witnessing one or being in a car accident, breaking a bone in an accident or in a sports activity or losing a family member (estimated 70% in the US). Trauma is as old as humanity, however the field of Traumatology is relatively young with its origins in the 1990’s. The study and treatment of trauma incorporates biological, social, psychological, economic and political factors. Trauma is an exceedingly complex subject and my intention in this article is providing important information about Trauma and PTSD for my clients, colleagues, and readers. Understanding trauma and the profound affects it has on individuals and communities is essential in providing the resources for those people struggling with the effects.

Background

During my Masters training in Chicago I was introduced to Dr. Colin Ross’ work, a Canadian born and trained psychiatrist, whose book The Trauma Model (2006) profoundly influenced my practice and my understanding of trauma and psychological disorders. Dr. Ross suggests that trauma is usually the factor underlying most mental illness diagnoses and that using this model helps in dealing with the issue of co-morbidity. The Colin A. Ross Institute (www.colinross.com) contracts with psychiatric facilities in Texas, Michigan and California providing treatment for psychiatric disorders.

Another of my instructors in trauma work is Dr. Bessel van der Kolk whose work at the Trauma Institute (www.traumacenter.org) in Brookline MA is at the forefront of trauma treatment. His recent publication The Body Keeps the Score (2015, Penguin books) is an excellent resource for practitioners and clients. The research he conducted on Eye Movement Desensitization Reprocessing (EMDR) and incorporating Yoga in treatment for trauma is important work.

The Definition of Trauma

Posttraumatic Stress disorder (PTSD) is the term for the clinical diagnosis that meets the criteria for the disorder after a trauma event or an extreme stressor such as:

• Serious accident or natural disaster
• Rape or criminal assault
• Combat experience
• Child sexual abuse or physical abuse or severe neglect
• Witnessing a traumatic event
• Hostage/imprisonment/torture/displacement as a refugee
• Sudden unexpected death of a loved one

The first month after a trauma event or an extreme stressor, if distress is present, a person could meet the criteria for an Acute Stress reaction that may or may not lead to a diagnosis of PTSD. Not everyone develops a diagnosis of PTSD after an extreme stressor. If they do not meet the entire criteria they can be diagnosed as having an Adjustment reaction.

Symptoms and manifestations

Symptoms fall in three categories:

• Re-experiencing of the traumatic event or intrusive thoughts and images including nightmares and exaggerated responses to triggers and avoidance of reminders of the event;
• Avoidance and emotional numbing including detachment; and
• Another affect is increased arousal including difficulty sleeping, hypervigilance and difficulty concentrating.

PTSD is difficult to diagnose as it is often masked by other symptoms and people can be asymptomatic for months or even years. Often clients are misdiagnosed with depression, high anxiety, bipolar disorder /or psychotic symptoms when at the root of their distress is a traumatic event that more than likely is forgotten or repressed. The memory, likely in a fragmented state, of the trauma is located, at least partly in implicit memory, the very large repository of unconscious material in the brain. This area governs most of our decisions and actions however for most people it lies beyond their conscious awareness.

Often the person develops panic attacks without a connection to a trauma event. Untreated trauma could also be indicated in suicidal thoughts or high-risk behaviours. Other possible symptoms include anger and irritability, feelings of alienation, betrayal, mistrust and isolation. Sometimes the trauma is manifested in psychotic symptoms such as paranoid and/or delusional thoughts. Another complication is when people distract or self medicate with substances such as alcohol or drugs. Generally the person feels on guard with a general feeling of unease when outside of their home.

Political and Social context

Tragically, there is a widespread blind spot where trauma is concerned and the treatment of trauma is mixed in part due to the fact that there is organizational and cultural amnesia and denial of the symptoms of PTSD and the reality of trauma. Both Judith Herman (1997, 2015) and van der Kolk discuss the political implications of addressing PTSD. Perhaps it is as Van der Kolk, Weisaeth & van der Hart (1996) suggested, in their view of psychiatry’s historical approach to trauma. They are highly critical of psychiatry and the medical profession as a whole, stating that it has amnesia about the reality of trauma and its affect on the human psyche, and that there is periodic denial and minimization of the fact (and impact) of trauma.

Herman and van der Kolk suggest that the acknowledgment of the reality of trauma has gone through periods of discovery and periods of invisibility, closely mirroring the public and political appetite to address its importance. Compassionate lay observers tend to be the only people who keep the importance of trauma in their awareness. The biggest concern is that valuable knowledge and time has been lost in the process of denial (van der Kolk et al.). People do not get diagnosed or treated appropriately.

Herman (1997, 2015) also delineated the political aspects of trauma and she asserts that trauma cannot be understood without examining the social context surrounding the situation. Essentially, the recognition of psychological trauma is a political issue. In order for trauma to be considered, the issue of war itself needs to be addressed, as does the inequality of minorities, and of women and children in domestic abuse and violence in society. Unless human rights are a priority, and oppression is challenged, there is minimization, denial, and “forgetting” in the minds of individuals as well as society when it comes to trauma. The affects of trauma and perpetual war are profound in society and rarely acknowledged.

Clinical examples

Examples that I often deal with in my practice are traumatic injuries, assaults and bullying and harassment in the workplace. Other examples include veterans who have long fought for recognition of traumatic stress in combat and vicarious trauma and secondary traumatic stress of police, firefighters, paramedics, frontline workers and health care workers. In addition, trauma dramatically changes the brain and often the worldview of the recipient. When examined under a functional MRI the brains of trauma recipients show scattered activity whereas the brains of non-recipients show focused activity.

With symptoms, tolerance for stress, much like a physical injury’s tolerance for physical activity, is decreased and people are easily triggered into a stress response. They can exhibit fear behaviours such as the flight/fight/or freeze response likely not in keeping with the situation. I remember General Romeo Delaire speaking at conference I attended. He is a vocal proponent of the military’s recognition and support for PTSD.  General Delaire said he was in a marketplace in Africa when a fruit vendor used a machete to cut a large watermelon. He said when he noticed this happening he just “lost it”. He knew then that he had PTS symptoms and needed help.

Longevity of Symptoms

An important piece of information to consider is that the affects of trauma do not disappear overnight even with prolonged treatment, they linger in some form for years. Treatment such as EMDR and desensitization certainly help reduce the emotional impact but symptoms remain. We also know that if someone has had PTSD symptoms once, they are at high risk for developing them again, especially with subsequent trauma experiences.

People with trouble concentrating, disorganized thinking and sensitive nervous systems, hair-trigger reactions often with anger, depression and anxiety, and somatic symptoms such as chronic pain are likely suffering from residual symptoms and often their condition is misdiagnosed. Another symptom of trauma is dissociation, a condition where the person feels like they are outside their body. They never appear grounded and in the present. This is survival technique that over time causes dysfunction in everyday life. In more severe forms it can develop into separate egos or “alters”, and dissociative identity disorder.

Treatment Approaches

Treatment varies depending on the treating professional. I tend to take an integrative approach, using the following:

• Mindfulness-based stress reduction,
• Eye Movement Desensitization Reprocessing (EMDR),
• Emotional Freedom technique,
• Acceptance and Commitment therapy
• +Dialectical Behaviour Therapy,
• Cognitive Behavioural approaches
• Client centered approaches
• Psychodynamic therapy.

Grounding and containment are very important in making a person feel safe again because people often feel unsafe and a sense of betrayal and the trauma has changed their lives significantly. Their core self seems no longer accessible and they have difficulty trusting that life will be manageable and safe again.

Newer training approaches suggest that reliving the trauma or in vivo-desensitization is not necessary to heal from a trauma and some practitioners warn about the potential of traumatizing the person unnecessarily if they are pressured to revisit the original trauma event. EMDR performs desensitization without specifically revisiting the original trauma and body–centered approaches are helpful in helping clients feel grounded and secure in their body an essential component of feeling safe again.

Most treatment professionals have adopted a trauma-informed practice, which recognizes trauma as a component in diagnoses and that certain practices can re-traumatize. They recognize the need for helping people transform feeling helpless to empowering people to take back their lives from the effects of trauma.

Medication or Not

Medication is a personal choice and many people express concern about taking psychoactive medication. In severe responses to trauma, medication is generally indicated to assist people to be able to function again. Sleep is an important component of healing both physically and psychologically and if a person has severely disrupted sleep they will have difficulty stabilizing and beginning to heal. If a person is actively thinking about suicide medication is also warranted. Research supports psychotherapy along with medication is more beneficial than medication alone. If a person’s response is moderate then psychotherapy may be sufficient to alleviate the symptoms.

Summary

In summary, the study of trauma is relatively new and appears to be politically and socially situated. It is often misdiagnosed or missed altogether and is often an underlying component of psychological distress. PTSD and Acute Stress Disorder are the diagnoses and the affects are cumulative. Treatment approaches vary and new approaches focus on empowerment and treating the affects and feelings around the trauma not reliving the trauma or extreme stressor. There are a number of treatment choices and it is not necessary to relive the trauma to heal. Medication along with psychotherapy is indicated in severe symptoms but with moderate symptoms psychotherapy alone might be sufficient.

Your feedback about this article and to contact Dr. Denise about psychotherapy Email denisehallpsychology@gmail or phone 604-562-9130

Last year my wife and I came to Canada for the first time to present at the joint conference between CCPA and ACA (American Counseling Association). Though she has been to other countries before this was my first time out of the USA unless you count a few trips that I took in high school when I went across the border in Fort Kent for five to ten minutes, once I even got out of the car and bought some pop. My knowledge of other countries came from stories from relatives, friends and clients for the most part, supplemented by some TV and readings of course.

After I secured my first passport ever, we headed to Canada ready to present and to explore as much as we could in the few extra days we were able to stay prior to the conference. Driving around Kingston and through to Montreal we stopped at many shops, spoke to countless folks and found the conversations to be engaging, sometimes entertaining but always enlightening. In one otherwise empty shop a conversation took a turn to the more clinical and I found myself doing an unofficial consultation with someone that was feeling overwhelmed. We found a private spot and talked about what was going on and explored some ways to improve, where real help could be accessed in their area and that above all, that they were far from alone. A nice thank you was the result and then we got into our old Merc and headed for our next destination. Though the person was far from suicidal and posed no risk, I have thought of them often and hope that they did enter formal treatment.

Most folks were curious to learn where we were from and typically had kind words for us about our country. In some areas language was a barrier but for the most part folks found my confused stare as a sign to speak English as I was clearly lost as to what they said. I often apologized for being in a country where I did not speak their native tongue but most shrugged it off and welcomed me fully. A few agreed that perhaps I should not be in a place where the language was unknown (there are some of those folks everywhere I suppose).

So here we are, two clinical professionals from a different country, one that speaks the language a bit (my wife took French in high school and traveled to France before so she can hold her own) and one that can look confusedly at the speaker of any language other than English, but we found many a kindred spirit in our northern neighbor. We were outsiders yet we were accepted.

A man named Michelle who was also a counselor, and proudly in recovery told me about the Canadian health care system and gave many real world examples. He spoke of his mum and how she went from a diagnosis of cancer to specialized care, including surgery to remove the cancer in a matter of three weeks or so. She, along with Canadian healthcare in general, are fit and fine as of our meeting. When asked about the mountain of debt she surely must have from treatment (here in the states, losing one’s home and life savings after a major illness is not uncommon, nor is the need for a “go fund me” page or fundraisers to help fund care). He told me she was covered and simply needed to focus on her health.

We met with many interesting clinical professionals during our stay and enjoyed the sights to be sure. And while we in New England USA know maple syrup (I believe it is in the DNA of every Vermont born person) we stocked up on the Canadian staple as well. The more we may sometimes feel different, the more we realize that in many ways, a border is just a made up division. We are all one though we may live under different conditions and authorities.

As counselors we’d like to thank our northern hosts for allowing us to present in their great country and for helping to educate us as to how your system of healthcare differs than ours. As a token of my esteem, I have become a member of this fine organization and have spoken with them on sharing freely many years’ worth of my writings. I have also applied for the CCC and CCC-S credentials and hope to play a small role in Canadian health care. Most important however, is my desire to learn as much as I can on the Canadian healthcare style so that much of your ways can be taught to my readers back in the states. This information exchange has much promise in my eyes.

While we may have different authorities and our take on health care differs greatly, it is my belief and my experience that counseling knows no borders.  I hope and pray for a day when the USA adopts a similar mindset on health care and refinds much of the humanism that it appears to have lost recently. If you ever find yourself in Wolcott Connecticut USA, consider this an invitation to tour our humble therapeutic farm. We hope to receive many such invitations from Canada as well. As I send this, my wife and I are packing our bags to head to other parts of Canada over the next four days. We hope to meet and speak with many folks including counseling professionals, to learn from and share with in order to help make real and lasting change for those we serve. If you see an old Merc with Connecticut plates in your neck of the woods, please give us a shout as we’d love to talk with you. Until then, Be safe and do good.

-”Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, clinical & executive director of Community Counseling of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). He can be contacted at [email protected]