I AM
Nicole Perry
Writing about mental health from a feminist counselling perspective
Dealing with a sinus infection over the last few weeks has me once again thinking about sustainability as a therapist. I was thinking how glad I was that I had room in my calendar to reschedule clients. I was thinking about how gracious everyone was being when I did have to move things around. And this got me thinking about some of the things I’ve done to make all of this possible. For all you emerging therapists out there (and curious cats), please read on… Schedule for a Realistic Week There have definitely been times in the past where my schedule has been much more full. I’ve been booked solid for a month in advance, with no room to add in an extra client here or there. I know a lot of emerging therapists who will do this too – we fit in the most clients possible, leaving practically no room for flexibility. I think we plan for the “ideal scenario”, meaning, “if all goes as planned for me, then this number of sessions I’ve booked will be fine”. What we may not always consider is the “realistic scenario”. In a realistic week, I often end up getting an emergency request from a client to book a session because they’re really in crisis. I sometimes get a letter from a lawyer, insurance company, or Victims Services requesting forms to be filled out or paperwork to be put together. I have clients who I need to do research for, make referrals on behalf of, consult regarding, or make ethical decisions about. I also sometimes have sessions that knock me off my feet for one reason or another. I also get sick sometimes, or get stuck on Edmonton winter roads. If there’s no room in my week to recover, fit in, or move around, what do we do? For awhile, I think the mistake that we make is just to keep adding on to an already full schedule. Many new therapists will work through their lunch hours, stay late to complete their notes and letters, or do the extra work on what should be days off. I believe all the work I described above is an important part of being a therapist, and so we need to start making room for it within our schedules, not leave it as an extra that can be appended on to a full week. I’ll give you an example. I have about 25 client spots open per week. It used to be that I would open all of those to be filled, banking on the fact that I would get one or two cancellations. But, it just so happened that the cancellations wouldn’t always come when I needed it, and 25 client hours a week every week left me very little room for all those other parts of being a therapist I already described above. Now, I’m leaving 22 spots open on my online calendar. I know it doesn’t sound like much of a difference, but those extra three hours are now mine to be flexible with. I can go home early, add in an extra client if I need to, catch up on client notes, or anything else I need. Stop Seeing New Clients In order to have this kind of room in the calendar, I stopped seeing new clients a year ago. I added people to a waiting list if they wanted to wait. In order to feel less guilty about not being able to accept new appointments, I provided them with a list of other therapists in the area who were accepting new clients, as I just couldn’t predict how long it might take for things to slow down. It turns out it took about a year, and things are finally becoming more balanced. Remember that Being Emotionally Well is Part of the Work Within my work week, I also had to consider what helps me stay emotionally well. I now see this as a foundational part of being a good therapist, rather than an extra to hope to fit in outside of my work hours. From my perspective, being emotionally well involves seeing a therapist to work through issues that come up in my life and in the therapy room, it involves somatic practices to help nourish my body throughout the day, and it involves connecting with colleagues and peers in consultation and support. In order to provide the emotional care for my clients that my job entails, I need to be present, attuned, and grounded. I take this seriously and I know it’s not just going to happen on its own. Take Sustainability Seriously What this brings me back to is what eventually happens when we don’t keep sustainability in mind. I’ve watched some emerging therapists power through very full schedules, and I know that on top of the client hours, they’re also studying for licensing exams and dealing with a steep learning curve.
When we have so much on our plates, we will eventually make mistakes. I have, and I try to remind all the new therapists I supervise that we all will. It’s part of the work. What I have found that clients are generally forgiving if mistakes are made in good faith (accidentally double booking a client because brains are just like that). I think it gets harder when mistakes are made because we’re not caring well enough for ourselves (not consulting when we should have because we ran out of time, overbooking ourselves and then being shorter with a client than intended because we’re emotionally exhausted, or showing up late because we haven’t been getting enough sleep). By no means is this a call for perfection or a public shaming for those inevitable mistakes we all make. Instead, I’m offering a moment to pause. As we continue in this field, we can ask ourselves if the foundation we’re laying has a strong foundation for sustainability, or if we’re leaning in the direction of burnout. We can notice if what we’re doing has room for our own humanity. We all know that doing this work requires being deeply connected with ourselves so that we can connect with the person in front of us. I continue to believe that the biggest gift we bring as therapists is our own aliveness. So, I’m rooting for that.
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It Starts with Connecting to Our Bodies There’s a theme in my work of connecting back to the body (which I think is already a feminist idea), and I wanted to describe one of the modalities I use to do that. I think a lot of people are used to the idea of therapy as talk therapy, and may not realize that there are other, more body-based forms of healing that can be used by trained trauma specialists to allow clients to move through their traumatic symptoms. I think this can be especially helpful when clients are dealing with more body-based symptoms like hypervigilance, a more sensitive startle response, freeze responses, dissociation, chronic tightness, tension, or pain they feel is related to the trauma, and so on. It may help clients who feel they have already told their story and and looking for the next layer of healing, along with clients who don’t want to have to share the details of what happened to them with anyone. A Quick Synopsis of Somatic Experiencing Somatic Experiencing is based on the work of Peter Levine. He wrote Healing Trauma, Trauma and Memory, and a few other books of a similar vein. His work is based on this idea that when we go through a traumatic experience – which could be anything from a sexual assault, childhood abuse, to a car accident or fall, for example– our nervous system responds. It goes into fight flight or freeze – a natural, survival response that allows us to live through a situation. And here, especially coming from a feminist lens (where I recognize that clients can be blamed for their experiences and their survival responses) I want to reiterate that all of these survival responses are equally valid. In less than a second, our body reads a situation as life-threatening and does whatever it needs to do to survive. The body also doesn’t judge one way of surviving as better than another – it just does what it needs to in order to get through. I spend a lot of time working on this with my clients and helping them recognize the ways in which their bodies actually protected them (even when it doesn’t feel like it). Levine recognizes that sometimes, even after the traumatic event is over, all that nervous system energy gets stuck, or thwarted, and we’re not able to come back down into feeling re-regulated again. Maybe there wasn’t someone safe to run to, or it all happened so quickly. We may end up left feeling still frozen, still stuck. Or constantly vigilant, like there’s something terrible about to happen. Or consistently angry, in fight mode all the time. When that happens, which is more common for humans than it is for animals in the wild, the therapy is that we slowly, safely, and through containment make space to go back and process those past events. We release any activation so that our traumatic symptoms no longer have such a hold over our current lives. What Somatic Work Looks Like in the Therapy Room The way I typically use Somatic Experiencing, if clients want to give it a try, is to start with some grounding and resourcing activities. We could end up spending one session on this, or three, or ten, all depending on each person and what their body needs in order to feel safe. Really important here as a feminist therapist is offering somatic work with consent (“would you like to give this a try?”) and working at the client’s pace. Once we’re both feeling confident that they’re ready to begin processing the traumatic event, we take the time to ground ourselves, then begin with the part of the experience that is least activating for them. This is known as titration. It basically means doing a little bit at a time (the smallest amount that the client can stay present to) and not just overwhelming the nervous system by diving into the most difficult part of the trauma. Once we’ve processed the least activating part, we move a little further in, and so on, and so on. The entire process can take five sessions, or ten, or …. You get the idea. That’s my attempt at describing Somatic Experiencing for tonight. Please note I have taken the Beginner and Intermediate trainings but not the advance, which means that though I of course integrate everything I've learned into my work, and do so often, I am not an official Somatic Experiencing Practitioner (SEP). If you’d like to learn more about Somatic Experiencing, Peter Levine has been interviewed a number of times about his work and he's shared some fantastic stories, metaphors, and wisdom, a lot of which is available for free on YouTube. Try Anti-Depressants Medication is a topic that's come up a lot in the last few months, and I wanted to put my thoughts to paper. A lot of people have been wondering if it's time for them to try anti-depressants, and my thought is this: it's okay to try. You're allowed to ask for help. Doing so doesn't mean you're "giving up" and it definitely doesn't mean you failed. A little bit of history: As a feminist therapist I've often tried to help look for the broader contextual reasons that people are feeling depressed (traumatic experiences from the past, current job situations, difficult relationships, state of the world, etc). In traditional therapies, this has sometimes been overlooked. Instead, psychologists of the past have honed in too much on the individual and forgotten the broader social context we live in. Way too many people (women and marginalized individuals particularly) were left feeling as though how they were responding to unjust situations was somehow wrong, or pathological. At the same time, addressing the social context is just one way of working with depression. Since it's typically been an overlooked area, it's one that I as a feminist therapist tend to focus on. But there are also other, totally important management strategies that we can still use for depression. Medication can be one of those strategies some people use part of managing their depression. I also think it's important to say that trying medication is totally valid EVEN IF depression can be traced back to contextual factors. It might be that thing to help someone get out of bed in the morning and be able to do all the other things they know help them. It's not the right fit for everyone, and I know it's important that it's part of a bigger depression management plan, but let's start here: it's okay to try. P.S. Let's be super clear: I'm not a doctor! I can't give medical advice and I get no benefit at all from pharmaceutical companies, which is why I didn't name any. If you're curious about medication, please talk to an actual doctor. One that you trust. And make sure they know about any other substances you're taking including over the counter, naturopathic stuff, and any other drugs you might use. Meditation Someone read all of the above thinking I wrote “meditation”, and hey, it still fits! So, there ya go. Meditation and mindfulness practices don’t have to be done in a particular way, in a particular place, or in a particular style. It’s mostly about bringing our attention to the present moment, without judgment. There’s a ton of research these days on the psychological benefits of meditation and mindfulness practices, giving us reason to think that this might benefit a lot of people. It doesn’t have to be your “go to”, but it’s okay to give it a try. It’s okay to give it a try at different times in your life, in different ways, with different people. If you want to. Take a Break From WorkYou're also allowed to take a break from work. Around these parts we call this "stress leave", and my thought? We have stress leave set up for a reason. That reason is so that we can use it when needed. I watch waaaayyyy too many people wait too long to step back from work and by the time they do, they're completely burnt out that even getting out of bed is difficult. At that point, it takes months and months and months to recover, let alone feel rejuvenated and do the healing work that's needed and think about new boundaries going back into work. If you're overwhelmed enough that you're thinking about taking stress leave, chances are you need it. I encourage you talk more to your doctor or mental health professional about your options! ps. Not sure if I need to say this but what I'm sharing here is not intended to replace the medical advice of your doctor or healthcare provider. Seriously. Go talk to them! Access Therapy This one may just seem like a plug for my own services, but that’s not my intention. The reason I wanted to include it is that it’s not uncommon in my office for clients to show up and feel bad for “using up my time”. So, I’ll make it clear. You’re not taking a spot from anyone else. I fully consented to being here. I’m 100% okay with doing it. And, I actually appreciate the opportunity to walk through life with you.
People sometimes worry that their problems aren’t bad enough for them to go to therapy. So I’ll be honest: I’m not a fan of waiting until it gets bad enough, if we can help it. Another way to think about it is there’s always going to be someone with “bigger problems”, and it doesn’t serve us to get into the comparison trap. We can recognize our privilege and acknowledge the gifts we’ve been given without dismissing our own pain and hurt. So here’s my big message here, one more time: you’re allowed. You’re allowed to do the things. You can give yourself the nourishment you need and know that’s not selfish or indulgent. That’s doing the work. Most of us here can’t help but notice the abrupt change in seasons we experienced at the end of summer. Many people walked into my office feeling “off” – for some, this was a subtle feeling of strangeness, while for others, it was a more profoundly felt environmental grief. We’re a part of nature and so of course, it makes sense that we’re deeply impacted by it, emotionally and physically. I was sent a beautiful article that touched on environmental grief that you can check out here. For this post, I’m going to focus on how we can cope with change of seasons more generally. Take the Time to Reflect For me, fall equinox was a time to slow down and set some new intentions: rest, support, and self-regulate. Not because I’ve met all my goals for the year (that would be nice) or have somehow otherwise “earned” it. I don’t believe that we need to earn rest. I’m listening to my body now because I’m tired. Now is a time for me to keep slowing down, to let extra work fall away (just as the leaves fall...) and focus on these 3 intentions so that I can continue offering the presence of self with my clients that’s so important to my work. Many of my colleagues who live South of here speak about letting ourselves move with the rhythm of the seasons. For example, there may be a naturally “turning in” or cozying that we do in the winter months. At the same time, this is my perspective: as residents of Edmonton we’re in kind of a unique situation. Yes, it makes sense to move with the seasons to some degree. At the same time, I think we can really start to suffer when we’re alone or in our beds for too long, and the winter IS long here. We miss out on social connection, we miss out on being with nature, and if a lot of that time in our homes is in front of the tv, we can really miss out on being with ourselves. It seems like a real balance – allowing ourselves to cozy in at times, while also stretching our comfort edges and ensuring we get outside at times too. The change of seasons gives us a clear chance to reflect on what we need and how we want to move into the next few months. Get Your Routines in Place Okay, so now you know that winter is coming. Time to get your routines in place. Bring your SAD lamp out of its hiding place. Sign up for the dance class that’s going to get you out of the house over the winter and keep your body warm. Organize that book club that helps you keep connected. Okay serious note. If your depression symptoms are worse over the winter, I’d seriously consider investing in a SAD lamp. If seasonal depression is truly at play, it’s one of the most supported treatments in the research. And did you catch the three other things I put in there? Movement, being in nature, and social connection. These are often missing in winter and worth thinking about how you might integrate them. Of course, it’s up to you to consider the routines you need in place to feel whole. I think it’s also super important to actually carve out time for this daunting task. Personally, I spent an entire day getting the routines in place and on the calendar. From my perspective, it’s worth the investment, and best to do early, before it’s hard to find the energy for. Give Yourself Something to Look Forward to Okay, while you’re planning all those necessary daily and weekly routines, are there parts of fall and winter you can actually look forward to? Maybe you love making your way through the corn maze and listening to the sound of the leaves crunching under your feet. Perhaps the quiet of the snow is really peaceful for you, and you’re looking forward to some cross-country skiing this year.
If finding something about fall and winter specifically seems to daunting at the moment, you can still find things over the next 6 months to look forward to. It might be a trip to the mountains, a vacation somewhere warm, tickets to the ballet, or some good local craft shows and holiday festivals. And of course there’s Halloween – a lot of my clients love dressing up, carving pumpkins, and having an excuse to get together with friends. If there’s even one thing a month you can look forward to, that’s wonderful. Again, I really encourage people to take the time to sit down and plan this out. Often, we can fall into a trap where we don’t end up organizing the things we need until we’re already in need of them, and then we’re more likely to run into barriers. None of the things I’ve suggested are mind-blowing, I realize that. But I wanted to be the Psychologist in your ear saying, “you’re allowed to have things to look forward to. You’re allowed to take this time for yourself.” I hope it helps. Over the years I’ve worked with a number of people trying to make hard decisions, and these hard decisions usually boil down to this: “should I stay or should I go?” What people struggle with most is knowing whether the situation they’re in (a workplace, a relationship, etc) is one that will get better by working on or not. I watch people struggle for months and sometimes years, caught up in the distress of trying to make a decision that’s best for them. Hope you're all having a lovely Thursday - just a quick announcement on my end. After much consideration, I wanted to let you all know that I will soon be increasing my rates. As of September 1, 2018, standard fees will be as follows:
The other day I was explaining to my 3 year old why I’m not spending quite as much time outside as I’d like to. I explained to her that there’s a lot of pollen this year and that the pollen can make my nose itchy, and my eyes watery, and it’s not very much fun. “I have allergies,” I told her, “you know, just like how Grandpa gets.” I further explained that’s why I wasn’t using my lawnmower as much this year, and why her dad was doing the lawn instead. Without missing a beat, she asked, “so who mows grandpa’s lawn?” It’s not uncommon in my therapy office to talk about social media. Specifically, I’ve been having a lot of conversations about wanting to not be on social media but having a hard time stopping. When people bring up the topic of their social media use, it’s usually said with a bit of a guilty look, and can come across as a shrug off comment. “I really shouldn’t be using my phone so much,” they might say in an off-hand way. But, since people are paying me money to notice things, I don’t just shrug it off. Instead, I invite them to talk about it. So many of my clients are finding that they’re on social media more than they actually want to be, and that it’s causing upset in their lives. These are some of the things we’ve been talking about in those conversations. It’s hard saying no. For a lot of new therapists, we really struggle with the idea of disappointing someone in our care. It can be easy to feel that because our clients need something, we need to be the one to give it to them. I hear new therapists say things like “but they need evening hours – they can’t make it during the normal workday“ or “they need a sliding scale – they can’t afford the full fee”. My good friend Lily recently did an episode on "mom pressures" for her podcast (the fantastic Lady Sh!t with Lily and Britt). She asked me to write a few things about the pressures moms face, and I accidentally wrote her a novel about it. Here's what I came up with one evening. As a partner/friend/lover/ally of someone who is working on boundaries, you may be noticing some changes. Like most changes, this can feel pretty scary and you might be unsure or hesitant about what’s happening. That’s why I wanted to write you this letter. I think it’s normal to feel afraid in times of change, especially when the change involves something unfamiliar.
Annina Schmid (M.A.) is a feminist counsellor who helps women recover from binge drinking and disordered eating, as well as families with young adults who "failed to launch". Annina employs Solution Focused Dialogue to support and empower her clients in making lasting life changes. She works from a strengths-based harm reduction approach. Annina works with all genders and people on the LGBTTIQQ+ spectrum. As a counsellor who works mostly with women who struggle with disordered eating and binge drinking, I have started running monthly online support groups at the beginning of the year. Here are the four most important things I have learned from my participants: Alright y'all, big announcement time! I'M MOVING... UPSTAIRS! I'm excited to share with all of you that as of May 31, I will be relocating upstairs, to the 5th floor of College Plaza. The new space I’ll be practicing out of is located within Transcend Psychological Services and Blossom Counselling, though of course I'll still always be Feminist Counsellor Edmonton. It’s a dedicated therapy office which means I get to work alongside some amazing therapists. It's got some big beautiful windows, a little more space... and I'm so looking forward to sharing it with all of you. As health professionals in positions of power, we have certain standards of practice we need to adhere to it in order to protect the public. The Standards of Practice of the College of Alberta Psychologists are “the minimum standards of professional behaviour and ethical conduct expected of all regulated members”[1]. These include informed consent, avoiding dual relationships, and acting within our scope, to name a few. These are incredibly important to know and adhere to, and yet it’s not enough to ensure that we’re working in a way that’s ethical and sustainable. This is soon going to become quite obvious, but I still want to begin this post by saying that I wrote out these ideas based on my own experience of pain. They've helping me immensely in coping with what's probably been the most despairing experiences of straight up suffering I have lived through (and continue to live through). I continue to be humbled by it. So, from someone who's in it with you:
I want to offer some assurance for anyone struggling with setting boundaries. Ready for it? Deep breath.
It’s not your fault. Yep, I said it, and I’m going to say it again. It’s not your fault.
Tiny Beautiful Things: Advice on Love and Life from Dear Sugar by Cheryl Strayed
My rating: 5 of 5 stars Amazing. After having this book on my shelf for several months, I read it over the December break, knowing that I needed the time and space to fully immerse myself in it. And I did. I sat on my office couch, and in my bed at home, and I had a good long cry or two (or more). I let myself take in the sorrow of the letter writers' grief and be moved by it. I let my guard down and allowed myself to be different. I even took off my psychologist hat (a thing I almost never do) and let myself read it as a person first. This book will transform you, if you let it in. I definitely recommend reading it over several sittings (all at once could be overwhelming) but within a short enough time frame that you can stay down in the depths with it. I thought it might be too much but the order of the letters has been designed wonderfully, so it intersperses shorter more humorous letters with the more difficult ones. I was particularly moved by the letters that had to do with family and mothering, but really this is a book about life. Trigger warning: Cheryl Strayed talks pretty openly about her childhood sexual abuse, and a number of the letters have to do with sexual violence. I absolutely found it readable - and I don't always - but it wouldn't be the best book for someone in the early stages of healing from trauma or dealing with active flashbacks/nightmares. View all my reviews Most people who have seen me in the last few years know how much I rely on self-compassion - in my own life and in my life as a clinician. I've seen so many amazing people struggle with never feeling good enough and self-compassion is the foundation I return to again and again.
Come as You Are: The Surprising New Science that Will Transform Your Sex Life by Emily Nagoski
My rating: 5 of 5 stars This is absolutely my favorite book for women related to sex and sexual desire. I first heard Emily Nagoski speak as a guest on Sex Nerd Sandra's podcast, and loved what she had to say in that episode. I feel like I learned a ton and it also left me wanting to know more. She spoke so clearly and knowledgeably that I was pretty excited to learn she'd also written a book, complete with worksheets to fill out. Emily brings a really fresh perspective on desire styles and offers insights about female sexual desire specifically (unlike old models that were based on the average male desire style). I've found myself teaching others what I've learned from her about spontaneous vs responsive desire. She also teaches readers (in a really accessible and fun way) about the dual control model of sex, suggesting that if we want to feel like having sex more often, we need to focus on "turning on the ons and turning off the offs". At the same time, it never comes across as prescriptive or judgmental. She reminds readers every chapter or so that there's nothing wrong with your desire, and helps us understand what a huge role context plays in desire for women. "Come as You Are" is great for folks who might like to have a more active sex life, but don't necessarily feel like having sex. It's great for women in relationships where their desire style is much different than their partners (higher or lower). It's great for women who've worried that there's something wrong with their desire. It's great for partners of these women. It's great for women in heterosexual relationships and queer relationships. And the list goes on. I love love love this book! As a bonus, Emily Nagoski is a generally awesome person and speaker who really does come across as wanting to share what she's learned and help remind readers just how fantastic and normal they are. The audiobook is read by her and it's lovely to listen to. View all my reviews
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AuthorNicole Perry is a Registered Psychologist and writer with a private practice in Edmonton. Her approach is collaborative and feminist at its heart. She specializes in healing trauma, building shame resilience, and setting boundaries. About the Blog
This space will provide information, stories, and answers to big questions about some of my favorite topics - boundaries, burnout, trauma, self compassion, and shame resilience - all from a feminist counselling perspective. It's also a space I'm exploring and refining new ideas.
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