Writing about mental health from a feminist counselling perspective
In a post last month, I shared with you some reasons why you might find therapy useful for dealing with some aspects of the coronavirus crisis, like shame reactions to feeling judged, pandemic-related anxiety, and information overwhelm that can lead to feeling hesitant about medical advice. If you’re still unsure about starting therapy, here are three more ways psychologists can help during a pandemic.
Many of you have shared with me the feeling of stagnation you've been experiencing this past year, or feeling ‘blah’. Handily, a number of you have also sent me this incredibly popular New York Times article on “languishing” that finally put a name to this experience so many people have been having. If you haven't read it yet, it may be worth your while, but here’s a summary. Languishing can be placed in the middle of the mental health spectrum between depression (ill-being) and flourishing (well-being): it’s the absence of well-being. You might experience a lack of excitement or joy, a sense of emptiness, difficulty to focus on work or to feel motivated, but you’re not having symptoms of mental illness—however, research suggests that languishing might be a risk factor for experiencing them later in life.
Languishing is different both from burnout and depression. In this short column my colleague Tami-Lee Duncan did for Edmonton AM, she describes how you might be able to distinguish languishing from major depression, and what you can do if you've been feeling this way.
I know for many people I spoke to, having a name for the experience was enough to bring some relief. We know this as psychologists—naming our emotions and contextualizing them helps us feel better, even when we can't change our situation. This is why bringing up this feeling in therapy can be immensely useful, and help move you once again towards flourishing.
Intimate partner violence
Since the onset of the pandemic, increased social isolation and less access to resources mean that people who typically experience intimate partner violence (IPV) are even more at risk for abuse. Psychologists recognize this increase in violence against women as a "shadow pandemic", although some initiatives point out that this narrative can impact the way we think about sexual and gender-based violence (SGBV) as something that is hidden, or that is only related to the pandemic, and the responses to it.
If you have experienced or currently experience IPV or SGBV, therapy can be a safe space for you to work through it and the various issues that can come up related to that, such as depression, anxiety, low self-esteem, challenges in new relationships, financial autonomy, and more. Psychologists can also help you identify signs in your relationship that might point to an abusive dynamic, and direct you to other resources you can turn to. Most importantly, they should be able to offer empathetic, non-judgemental listening.
I recently came across these wonderful resources from the Centre of Excellence for Women’s Health that frontline workers and service organizations can use to ensure they're responding in a trauma-informed way. If you're a frontline worker hoping to increase your knowledge on IPV or trauma, you may also be interested in the manual I wrote last year for the United Cultures of Canada Association.
If you’re a COVID-19 frontline worker or first responder, you may need extra support to stabilize the nervous system during times of immediate crisis and distress in order to do your job. Your psychologist can find specific strategies that work for you and walk you through them, so that you can have these tools whenever you need them.
One of those strategies is the SE Crisis Stabilization and Safety Aid toolkit, SCOPE: Slow down, Connect to body, Orient, Pendulate, Engage.
These simple interventions take less than five minutes to do, and you can print out the toolkit to keep it with you everywhere (check the link for the printable PDF version).
Remember that if you are a health care provider or first responder living in Alberta and you’d like to access support specifically for coping with the COVID-19 pandemic, the Disaster Response Network offers 1-3 pro-bono sessions for those who need it.
Let me ask you a question: Have you thought about seeking therapy recently? A sentiment I’ve sometimes heard out there in the general public during the past year is “I can’t change the situation, so what’s the point of talking to someone about it?” If you can relate to that, and you’re wondering how psychologists can help you during a pandemic, please keep reading.
Counselling is not solely reserved as a space for solving problems or changing our circumstances. It can also be a space for seeking comfort, finding new ways of coping, healing emotional wounds, building emotional resilience, getting out of old patterns, feeling seen and understood, and seeing new perspectives. I also want to assure you that therapy isn’t “just talking”. Psychologists and other licensed clinicians are specially trained to do work that goes beyond having a conversation in the way that you would have with a friend. Here are a few of the ways psychologists can help during a pandemic:
Shame reactions to judgment
People have been asking me how to make sense of the increased criticism and judgment they’re seeing within their own communities right now. I think it partly has to do with shame. When we feel judged about our actions, shame reactions can arise. As Nathanson originally described, these shame reactions include self-criticism, withdrawal, denial, and blame.
Let’s imagine a situation where someone feels judged because they decided to send their child to school and a close friend chose not to. Perhaps the friend said something that was ambiguous, and could be seen as judgmental. The person feeling judged might isolate from that friend, numb by drinking more than usual or keeping overly busy, criticize themselves (“I’m obviously failing as a parent, I can’t do anything right”) or blame and criticize the friend (“This is their fault for making me feel this way. What, do they expect me to just stop working?”). The blame can sometimes extend to other people in attempts to separate ourselves from those who are the “real” problem (e.g., “At least I’m not like _______, who is obviously doing the wrong thing”). Psychologists can help you identify your reactions to shame and incorporate compassion-based practices.
Naturally, this is a time of heightened levels of anxiety for all of us. Some people might also be experiencing what’s known as “death anxiety”:
“We are living in a time of extreme insecurity and multiple threats to our existence [...]. Within a few months in 2020 we went from a world in which death was something in the indefinite future for many of us, to a world in which not only our own death but the deaths of millions became an imminent possibility.
A rational response would be to come together and fight for our collective survival. So why are so many people choosing divisiveness instead? Sheldon Solomon, a professor of psychology at Skidmore College in Saratoga Springs, New York, offers an answer: when reminded of the fact that we die, we double down on our existing beliefs and circle the wagons, regarding anyone outside our cultural group with suspicion.”
Without ignoring the real causes of concern, there are still things we can do to reduce our overall anxiety and panic so that we can be more present and grounded in the moment. I find it’s important to acknowledge how our current stressors have contributed to the way we’re feeling, then take a moment to ask ourselves what might help bring us comfort with the experience of anxiety. Sometimes it might help to have a plan, distract ourselves, and move our bodies, or try out some grounding exercises.
Vaccine hesitancy and the spread of misinformation
The pandemic has brought to the forefront another phenomenon we might not even had heard about before: an infodemic. This saturation of false or misleading information, as we’ve seen, creates confusion and mistrust in authorities, which can be disastrous for public health. However, this also has an impact on a personal level: we might be affected by this confusion ourselves and not know who to trust, or we might struggle with the beliefs held by someone we care about.
Well, psychology has something to say about this! I was really glad to get this article in my inbox from the Psychologists' Association of Alberta last month. I'm looking forward to learning more about how the spread of misinformation happens and the ways we can better help people in our community sort through how to debunk myths so they can make more informed decisions about their health.
Another really interesting article from a psychology perspective is this one published in Forbes. This is a good read if you’re curious about how vaccine hesitancy might relate to the mental blind spots we all have and how we can avoid them. It’s also worth looking at this piece about the influence of US media in our perceptions and beliefs about the pandemic. Maybe it’s a good time to start curating our follows on social media!
When you’re feeling hesitant about any medical information or advice, you might consider asking yourself if there’s a source of trustworthy information you can turn to during this difficult time (e.g., your family doctor, a pharmacist, or an evidence-based source of information online). Here are some non-partisan sites dedicated to combating misinformation that you might be interested in consulting: Science Up First, AFP Canada Fact Check, FactsCan, Snopes, and the app Project Fib for Chrome, which detects fake news on your Facebook feed!
In addition to all the above, psychologists can also help with a ton of other pandemic-related issues like coping with loneliness, relationship issues, dealing with trauma and vicarious trauma, grief, figuring out new boundaries, and so much more.
For those of you who are residents of Alberta and seeking help specifically related to the COVID-19 pandemic, you might try accessing the Disaster Response Network: “Our Disaster Response Network members are offering pro-bono psychological services with priority for health care providers and first responders traumatized by recent events. This is not a crisis line or a referral service but pro-bono support by volunteer psychologists of 1-3 sessions for those in need.”
I’ve been offering video sessions for years now, and so when I made the move to mostly telehealth services this week, I knew I’d be in my comfort zone. I already know what wonderful connections can be made this way, and the deep work that can be done. As a somatic practitioner, I’ve been pleased to receive reminders about the ways we can work with the body. It feels like so much is possible. I know we wouldn’t have chosen the situation we’re in now, but given what’s going on, I’ve been thinking of a few of the benefits to telehealth services, and wanted to share what I came up with.
1. Accessibility: I’ve always thought that telehealth would be ideal for people who are otherwise unable to come into the office but still want to prioritize their mental health and access services. It could be transportation issues like you’re in a small Albertan town and the commute is just a bit too far, or you’re here in Edmonton winter and the roads are not worth driving on, or you don’t have access to a reliable vehicle but you still want to access services. I also think about accessibility in terms of chronic pain where sometimes it’s better not to leave the house because you’re more able to take care of yourself at home, and part of taking care of yourself is still having a session. Or maybe you’re sick and staying at home to take care of your health and the health of others, but you really still wanted to connect about that anxiety and depression you’re working through. Or, you’re taking care of young children and today you have no other childcare options. For me, this one is all about reducing barriers.
2. Comfort: Some people really like having the comforts of home around them – like an important animal, a blanket they can curl up with, and being in their most relaxed clothes. When our nervous system can begin from a more settled place, there’s already room for more of a shift to occur. When we’re done the session, you can stay in that comfort and continue to relax into it, rather than worry about dealing with traffic on your commute home.
3. Bravery: This one’s kind of interesting. Over video, sometimes people find themselves able to be a bit braver with what they share or are willing to try out. I’m not sitting in the room staring straight at you (okay, I try not to do that anyway), and sometimes that bit of distance allows people to feel like they can actually be more vulnerable. Also when I invite people to do something they feel silly about, they can move offscreen to do it. Tada!
4. Integration: Sometimes people feel like my office is a magical place where they can self-regulate and feel their boundaries and all sorts of good stuff, but have a hard time translating those skills to home. Doing a session from your home space may allow you to embody self-regulation and other skills into areas of your life that you’re most hoping to take them into.
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.
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.
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”.
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”. 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.
I know some people aren't going to like this post. At the same time, as a Psychologist I think it's important to tackle difficult issues and share what I know from the research and from making a career out of helping people heal and move forward in their lives. Especially for those of us who are mental health professionals or are trusted experts in our communities, we need to make sure that what we tell others about healing and growth is safe, compassionate, and ultimately does no harm. I've been seeing more and more professionals suggesting books like The Secret, and it's extremely worrisome to me.
I wrote this critique while completing my Masters in Counselling back in 2008. Now that I’ve been practicing for awhile, I have different critiques, a more nuanced understanding of the humanistic style of therapy as it’s practiced today, and a more body-based approached to working with people who’ve experienced sexual violence. This critique is aimed at the more traditional style of humanistic therapy, and I've posted just the second half of it. Still, I thought some of you might appreciate the fierce, no-bullshit language of young Nicole and the references to the Garneau Sisterhood. (Who wouldn’t?). Enjoy :)
In the last 5 years I've worked with more and more helping professionals and caregivers, supporting them to be a support to others. It's probably one of the things I enjoy the most, because there are so many good people out there trying to do helping work, and I've actually figured out some things that can allow them to keep doing what they're passionate about, despite the heaviness of the work. I get a little excited about this because I now know without a doubt that it is completely possible to do some amazing things without giving up your life in the process. And actually, it's not only possible, but better for everyone involved - keep in mind that we're able to do more and better work when we can still connect to our own aliveness.
Nicole 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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