COUNSELLING...Insights into Clinical Counselling By Michelle Morand, Editor Note from the Editor 3 W...

COUNSELLING

INSIGHTS INTO

CLINICALDecember 2013

Published by the BC Association of Clinical Counsellorsto enhance mental health in British Columbia and beyond...

‘More-So’

The Impact of Volunteer Services Provided by Helping Professionals

Psychosocial Counselling Amidst Chaos

Witnessing as Short-Term Trauma Support

Archetypal MusicPsychotherapy

The Importance of Clear Contracts

Living Between Omnipotence and Deflation

Psychedelic Psychotherapy

Obtaining Children’s Views for Litigation and Collaborative Processes

Dancing with Pain

The Worldis Too Much With Us:Social Mediaand IncreasedTeen Suicide

Insights into Clinical Counselling

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C O N T E N T S

The Insights into Clinical Counselling team wishes to thank the outstanding writers who contributed

to this edition of our magazine:

Nancy Routley; Loray Daws; Joel Kroeker; George K. Bryce; Dave Prette; Laleh Skrenes; Jack Jardine; Kevin Parker;

Sophia Sorensen Proctor; Su Russell; Bob Finlay; Mavis Lloyd

Insights Into CLINICAL COUNSELLING is published three times per year:April – August – December

NEXT ISSUE:

Article Submission: January 15, 2014Ads Submission Window: January 13 - 17, 2014Insert Submission Window: March 13 - 21, 2014

SUBMISSION CONTACTS:

ArticlesMichelle Morand, EditorE-mail: [email protected]: (778) 990-4606Ads & InsertsUri Sanhedrai, PublisherE-mail: [email protected] • Tel: (604) 988-5066

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Advertising and InsertsPolicies and guidelines for placing advertising and inserts in Insights Into CLINICAL COUNSELLING Magazine can be obtained from BCACC’s website (www.bc-counsellors.org/iicc-magazine) or from the publisher, email: [email protected], Tel: (604) 988-5066Articles For Contributing Writers’ Guidelines, contactAina Adashynski, Editorial CoordinatorE-mail: [email protected] Tel: 1-800-909-6303 ext. 4

IICC MAGAZINE TEAM

Editor-in-Chief: Jim BrowneTel: (604) 535-8011 • [email protected]: Michelle MorandTel: (778) 990-4606 • [email protected] Creative Director/Art Director/Publisher:Uri Sanhedrai Tel: (604) 988-5066 • [email protected] Coordinator: Aina AdashynskiTel: (250) 595-4448 or 1-800-909-6303, ext. [email protected]

Thank you for your interest in Insights Into CLINICAL COUNSELLING

BCACC 1-800-909-6303

Note from the Editor (Page 3)

Editorial Feedback (Page 3)

‘More-So’ (Page 4)Nancy Routley’s article is a profound yet whimsical and very relatable look at human nature and aging, as told through the lens of her self-observation and witnessing of her own family dynamic.

Growth and Revival: The Impact of Volunteer Services Provided by Helping Professionals (Page 6)Laleh Skrenes and Jack Jardine briefly share their day to day experience of volunteering in High River, Alberta, during the flooding this summer and how it impacted their lives and those of the residents living through that trauma.

Psychosocial Counselling Amidst Chaos: A Canadian Experience (Page 8)Sophia Sorensen Proctor takes us on a journey through her week as a volunteer counsellor, sharing her experience of the chaos and coordination, and of the strength of the survivors, during the Alberta flood emergency this past summer.

Witnessing as Short-Term Trauma Support (Page 11)Read Su Russell’s educational and touching experience of volunteering after disaster struck in New Orleans and Africa.

Archetypal Music Psychotherapy: Bridging the Gap between Counselling and the Creative Expressive Arts (Page 12)Joel Kroeker shares a unique form of therapy that can enhance the work of counsellors with every client population.

The Importance of Clear Contracts (Page 15)BCACC’s own legal counsel, George K. Bryce, presents us with a recent case study and significant points to consider regarding the creation of clear and reasonable counselling partnerships and contractor agreements.

The World is Too Much With Us: Social Media and Increased Teen Suicide (Page 18) A 27-year mental health veteran, Dave Prette shares his professional experience and a review of current literature in this detailed exploration of the impact of social media on teen suicide.

Living Between Omnipotence and Deflation: A Mastersonian View of the Narcissistic Dilemma (2)Loray Daws deftly describes the 3 main Narcissistic types and, using the Mastersonian model, gives specific examples for how best to support them in the therapeutic environment.

Psychedelic Psychotherapy: The Day-Glo Elephant in the Room (Page 24)Kevin Parker explores the history and current theory and practice, in Western culture, of the use of mind-altering substances as a support to successful psychotherapy.

Obtaining Children’s Views for Litigation and Collaborative Processes (Page 27)Bob Finlay gifts us with his extensive experience of child interviewing and court reporting and lays out a simple, solid framework to create the most positive outcome for children and their parents.

A Review of Dr. Leora Kuttner’s documentary: Dancing with Pain (Page 36) Mavis Lloyd introduces us to a new, powerful documentary about teens with chronic pain and their journey to wellness.

Community Pages (Page 37)


By Michelle Morand, Editor

Note from the Editor

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Winter is upon us, and with it we have the standard fare of short, grey days and of rain in many forms from sprinkle to drizzle to torrential downpour. Yes, it’s damp and dreary, but hey! Your new edition of Insights has ar-rived so here’s to a little BCACC sunshine in your day!

And now, allow me to issue a special thank you to each of the authors who contributed to our magazine this year. Your contribution helped make our magazine a top notch publication for practical counselling tools and modalities. Through your willingness to share your time and expertise as Clinical Counsellors, you helped all of us to be more knowledgeable and all the more competent in our work with clients.

So, I issue a very special thanks to:

Alex Angioli; Myrna Martin; Lindsey MacInnes; Abby Petterson; Glynis Sherwood; Colin James Sanders; Amita O’Toole; Jennifer Montgomery; Johanna Simmons; Mary E. Duddy; Claudia Byram; Ian MacNaughton; Sherry Bezanson; Heesoon Bai; Brian Callahan; Avraham Cohen; Christopher Conley; Ivana Djuraskovic, Suzana Dujmic, Laura Hamilton, Rosalind Irving, Clive Perraton Mountford; Sue Diamond Potts; Kevin Prouse; Seth Raymond; Nancy Routley; Loray Daws;

Joel Kroeker; George K. Bryce; Dave Prette; Laleh Skrenes; Jack Jardine; Sophia Sorensen Proctor; Kevin Parker; Su Russell; Bob Finlay; and Mavis Lloyd.

Thanks to your contributions our magazine is filled with solid, practical content that greatly benefits our members and all the residents of British Columbia who receive their care.

And lastly, I wish you, my readers and peers, a relaxing and fulfilling holiday season. May you fill your time, such as it is, with pursuits that honour you and bring you peace, joy, and happiness.

See you in 2014!

Now, for your part. In response to my request, in our Summer edition, for you to share about what you enjoy most about being a counsellor and what you’d like to know about the experience of others in the counselling profession, here’s a question for you from our peer Andrea Dasilva:

What I like best about being a counsellor is that I am in a position to help other people in times of distress by teaching (strategies, etc.) and listening.

Seeing a client’s face light up when they realize that they are being LISTENED to and not just HEARD is an amazing experience in itself; as is watching the proverbial lights go on in a person’s head when they understand how a principle/strategy makes sense to them/their circumstance/their context. A question that I have for all 2700+ of you is with regard to goal setting. I understand that it gives a sense of purpose/direction to sessions but can it not also lead to clients feeling like failures if they do not reach a certain point (goal) by a certain date/point in time? How do you approach the use of goal setting in your sessions?

Cheers and I look forward to learning with/from all of you!Andrea Dasilva, M Ed., RCC

Thank you Andrea for putting your question out there to our readers. Those of you who would like to respond please email the editor at [email protected] with your responses. And please send along any questions that you’d like to ask our peers.

Editorial Feedback


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And me? What’s my role, my more-so? I’m the middle child, the peacemaker. I’m the educated professional. I calmly, logically lecture. And if that doesn’t work I climb unto my pedestal and spew a righteous yet articulate rant, to make sure I’m really heard. And I’m really good at it. I can shut them all down. Get the last word. After all, isn’t mine the voice of reason? Isn’t this my job in the family?

When I am able to see my more-so at play, when the fear isn’t pulling my strings I have moments where I am able to listen instead of pontificating. This is where I am really useful, a compassionate observer. I remind myself my parent’s aging, and all of our individual reactions, are how we cope. Our more-so is how we manage our fears and that is okay. I breathe. I soothe the burn that lives inside my chest. And sometimes it even helps.

BiographyNancy Routley is a therapist in private practice living in Whistler, B.C. for almost 20 years. In her spare time she is a budding writer, painter and Nia (fusion fitness) teacher. [email protected]

This article was originally published in the Globe and Mail in Fact and Arguments on June 4th, 2013. See, http://www.theglobeandmail.com/life/facts-and-arguments/a-shadow-of-my-future-self/article12315966/

“The doctors are idiots Nancy, they don’t know anything about nutrition, they only take a month course in their training. They don’t know what they’re bloody well talking about.” I hold the receiver away from my ear. This time, I stop myself from responding. I don’t raise my voice; don’t slip into my big sister know-it-all role. My sister needs to vent. While I struggle to stay in this place of no reaction, an old adage rattles in my brain, a piece of wisdom oft repeated from a family friend, long deceased: You know, as we age, we just get more-so.

She was referring to the human phenomena that if you were a whiner and complainer at 30, you are apt to be more-so by the time you reach 70. If your tendency was to boss everyone around, tell them how to live, chances are you will insufferable by 60. More-so.

I’m pretty sure this theory has never been empirically tested but it strikes a chord, especially of late. You see I, like so many Canadians, have elderly parents. My parents’ deaths are inevitable. How, remains a mystery. Illness: Short and difficult, or slow and insidious? Or will they die from an accident? Who knows? But the naked truth is the temperature is rising. Fear is sneaking in. My parents’ fears, my sister’s fear, my brother’s and mine. And our behavior is becoming more-so.

My dear father is ramping up the control. He has told me on many occasions that my mother has to go before him. She is the one with numerous ailments and he takes care of her. He cooks, does the washing, helps her in and out of the tub, organizes her medication and gets her to doctor’s ap-pointments. And as much as he would be delighted to have a wife who was able, one he could still travel with, one where the burden was not so great for him and for her, he likes to run the show. Always has. It’s been a source of tension between them for sixty years.

“Now Nancy, if your mother goes first we will have a party, a lunch, she has so many friends, they will want to get together. Of course the children won’t need to come home (my adult children.) They’re busy. I don’t expect that. Then when I go I don’t want anything. After all, who do I know? They’re all dead.”

He says this without a trace of self-pity, his decree interjected with laughter. But this has become his new fixation, the instructions he gives me each time we are together, the line about my mother going first. He believes if he repeats it enough things will go according to his plan. He has even arranged and paid for their ‘niches,’ their final resting place.

“If it happens at home make sure those donkeys (he is referring to the ambulance attendants) send me straight

to the funeral home. Don’t let them send me to the hospital, no point, just a waste of money.”

He is going to control to the end. And beyond. My sister has same control gene only hers comes with a healthy dash of hysteria. In fairness she lives ten minutes from my parents as opposed to the full day it takes me by planes, trains and automo-biles. Their decline is in her face. But she will have none of it. She shows up with the latest and the greatest. Juicers, bullets (a mini juicer really), a walker, get that old woman moving, a veritable campaign designed to stop this damn progression. Arrest it. Reverse it. Her anxiety doesn’t allow for the inevitable. Her anxiety demands action.

Whose fear behaviours are worse? My mum’s are erratic. Always have been. Growing up she would be fun-loving and goofy or removed and angry. Now she vacillates from stoic and chipper, to anger then resignation. Dad’s fears are less obvious, wrapped neatly in their logic. My sister’s are front and center in volume and content, spiraling and spinning. Once she is amped she has a total inability to hear anyone else. My brother removes himself like he did as a kid: Sneaks out the door. He denies anything is happening and shows surprise when I suggest they are aging. I imagine him bewildered at their funeral.

By Nancy Routley, M.Ed., RCC, Contributing Writer

‘MORE-SO’


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I spent much of this summer in High River, providing Psychological First Aid on a volunteer basis. I was part of the multi-discipline team from BC. We were helping Alberta recover from the worst natural disaster in Canadian history. It was dirty, hot, and the hours were long. Yet in dialogue at the end of the hard days, when my fellow volunteers talked of their own experiences in the event, they used words such as transformative, spiritual, community and respect. Days and weeks after the volunteers continued to relate their renewed sense of purpose, focus, and gratitude for their experience.

These thoughtful comments caused me to reflect on my own beliefs around the nature of volunteer service. Like everyone else, helping profession-als need to take care of themselves or we burn out. We relax and re-energize through exercise, hobbies or social events. We go on vacation. My col-leagues at High River illustrated to me once again how volunteer service to others can enhance one’s own sense of wellbeing and bolster our positive re-gard for the world around us. Gandhi

By Laleh Skrenes, Ph.D., RCC, CCC & Jack Jardine, BSW, MA, Contributing Writers

said, “The best way to find yourself is to lose yourself in the service of others.”1

While in High River, our team met each morning to prepare for the day. It was a time to form ourselves as a team, to gird ourselves for the tasks ahead, and to get a sense of where we would be and what we would face in the coming hours.

At the end of the day, tired, disheveled and a little shell-shocked we came together again to inform each other of the key events of the day and to make human contact with each other; to care for each other. In relation with and in observation of the people who were living in this disaster, from the survivors, to the first responders and the other helpers, the essential struggles of life were highlighted and compounded by the dynamics of crisis.

Abdul-Baha stated that “A soldier is no good general until he has been in the front of the fiercest battle and has received the deepest wounds.”2 Our team provided comfort, guidance and

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support to people experiencing the most trying of circumstances. We did this with no offices, no resources except that which we cobbled together, we worked with what we had. And along with the residents, we became stronger, more resilient.

There was an incredible sense of the ‘here and now.’ My concerns and anxieties were pushed aside to meet the needs of the moment. Most of the people I met had lost their homes, and everything they owned. Their photo books were gone. Their mementos, their touchstones to their lives; gone.

Time after time, I talked with people who were struggling back to the surface, after being engulfed by the maelstrom. Repeatedly I walked and talked. I helped people get items from the Red Cross to their cars. It was during this practical help that people would off-handedly comment on how they lost their house, or their friend was removed to another town, or their insurance company was refusing to reimburse them. The balance was between helping them shoulder the burden, to discharge a little of their

Growth and Revival: The Impact of VolunteerServices Provided by Helping Professionals

BC Association of Clinical Counsellors’ News

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experience in context with others, in the disaster event, in my life, and in the global community. Altruistic service, I believe, allows us to hone our higher nature. We gain perspective about who we are as human beings and it is an admirable means of self-care.

Biographies Laleh Skrenes, PH.D., RCC, CCC, has been working in psychotherapy and counselling psychology in a variety of settings including private practice, mental health centers, and hospitals for the past 20 years. She also teaches Masters in Counselling Psychology in various universities both in Vancouver and abroad. Her two decades of experience consists of volunteer services on a broad spectrum of clients/patients in non-profit organizations both nationally and internationally. She can be reach at [email protected].

Jack Jardine, BSW, MA, Leadership, has been a social worker for over 30 years. He is a social entrepreneur, building agencies and programs to help individuals, organizations and communities to better manage their social issues and aspirations. He has recently returned from several years practicing child protection in East London, UK.

References1. Quotes About Service(On-line). Retrieved from the World Wide Web Aug. 28, 2013: http://www.goodreads.com/quotes/tag/service2. Abdu’l-Bahá. (1979). Paris talks: Addresses given by ‘Abdu’l-Bahá in Paris in 1911 (11th ed). Wilmette, Illinois: Bahá’í Publishing Trust. P. 51

stress and distress, and yet to leave them in shape to carry on.

I met an elderly man who was travelling when he received a phone call that his house was in danger of being destroyed by the flood. After days trying to get home, his house was gone and his pet had perished in the flood. Now he has to live with his daughter in cramped conditions. I spent a fair while letting him talk and unload some of his stress and assisted him to locate options for temporary housing as well as the Red Cross for cleaning supplies and to some hot food elsewhere on the site.

A recent immigrant woman in her seventies came back from her mother’s 95th birthday to find herself homeless. Her home of decades was gone. I stayed with her as she worked to access temporary housing. She was relieved to be able to talk to someone about her feelings of despair and loss.

One gentleman I talked with said that he was in the middle of a conversation with God as the flood struck. He said their discussion was about giving over his earthly possessions to the event and freeing himself from the sadness of their loss. Though he said he was mainly untouched from the flood, he did need to share his close call and his concern for his community’s plight.

Members of our team were on site for one, two, or three weeks. Red Cross,

the Mission Possible folks and the Samaritans Purse were there for many more weeks. Many people and companies came for the day to help out. Over time, each of these contributions added to a sense of a great endeavor taking place; of belonging to something greater than oneself. There was a palpable sense of a giving community, of grace, and spirit. By volunteering, I had become a participant and a beneficiary to all of this.

In hindsight, it was soon over. Like other volunteer missions I have been on, I and my colleagues experienced heightened and transformational self-and-other awareness with spiritual and emotional depth. The volunteer team received much appreciation and positive feedback about the care we provided. We heard comments such as “Awesome volunteers,” “Hard shoes to fill,” “We want to be like BC’s lite touch” and, “Maybe one day we will have to come and help you.” Volunteers came from all across Canada. This was recognized by the residents and, this gesture in itself, had a strong healing power. I have kept in contact with a few of my comrades. As is often the case, friendships have formed through the sharing of such strong experiences in the service of others. Though I might not see them every day, I come away with the strong knowledge that I am not alone. There is a renewed awareness of my personal


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By Sophia Sorensen Proctor, BBA, MA, RCC, Contributing Writer

June 20, 2013. Without warning, Central and Southern Alberta are hit by what is described as the worst flood in pro-vincial history. Seven major rivers and their tributaries were impacted, with 100,000 people displaced, 32 states of emergency declared and 28 emergency operation centres established. In BC, we viewed some of the shocking images: Animals swimming in the Calgary zoo; the Saddledome flooded up to the tenth row of seating; cars floating aimlessly down streets; and homeowners stranded on rooftops.

Flash forward four weeks. Eight strangers rendezvous at noon outside Starbucks in the Calgary airport. A mix of registered clinical counsellors and social workers, we are united by our role as volunteers with the BC Provincial Disaster Psychosocial (DPS) Program. We have taken leave from our jobs to respond to a request from the Alberta government to provide mental health support to flood victims. Our deployment started with a briefing by Shawn Currie, the Head of Alberta Health Services, Addiction and Mental Health, who briefed us on the current status of displaced residents. Many, including

families, temporary foreign workers and homeless people from Calgary, had been temporarily housed at the University of Calgary dorms for several weeks. Many others, primarily from the hardest hit area, High River, had temporary housing at local hotels, with friends or family, in RV parks or tents.

A BC DPS team had worked in Calgary the previous week and we picked up the threads of their work, deliberating over assignments in the areas of greatest psychosocial need - the dorms, the hotels and ‘Welcome Centre’ in High River, the Emergency Command Centre in High River, and potential outreach in the community. Three team members volunteered our first night to visit the dorms, initiate contact and determine resident needs.

Early the next morning, we drove to the Welcome Centre, a temporary logistics spot at the rodeo grounds, which was the destination for displaced residents in High River who needed help. The heart of the operation was a large building, which housed a melange of social, government and community organizations, including the Salvation

Army, Alberta Environmental Health, the multicultural society, Foothills Foundations (who managed the temporary housing registry), the Alberta emergency funding, Samaritan’s Purse and various local, municipal staff members. Outdoors, amidst the mud and dust, was a sprawling array of volunteers; the Red Cross at one end of the parking lot, and a grassroots group of volunteers from across Canada (self-titled ‘Mission Possible’) at the other end, bridged by a table of canteens full of free Tim Horton’s coffee, and volunteers manning large grills, who kept burgers and hot dogs ready all day long for hungry residents.

For those of us arriving from stable living situations, the initial impression was of entering a scene of chaos which took some time to absorb. But we soon began to see the underlying order which had been developed over the previous month. As ‘outsiders’ from BC, we were tentative about how we would be received by locals, and how best we could help; I started by approaching those who entered the Welcome Centre and appeared uncertain or confused. Hundreds of High River

Psychosocial Counselling Amidst Chaos:A Canadian Experience


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they were doing when they discovered the flood waters were rising.

One woman told me of being ten kilometres away from her sister and talking to her on the phone; the last thing she heard her sister say was “the water’s coming in the front door of my office” and then the phone went dead. Two days later, she learned that her boyfriend had swum through the muddy floodwaters to her sister’s office, but her sister was too frightened to leave the building. I heard several stories of people swimming in the muddy, coursing river to save others or themselves. One man who had chronic back pain and walked with a cane, swam to his wife’s workplace, the hospital, only to discover she had already left the building. Even a month after the flood, with the community in recovery, much of the anxiety seemed to be connected to the initial moment of the flood; where someone was when it happened, or where they felt they should have been; what they were able to do or to save, or not.

Officially, the Alberta flood had few victims – only four, although three were in High River, this is a miracle since all of High River’s 13,000 residents were evacuated by 2,400 military over the course of two days. However, there were other unofficial victims. One woman told me she lost “everything,” and when I started helping her access financial aid, she said “Fred always dealt with these things.” It turned out that her husband had died the day after the flood, of a heart attack.

There were several similar stories of additional loss. I spent some time with

a resident who had lost his car, his apartment, all his belongings, and finally, had been fired from his job because he wasn’t able to make the one hour commute to Calgary. He said “I’m overwhelmed and barely hanging on to my sobriety.”

Flooding is the most frequent type of natural disaster, and according to NATO, “the psychosocial impact is particularly prevalent and prolonged,” and “the psychosocial and mental health consequences have a long tail rather than one low point”

My role as a disaster psychosocial volunteer was short term; however, it was evident that the impacted residents will be dealing with practical issues such as insurance, financial loss, impact on business or jobs, and impact on community for a long time; related to this are the emotional reactions and mental health outcomes that require longer-term support and attention.

Mitigating Psychosocial Effects on Emergency RespondersThe displaced residents needed tremendous support, and the Town of High River, the province of Alberta, social agencies and all local businesses, appeared to respond collaboratively and offer support; this will accelerate the recovery process. “The evidence indicates that the way in which people’s psychosocial responses to disasters are managed may be the defining factor in the ability of communities to recover” (IBID). However, the residents were not the only group that needed psychosocial support. There were hundreds of

residents came and went every day; there was no shortage of clients.

By the end of day three, I felt there was a kind of confluence between my role, understanding the needs of residents, and understanding organic nature of the environment. Any initial shyness about approaching strangers had quickly dissipated. Everyone had a need, and they seemed, understandably, to be focused on Maslow’s bottom two levels of need, physical and safety. My role was to help them address those needs which might include locating food and water, helping them find out where they were on the list for temporary housing, escorting them to key contacts who could confirm or deny the daily crop of new rumours (particularly about the status of homes, government intentions for remediation, and compensation), or locate lost pets. In every case, practical needs were accompanied by emotional and/or mental needs, and often people had the need to share their story to a fresh and empathetic listener. In every encounter I experienced, people wanted to talk.

‘I’ve lost everything.”

I heard this comment dozens of times each day, and each story was brought to life with vivid and often shocking details. The citizens of High River had no prior notice of a flood, and this lack of notice, lack of time to anticipate and prepare, added to many residents’ anxiety. Their trauma was noticeable in how the stories started; and they always started with where they were and what


Each person has a unique experience of a disaster, and will experience varying degrees and duration of distress. The reactions may span the range of psychological, emotional, social and/or physical experiences. One woman was stranded in her apartment on the 9th floor. She went to the lower floors of her building as the flood water were approaching and moved eight elderly residents into her apartment. She had been expecting family to visit and had beds and food prepared for a week, which were shared with her new refugees. The group was evacuated by the military on day three after the floods; three days she said which had been spent enjoyably getting to know her neighbours, eating and drinking. This same woman showed me a video of a body floating down High River on the day of the flood. She appeared to be undisturbed by the image.

Some of the BC DPS team members were stationed at the University of Calgary dorms and had a different scenario to manage. A disparate group of residents had become unlikely neighbours, and at the time of our deployment, were about to be disbanded in one of several directions. In addition, there were a significant proportion of the residents who were previously homeless, living on the Calgary streets, and with pre-existing mental disorders. These team members had a different role; not only to offer general support to displaced individuals, but also to recognize those with mental disorders and alert local mental health providers to situations that may require immediate support.

Of course, a complicating factor is the reality that existing mental health conditions could be exacerbated due to the trauma of the flood experience.

Disaster psychosocial counselling is not counselling in the usual manner, and as such, expectations for both what service I can offer in this setting, and expectations for how ‘clients’ will behave, must be set aside. It took several days to understand the dynamics of the Welcome Centre, make connections with the existing social agencies and responders, and effectively connect with displaced residents. At the end of the week, we departed and a fresh set of BC DPS volunteers arrived. I can attest on the one hand to an element of discomfort, parachuting into such a critical role and connecting with people at a highly vulnerable time in their lives, only to quickly exit the relationship. However, I can also attest that small efforts, listening to a story, connecting someone with resources that address their basic needs, helping a resident feel heard, are all valid, useful and meaningful counselling activities, within this context.

BiographySophia enjoyed a successful 20-year career in marketing, corporate communications and project management before seeking a new challenge, and embarking on a Master’s degree in Counselling Psychology. In her second career, she has a private practice counselling business professionals with diverse life/work challenges, and manages a government program for new immigrant professionals transitioning to life & work in Canada.

emergency responders and volunteers who had been on site for durations between one week to one month, and many were experiencing fatigue and various degrees of distress. Part of our role as a DPS team member was also to provide support to the responders and fellow volunteers, something we primarily achieved on an informal basis, through introducing ourselves and informal conversations on a frequent basis. On one occasion we were asked through the Red Cross team leader to convene a group session with several volunteers who felt overwhelmed and were experiencing various signs of fatigue and burnout; on short notice we conducted an impromptu session in the back of an ambulance.

Learned Experience – Disaster Psychosocial Counselling One tenet of psychosocial counselling is the importance of supporting and nurturing an individual’s inherent self-sufficiency. In this case self-reliance was in abundance. In many circumstances residents protested variously: “I don’t need any help,” “I find it difficult to accept help,” or “I’ve always done everything on my own,” and “the Red Cross dona-tions should go to someone who really needs them.” True to the stereotypical Albertan spirit, they were strident in their efforts to protect their indepen-dence, and this same inner strength may be key to their ability to cope with, and recover from, the disaster. High River is a rural, tight-knit community and the community connections are likely a factor in the individual resil-ience and community resilience to manufacture a successful recovery.

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By Su Russell, MEd, RCC, Contributing Writer

present to the emotional pain of these women was a kindness I could offer, even when practical solutions to their poverty and illness seemed so much more important.

By being fully present to a person, we can provide a container for the devastation of traumatic experience. We can witness the suffering, and by doing so, help heal the all-encompassing sense of physical, emotional and spiritual isolation which trauma can create. We can help those suffering to feel valued and acknowledged.

While in Africa I worked in a small hospital serving a village and its environs. One day a volunteer doctor asked if I would see an older patient in the woman’s unit. She had been treated and discharged for her illness, but returned, again and again, complaining of un-diagnosable symptoms. The doctor suspected an underlying emotional cause for her complaints.

With the help of a translator I asked her where she hurt. She cried. I asked about her village, her family. With each question the story unfolded. She had been infected with HIV by her husband. Her husband had thrown her out once her illness was discovered. Her family had disowned her. Her village had ostracised her. Her husband took all her savings; she had no money for food. She was homeless, penniless and without community. She had returned to the hospital because it was the only place that had accepted her and been kind to her.

I asked if there was anyone at all she could think of who had been loyal to her. Slowly, her face lit up and she said

Various therapeutic techniques inform our practice and expand the effectiveness of our work with clients. Less obvious, but equally important are the skills of supportive ways of being. These skills are often educationally and culturally minimalised.

The focus of much of my work as a therapist is working toward re-establishing resilience in clients. I have practised in myriad locales; disaster relief centers, mud huts in Africa, urban training sessions and in-office private consultations. By the telling of four personal stories, I illustrate how these skills of witnessing can be invaluable, if not preferable to any particular technique, in difficult or extraordinary circumstances.

In Rwanda, I walked, following the winding, rocky roads to the association offices, to the homes of widows, the church, the crop fields and the market. After a few of these excursions I realised that I was uncomfortable, not because I was the lone muzungu in the village, but because I could not easily hold the gaze of most of the women we passed on the roads.

Many of the women were widows marked by genocidal rape and the social stigma of HIV. Shame permeated their bodies and their psyches and I was witness to it. Normally effusive in their greetings to white visitors, these African women turned away; some looked past without a hint of response; very rarely, one would smile broadly and extend a hand in greeting.

I challenged myself to hold them in my gaze, not to flinch or turn away from their discomfort. I sensed that to be


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By Joel Kroeker, RCC, MA, MMT, MTA, Contributing Writer

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ArchetypalMusic

Psychotherapy:Bridging the gap

between counsellingand the creativeexpressive arts


inherent creative capacity of our clients we may be able to more effectively harness the therapeutic potential of this intersection between words, sound and image.

The purpose of this article is to focus in on this porous boundary between verbal modalities and the creative expressive arts and to make a case for trusting the client’s psyche and its inventive ability to leap beyond the seemingly impossible dialectical oppositions presented by the linear constraints of words.

As a Registered Clinical Counsellor and a music-centred psychotherapist I often find myself at this crossroads between verbal and expressive arts-based modalities in my clinical work. After twenty years of working with people through creativity-based processes as an educator, performer, composer, workshop facilitator and more recently as a therapist, some patterns have emerged with enough consistency and coherence that I have decided to give my way of working a name. I call it Archetypal Music Psychotherapy (AMP) and it involves accessing, amplifying and integrating unconscious material through musical

processes for the sake of well-being, individuation and self-discovery.

Our minds, unlike computers, tend to float around, drifting in and out of concentrated focus. Images rise

up and then vanish, sensations pass through our bodies, and emotions and moods contract and

release, as the world appears to reify itself before

Talk therapy can be effective and potent. We know this from the research and from our daily hours

in consulting rooms as clients, therapists and supervisors. But sometimes words

fail to match the profundity of the client’s present situation and the resulting weight of silence can feel

isolating. These tacit moments of charged potential can be

an opportunity to transcend verbal constraints by

inviting our clients to give voice to inner

experience through sound and image.

By invoking the

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us into linear time and space. Carl Jung referred to these primordial human motifs and symbols that come to us through image and sensation, as archetypes, and he considered them to be the fundamental building blocks of behaviour, experience and individuation. He stated that, “(Archetypal images) are not mere philosophical concepts, (but rather) pieces of life itself – images that are integrally connected to the individual by the bridge of the emotions” (Jung, 1985, p.58).

Therapy can be a delicate balancing act between this nebulous inner cosmos of image, feeling and emotion and the more concrete tangibles of the external work-a-day world. From a creative expressive arts perspective, all of these disparate images and experiences can be relevant and valid aspects of the therapeutic process. Jung found that a deep sense of meaning can take root through the emergence of these deeply felt images. But the question remains; how do we as counsellors effectively work with such fleeting and

slippery material.

I often draw on music and sound in my clinical practice because I have yet to meet someone who has no intimate connection with some form of music:

• Children and some adults respond bodily to music and rhythm combining proprioceptive awareness with deep-seated emotional release.

• Seniors can re-live long forgotten

moments from their life through singing old

favourite songs in a group setting.

• Youth can establish and express social identity through group improvisation and experimenting with digital media in my recording studio.

• Clients who are non-verbal, due to brain injury or a wide range of pervasive developmental disorders, can find a way to communicate through the language of musical elements such as tempo, dynamic volume, turn taking, crescendo and repetition.

• Clients in active psychosis can experience a sense of shared, grounded reality through the methodical process of recorded songwriting sessions, which are reinforced by listening back to their own voice through previous musical creations.

• Clients with anxiety-related issues can engage in mindfulness-based musical processes to re-establish a sense

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Non-verbal

expressions

tend to slip past

defenses more

directly into the

vulnerable realm

of emotion

and deep-seated

feeling

of solidity and reliability in the present moment through the predictability of certain types of music and rhythm.

These are just a few examples of the diversity of populations that engage regularly with therapeutic musical processes.

Some of the work I do as a psychoeducational workshop facilitator is about helping counsellors hear the music that already exists in their current clinical work. It simply takes a slight shift of perception to hear the underlying musical qualities and characteristics of the duet, trio or chamber orchestra that is expressing itself musically throughout the therapeutic dialogue. The voice naturally contains musical aspects of tempo, pitch, phrasing, timbre, meter, registral range, melody, rhythm, pacing, dynamic volume and even harmony.

When we are at a loss for words with a client, we can allow ourselves to hear and feel the dialogue as a musical exchange, as if we were listening intently to a piece of music. One could ask themselves; ‘What genre of music is this?’, ‘What is the form of this piece?’, ‘Who are the musical characters?’, ‘Where is the power within this music?’, ‘Where is the tension and where is the release within this dialogue?’, ‘Is there silence?’, ‘Is this a medley, a concerto; am I being a soloist or am I playing a supporting role here?’

Words can be used defensively or as a way of shielding some of the core issues at play within the therapy. Music can too, but non-verbal expressions tend to slip past defenses more directly into the vulnerable realm of emotion and deep-seated feeling. This is why creative expressive arts therapists need specialized post-graduate level ethics training to learn about potential dangers, risks and contraindications before practicing professionally.

The shared professional ethics between the fields of counselling and the creative expressive arts therapies are essential, but when working directly with abreactive experiences of catharsis and deeply held archetypal symbols, the alchemical chalice of therapeutic containment must be impeccably maintained. This ethical imperative can include a psychoeducational component to inform clients of the potential dangers of amplifying material that emerges from the psyche. This crucial clinical containment aspect can include abbreviated session times, periodic mindfulness-based grounding exercises, clearly stated and reliable interpersonal boundaries and the maintenance of a non-judgmental clinical space.

Those of us who work at this dynamic intersection between verbal counselling and integrative arts modalities observe

time and again that one of the main active components of the therapy is the cli-

ent’s own creativity. In our attempt to fulfill our multi-faceted role as counsellors we sometimes forget that imaginative acts such as fanta-sies, dreams, art making and even

musical improvisation can be signifi-cant in themselves as a movement toward

personal development. Hillman (1989) suggests that the very

Carl Jung

Joseph Campbell

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Control over client filesAs noted above, when Counsellor B advised Counsellor A that she was going to terminate their business relationship, Counsellor B also removed from the Clinic the clinical records for all of her then active clients. Counsellor A sought the return of these files.

The Court found that the client files contained personal information as per the Personal Information Protection Act. While PIPA required the Clinic to exercise reasonable care to fulfill its obligations with respect to protection of personal information under

its control, the Court did not feel the Act specified who, in these particular circumstances, should exercise that control. In addressing this issue, the Court found that clients had understood they were clients of the Clinic rather than clients of any individual counsellor.

Therefore, the clients would reasonably expect their files would remain under control of the Clinic, unless they had agreed to a different arrangement. Therefore, the Court concluded that the files Counsellor B had removed

belonged to Clinic and not to her

as the individual counsellor.

The Court also noted that, despite her claim that she

had to take the files to ensure client confidentiality, Counsellor B’s obligations under PIPA would have been discharged if she had simply left the files at the Clinic, where they were secure. The Court ordered Counsellor B to return the files to the Clinic, unless a client had since become one of her clients and requested that his or her clinical information be transferred to Counsellor B. In making this decision, the Court pointed out that the parties did not discuss or agree at the start of their working relationship what would become of the clinical records if and when their relationship ended. Their limited knowledge of PIPA and a lack of clarity between them regarding control of client files appears to be the source of this problem.

The BC Provincial Court recently issued a decision in a small claims case that involved two quarrelling counsellors. While this case is now a matter of public record, for the purposes of this article I will not identify the counsellors involved. Instead, I will focus on the lessons all clinical counsellors can take from their unfortunate legal experience. The factsCounsellor A owned and operated a therapy centre I will refer to as the Clinic. Counsellor B initially contracted with Counsellor A to provide part-time counselling services at the Clinic and, two years later, practiced there full-time. The two counsellors discussed the option of Counsellor B buying into the Clinic. As they were unable to reach an agreement, Counsellor B decided to leave and open her own clinic. She gave notice and took with her the files of the clients she had

been seeing. A few months later, Counsellor B sued Counsellor A claiming that she was owed payment for clinical services she had provided to clients at the Clinic.

Counsellor A counter-sued Counsellor B for unpaid office expenses, wrongful removal of client files and breach of a non-competition agreement. In reply, Counsellor B claimed she alone was responsible for the client files she had taken from the Clinic and denied there was any sort of non-competition agreement. While the Court dealt with a number of legal issues in its decision, two should be of particular interest to counsellors working in a clinic or shared office space: (a) Control over client files; and (b) Non-competition agreements.

Lessons for all Clinical Counsellors

By George K. Bryce, LLB, MHA, BSc, BA, Contributing Writer

The Importance of Clear Contracts


6. Who will own the clinical files that will record the client’s personal information? (Remember that, while the client “owns” their information, a counsellor may own the clinical files which record that information.2) 7. Who will receive and respond to client request for access to his or her records, if a client makes such a request?

8. Will a counsellor leaving the clinic or shared office be entitled to take the clinical files of his or her clients? Or do those files belong to the clinic/owner of the clinic? (Control of client files is separate from soliciting and notifying clients, which is discussed below.)

9. Who will act on client requests to have clinical records transferred, if a client makes such a request?3

10. Can the other counsellor charge the leaving counsellor a reasonable fee for transferring a file? What will be that fee? And the maximum period of time to respond to such requests?

Soliciting or notifying clients

12. If a counsellor leaves a clinic or shared office and opens a new clinic or office, can that counsellor then invite the clients he or she

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Nature of the relationship

1. What is the status of each party to the agreement? Employer? Employee? Landlord? Independent contractor? Renter? Partner? Shareholders in a company?

2. What is the nature of their business relationship? Employment? Shared office? Contracting services? Partnership? Corporate? Co-directors?

Personal information protection

3. How will the parties ensure the information they collect from clients will be protected, as required under the Personal Information Protection Act?

4. In particular, who will be responsible for making reasonable security arrangements to prevent unauthorized access, use, disclosure, copying, modification or disposal or similar risks of the information in those clinical files? What specific details concerning these arrangements need to be documented?

5. Will there be a single, common Privacy Policy for the shared office, or will each counsellor have his or her own Privacy Policy? And how will clients be informed of these policies?1

Non-competition / non-solicitation clausesAt the start of their business relationship, Counsellor A had written a simple memo that set out certain elements of their understanding at that time. During the trial, Counsellor A argued that there were other terms, unwritten but expressly agreed between them, one of which was an understanding that Counsellor B would work only for the Clinic and, in particular, that she would not compete with Counsellor A or the Clinic after leaving.

Counsellor B denied there was any sort of non-competition agreement. She had in fact worked part-time during the first year or so of her relationship with the Clinic, and had done so without any objection from Counsellor A. Counsellor A could not provide the Court with any evidence concerning the duration, scope or effect of her claimed restriction on Counsellor B’s practice. In particular, the Court noted that Counsellor A’s memo did not contain a non-competition clause that prevented Counsellor B from setting-up a counselling office in the area. In the absence of evidence concerning a written non-competition agreement, the Court rejected this aspect of Counsellor A’s counterclaim.

The fact that there was no detailed, written office sharing agreement between the two counsellors that set out details of various aspect of their business arrangement was the root cause of this problem. Generally speaking, the common law does not support non-competition or non-solicitation agreements. Therefore, if it is to have any legal force and effect, any such arrangement should be documented in a written agreement. Even then, the courts will strictly interpret such limitations to an open market.

Lessons for all counsellorsThere are various ways that counsellors may work with other counsellors (or health care practitioners) in a common clinic or shared office arrangement. The nature of their relationship and the rights and liabilities of each counsellor will depend on whether they are employees or self-employed independent contractors, or – if self-employed – whether they have formed a partnership or a partnership can be implied from their business arrangement.

Before counsellors enter into a shared office arrangement or agree to work under contract, they should ensure that certain critical issues are addressed in a written agreement. This is important because, like life itself, it is inevitable that any shared office arrangement or contract work will end. As the two counsellors in this case no doubt found out, it is better to address areas of potential dispute before they arise, rather than fight it out in court after the fact.

To help frame a shared office or contract service arrangement, counsellors should consider a number of key questions. I have framed these issues under general headings, and will refer a counsellor who is entering a shared office or working under contract, and to the

To help frame a shared office or contract service arrangement, counsellors should consider a number of key issues.


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has seen to come for services at the new location? Or is the leaving counsellor limited to notifying clients as to where the counsellor’s new business will be?

13. How will an invitation or notice be provided to clients? By a form letter? Posted notice? Newspaper advertisement?

14. Will soliciting or notifying clients apply to all clients or only some? For example, to only those the counsellor was seeing at the time? Or to all the clients that he or she brought to the clinic?

15. Should there be time limits on either soliciting or notifying such clients after the counsellor leaves? Or a maximum time limit on any restriction on soliciting or notifying clients?

Exclusivity11. Is the counsellor restricted to providing counselling services only to clients at the shared office or clinic? Or may the counsellor provide counselling to other clients outside the office or clinic?

Non-competition16. Will a leaving counsellor be limited in terms of where he or she may open up their new office?

17. What geographic limitation would be reasonable in the circumstances?

18. What time limits would be reasonable in the circumstances?

19. Are these limits critical to protect the other counsellor’s business?

Financial issues20. What should be the financial arrangement with respect to fees, expenses, etc.? Will there be fee-sharing arrangement? Who will pay the expenses?

21. Who will bill clients (or third party payors) for services that are provided? Will bills be sent out over clinic letterhead? 22. Who will collect received payments, and allocate them according to the arrangement? 23. Who will be responsible for pursuing over-due accounts?

Ending the relationship 24. How much notice must be given to end the relationship?

25. How should such notice be given?

26. Should there be a mechanism to resolve disputes on matters set out in the agreement so as to avoid taking disputes to court?

other counsellor who owns the office or is hiring the contracting counsellor. Counsellors may want to consider hiring a lawyer to help them prepare appropriate clinic or shared office agreements.

Additional readingThis court case is a good example of the problems that can arise in a shared clinic or office arrangement, as discussed in my 2011 Legal Commentary on Restrictive Covenants in Shared Office Contracts. Counsellors who would like to gain a better understanding of the issues that were considered by the court in this decision are encouraged to read that Commentary which is posted at the membership side of the BCACC website.

BiographyGeorge Bryce has been the BCACC’s legal counsel since 1993, and over the years has authored several Insights into Clinical Counselling articles and produced a number of legal commentaries, most of which are currently posted on the membership side of the Association’s website. His preferred area of practice is professional regulation and governance.

Endnotes1 PIPA requires that all counsellors in private practice must have their own privacy policies to explain to their clients what steps the counsellor will take in terms of collecting, using, disclosing and disposing of a client’s personal information. But such policies can be a single policy that applies to all counsellors in a shared office arrangement.

2 Generally, clients’ rights to control their information supersede a counsellor’s claim over the physical record. While counsellors can assert ownership over the physical record, in most situations counsellors cannot extend that right to prevent clients from directing how their recorded information is to be used or distributed to others, including having copies sent to other counsellors. Therefore, any provision in a shared office agreement that has the effect of preventing clients from exercising their rights to control their personal information and, in particular, to make decisions as to who may access or have copies of that information, would conflict with BC’s privacy legislation, if not the common law.

3 A shared office agreement should not prevent clients from directing that their personal information (as set out in a clinical record) be provided to the departing counsellor.

To help frame a shared office or contract service arrangement, counsellors should consider a number of key issues.


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By Dave Prette, M.Ed., RCC, Contributing Writer

The World is Too Much With Us: Social Media and Increased Teen Suicide

culture of our time. It feels important to explore the nature and attraction of social media in the lives of teens and why connecting with a common interest in suicidal ideation is so dangerous.

The Attraction and Addiction of Social Media for Adolescence

From a developmental perspective, the age of adolescence is marked by a shift in attachment from parental caregivers to same age peers. There are volumes of developmental psychology texts describing the inherent pressure on teens to become autonomous, within a separate identity from their parents, and yet establish some sense of self-esteem through inclusion with and acceptance from peers. Struggling to understand who they are and how they can fit in to their evolving and expanding world, while undergoing hormonal upheaval, provides a dramatic metamorphosis that is often overwhelming to even the most secure personality. It is the age of the ‘Fish Bowl Affect’ as teens

become more self-conscious and absorbed in existential questions such as: Why am I here? What is life all about? And, Will I have what it takes to be happy and successful with my life? In addition, we cannot underestimate the powerful emotions that emerge related to sexual identity and whether a teen will, not only be accepted for who they are by their peers, but be attractive to desirable partners.

The world is too much with us; late and soon, Getting and spending, we lay waste our powers William Wordsworth, 18021

As a mental health clinician working within our local hospital, I am confronted every day with teens that are suicidal. Regardless of the years of experience that any of us may have in working with this population, there is constant surprise at the volume of cases and shock when repeated attempts are made. When suicide completion occurs, we are left to reflect on our own efforts and to wonder whether we as individuals, and as a collective society, have done enough. With these thoughts in mind I am compelled to share my experiences and concerns. Within today’s culture, there is a trend towards increased suicidal behavior among our youth. While effective inter-vention has to focus on understanding the internal thoughts and feelings of the individual involved, consideration for the larger social context in which they are embedded is essential. Involving family members not only enhances our insight, but also provides an opportunity to address potential areas of tension and conflict while engaging in safety planning.

What remains less available, within traditional counselling interventions, is access to other social forces and, in particular, the critical influence of peer relations within the adolescent’s world. Hospitalized teens may benefit from the sanctuary of time away from the pressure of their lives, and some may have the capacity to engage in supported self-reflection. They will, however, return to the environments that contributed to their hopelessness and to the potential continuation of habits of self-destruction. Typical suicidal assessments explore common risk factors, such as substance use and mood disorders, as well as, exposure to completed suicides within family relations and peers. This later consideration is based on the well-documented reality of the contagious nature of suicide. The more an individual is exposed to attempted and completed suicides, particularly within meaningful relations, the higher the risk for their own suicidal thoughts will be.

The ‘Contagion Affect’ alone may account for an alarming trend that is emerging and providing practice-based evidence that should be of high concern. Many contemporary teens are revealing their common habit of significant engagement in social media sites that are used to connect them with other suicidal teens. Having interviewed patient after patient who have described entrenchment in this shared activity, many questions arise regarding the impact of social-media use and increased adolescent suicide in the


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directly (and literally!) in the hands of contemporary teens. Today’s youth are networked together in immediate connections with one another, fulfilling their developmental need for attachment and inclusion. There is, however, an inherent risk that, like Narcissus of Greek mythology, adolescents can be increasingly drawn to stare at their own reflection, in the pool of their glowing screen, compelled towards further self-absorption.

From a mental health perspective, increased dependence on screen-time raises several issues of concern. Basic health

While past generations have

shared in the experience of this

tumultuous age, the advent of social-media

technology places intensified opportunities for positive and

negative feedback, related to acceptance and identity formation,


needs are met through proper sleep hygiene and exercise, particularly outside in nature. Further adverse consequences occur when marginalized individuals rely on Internet connections to meet their social needs. Teens are particularly vulnerable to the seduction of social-media sites that offer pseudo-relationships through cyberspace networks.

With a click of the finger they can access apparent social relationships and connections to others, while drawing attention towards themselves, as they post their own comments and pictures. In his recent novel, The Big Disconnect: The Story of Technology and Loneliness,2 author Giles Slade (2012) presents a historical account of hu-mans evolving towards a dependence on ma-chines to fulfill our needs. He argues that we are increasingly moving away from involvement in natural social relations, towards technologically mediated interactions that do not meet real human needs.

He concludes with an encouragement to spend more direct physical time together with those we care for, and to do so as much as possible, in the green outdoors (again!).

It is difficult and ill advised to argue these concerns with teens if we want to support them towards a healthy change. They will not only dismiss criticism of social media as naive and prehistoric, but also will defend their habits and feel threatened if we approach them from a position of authority. Clearly, older generations struggle to understand the world in which they live, as our personal experience is so different from theirs. The attachment that many youth feel towards their technology devices has for them replaced the security blanky they just recently discarded. The challenge that professional helpers face will be to address their dependence, by appealing to their sense of health, while enlisting the support of caregivers around them to offer support. Many suicidal youth have given up on their future wellbeing for a variety of personal reasons and are often disconnected from the healthy support that may exist around them.

What is it about our age of informational technology that has left our youth so vulnerable? Clearly, times have changed and we have moved from a society that focused on the protection of children, within what was known as a ‘Nuclear Family,’ towards what psychologist David Elkind,3 back in 1994, labeled as the new, “Permeable Family.” This description seems even more prophetic in considering

the manner in which youth today are constantly exposed to ever increasing amounts of Internet material that can be damaging in many ways. The layers of protection in which most children were once enveloped are gone, and now as Wordsworth feared the world has become “too much with us,” entering directly into our homes and then into our minds and hearts through technology. The eventual cost of this permeable existence may be difficult to predict, and research slow to prove, but the example of suicide contagion among cyber-world-connected youth may provide insight.

From personal experience, I have been consistently meeting emotionally troubled youth who are describing the use of social-media sites that they use to post their own suicidal thoughts and to connect with other like-minded peers. In addition, these often depressed and marginalized youth are doing so while alone, isolated in their rooms at night, while their naive families are unaware and asleep. The result is

increased isolation and poor sleep hygiene, along with identification with other ill youth, whom they feel an

intense social connection and bond with.

The phenomena of illness-promoting cyber subcultures are well documented in other

self-destructive behavioral habits, such as self-mutilation and eating disorders. Individuals

can easily search for and find those who dwell on and describe their own self-destructive behavior,

and in many cases actively encourage others to follow their example.5 While it is true that the

Internet can offer sites that support health and discourage self-destruction,

studies have shown4 that these sites receive fewer visits in comparison to those that promote self-harm.

It is speculation at this time whether it is our natural human tendency towards morbid fascination

or other potential social reinforcements that are acting on these youth to encourage this behaviour. It is clear, however, that it is happening on a much larger scale than most adults are aware.

Personal examples include a 15 year-old female who was proud to announce that she had “100 followers on her Tumblr site,” who followed her suicide related pictures and comments, and a 16 year-old male who described, like many others, using Facebook messaging to engage his cyber-friends in supporting him when he felt suicidal. It is concerning to realize that suicide is being used as the common ground for relationship building and that posting messages regarding one’s suicidal thoughts would offer needy youth immediate social connections. Clearly this attention can be reinforcing for this behavior and the majority of youth involved in the activity have no conscious awareness of the dangerous slippery slope they are on.

Intervening in Suicide-Promoting Social Media UseCounsellors who attempt to intervene with youth who are using social media to engage in suicide related posting face significant challenges. Regardless of the theoretical approach that is used, the ability to encourage behavioral change in the lives of adolescence will be dependent on their reception to the particular helping professional. While we cannot change

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who we are, and there is no guarantee of a comfortable fit, familiarity with client-centered techniques to foster engagement remains the tried-and-true course of action in forming a therapeutic alliance. When we can present our genuine, empathic and accepting selves, rather than a more distant and judgmental authority, we may be able to encourage youth to work with us towards change. Sensitivity towards this reality supports the use of a cautionary and tentative manner that will not alienate the already troubled and often hopeless suicidal youth. Awareness of the dangers of social networking may provide a meaningful exploration within discussions, but the receptiveness of the youth himself remains the indicator for how this subject should be approached.

In many ways suicide related cyber-behavior could be conceptualized as an addiction. Youth, however, are not likely to view it that way and will naturally resist controlling forces that attempt to block access to their habit. As in addiction counselling, Motivational Interviewing techniques that explore the personal costs and benefits within Stages of Change, can offer effective guidelines. A Pre-contemplative client requires encouragement to even consider how Internet behavior may relate to their suicidal ideation and a more psycho-educational exploration could be beneficial.

A Contemplative client on the other hand, understands the influence that social media can have on them and can benefit from support to explore replacement activities for the habits that they have formed. In an ideal world, youth will be encouraged to take responsibility for their own health and wellbeing by developing habits and activities that are more life enhancing. Encouraging them to become more physically active, preferably in communion with the great outdoors, nature and animals, along with developing healthy eating and sleeping habits can be offered, within consideration to their receptiveness.

Dependence on electronic technologies to fill our needs is not only a concern in the area of social relationships, but also as a disconnection from the natural world around us. Green Therapy promotes a reconnection with nature as a way to gain emotional and physical balance in this, often unnatural, world.

Cognitive Behavioural Therapy approaches can be effective with youth who are receptive to engaging in self-reflective dialogue. The common sense concepts inherent in this model provide a framework to explore how the things that we focus on will affect the way we feel and how this in turn influences the behaviors we do. Clearly the more time you spend thinking about and focusing on a particular subject the more familiar it becomes and the more it is on your mind. This concept is directly related to the reality of suicide contagion that was described earlier, as focusing on the suicide of others increases personal risk. Spending hours on end, immersed in the world of suicidal text conversations and visual images, will lead to a higher probability of eventual suicidal behavior. While there has been woefully few academic research studies into this phenomena, Zdanow and Wright (2012),4 found conclusive evidence that those who engage in blogging about suicide are comparatively more likely to engage in that behavior.

Ideally, the youth themselves will engage in the development of their own safety plan and make agreements to alter their social media habits. Regardless of their reception towards change, the inclusion of parents, or other support network individuals, is essential. Caregivers are often naive of the impact of social media behaviors that teens engage in and are even less familiar with the content of sites that are used in the cyber-world. Adult education is needed to warn parents and other caregivers of the potential negative influences that may be contributing to their child’s suicidal ideation. While the adolescent may not like it, parents and caregivers have to be aware of and monitor the use of social media sites, as best they can, to provide encouragement and support.

Counsellors can assist families to negotiate expectations, structures and routines around the use of electronic devices. As an example, making explicit the dangers of late night, free access, to social media as a risk to health, only from a sleep deprivation perspective, may be sufficient for families to develop limited time restrictions for their use. In the least, youth who have engaged in suicidal behaviors should have their use of social networking addressed and in some cases monitored for safety.

It is always better to engage the youth in an open discussion of the dangers and in the development of agreements towards behavioral change. Often families will need ongoing facilitation of conversations to address these and other issues and to be able to develop their ability to do so in a non-confrontational or non-emotionally reactive manner. As clinical counsellors we should invest our efforts to advocate for change within our society in regard to the risks associated with uncensored access to the Internet and social-media sites. While freedom of expression and freedom to pursue personal interests are values worth defending, we must also consider the cost of human lives. We are ethically bound to increase our understanding of the social dynamics of suicide contagion and to use our influence to educate others and promote increased social responsibility. Investment in research projects that can shed additional light on this subject is needed to provide the evidence to support policy changes and program development. In addition, all suicide assessments should include an exploration into the use of the Internet and social-media sites to consider the full impact of these behaviors on suicidal ideation.

BiographyDave Prette is a Registered Clinical Counsellor who has spent the last 27 years employed, through the Vancouver Island Health Authority, as a Youth and Family Counsellor, in Child, Youth and Family Mental Health Services. Dave facilitates ASIST workshops for suicide responders and has a small private practice that he runs in his home in Victoria, B.C. ([email protected].)

References1. William Wordsworth, The World is Too Much With Us, circa 1802.2. Giles Slade, The Big Disconnect: The Story of Technology and Loneliness, 2012.3. David Elkind, Ties That Stress: The New Family Imbalance, 1994.4. Zdanow C. and Wright B., The Representation of Self Injury and Suicide on Emo Social Networking Groups, African Sociological Review, Vol. 16, 2012.5. Birbal R., Maharajh H. et el, Cybersuicide and the adolescent population: Challenges of the future? International Journal of Medical Health, 2009.

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Living Betw een Omnipotence and Deflation

a “well done,” “amazing” and the like. We may easily have access to visceral feeling such as “swelling with pride,” “feeling on top of the world,” and “intoxicated with joy” at our mastering of ourselves and our environments. We may just as easily have immediate access to feelings of shame, humiliation, and deflation at our failed attempts, imagined or real.

Psychologically, taking pride in the infant/child’s growing ability to master his/her true self serves as scaffold to the affective vicissitudes faced in mastery. As psychological midwife, the mothering environment is expected to support in bridging the process of much needed initial omnipotence to more reality-orientated adjustment, wherein self-esteem and self-confidence remains in active partnership with ‘reality’. Reality, as used here, is the continual assimilation and accommodation of various developmental demands through the process of separation-individuation.

It is hypothesized by Masterson, based on the work of Margaret Mahler, that the initial dual unity facilitates an experience of omnipotence and this omnipotence is mostly evident in the practicing sub-phase of separation-individuation wherein the child has a love affair with the world. It also seems evident, at least initially, that the child acts invulnerable and impervious to frustration. This omnipotence is ascribed to the feeling of dual unity - mother and child as one. Think of fall-ing in love, being so “into” and “part” of each other - the word is one’s oyster. With a supportive other, the latter is slowly and gently defused (i.e., limit setting, seeing the larger world of cause and effect) so that the young child may become aware of his/her need for others, and their own and other’s imperfection without

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extreme feelings of vulnerability and deflation.

When ‘optimal’ maternal attunement and mirroring is absent, difficulties can arise in the child’s SI phase of development, that is, the child is not psychologically bridged out of the symbiotic omnipotence and imper-viousness into the realm of ‘reality’. There are various explanations as to why this happens, although each client teaches us anew about how and why this developmental difficulty arises. Nonetheless, one possible explanation is that the mother, due to her own legitimate, developmental conflicts, relies on her child to serve as a narcissistic extension thereby stimulating the child’s grandiosity at the expense of reality considerations and limitations. The child becomes the hope and dreams of the mother; a Joseph of sorts. In reaction, to not be abandoned, the child has no choice but to accept the idealizing tendencies of the mother: ‘If I am not perfect, I will be bad and aban-doned.’ Another developmental pathway is an extremely rejecting and humiliating parenting environment in which the child

“La vengeance est un plat qui se mange froid”

IntroductionNarcissism, for reasons central to the development of western culture, has been the focus of various ethical, religious, cultural and psychotherapeutic debates. For societies, wherein virtues such as altruism, care and empathy are of central importance, the very notion of narcissism is seen and experienced as a stain on the soul, worthy of scorn, if not condemnation.

Narcissism is mostly reserved for the most malignant of human passion: Deviousness, malice, and sinfulness. It comes as no surprise that within the psychotherapeutic community the narcissistic dilemma proves a complex phenomenon, dividing the various psychoanalytic contributions into further factions. Despite the latter, the work of Heinz Kohut, Sheldon Bach and James Masterson support a greater empathic understanding, enabling clinical flexibility and suspending cultural/moral counter-transference tendencies. The aim of this paper is to synoptically review the Development, Self, and Object Relations Approach of James Masterson in treating the narcissistic personality.

The Development, Self and Object Relations Approach of James MastersonAs mentioned by Masterson (1993) healthy narcissism, or the real self, is central to mental health. The real self is hypothesized to come about through the mastering of various developmental demands (through the stages of separation-individuation and beyond) wherein the environment (parenting other) supports the budding ego’s various successes and disappointments. Growing up is a painful emotional task, and the real self is continuously confronted with losses and successes, feelings of shame and humiliation, as well as feelings of pride and achievement. In narcissism, healthy or otherwise, the eye of the other is central; noting one’s incremental achievements with

By Loray Daws, Contributing Writer

A Mastersonian View of the Narcissistic Dilemma


Living Betw een Omnipotence and Deflation

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se-cretly

harbors omnipotent fantasies

as a way to protect the self against extreme injury,

vulnerability and aloneness. In the writing of Lieberman (2004) these developmental realities may result in three different types of narcissistic

adjustments; exhibitionistic, closet and devaluing narcissists:

“When the sense of self of the Narcissistic patient has been so severely injured because of ruptures in any or all of these, a child will:

(1) Dismiss the real self, and try to recapture the narcissistic relationship

by becoming grandiose (Manifest/Exhibitionistic).

(2) Push the real self underground, idealize the object, and try to comply (Closet).

(3) Or feel under siege, in danger of disintegration or fragmentation if the object was so narcissistically

injurious. The child will give up being

mirrored by, or idealizing, the mother. There is

a strong development

of the aggressive-empty unit that is projected externally,

in order to protect the self against the per-ception

that the other is harsh and

attacking (Devaluing).” (pp. 81-82)

(Italics added).

The developmental difficulty thus becomes evident in a split internal world.

The Internal World of the Client Struggling With the Narcissistic DilemmaThe intrapsychic structure of the narcissistic sense of self can be described as the inner templates of the narcissistic dilemma. On the left

side of the split one finds a defensively fused part unit consisting of a grandiose self-representation and an omnipotent object representation, which is more or less continuously activated. This unit is to defend and protect a fragile, if not deflated, sense of self against the underlying aggressive or empty object relations fused unit, and thus the possibility of a severe abandonment depression.

As mentioned, Masterson differentiated various ‘types’ of narcissistic pathologies that share a similar intrapsychic split, but rely on different defense mechanisms. In the case of the exhibitionistic narcissistic disorder of self the clinician will, in the initial stages of therapy, be principally aware of the libidinal grandiose self and omnipotent object relations fused unit, that is, a grandiose object representation that contains power, perfection and so forth, fused with a grandiose self-representation of being perfect, superior, entitled, with its linking affect of feeling unique, adored and admired.

The exhibitionist projects this fused unit while underneath the client continuously defends against the aggressive object relations fused unit. The latter consist of a fused object representation that is harsh, punitive, and attacking, and a deflated self-rep-resentation linked by the affects of the abandonment depression.

Whereas the borderline disorder of self’s abandonment depression is experienced as the loss of the object, the experience of the narcissistic patient is of the self- fragmentation and/or falling apart. As with the borderline disorder of self, the abandonment depression can be activated by true self-activation (doing what one really wants) or by the object’s failure to provide necessary nutriment, that is, perfect mirroring.

Devaluation and splitting can restore the libidinal fused unit and the ‘free

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During the 1960s, pioneers in the field of psychedelic studies such as Stan Grof, James Fadiman, Richard Alpert (Baba Ram Dass), and Timothy Leary were teaching and conducting research at Harvard, Stanford, and other prestigious universities. They were pushing the envelope of human consciousness research by administering LSD and Psylocibin to student volunteers, psychiatric patients, alcoholics and prisoners – in an effort to determine if such substances could be useful in such diverse arenas as complex problem solving, managing schizophrenia, treating alco-hol addiction and reducing recidivism in the prisons.

The summer of 1966 effectively brought an end to most of the research that was taking place in the USA, when the Food and Drug Administration sent letters to dozens of private and university affiliated institutions ordering them to stop administering LSD under any circumstances, effective immediately.

Psilocybin was classified in 1971 as a Schedule 1 drug and made illegal. Sched-ule 1 drugs are defined as drugs with a high potential for abuse that have no recognized medical uses, though the concept of medical use may vary depending on who is putting out the information. Some of the researchers such as Leary and Alpert dropped out of

“straight” society and became counter-culture icons extolling the mind liberating properties of psychedelics.

The field of Transpersonal Psychology has opened the door to beginning to understand the interface between psychology and spirituality. I did my graduate work in integral counselling psychology at the California Institute of Integral Studies (CIIS), an institution founded indirectly by Sri Aurobindo the Indian mystic/scholar. He helped to synthesize Western psychology and Eastern mysticism with the creation of Integral Yoga. While at CIIS, I heard whisperings about a psychoactive tea from the Amazon Basin known as Ayahuasca and its ability to help heal deep trauma and core wounding.

Ayahuasca, is a Quechua Indian word meaning “vine of the dead” and has been used for hundreds of years in Ecuador, Peru, Brazil, and Columbia in shamanic ceremonies and rituals, as well as the church-like settings of the Santo Daime and Uniao do Vegetal religions. Two years ago, CBC aired a documentary featuring bestselling author and physician Gabor Maté as he explored the potential use

The End of Prohibition?On the weekend of April 19-21, 2013, the Multidisciplinary Association for Psychedelic Studies will host the second Psychedelic Science Conference (the first was in 2010) featuring over 100 of the world’s leading researchers in the field of psychedelics from 13 countries.

Conference organizers are anticipating over 1,200 participants. Some of the topics on the agenda: Psilocybin-Assisted Treatment for Alcohol Dependence, LSD and End of Life Anxiety, Neurobiology of Psychedelics - Implication for Mood Disorders, and Long Term Effects of the Ritual Use of Ayahuasca on Mental Health.

The fact that a large group of respected researchers, medical doctors and psychiatrists is gathering to discuss the efficacy of a variety of psychedelic and mind altering substances for treating various forms of mental illness and addiction is surely an indication that the prohibition on researching such substances that began in the late 1960s is coming to an end.

The use of psychedelics in psychotherapy is, indeed, a very touchy and controversial subject due largely to the legality of some of the substances being researched such as Psilocybin, Ayahuasca, LSD, and MMDA.

By Kevin Parker, MA, RCC, Contributing Writer

Psychedelic Psychotherapy: The DayGlo Elephant in the Room

of Ayahuasca for treating drug addiction. The documentary created a firestorm of controversy with people weighing in on on-line blogs and forums as well as radio and television shows on the merits and dangers of using a powerful hallucinogenic compound for such treatment.

In November of 2011, Maté was ordered by Health Canada to stop using Ayahuasca in his addiction treatments or face criminal prosecution. Responding to the Health Canada order, Maté stated, “I wish it was otherwise because I have seen how I can help people with this and now it is going to be much longer to seek approval if we even get it.”1

The website Erowid, a clearing house for information on all things psychedelic describes Ayahuasca as a powerfully psychedelic South American brew traditionally made from the B. caapi vine and admixtures such as P. viridis (and/or other DMT-containing plants). One of its primary effects is considered to be the vomiting (the purge) that accompanies the experience.

The term ayahuasca is sometimes loosely used to mean any combination of an MAOI with DMT. An entheogen (“generating the divine within”)[4] is a psychoactive substance used in a religious, shamanic, or spiritual context.[5] Entheogens can supplement many diverse

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practices for healing, transcendence, and revelation, including: meditation, psychonautics, art projects, and psychedelic therapy. (www.erowid.com)

An MAOI is a monoamine oxydase inhibitor, a substance which inhibits the enzyme which would prevent the active psychedelic component, Dimethyltryptamine, from passing the blood/brain barrier, thus enabling the user to remain under the influence of Ayahuasca for several hours.

I spoke with Gabor Maté recently on why Western psychology may have difficulty embracing plant medicine work and he said this: “Western psychology focuses on the personality and the dysfunctions of the personality. At very best it tries to make the personality less rigid and more spontaneous and more healthy, and that’s not a bad thing.

That’s the purview and the mandate of Western psychology. But it takes the existence of the personality for granted. It doesn’t consider that there is something deeper than that in human beings which might be called essential self which has the aspects of unity and strength, love and joy, and connection with the oneness of it all. And it doesn’t recognize that the personality itself is just a defensive structure that we build as a way of dealing with the wound of being cut off from our true nature. Nor does it recognize the essential healing process that’s alive and available inside everybody. The plants do this in a very time-efficient fashion – they put us in touch with that deeper stuff.”

When I asked Maté whether he thought that Health Canada would ever embrace

Ayahuasca’s use in therapy or consider researching such uses, he answered: “Health Canada was open to a clinical trial, but the conditions for a clinical trial were so difficult that it’s impossible for me to even consider that. There is no way on that front to move forward.”

Ayahuasca ceremonies continue to be conducted in many countries despite the illegal status of the brew, the dates and locations revealed often by word of mouth or through emails which do not actually name the substance. The underground status of such ceremonies makes it difficult to study the long-term effects of the use of Ayahuasca or its effects on trauma and addiction.

Ecstasy and Post Traumatic Stress DisorderResearch forusing MMDA (Ecstasy) in thetreatment of Post Traumatic Stress Disorder was recently approved by Health Canada following recent studies by Medical University of South Carolina psychiatry professor Michael Mithoefer and wife Ann Mithoefer, a nurse.

The studies reported that more than 83% of several PTSD patients treated with MDMA and therapy had completely recovered, “without evidence of harm.” Speaking on the effects of treating trauma with Ecstasy, Dr. Ingrid Pacey, one of the researchers in the Canada study said, “What the MDMA does, because of the physiological effects, it means you are in

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science and religion is also beginning to mend as quantum physics and string theory reveal mysteries alluded to in ancient Vedic and Buddhist texts and cosmologies.

John E. Nelson MD, in his book Healing the Split writes: “Ideally the role of religion is to lead science as it searches for ever higher truths. Disciplined spiritual practice has the power to condition human consciousness to rise above the material realm, freeing the mind to generate insights into subtle aspects of reality that lie beyond the grasp of physical science. Rather than opposing science with dogma, religion should help us transcend its limitations. In turn, sciences like medicine and psychiatry would do well to embrace those spiritual insights that take into account the power of consciousness in determining health or sickness.” 4 This leap of faith for those entrenched in the rigors of empirical scientific study of things such as neurobiology and pharmacology is a big one for it entails suspending the belief that the only way to prove something is through scientific experimentation that can be verified with mechanical instruments and high-tech machines.

Psychedelic drugs produce non-ordinary states of consciousness. Stan Grof writes: “All the ancient and pre-industrial cultures have held non-ordinary states of consciousness in high esteem. They valued them as powerful means for con-necting with sacred realities, nature and each other and they used these states for identifying diseases and healing.” 5

Whether modern psychology will turn to embrace the gifts that some indigenous

cultures are offering to help heal a world that is severely out of balance is yet to be seen. The ceremonial and ritual use of psychedelics for healing trauma, addictions or mental illness is still viewed as far outside the box in many government, scientific and psychiatric circles. Therapists and those in the healing arts who hope to work with these radical and unconventional modalities stand at the edge of a mysterious, new frontier for which the map has not yet been drawn. The Psychedelic Science conference will be an important step towards drawing that map.

BiographyKevin Parker received a Masters degree in Integral Counseling Psychology from the California Institute of Integral Studies. He is a Registered Clinical Counsellor in private practice with offices in Nanaimo and North Vancouver. His focus has been the link between spirituality and psychology and he has learned from such pioneers in the field of transpersonal psychology and spirituality as Stanislav Grof, Ram Dass and Reginald Ray. He leads groups and workshops on couples communication, mindfulness practice for managing stress, and the mind/body connection. Kevin is also an accomplished singer/songwriter and drum circle facilitator.Kevin can be contacted at [email protected] or 250-323-3233

References1. Boyle, Theresa ( Nov 9, 2011) B.C. doctor told to stop using hallucinogenic tea to help addicts Toronto Star (Star Online)2. Ball, David P. (2012, December 28) ‘It opens your heart’: Canada approves use of ecstasy in study into post-traumatic stress disorder. (National Post pp A1)3. Strassman, Rick DMT The Spirit Molecule Rochester Vermont, Park Street Press 20014. Nelson, John E. Healing the Split (Albany, New York State University of New York Press, 1994)5. Grof, Stanislav The Holotropic Mind (San Francisco, Harper Collins, 1993)

a present, fearless state — able to look at those events without being re-traumatized, and healing in the present what was the trauma of the past.” Her research partner, psychologist Andrew Feldmár adds, “It brings you into the present, you don’t worry about the past or the future. It opens your heart; you don’t feel any shame. Something horrible is done to you, and an alarm starts ringing. You just don’t know how to turn it off. Even though the war is over, or no one is torturing you, or no one is hurting you, the alarm is still ringing. With the help of MDMA and good therapy, good connection and good company, the alarm can be stilled.” 2

Set and Setting: The Key to Safe VoyagingIn my teens and early twenties, my own experimentation with psychedelics was often random and chaotic, the consequences of which were sometimes severe and unpleasant. Although the insights received during these experiences were powerful and profound, there was very little in the way of grounding and integration. I had little to no information on respectful ways to approach entheogens in ceremonial or ritual settings.

It is my opinion that many of the casualties and psychotic breakdowns that result from misuse of psychedelics can be avoided if such substances are held in a context that treats these medicines with profound respect and honours the traditions (indigenous, shamanic, mystical or religious) in which the use of such substances evolved. Currently there exists no template for the ideal safe and successful model for

working with entheogens. There are many Westerners, that have trained in South America in various indigenous traditions, who are now leading ceremonies using Ayahuasca, San Pedro cactus, Peyote, and a number of other psychoactive plant medicines. Anyone wishing to participate in such rituals should be mentally stable and know the background and training of the person or groups they are working with.

Varying greatly from a ceremonial or ritual setting,the clinical study of psychedelics in a controlled, laboratory or hospital setting is another arena that is subjected to the influences and intentions of those conducting the research. Between 1990 and 1995 Rick Strassman MD performed the first new human studies with psychedelic drugs in the US in over 20 years. During that time, Strassman administered several hundred doses of DMT to approximately 60 volunteers. Unlike the ceremonial setting that accompanies an Ayahuasca ceremony, which incorporates chanting and singing, Strassman’s experiments were conducted in the sterile, clinical, setting of a hospital. How this may have affected the outcome of his research is unknown. He recounts his work on the effects of DMT in the book DMT: The Spirit Molecule, which has sold over 100,000 copies and became the subject of a documentary film. 3

The Future of Psychedelic PsychotherapyThe acceptance of meditation and mindfulness practices as practical tools for managing anxiety and depression is an indication that spirituality and psychology are finding a common language. Perhaps the rift between

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There are a number of considerations that the child interviewer must be aware of prior to interviewing the child and after the interview process has started. The very first consideration is obtaining the written consent of both parents.

In a low conflict separation, this is usually not difficult to obtain as both

parents seem to be quite reasonable and they can see the value of knowing how the children feel about the separation and obtaining their views on issues such as parenting time, residence and activities.

However, in high conflict separations, obtaining the written consent of both parents can be challenging and difficult. One or both parents may attempt to triangulate the child interviewer by asking them to interview the child without the other parent’s knowledge so that they can use this information in a litigation process to gain advantage over the other parent.

It is imperative that the child interviewer avoid this situation both from a professional code of conduct perspective but also from a clinical perspective where triangulation is unhealthy for the child. In the event that the child interviewer is not successful in obtaining the written consent of both

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On March 18, 2013, the Family Law Act replaced the Family Relations Act as the legal framework for all family matters in BC. One of the most profound changes is that the child’s best interests are the only consideration in settling disputes between parents. It is now a requirement that the child’s views must be considered “unless it would be inappropriate to do so.”

I anticipate that Registered Clinical Counsellors who conduct child therapy or provide Court involved services will be asked more and more frequently to offer their opinion on a child’s views as part of a litigation or collaborative process.

I believe this is a positive step forward for our profession as we increasingly come to be valued as experts in providing child focused information to separated (and separating) couples in conflict. My hope is that RCC’S will embrace this natural evolution in our professional role rather than distance from this responsibility because there is a risk of Court involvement.

This article is intended to provide practical information and tips for increasing your effectiveness in your role of child interviewer. It is based solely on my experience in interviewing children for Court/ Collaborative purposes in Family Law matters. I have authored over 120 ‘Views of the Child’ Reports and interviewed over 700 children as part of a mediation process in my role as mediator; as part of a collaborative law process in my role as a Divorce Coach; and in my role as a Parenting Coordinator. I hope that this article will stimulate greater awareness and dialogue in fulfilling these roles.

By Bob Finlay, MA, RCC, RFT, Contributing Writer

Obtaining Children’s Views for Litigation and Collaborative Processes

parents, an interview of the child must be ordered by the Court.

Other considerations include who is the best person to interview the child? If a child therapist has already established a positive relationship with the child, this person may be the most appropriate one to provide the child’s views as the parents can be assured

that the child therapist is a neutral professional who has seen the child over a number of sessions. The therapist can then obtain a more objective perspective regarding the child’s views over time.

In other contexts such as mediation, and where a child therapist has not been retained, it may be appropriate for the mediator as the neutral party to interview the child and provide that information to the parents

in the mediation session. However, the mediator has to be careful to explain the benefits to the parents and obtain their support prior to interviewing the child.

The mediator may want to elicit questions from the parents that they would like the child to answer so that they remain in control of the mediation process. Sometimes in a mediation process, if there is enough trust between the parents, and they agree not to place undue pressure on the child, I will suggest that the parents themselves, in separate interviews, talk to the child as long as there is agreement on the questions that will be asked of the child.

Another consideration for the child interviewer is the effect on the child of the interview itself. This is particularly relevant in separations where the child may feel a great deal of pressure from one or both of the parents to provide views that align with the

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parents’ views. The age and stage of development of the child as well as their coping abilities need to be taken into consideration in terms of the child’s ability to resist and cope with the negative effects of being caught in the middle.

The child interviewer may need to assess the child’s ability to retain their own independent views in the face of parental pressure and influence. Children in high conflict separations often feel caught in the middle of the parents’ conflict and this can be very stressful for them. Undergoing an interview can add to that stress and pressure and so the child interviewer has to be careful to ensure that the child is protected from negative conflict that is fuelled by the parents.

Another consideration for the child interviewer is whether the child can understand the issues for which they are being interviewed and whether they can form an independent opinion about each of those issues. This is dependent on a number of factors, the most significant of which are the child’s age and stage of development and cognitive ability.

In my experience younger children tend to have more difficulty understanding complex issues and therefore the questions posed by the child interviewer need to be age appropriate and designed to elicit responses that give the parents insight into the child’s world.

In situations where the cognitive ability of the child is impaired because of developmental delays or mental challenges, the child interviewer may need to modify their approach and assess whether the child can provide an independent opinion on each of the issues. In a recent case, I interviewed a teenaged child with autism and developmental delay. After spending some time with the child, I determined that he was not able to form an independent opinion and that he was heavily influenced by the opinions of the adults around him.

On the same file, his brother who also was diagnosed with autism but was much higher functioning, was able to provide clear and independent opinions about the issues at hand.

Therefore, in providing the information to the parents I stated in the Views of the Child Report that the views of only one of the children should be given weight by the Court.

Another consideration by the child interviewer is the child’s style of communicating and ability to communicate. Some children are very verbal and very articulate and a “talk therapy” approach is useful and appropriate. With other children, who may have a poor ability to verbalize their thoughts and feelings, a “play therapy” type of approach tends to provide information that gives us insight into the child’s world but with the use of symbolic means.

Another consideration for the child interviewer is to what extent the child may be influenced by one or both parents. In low-conflict cases, this tends to be less of an issue as both parents tend to be respectful of the child’s thoughts and feelings and do not perceive the child as a weapon in the war against the other parent.

Conversely, in high-conflict files, one or both parents may attempt to influence the child to align with them. The child will often show signs of having been influenced such as coming into the first interview and declaring a position on a particular issue without prompting from the interviewer. An example of this is a child I saw who came into the first interview and told me within one or two minutes of me introducing myself that he only wanted to live with his mother.

I have learned to follow a particular sequence or process in child interviewing. I have found that this process reduces the risk of the child being negatively impacted by the interview and as well I have found this process to be effective in gaining insight into the child’s world.

The first step in this process is to interview each of the parents and to gather background information about their separation, the issues in which they are seeking resolution, a description

of each of the children and a description of the children’s relationships to each of the family members.

I also ask the parent’s for their recommendations on how to connect with and relate to the child. I find that this first step is crucial in obtaining the parents cooperation in supporting the child interview and viewing it as a positive source of information.

In the event of a high conflict separation, I am able to advise the parents that it is not in the child’s best interests to attempt to coach or influence the child and that the information will be obtained in a neutral and objective manner. I find that most parents when approached in this way are cooperative in following those guidelines.

The next step in the process is to have each parent bring the child in for one interview. This helps me to assess whether the child responds differently to my questions when brought in with one parent as compared to the other. It also gives me the opportunity to note or to observe the parent child

interaction and the type of attachment that exists between the parent and the child.

The child interview is conducted without either parent present.

In my first interview with the child, I take time to engage the child by being friendly and warm, asking the child their understanding of why they are speaking to me, asking them what they have been told by each parent in coming to see me and then explaining to them in an age appropriate way, why their parents are seeking their opinion about particular issues.

If the child interview is for a litigation process, I will often explain to the child in an age appropriate way the role of the judge, the role of lawyers, and the fact that the information provided by the child will be shared with all of those parties.

If the child is anxious about the information being shared, I clarify


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what they feel comfortable sharing with other people and if there are particular pieces of information they want me to keep confidential. My experience is that it is rare for a child to tell me that they do not want certain kinds of information disclosed to their parents or to the Court.

I then attempt to tailor my approach and questions to the approach recommended by the parents and the age and stage and cognitive ability of the child. I also pay attention to the child’s body language, their tone of voice, and their facial expressions as I conduct the interview and adjust my approach accordingly. My goal is always to support the child in feeling comfortable and in feeling safe in the interview.

In my child interviews I usually cover topics that touch on all aspects of the child’s life moving from emotionally neutral subjects to emotionally sensitive subjects.

I discuss with the child their understanding of why they are being interviewed and what their parents told them about the interview, confidentiality, neutral topics of interest to the child such as where they go to school, the subjects they take in school, how they feel they have performed in school in each of those subjects and in school and out of school activities.

If the child feels particularly proud of an accomplishment, I will take extra time to ask them more detailed questions about why they like that activity and how they are able to do so well in that activity. This usually helps the child to feel supported by me and to feel a connection with me through my genuine curiosity and support of them. I then go on to discuss peer relationships and usually ask the child to tell me how many friends they have and to name some of their closest friends.

This gives me some idea of their friendship network and in particular their friendship network in each of

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their parents homes. This helps me to determine and assess how grounded and rooted the child feels in each of the

parents homes.

I then begin to move into what could be considered more sensitive topics. For example, I may ask the child their understanding of why the parents separated. Children respond to this topic in a variety of ways with some children saying they do not know and have no idea why their parents separated to other children who have a much more sophisticated

and detailed understanding of why their parents separated.

These children may have been told a number of details by one or both parents and this may have been helpful for their understanding of the separation, while, for other children, the disclosures may have had a negative effect.

The next topic I typically cover is what they like and do not like about being with each of their parents and living in each of their homes. I will ask them to give me examples of what they like and what they do not like so that I am able to clearly understand their preferences. I will often ask a child what they would like their parent to change.

Another topic I cover is the child’s extended family and the degree of support for them within that extended family network. I ask them about extended family members including grandparents, aunts, uncles and cousins, how often they have contact and what they like/don’t like about those relationships. Once again this gives me insight on how grounded and rooted the child may feel with each of the parent’s families.

A particularly useful tool in interviewing children is the Family Relations Test.

The child is asked to name all the people they consider to be family members. They are then read statements both positive and negative statements and asked to assign family members to each of those statements. This test is quite revealing in that it tells me how the child defines their family and the feelings they have for each family member as well as the feelings they perceive that family members have for them.

The most common issues in dispute between separating parents are where the child will live and how much time they will spend with each parent. At this stage in the interview I may ask direct questions such as “If you could tell the judge how many hours you would like to spend with each parent, what would you say?” Or an example of another question might be “Do you feel like you are spending too much, too little, or just the right amount of time with a particular parent?”

If I have developed a good rapport with the child and they are feeling safe in the interview, they will have no problem in answering these questions directly.

The last part of the process involves reporting the information to the parents, Counsel, and the Court. In the context of a mediation or collaborative process, the report is a verbal report that is often given at the beginning of the process.

I like to write down a lot of quotations from the child and report the quotations to the parents as this often helps them to connect to the child’s world without me editing or

interpreting the child’s responses to my questions.

Typically I will begin my report by complimenting the parents on the child’s strengths, in most cases the parents are quite devoted to the child and I will compliment them on what a good job they have done with the child because of these strengths. I will also report my


If you know of a person, or agency that qualifies to be nominated for an award in one of the following awards categories

please forward your nominations to: Coordinator Awards Program, [email protected]

BEV ABBEY VOLUNTEER AWARDRecognizes an Association member who has been active in services or management, and/or has actively

promoted the goals of the Association.

COMMUNICATIONS AWARDRecognizes a member or organization from the media field who has provided regular,

continuing, or special assistance in promoting counselling and/or mental health issues in the community.

PROFESSIONAL CARE AWARDRecognizes a professional mental health worker (who could be an Association member) or agency who has exhibited

special creativity and effectiveness in providing counselling or mental health care.

PRESIDENT’S AWARDRecognizes distinguished contributions to the profession of counselling or the Association.

PRESIDENT’S AWARDRecognizes distinguished contributions to the discipline of counselling through teaching, research, or advocacy.

Nominations must include the name and address of the person or agency nominated and supportive documentation.

The deadline is April 28, 2014

Awards will be presented at the Annual General Meeting, March 28, 2014 Coast Plaza Hotel & Suites at Stanley Park, 1763 Comox Street (near Denman), Vancouver, BC

Announcing the


31

Notice of Annual General MeetingFriday, March 28, 2014

We welcome and encourage all Members to join us as we celebrate our members, volunteers and dedicated supporters,

at our Association’s Annual General Meeting.

Annual Business Meeting - 3:30 pm to 5:00 pmReception & Members’ Forum - 5:00 pm to 7:00 pm

The Coast Plaza Hotel & Suites at Stanley Park1763 Comox Street (near Denman), Vancouver, BC

Nominations, Offices and Elections 2014Any registered member of the Association, in good standing, is eligible to stand for nomination

and vote for candidates. Members should stand for one position only. Regional Vice-Presidents are nominated and voted for by members in their region.

Following is a list of Board positions open for 2014. Under current Bylaws directors will hold office for a term of two years (currently under review, with a proposal to go to three-year terms).

Interested candidates will be aware of the transitional times that the Association is moving through, and the many challenges before us.

All Board positions are very time and work intensive and candidates must be able to make a sizeable time and energy commitment.

The following Board positions are open:President Elect

Chair, Member ServicesCommittee Chairs: Discipline, Inquiry, Continuing Competency, Registration

Regional Vice Presidents: Region 2, Region 3, Region 5Successful candidates will assume office at the Association’s Annual Business Meeting, March 28, 2014.

Nominations and Elections ScheduleCall for Nominations: BCACC NEWS Winter Issue December 2013

Nominations Deadline: February 7, 2014Ballots: Out: Feb 28, 2014

Deadline for Return: March 14, 2014Report to Annual Business Meeting: March 28, 2014

Position Descriptions, Nomination Forms, and Biographical Information Forms are available and distributed through the Victoria Office, 1-800-909-6303 or E-mail: [email protected]

The following positions continue for 2013: Executive Vice-President: David PatersonChair, Ethics and Standards: Clive Perraton Mountford Chair, Legislative Review: Glenn Grigg

Vice-President, Region 1: Chris StasiukVice-President, Region 4: John FraserVice-President, Region 6: Brian Bulgin


After a few moments of settling, I asked Tom what had helped him manage while he was in jail. He talked about thinking about his two little girls. I encouraged him to tell me more about them; their personalities and the things they liked doing. I asked him what it was about being in church that was helpful for him. He described a sense of calm and well-being and an overwhelming feeling of connection and support. As he talked, he described a sense of spreading warmth, tranquility and strength in his body.

“What would it be like to imagine yourself sitting in your church right now?” I asked. With drying tears, a huge grin spread across his face and with a look of astonishment he said “I could go there any time, couldn’t I!” As we headed back to the clinic after lunch, we saw Tom walking along the street, food bags in hand, still with a big smile on his face.

Listening with an empathic, open heart can be more supportive and effective than any therapeutic technique in the early stages of traumatic upset.

The overriding result of trauma is that resiliency is compromised. Our usual interpretation of physical resiliency is that it relates to our ability to function physically – walk, talk, eat, sleep - but in the context of the experience of trauma we, as therapists, are more concerned with internal resiliency, the physiological state of the central nervous system which is responsible for our overall health and sense of well being. It is the system which, in the event of trauma, is activated to protect us. If a regulated condition of resil-iency is not re-established post trauma, that hyper-vigilant state remains to be triggered when traumatic events are remembered or re-occur.

As therapists, we have the ability to support the calming and repair of that activation in those with whom we sit. By asking Tom to ground himself, he was able to come back to the present moment and ease himself toward more internal calm. Because of the hectic circumstances in which many people in New Orleans were living and working, they found this ability to find a few minutes of composure and quiet invaluable.

In previous visits to Africa I had conceived of a bead project which encouraged children and adults to talk about the things in their lives which provided them with a sense of comfort and support. In Kibera, a huge slum on the outskirts of Nairobi, Kenya, I spent two days with a eighteen HIV positive women. Sitting in a circle around a table, I asked the women to string small beads onto some line. Then I asked the question “What person in your life has given you hope when times have been difficult?” Once they chose someone, I asked them to pick a larger, fancier bead to represent that person on their string of beads. I ask more questions about that person. How did they support them? When? Where? As they answered the questions they explored their feelings around their choice more deeply. “What place has provided you with a sense of hope and support?” and then, “What thing brings strength and comfort to mind?” Interspersed with seed beads, they placed a large bead to represent the answer to each question. The end result: A simple bead bracelet with three larger beads to remind them of the person, place and thing which had sustained them in difficult times. The

“Yes, God has.” Her faith, so buried in the onslaught of these traumatic events re-emerged. The next day she left the hospital not to return again.

Trauma creates the experience of overwhelming helplessness which compromises our ability to make choices and destroys our ability to feel empowered. I believe that if we suffer we can begin to assume, unconsciously, that we deserve the bad things that happen to us. This lack of a sense of personal efficacy can be a crippling result of trauma. By listening, not to the facts of the surrounding events, but to the emotion underlying them; the anger, the grief, the sadness; our intention and our presence can have a profound and healing impact on this all-pervasive shame.

As support people, we can reconnect people with those things that provide a sense of connection, aliveness and safety; we can offer them the awareness of alternatives to suffering even if the suffering does not end. The reminder of the “good things in life,” no matter how small, may escort a client along the path toward the re-establishment of emotional capacity and resiliency.

St John’s Community Center in New Orleans provided financial and medical support to people who had few resources in the aftermath of hurricane Katrina. I had been asked to spend the day there providing supportive care to some of the people waiting for these services. I noticed a man sitting slumped silently in the lineup of people. I went and sat beside him. Tom said that he had a sore arm. I asked him how he had been injured. He began to tell his story and soon after he covered his face as tears streamed down his cheeks.

Tom, an African American, his wife and two little girls had been evacuated to San Antonio, Texas after losing everything they owned. Once relocated, he went one day to sit in a chapel to “talk to God.” When he entered the chapel a policeman, already there, approached him and told him that he was trespassing. Tom responded by saying that the chapel was open; he had seen no signs saying he could not enter. The policeman left. Tom sat enjoying the quiet. As he left the chapel he was ‘jumped’ from behind by four policemen. They beat and handcuffed him. Tom was charged with assault and spent eight weeks in jail. (Post hurricane racism toward non whites in Texas was a commonly acknowledged occurance.)

It was apparent to me that Tom was experiencing the past; I asked him to sit quietly for a moment, to feel his weight in the chair and find where he felt the most comfort in his body. I asked him to notice his breath and to look around to orient himself in his present environment.

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Continued from page 11



33

BiographySu Russell has a private practice in Victoria. Life transitions and trauma are among the focal issues of her work. She has volunteered as disaster outreach worker in New Orleans and in Africa as a volunteer for positivelyAFRICA/VIDEA. Su can be reached at [email protected]. Her website is www.surussell.com.References1. Kearney, M. K., Weininger, R. B., Vachon, M., Harrison, R. L., Mount, B.M.,(2009) Self-care of physicians caring for patients at the end of life: Being connected ...a key to my survival., Journal of American Medical Association, 301, (11) pp 1155-11642. Harrison, Richard L.; Westwood, Marvin J., (2009) Preventing vicarious traumati-zation of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, Vol 46(2), pp 203-219.

women then paired up with their neighbour and each shared their bracelets with the other.

In their history of trauma, their isolation, poverty and illness had defined who they were, to themselves and to their neighbours. By sharing their personal resources they began to see how individual and alike they were and how they could support each other. By sharing with other people in their community, they witnessed each other’s struggle with many of the same or similar issues. For some it was the first time they had talked of their HIV diagnosis or found understanding and empathy in their community. This small bracelet remained on their wrists to be a visible reminder of their personal resources.

Human connection and empathy reduce that sense of aloneness and terror which accompanies trauma. By connecting, we see ourselves in others and recognise our humanness. We dilute the intensity of isolation.

Resiliency is our original state of a healthy physical, emotional and spiritual balance. Trauma compromises our nervous system’s resilience which affects our overall sense of wellbeing. In order to re-establish resiliency we need to be reconnected to our grounding, our resources and to one another. To be present to others we need to be settled and grounded ourselves. To be present we need to maintain personal boundaries and to know when to attend to our own self care. Connected, reciprocal relationships may prevent compassion burnout in healthcare workers.

Trauma therapists with the protective practice of exquisite empathy were “invigorated rather than depleted by intimate professional connections with traumatized clients.” Exquisite empathy was described as a “highly present, sensitively attuned, well-boundaried, heartfelt empathic engagement.”1

Witnessing can be a healing connection which can transcend the boundaries of culture, language, time and circumstance.2 It can offer an experience which is enriching, energizing and empowering for both parties in a verbal, at times even non-verbal, dialogue. Like a sustained sound wave our settled presence may provide and deepen the experience of an internal and external sense of calm.

We can witness and validate the experience of another and give it meaning. By noticing their being – the totality of who they are – we can connect with them, and they to others, and begin to repair the sense of despair which accompanies trauma.

So sit with people. Listen to them with your open heart. What is it that they are really saying, buried in among the facts of their situation? What do they turn to when they are overwhelmed? What gives them hope, a sense of connection? How do they find comfort and peace in their presently chaotic lives?

Know that your absolute presence, in and of itself, is often enough to begin to re-establish resiliency and the felt sense of community in others.

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access’ to aggression can also serve as a way to coerce the other to ensure psychological nutriment.

In contrast to the exhibitionistic disorder, the intra-psychic structure of the closet narcissist differs. It seems to be both dependent on, and even vulnerable to the other. The grandiosity of the self is protected by the projection (onto others/the therapist) of the idealized, all good, object and then the ‘basking in the glow’ of that object: Because you are perfect, great and accept me, I too must be great. This dynamic causes greater variance in mood, and closet narcissists thus have greater ‘access’ to dysphoric affect and depression.

When the object(s) fail, the closet narcissist may project the attacking internal object onto the external object and in turn feel attacked, humiliated and fragmented. Finally, in the case of the devaluing narcissist the much needed grandiose self and the idealization of the other seems absent, and rather what is evident is an active state of deployment.

Given the reliance on a continuously activated grandiose unit, one comes to truly grasp the difficulty narcissistic patients have with depression and human failure. The elements of the abandonment depression experienced by the narcissist are similar to that of the borderline- suicidal depression, homicidal rage, panic, guilt, hopeless-ness, helplessness, emptiness and feel-ings of void. Clinically it seems evident that depression is not easily accessed or felt by the exhibitionistic narcissist due to the grandiose defensive

structure, whereas the depression experienced by the closet narcissist contains feelings of shame, humiliation, and falling apart. Envy is very present in narcissistic disorders as well as feelings of rage. Active avoidance of the experience of depression/mourning can be a true stumbling block in therapy.

Differential Diagnosis and Therapeutic Intervention

Given the developmental realities it is clear that addressing the narcissistic dilemma requires great sensitivity over extended periods. For those struggling with the narcissistic dilemma it is the interpretation of the narcissistic vulnerability that is relied upon and follows the following algorithm;

(a) Pain: During this part of the interpretation the therapist actively identifies and acknowledges the painful affect the patient is experiencing. (b) Self: The therapist focuses on the impact on the patient’s self-experience and thus illustrates understanding.(c) Defense: The therapist then identifies and focusses on the defense(s) the patient is using to protect, defend, and sooth the self from the painful affect.

Examples of Pain-Self-Defense: The Manifest/exhibitionistic narcissistic type:

The patient, Matt, who invested much of himself in his work, rages against his boss after being given feedback that his work needs more attention. Matt argued that his boss is ‘an idiot,’ unable to see his ‘special contribution’ and only envious of his accomplishments. In reaction to his boss’s ‘stupidity’ Matt thinks of quitting his job and going to work for the competition;

“Matt, your work is very important to you and the feedback must have been very painful to hear (pain). You need good feedback to feel good about your contributions and be seen as someone with important knowledge (self), and since it did not happen you are very angry that your boss did not see your work in the same way you did. To

protect yourself from your feelings you want to walk away and work for the competition, to hurt your boss the way he hurt you (defense).”

Closet Narcissistic Disorder of Self:

A patient, Gary, would make important observations about his behavior, thoughts and feelings, but when he did so he would frequently turn to the therapists and ask, “Is that right?”

The response could be: “It is difficult for you to explore your own thoughts and feelings and trust yourself (pain). I wonder if you start feeling insecure about yourself, vulnerable and extremely aware of making a mistake and so disappointing me (self). To protect yourself from these feelings you turn to me to make the decision for you (defense).”

Devaluing narcissistic disorder of self:

Julie was raised in a family wherein she was continually humiliated and made to feel powerless and inadequate. Frequent anger outbursts (usually after a disappointment or feeling ‘stupid’) threatened her work as well as her family life. Despite the therapist’s best intentions, Julie would turn on him and make him feel powerless and unimportant:

“You had to learn to be independent to survive being made to feel powerless and ashamed. It must be frightening to be in another relationship with someone where it could happen again, where you could feel exposed (pain and self). To protect yourself from this situation you put me down and ignore my attempts to reach you in the hope that I will do what others did and turn away from you (defense) thereby leaving you in power.”

Conclusion

It was the aim of the current paper to introduce the reader to the developmental, self and object relations view of James Masterson in understanding the narcissistic dilemma and the various variations it may take. It is hoped that the


A Mastersonian View of the

Narcissistic Dilemma


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conceptualizations given may further clinical intervention and support clinicians in understanding and treating those caught in narcissistic dilemmas with greater compassion and empathy.

BiographyLoray Daws PhD is a psychoanalytic psychotherapist in Comox Valley, Vancouver Island, British Columbia. He currently serves as faculty member at the International Masterson Institute and the Director for the BC Masterson chapter. He has published on the Rorschach Inkblot Method as well as pain, eating, personality and bipolar disorders. Loray also currently serves as assistant editor for the Global Journal of Health Science. Contact; [email protected].

ReferencesLieberman, J. (2004). The Narcissistic personality disorder. In J.F.Masterson & A.R. Lieberman (Ed). A therapist’s guide to the personality disorders. The Masterson Approach. A handbook and workbook (pp.73-90). Phoenix, Arizona: Zeig, Tucker & Thiesen, Inc.

Masterson, J.F. (1993). The emerging self. A developmental, self, and object relations approach to the treatment of the closet narcissistic disorder of the self. New York: Brunner/Mazel publishers.

act of perceiving one’s personality is an imaginative act in itself (p.67). Csíkszentmihályi further formalizes this role of creativity for enhancing

personal psychological well-being in his work on “flow states,” (1996) which he characterizes as a feeling of energized and inspired full immersion in a creative act. In the words of Oscar Wilde, on the topic of aesthetics, “by beautifying the outward aspects of life, one would beautify the inner ones,” (1988, p.164) and perhaps the same connection exists regarding creative expression in general.

Archetypal Music Psychotherapy relies on the notion that the creative process is a “living thing implanted in the human psyche,” and that “art [and presumably all creative expression] represents a process of self-regulation (Campbell, 1971, p.313).” Jung (1954) implies that our life tensions, though necessary for potential growth, are often due to failures of creativity and an overvaluation of polarizing logical processes. He recommends that we find a way to “powerfully constellate the opposites” in order to engage the psyche’s self-regulating dynamic transcendent function to bring a relational union between consciousness and that which is still unconscious.

Within an appropriate therapeutic setting the brilliance of a client’s psyche can activate these oppositional archetypal images, which we can then translate together into the language of the present. One of the common images that clients report after engaging in a creative “flow state” process involves the sense of returning to a deeply familiar life-affirming place.

As a client and I make music together, manifesting our hazy inner world into sound, we can often hear, feel and sometimes even see more clearly aspects of an underlying dynamic that may have had a powerful but secret influence for a long time. This process of transformation from unknown to known can be observed through changes in somatic sensations and mental/psychological states and through the awareness of shifts in energy level and these changes can be identified, articulated and communicated.

In recent years I have had the good fortune of being able to present this

Archetypal Music Psychotherapy work internationally in places as far reaching as Brazil, New York, Califor-nia and across Canada and one thing it has taught me is that we have only begun to scratch the surface of how music and sound-based methods can be effectively integrated into our work as counsellors and therapists.

This voyage of self-discovery through musical processes can lead to the development of empathy, an increased ability to integrate difficult emotions, enriched relational abilities, expanded awareness, increased self-confidence, a deeper sense of meaning, and a renewed connection to one’s own creativity. One of the unique gifts that comes with doing this musically is that it can also be fun.

BiographyJoel Kroeker RCC, MA, MMT, MTA is a CVAP-certified Registered Clinical Counsellor, a Music-Centred Psychotherapist and the founding international workshop facilitator of Archetypal Music Psychotherapy (AMP). He serves on the board of the Vancouver Jung Society and is an international recording and touring artist on True North Records. He currently divides his time between his clinical practice in Vancouver, pursuing post-graduate studies at the C.G. Jung Institute in Zürich and lecturing at various universities across Brazil and North America. Feel free to contact Joel by email at [email protected]. For more information about Archetypal Music Psychotherapy please visit his website at www.joelkroeker.com.

ReferencesCampbell, Joseph (ed.). (1971). The Portable Jung. Penguin Books, New York, NY.Csíkszentmihályi, Mihály. (1996). Creativity: Flow and the Psychology of Discovery and Invention. New York: Harper Perennial.Hillman, J. (1989). A Blue Fire: Selected writings by James Hillman. Thomas Moore (Ed.). New York: Harper Collins.Jung, C. G. (1954). Collected Works. Vol. 7: The Function of the Unconscious. Princeton, Princeton University Press.Jung, C.G. (1985). Synchronicity. London: Routledge.Wilde, Oscar. “The English Renaissance.” Quoted in Ellman, Richard. Oscar Wilde. New sYork: Knopf, 1988.


ArchetypalMusic

Psychotherapy


Dancingwith pain

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By Mavis Lloyd, PhD, RCC, Contributing Writer

A Review of the documentary:

Medical science, with its many types of treatments, had been unsuccessful in resolving their pain. They all had emotional issues based on their predicaments which had not been previously addressed. Leora’s clinical interviews with them revealed a vital need for each of them to feel understood and then to explore new avenues for pain reduction. Counselling included teaching pain reduction techniques with mind and body relaxation via breathing, visualizations, hypnosis, etc.

The film unfolds in a fascinating way with a sequential pattern of a theoretical statement, followed by the animation of the brain’s central role, then its embodiment through dance. Every sequence concludes with the teenagers telling their experiences from initial connections, listening to their stories unfold, then being led into new and different stages of their healing with their chronic pain team.

After the film screening, the discussion between the audience and members of the production team gave us a fascinating glimpse into the intricacies of producing the finished film. Leora described the process from the

conception of the initial seminal idea to the creation of the team of specialists needed for the film’s production. This made all of us aware of the incredible support provided by the team members to produce this 20-minute masterpiece. A mother of one of the teens told us all how thankful she was that her daughter was able to get over her pain. The teens in the film concluded that they had changed through their pain and that, though they were initially reluctant to attend psychological counselling, once they were helped, they were all very grateful.

“Dancing with Pain” which was released in July is an invaluable addition to the libraries of any professional collection in the health/healing/ education fields, and is especially useful for anyone who works with the adolescent chronic pain population and their families.

Running time 20 minutes (therefore ideal for classroom or group presentation/discussion)

Purchase: www.bookstore.cw.bc.caFor information, contact Dr. Leora Kuttner at [email protected]

A Review of the documentary: DANCING with PAIN, by Dr Leora Kuttner with choreographer Judith Marcus, edited by Mo Simpson with original music score by Hal Foxton Beckett.

The topic of exploring pain management through the lens of dance is Leora’s latest unique contribution to our understanding of managing pain. Leora’s previous award-winning documentaries on pediatric pain management, “No Fears, No Tears,” “No Fears No Tears – 13 Years Later,” and on pediatric palliative care “When Every Moment Counts,” with the National Film Board of Canada are previous invaluable resources.

“Dancing with Pain” has the same goal as her previous films, namely to inform and support both professionals who treat patients, and families who experience pain in their lives. This time, with the aid of a team of dedicated experts, she explored the life and treatment of four teenagers, two from Toronto and two from Vancouver, each with different origins for their chronic pain, each coming to grips with its impact on their inner selves, and on their social and their career lives.


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2014 Application for Membership Renewal

DUE January 1, 2014Have you received your Application for 2014 Membership Renewal package? All renewal packages were mailed to members in November. Complete membership renewal application packages are due, with payment, on January 1, 2014. Contact Head Office 1-800-909-6303 or [email protected] if you have not yet received your package.

Upcoming Head Office Closures

December 23 to 27, 2013, inclusiveWednesday, January 1, 2014Monday, February 10, 2014

Friday, April 18, 2014Monday, April 21, 2014

RCCs Striding for Mental Health All Across Our Province

Are you a runner or walker?

This year, BCACC will continue to sponsor members and staff to participate in the Vancouver Sun Run and the Times Colonist 10K by paying half the entry fee and providing team technical shirts.

Contact Aina if you would like to join a team, or coordinate a team in your community.

We are happy to announce that we are extending the team to the rest of the province. If there is a race in your community, and would like to volunteer to coordinate a BCACC team, please contact Aina in Head office. [email protected]

own personal responses to the child such as I found them entertaining, or I found them to be very intelligent or I enjoyed their sense of humour.

Where a ‘Views of the Child Report’ is required, I will summarize the reasons for the report, provide some background

information and then report the child’s views on each of the topics in dispute. It is important to report the content of the child’s responses as neutrally as possible. Providing quotations from the child is one way of doing this.

I also find it useful to report to the parents either in a report form or in verbal format, my interpretation of what the child is trying to communicate. This sometimes requires me to intuitively sense how the child is feeling about the situation and particular issues.

I use my clinical skills including my ability to assess the content of the child’s responses but also their non-verbal cues and the feeling sense I have in spending time with them. Parents and the Court often find this very useful because I am providing insight into the child’s inner world and how they are responding to the separation.

The Family Law Act presents us with an opportunity to be the voice of the child in a legal context. Lawyers, Judges and Mental Health Professionals are being asked to integrate their different perspectives in order to help families going through separation. I hope that this article will stimulate

your imagination as to how you might “stretch” your practice to incorporate family law roles that are best filled by mental health professionals and are of service to the justice system.

BiographyBob Finlay is a Registered Clinical Counsellor and Registered Marriage and Family Therapist with 40-years of experience. He is a qualified Family Mediator with Mediate BC, a Child Protection Mediator with Family Justice Services, a Parenting Coordinator with the BC Parenting Coordinator Roster Society and a Divorce Coach. He authors Views of the Child Reports and is an inaugural member of the BC Hear the Voice of the Child Roster.

As well, he authors Section 211 Custody and Access Reports. Bob has been interviewing children who are experiencing the effects of separation and divorce for the last 20 years. He is a member of the Westminster Law Group, a collaborative family law firm in New Westminster. He can be reached at [email protected] or by calling 604-780-7945. His website can be found at finlaycounselling.ca.


Obtaining Children’s Views for

Litigation and Collaborative

Processes


Membership Update

To find out who among your colleagues has joined, moved on, or changed membership status, log into the Member Portal (https://bc-counsellors.secure.force.com) and visit the Membership Status Update link.

Resource Library

To borrow books, videos or DVDs, contact Carly at 1-800-909-6303 ext 3, or e-mail [email protected]. We have recently updated our library. For a complete listing of all Resource Library holdings in Head Office, log into the Member Portal (https://bc-counsellors.secure.force.com) and visit the Resource Library Holdings link.

BC Association Of Clinical CounsellorsMember Orientation Workshops

New members of the BCACC receive a Welcome Package containing a variety of information and resources to get them started. In addition to the Welcome Package, the Association offers a six-hour experiential orientation workshop which is held on the Lower Mainland and on Vancouver Island at various times of the year. The Board expects all new RCCs to attend the workshop within two years of joining the BCACC.

This event is designed to introduce new members to the Association’s structure, including member-support and regulatory functions, and to provide an update on the future direction of the counselling profession in B.C. Long-time RCCs are also welcome to attend. Attendance is free of charge, but advance registration is required. All materials, together with refreshments and a light lunch, are provided.

2014 Member Orientation Workshop Schedule

February – Region 2April – Region 6May –Region 4September – Region 1November – Region 5

Details about upcoming workshops and venues are broadcast from Head Office via e-mail. Note: there is an online version of the Member Orientation Workshop, for RCCs who are unable to attend a face-to-face version. The password for online access is available from Head Office.

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Workshop Presenter: John Gawthrop, MA, RCCJohn has a counselling background going back 30 years. He is Deputy Registrar of BCACC and is a past Chair of Ethics for the Association. He has conducted ethics investigations for BCACC since 1997 and is a certified regulatory investigator. In addition, John has delivered ethics training and consulting in academic and private sector settings since 1994. He designed the Orientation Workshop and drew from his knowledge of and history with the varied aspects of the Association in creating and/or editing the informational and experiential components of the day. The intent is to provide a well-paced and lively experience that will be of lasting relevance to new and current RCCs alike.

Insurance Information

The Mitchell and Abbott Group of Hamilton, Ontario, is BCACC’s Broker of Record for Professional Liability Insurance (Errors & Omissions) and Office Contents/Premises Liability Insurance for Members of BCACC. The annual Renewal date for your insurance policy is April 1st.

For information contact Brad Ackles at:The Mitchell and Abbott GroupInsurance Brokers Limited2000 Garth Street, Suite #101Hamilton, Ontario L8V 5C4Toll free 1-800-461-9462 or (905) 385-6383 Fax (905) 385-7905. Or contact Brad by e-mail [email protected]

HMR Employee Benefits Limited (formerly Pullen Insurance Agencies), Victoria, covers the BEN-I-FACTOR GROUP INSURANCE PROGRAM available to BCACC members. This program offers Dental Benefits, Extended Medical Benefits, Disability Insurance and Group Life Insurance. For information contact Rick Reynolds at:

HMR Employee Benefits Limited 220-2186 Oak Bay AvenueVictoria, BC V8R 1G3Toll free 1-888-592-4614 or (250) 592-4614 or by Fax (250) 592-4953

If you have any concerns or complaints about BCACC’s insurance brokers or policies please contact Aina Adashynski in our Victoria Office at [email protected] or phone 1-800-909-6303 ext. 4.


39


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Back Issues Online

Looking for an article you once read – or wrote – in an old issue of IICC? You can find PDF copies dating back to Summer 1999 at: www.bc-counsellors.org/iicc-magazine.

December 2013 BCACC News

Please be advised that the December 2013 BCACC News will be posted online for this issue of Insights Into Clinical Counselling. The December 2013 BCACC News will be posted under the IICC Magazine section of the website.

Subscriptions

Subscriptions for Insights into Clinical Counselling are available at a cost of $21.00 (incl. GST) for three issues. Please contact BCACC Head Office for particulars.

Important Notice to All Members Changing

Membership Status

When you need to change your Membership status, particularly when going from Inactive to Active, (i.e., resuming practice as an RCC) please notify Head Office at once. It is also important that you contact Mitchell and Abbott Insurance to ensure that you have the proper professional liability coverage before commencing private practice. Inactive insurance only provides you with coverage for counselling you undertook prior to the onset of your inactive policy.

Head Office verifies all changes in status with a letter of confirmation of the status change. Status changes are reported monthly to the Membership via the Member Portal.

Disclaimer!

Except where specifically indicated, the opinions expressed in Insights into Clinical Counselling are strictly those of the authors and do not necessarily reflect the opinions of the BC Association of Clinical Counsellors, its officers, directors, or staff.

The publication of any advertisement by the BC Association of Clinical Counsellors is not an endorsement of the advertiser, or of the products or services advertised.

The BC Association of Clinical Counsellors is not responsible for any claims made in advertisements. Advertisers may not, without prior consent, incorporate in a subsequent advertisement the fact that a product or service has been advertised in a publication of the BC Association of Clinical Counsellors.

Many thanks to you all for your contribution to the success and growth of our Association over the past year.

Together, our 2800 members are an incredible force for peace and positive change, and an essential resource to individuals,

families and communities across BC.

We wish each of you a wonderful holiday season and hope you have an opportunity to take time from the busyness of life

to spend time during the holidays with family and loved ones, to share a meal, or just be together.

Wishing you all a restorative, festive and healthy holiday season and a Happy New Year.

From the Board and staff of the

BC Association of Clinical Counsellors Enhancing Mental Health All Across Our Province

COUNSELLING...Insights into Clinical Counselling By Michelle Morand, Editor Note from the Editor 3 W...

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Transcript of COUNSELLING...Insights into Clinical Counselling By Michelle Morand, Editor Note from the Editor 3 W...