It's Been a While

Dear Readers:

It's been a while.

Since last fall, I've been devoting my efforts to the Facebook page for our Caring for Self while Caring for Others series.

I'm still thinking about many of the themes that arose during the years I was working on this blog.

If you find your way here, please pay a visit to:

https://www.facebook.com/WhileCaringForOthers/

And please let me know if there are any ideas, topics or causes you would like to see covered either on the Facebook page or on Wild Psychotherapy Frontiers.

Wishing you all aliveness, connection and the flourishing of your unique Embodied Spirit.

Harry

Recognition

Like most, I remember where I was on the morning of September 11^th, 2001.  The historical moment occurred during a quiet and transitional period in my life, what Joan Borysenko calls liminal time, the moments between no longer and not yet.

I’d just left an obscure French movie at the Toronto Film Festival, which featured, among other things I forget, the presence of a witch doctor.  

I stepped out of the Cumberland Cinema in downtown Toronto and could sense something foreboding in the atmosphere.  The mood of the early day seemed pensive, introspective, slightly foreboding.  I don’t remember how long it was until I heard someone speak aloud about the events in New York City.  It wasn’t very long - news like that travels quickly on the currents of our instinct-driven, subcortical brains.

The events of 9/11 brought a sudden awareness of, and interest in, the role of first responders.  For some time, a new generation of heroes ascended the center stage of human interest.  They had their brief walk of fame, which would wax and wane for months, and last perhaps years after the last ashes of the burning, then burned, twin towers had cooled.

I remember hearing about Canadian paramedics heading down to New York, in a spontaneous upwelling of pride and willingness to serve.  Many Canadian emergency physician colleagues also stood ready to travel south and devote their energies and skills.

Some days later, one of our newspapers (the National Post, I believe) published a full page advertisement honouring first responders and emergency department staff.  At the time, I had my personal computer inside a narrow work cabinet.  I placed the ad on the inside door, where it lived for over a month. 

I was surprised then how touched I was by seeing such profound public acknowledgement of the dedication and sacrifice that characterized emergency medical responders and emergency department staff.  It wasn’t that I’d felt deprived of respect before that moment.  It didn’t really bother me much when people asked when I would become serious about my medical career, or when I confronted the general lack of respect for emergency physicians within the medical establishment.  Whatever deficiency of praise existed then had always been balanced by the amazing community that existed in every emergency department.  Within our small world of heightened urgency and intimacy, each day brought its fresh blessing of connection and the opportunity for shared acts of care, kindness, skill and courage.

Somehow, though, the ad touched something deeper in myself, something that – at the time – it was okay to feel without absolutely understanding.

EMS personnel I have known, both as an emergency physician, and later through my interest in PTSD, remind me of the uncertain and uncontrolled environments they frequently face.  And it’s so true.  If I was to set the archetypal stage of an emergency physician, it would be displayed in the moments before the arrival of critically ill or injured patients, standing gowned and gloved in an empty trauma room, with all the supplies there and ready to go: intubation equipment and rapid induction drugs, central line and chest tube sets, highly skilled nurses stationed at their own respective places.  Excitement, calm, the senses gathered together in a familiar state of high preparation.

I can only imagine the scenes that face paramedics on scene.  Dead bodies in their final positions post-suicide, homicide, or other cause of death.  Asthmatic children gulping air through pursed lips in filthy apartments.  Overweight cardiac patients awaiting carriage down narrow flights of stairs.  Dangerous scenes; hostile onlookers.  Abused infants and children in the native scenery of their misery.

Before starting to write this afternoon, I looked for something like that ad I’d so long ago posted next to my desktop computer.  I could find many images honouring first responders, and some honouring emergency department nurses, or even emergency department staff.  But nothing any longer connecting E.R. staff and first responders in a single web of camaraderie and service.

As I return to my old memories, I wonder what went through the minds of the medics as they brought in the most critical of their patients.  Did they believe in the capabilities of the E.R. at the end of their run? Did they believe in us?  Did they ever arrive and wonder which E.R. physician was working?  What did they think when they knew it was me?

I know that things are different now.  There’s a lot more distance between E.R. staff and first responders.  Emergency departments are overcrowded, and often chaotic.  A resuscitation in the field and ensuing hospital run is often followed by an unacceptable wait.  It must be terribly frustrating for the medics, to sometimes discover a lack of urgency in the hospitals that await their patients.  As I write now, I wonder if I can even start to imagine.  To be out in the field, amidst the unknown and unpredictable.  There must be such a powerful need to know that body bleeding out from a stab wound, or that flat, shocky child in septic shock is going to a place where expert help is available.  To stop believing in the E.R.s must feel like a bad nightmare to those EMS providers who put their very soul and being on the line.

And I imagine it cannot be that much better for the E.R. staff themselves, when they feel less a part of something magical and intact.  When my mother was early on in her year of suffering from metastatic cancer, she spent some time at North York General Hospital.  She had a kind and conscientious emergency physician, and she mentioned to her that I had also worked for a long time in emergency medicine.  And, of course, there’s the kind of questions that follow that kind of admission, the need to determine if indeed I really was legit, and where I worked, and so on.  My mom’s attentive doctor seemed surprised at the length of time I’d spent doing full-time E.R.  She mentioned that the current lifespan of an E.R. physician in my province is now six years.

And this leads me to say this:  To come to this broken system with a heart of gold and the desire to make the world a better place, breaks the hearts of those who most desire to serve.  We call this moral distress and burnout these days.  But it’s worse.  It’s seeing beneath what the blind eyes of popular culture and the distracted sensibilities of our contemporary age miss, gazing into the emerging betrayal of truth and human goodness. 

Last year, about this time, I published a post on feeling “felt.”  Today I write about feeling recognized.  Is there a difference?  I think of the thirty-eight Canadian first responders and twelve military personnel who died by suicide this year.  I wonder if, on a certain level, our collective ability to feel others and to recognize on an individual level is eroding.  When I think about the full-post ad, I think of a collective recognition of bravery and valour.  And yet, like any war veteran who’s been at a few medal ceremonies will tell you, that kind of recognition very quickly shows its dark underside, its shallow rhetoric.

I remind myself that every individual who put on a uniform, whether firefighter, or cop, or paramedic, or E.R. physician or nurse – started with innocence and a dream, and a hope.  Somewhere they discovered an aptitude and a calling.  And each and every one of us have a story of our own.  We need both the collective story and the individual one.  We need to be recognized and felt for the moments we worked seamlessly as a team, and for the sleepless nights that found us bleakly and profoundly alone.

  

Ten Years After – The Last Emergency Medicine Shift.

Last May, I decided it was the right time to write some reflections on the two decades plus I spent in emergency medicine.  A band from my teen years came to me, Ten Years After.  Then came their song, I’d Love to Change the World.

I wrote a close friend in Athens and told him I had the song.  He knew what I meant.  After the song, there would be connections.  And after the connections, there would be words.

I waited.  I learned that Alvin Lee, the lead singer and wild guitarist of Ten Years After, was dead.  I mourned him.

And still no words.  No story line.  A few images.  Lumbar puncture, infant, H. Flu on a gram stain; IV ampicillin and chloramphenicol.  Seamless teamwork, efficiency.  A mostly happy, distant world.

Sitting here now, feeling an internal deadline approaching (the year’s end), I ask myself why the story is so hard to access.  And I think there are twenty-two years of full-time E.R., demanding testimony.  And it all happened so fast.  The pace wows me as I look back from here.  How do I capture this fabric of experiences, describe the settings and amazing co-workers, the transformation within and without?  Two decades. Two very different emergency departments?  Pain, elation, hope, disillusionment, the whole raw spectrum of sensation and emotion.

I did my first ER shift in early July, 1983.  I’d finished a rotating internship in Toronto.  After four years of medical school and a year of internship, I still loved medicine, although I was already feeling estranged from the medical culture attached to it.

How did I get there?  Already, thinking back, I can see the messiness and humanity of a personal process that probably could not happen in today’s more sterile, more regulated and less vital world of medicine.

There was a point where I really dug medicine, the kind you find in crazy thick textbooks.  I liked lists of differential diagnoses and etiologies.  I could have drifted into internal medicine under the right conditions, perhaps, there was a leaning in that direction for a while.  Something, after all, did compel me to subscribe to a year of the esteemed New England Journal of Medicine.  And yet it faded.  I was reading a lot of fiction, and doing some writing then, and maybe I just had a hard time sitting with staff physicians who showed off book trivia concerning books they’d never read or fully grasped.  That was not the kind of doctor I wanted to be.  I wanted real, I wanted every moment of my career to speak for itself.

And I think it went deeper.  I was angrier, more alienated, in ways that extended beyond the world of medicine.  For whatever reason, the E.R. found me, more than I found the E.R.  I found myself shirking retractor holding duty in the O.R. or attending M&M rounds when I could be seeing patients in the ER.

I finished my internship with an ICU elective, where I started enough lines and did enough procedures to prepare me for the fast-paced world of emergency medicine. 

Back then, there was a big book, which amongst other things, listed the addresses of all the hospitals in Ontario.  I wrote to every ER director within one hundred kilometers of Toronto.  Most of the hospitals were still in the dark ages (even for 1983) and staffing their E.R.s with family physicians.  But the Kitchener and Cambridge hospitals had already moved to full-time E.R. physicians.

I was hired at Cambridge Memorial Hospital to cover a maternity leave.  I remember going for my interview and the E.R. director, Lorne Wilson, took me around and tested my knowledge on a few cases.  I remember one was a burn and I thought to myself – five years of intense medical training and I’ve learned about esoteric renal and parasitic diseases I’ll never see – and nobody thought to teach me how to care for a partial thickness burn on a human forearm.

I waited day by day for the regulatory college to send me my license.  They were in no hurry, but the hospital was.  I guess the bureaucrats weren’t worried about labour pains they would not have to feel.   They did send me my official papers in due course, and I got to work. 

(Meanwhile it would take me many more years to realize the cost of our health care system as a profligacy of bureaucrats who had never experienced the immediacy of a paediatric resuscitation or multiple traumas coming off the highway began to take over our health care system.)

In those earliest days, there were four of us covering a hospital E.R.  We worked fourteen-hour night shifts and ten-hour days – shift lengths that I can barely grasp from my current perspective, with all the changes in E.R. overcrowding and dysfunction and all the changes in myself.

But there I was, starting out, backed by experienced E.R. nurses who led my initiation, by weekly E.R. residency rounds that alternated between Toronto General Hospital and Sunnybrook Health Sciences Centre.  I was swept along, into something far bigger than I initially recognized.

In trauma psychology, we speak of state-specificity and memory.  Access to certain memories is to a large extent based on the intensity of arousal during the event whose recalling we attempt to evoke. It’s in this sense that military veterans often seem emotionally disconnected from the stories they tell.  Yet, place them back in combat and their recollections of previous war experiences become crisp and congruent and vivid.

I sense that may be part of why the words have been so slow in emerging.  I cannot put it back to the test by returning, but I admit that I did go to the gym before starting this.  Somewhere, as I write, my body begins to rekindle a sense of urgency, of mission, of incredible stamina.

In his song, Alvin Lee, who had his own beliefs and determination, sings of freaks and hairies, dykes and fairies, and asks, where is sanity?  He already senses the threat to art, the bottomless greed of the commercial enterprise.  It’s 1970, with the Vietnam war winding down but still seriously deadly and with three more years of life left in killing currents.  The terms have changed, and the words of his song sound naïve by contemporary standards.  Our E.R.s have freaks, yes, and gangbangers, and lost souls on hallway stretchers, cokeheads and methheads and the daily increasing flocks of form one’d suicidal despairing waiting for psych beds that don’t exist.  Like Alvin, maybe the lessen in all this is that we do change the world, we change ourselves, we change art and medicine … but they change us as well … and lurking in the background, less compelling than these spent passions and tragic, human scenes, is the continued presence of our insatiable greed.  A greed forever encouraging us to forget and to slide back into our befores ...

Nothing survives, perhaps, other than stories, which will outlast medicine as we know it.  This one will continue.  Stay tuned.

Samo Železnik 1 year ago (edited)

Nice song ! Unfortunately our world today has changed to worse and also there is no more such band as "Ten Years After" were ...

Reply · 1 

Caring for Self While Caring for Others 2015 to 2016

Welcome to our fourth year of Caring For Self While Caring For Others.

This year, I decided to step back and invite a new face into the series.  In a few weeks, Petrea Hansen-Adamidis, will be presenting on art therapy, with a focus on self-care.  I will be continuing to present this series, assisted by Irina Dumitrache, who will offer demos of different mind/body practices for self-care.  Irina will also be co-presenting the last talk on integrating a healthy nutritional plan into our self-care strategy.  Irina is currently enrolled in training at the Institute for Integrative Nutrition, and I’ve been watching some of her training videos.  It’s exciting to see a whole new frontier of wellness opening up before us.

If there is interest in more self-care presentations, please let me know.  I have lots more material, and the ability to repeat old talks.  I actually only made it through half my material for the first talk (How Burnout Looks to us in 2015) in October.  Sadly, there seems to be more and more to say about burnout in the helping professions, as our world goes through some very uncomfortable political changes and growing pains.

After your feedback last year, I have corresponded with Michael Kaufmann at the Ontario Medical Association Physician Health Program (PHP).  After last year’s guest talk given by Dr. Joy Albuquerque, some of you requested a talk on the physician in distress, for some guidelines for what we do and where we turn to for help when we feel we are at the brink.  These requests felt filled with an immediacy of emotional need.  So that’s the talk I asked for when I first initiated dialogue in September.  Dr. Kaufmann said he would discuss this with the PHP staff and get back to me.  I will let you know when he does.

I’m told that attendance is down for all the Ontario Medical Association presentations this year.  I hope you won’t pass up on these talks.  It is tempting to hunker down and minimize during hard times, but nothing is more precious than our own health and self-care.

I’m looking forward to seeing familiar faces this year.

October 7, 2015

How Burnout Looks At Us In 2015

Despite being inundated with evidence that the prevalence and severity of burnout is increasing in physicians and other human service workers, this condition remains poorly understood. There are as many myths as facts, and misconceptions abound.  Often burnout is confused with (and treated as) depression, when – in fact – these conditions are very different. As health care workers, we have an obligation to care for ourselves in order to be the best we can be for our patients. As Charles Figley, a pioneer in the field of compassion fatigue reminds us in the title of his book on physician wellness and stress resilience, we need first do no self-harm in order to best serve. How do we achieve this goal?  How do we begin to approach the tenacious condition of burnout that now threatens to erode away our happiness, our effectiveness and our sense of meaning?

In this presentation, participants will learn:

• To appreciate that many of the standard interventions recommended as treatment for burnout (diet, exercise, spending time with family, mindfulness meditation) have been shown to have minimal impact on outcomes.
• To better understand the impact of burnout (and secondary trauma) on subcortical brain structures and the HPA-G axis
• To gain a sense of which interventions do work best in addressing burnout
• To appreciate burnout as a systemic issue that requires systemic solutions
• To create a self-care plan informed by current understanding of Burnout and Secondary Trauma
• To practice a self-care tool aimed at regulating the autonomic nervous system

Suggested Reading: http://www.scottdmiller.com/wp-content/uploads/2012/11/Burnout-Reconsidered.pdf

November 18, 2015

Beyond Doodling, using art for self expression and self-care

Petrea Hansen-Adamidis, DTATI, RCAT

As psychotherapists and healers, we give our energy to those that seek our help in many ways that can drain us over time.  We listen to their stories, their narratives, ponder their experiences and hold the many tumultuous feelings that present themselves in sessions. We do our best to to keep this separate from our personal lives, but the truth is this is not always easy to practice.  Learn how art making can allow you to express yourself, release tensions and stress and debrief difficult sessions with clients.  Art making for self care can enrich your practice as a therapist and growth as an individual through deepening your connection to own feelings.

Petrea Hansen-Adamidis DTATI, RCAT, is a Registered Art Therapist with the Canadian Art Therapy Association working in the field of art therapy for over 20 years. She has worked for the past 13 years as an Expressive Arts Therapist at The Hincks-Dellcrest Centre on both the Birth to Six team and within the Specialized Therapy Unit.  A graduate of the Toronto Art Therapy Institute (TATI 1995), Petrea serves children, adolescents, parent child dyads, and families, specializing in trauma assessments and treatment. Petrea supervises art therapy practicum students and is an instructor for the Toronto Art Therapy Institute.

Learning objectives:

•         Learn ways to debrief using art after difficult sessions

•         Experience self care using simple art exercises

•         Develop a sustainable self-care practice using art expression

February 17, 2016

Expanding the Burnout and Stress Management Toolkit.

Recent literature stresses the importance of acquiring a set of short and long term skills as a means of addressing trauma and/or unremitting stress. These tools are frequently learned and then quickly forgotten. For instance, the efficacy of learning mindfulness meditation without making it part of a larger lifestyle is now being questioned. What tools work best and when? What is the range of tools available to us? What is the neurophysiologic “target” of these tools? How can we incorporate these tools into our lives in the most effective and lasting manner? How do we utilize these tools as a pathway to building resilience and new meaning in our lives?

Learning objectives:

•         To integrate a variety of stress management tools into their daily lives

•         To acquire a personalized set of both short-term and long-term stress management tools

•         New techniques to calm a dysregulated autonomic nervous system

•         Why some tools are best suited to health care workers including psychotherapists

There will be an opportunity to practice some new tools in a supportive and relaxed environment.

Suggested Reading: http://www.alternet.org/personal-health/how-fight-stress-and-burnout-when-you-cantgo-expensive-spa

March 16, 2016

Integrating a Healthy Nutritional Plan into Self-care Strategy

In this presentation, we will look at practical ways to integrate sound nutritional elements into an overall holistic lifestyle strategy. Rather than exploring diet in isolation, we will explore the interplay of the factors that nourish us every day; discover primary and secondary foods. There will be adequate time to reflect on our current approaches to diet and nutrition, and where the greatest opportunity for impactful transformation can be accessed. Is self-care a luxury? Or is it essential to our health and well-being? We will also get playful with a demonstration of home preparation of fermented foods, in our opinion the best source of probiotics.

In this presentation, participants will learn:

•         To integrate diet and nutrition with other key domains of self-care: work, relationships, exercise and spirituality

•         Myths and truths of dieting; why diets do not work

•         10 tips for self-care every day

•         Easy to follow guidelines for healthy eating

Harry will again be assisted by Irina Dumitrache. Irina has graduated from two yoga teacher training programs, at the Yoga Sanctuary in Toronto and at the Yoga Therapy Toronto. She is currently enrolled in the health coaching program through the Institute of Integrative Nutrition in New York City. Irina brings her avid interest in wellness and wellbeing to her teaching of self-care tools and her encouragement of healthy and balanced lifestyles.

The Main Speaker's Series 2015 to 2016

Sorry that this is arriving late.  As I mentioned in my last post, I’ve been behind in keeping up with the blog.  I think that’s about to change.

So this is our finalized schedule for the 2015-16 Main Speaker’s Series.  I hope that we have again covered a wide area, while remaining true to our vision of this program.

For more information on the philosophy of this series, please refer to my previous blog posting for the 2014-15 series.  Again, we’re hearing lots of you would love to have these small group experiences come to your city outside of Toronto.  I’ve been working hard, devoting mad amounts of time and energy to networking with other organizations (such as the Ontario College of Family Physicians, the Collaborative Mental Health Care Network, the Ontario Medical Association and the General Practice Psychotherapy Association).  Promises have been made, but none have yet come through.  I do want you to know that I am working on this, and hope that one day these talks can be more widely disseminated, while providing the community building and collegial interaction for which they were originally designed.

I hope to see some familiar faces between now and April.

And please add your comments.  This is your blog too, and your opportunity to share what’s important to you, and what’s true to your own calling and vision.

October 21, 2015

Déjà vu all over again: Understanding traumatic enactments and how to work with them

By definition, traumatic experiences overwhelm a survivor’s capacity to cope. To manage psychological trauma, aspects of the trauma are dissociated and not integrated in the survivor’s sense of self and personal narrative. Traumatic enactments are the inevitable consequence as the survivor unconsciously attempts to resolve the trauma. When enactments are played out with the health care provider they have the potential to derail treatment. However, when enactments are understood and appropriately addressed, they can be critical in laying a path for healing. This presentation will address traumatic enactments, including strategies for working effectively with those challenging encounters.

By the end of the session participants will be able to:

•               Provide a theoretical framework for understanding traumatic enactments.

•               Describe four types of enactments that are common among trauma survivors.

•               Describe basic strategies for helping a survivor work through a traumatic enactment.

Dr. Catherine Classen is a full professor in the Department of Psychiatry at the University of Toronto, director of the Mental Health Research Program at the Women’s College Research Institute at Women’s College Hospital, and the academic leader of the Trauma Therapy Program at Women’s College Hospital. She is a past president of the International Society for the Study of Trauma and Dissociation and past chair of the Traumatic Stress Section of the Canadian Psychological Association. Dr. Classen has been working in the field of psychological trauma for over 20 years as both a researcher and clinician. Her research interests include investigating psychotherapy interventions for trauma survivors and advancing trauma-informed care within the health care system. She has over 100 publications and recently co-authored the book, “Treating the trauma survivor: An essential guide to traumainformed care,” published by Routledge. She is also co-author of an online accredited CME course “Posttraumatic Stress Disorder: A Primer for Primary Care Physicians” sponsored by the Mood Disorders Society of Canada in collaboration with Faculty of Medicine, Memorial University, Newfoundland.

December 2, 2015

The Science of Yoga

Yoga and Meditation are becoming increasingly popular in the West for treatment of mental health and chronic illness. While often perceived as a mystical practice involving bends and twists, Yoga is actually an ancient secular philosophy describing how to cease or slow down the racings of the mind to achieve health and well-being.  This experiential workshop will clarify the misperceptions about this transformative mind-body practice, as well as present the scientific evidence for its neuroplastic and physiological effects. Through this workshop, participants will:

•         Understand key principles of the Philosophy and Psychology of Yoga and its common roots with Buddhism and other Eastern Practices
•          Understand the Neurological and Physiological effects of Yoga, and its benefits as an adjuvant therapy in Chronic Illness, Mental Health, and Trauma.
•          Appreciate the different styles of yoga, and which patient is suited for which practice.
•          Experience simple and accessible yogic practices, connecting, body, mind and spirit.

Dr. Shailla Vaidya practices Mind-Body Medicine for Stress Resilience in Toronto. She completed her MD at Dalhousie University, followed by a residency in Family and Emergency Medicine at the University of Ottawa. She went on to provide both Primary and Acute Emergency care to isolated First Nations communities, sub-urban immigrant populations and homeless, street involved youth. Gaining insights into what plagues our health and wanting to affect change, she went on to complete a Master’s in Public Health at the Harvard School of Public Health. Upon return, she lead teams of health care providers to improve efficiency, patient access, and safety. She also worked to implement medical group visits, improving social connection and peer-support for patients. She has served as a faculty member with the Departments of Family Medicine at McMaster University and the University of Toronto. Dr Vaidya is also trained as Yoga Teacher and Yoga Therapist, and has been incorporating scientifically sound Yoga techniques in her medical practice since 2005. Her clinical interests lie in how the social determinants of health, attachment, and disconnection lead to physiological stress and the development of chronic illness. Combining her knowledge, she applies an integrative, compassionate approach to help her patients restore health and build resilience. To learn more about her practice, please visit www.theYogaMD.ca

January 13, 2016

Understanding and Treating Chronic Shame

Chronic shame is a powerful and pervasive outcome of relational trauma, but it is usually hidden behind other symptoms of pathology.  If chronic shame is ignored, treatment of those symptoms will likely be effective only in the short term.  If we can recognize the presence of chronic shame in the symptomstories our patients present, and if we can imagine its particular formation and operation within each patient’s self-system, we will be in position to treat chronic shame directly and effectively.  Effective treatment is grounded in understanding that chronic shame is a problem with patients’ right-brain integration of affect, relationship, and self.  Treatment requires attuned, nonshaming engagement with our patients, the co-construction of narratives that integrate their sense of emotional/relational (right-brain) self, direct attention paid to their shame whenever possible, including shame-reduction strategies, and our own skillful, self-reflexive handling of the many ways shame becomes enacted within the therapeutic relationship.

Key Learning Points:

•               A definition of chronic shame as a relational and right-brain phenomenon

•               Assessment markers for chronic shame across symptomologies

•               How to make reparative right-brain connections possible with and for chronically shamed clients 

•               How to recognize and work through shame-disturbances in the therapy relationship

•               Strategies for life-time shame reduction

Pat DeYoung MSW, PhD is a psychotherapist and clinical supervisor in private practice in Toronto.  A founding faculty member of the Toronto Institute for Relational Psychotherapy, she has written Relational Psychotherapy, A Primer (Routledge, first edition, 2003, second edition, 2015) and Understanding and Treating Chronic Shame: A Relational/Neurobiological Approach (Routledge, 2015).

February 10, 2016

ACT in Practice

Acceptance and Commitment Therapy is gaining recognition as a mindfulness-based psychotherapy.  Its aim is to increase psychological flexibility through 6 ACT processes, including defusion, acceptance, present moment, self-as-context, values, and committed action. As it is a functional approach, it can be adapted for a wide variety of applications in both clinical and nonclinical settings. It can also be flexibly conducted in both individual and group format from single to multiple sessions. This presentation will review the core ACT processes and discuss how it may be potentially used in various contexts.

By the end of the seminar, participants will be able to

•               Describe the 6 core ACT processes

•               Identify potential applications of ACT

•               Discuss how it may be adapted to suit various clinical and non-clinical contexts

Dr. Kenneth Fung is a Staff Psychiatrist and Clinical Director of the Asian Initiative in Mental Health Program at the Toronto Western Hospital, University Health Network.  He is also Associate Professor with Equity, Gender, and Populations Division at the Department of Psychiatry, University of Toronto.  He completed a two-year fellowship in Cultural Psychiatry at the University of Toronto, and his Master thesis was on alexithymia among Chinese Canadians.  His primary research, teaching, and clinical interests include both cultural psychiatry and psychotherapy. He co-leads the Pillar 4 Dialogue of the Department of Psychiatry Strategic Plan, University of Toronto, which focuses on issues regarding equity, social justice, and social responsibility, and is the Block Co-coordinator of the Cultural Psychiatry Core Seminars for psychiatry residents.  He is the seminar co-lead and psychotherapy supervisor in Cognitive Behavioral Therapy (CBT) at the University Health Network, and teaches and conducts research in Acceptance and Commitment Therapy (ACT).  He has been involved in community-based research projects related to HIV, mental health stigma, and immigrant and refugee mental health.  He is psychiatric consultant to the Hong Fook Mental Health Association and is involved in various mental health promotion and education projects in the community.  He offers consultations at Mon Sheong Scarborough Long-Term Care Centre. He is the Vice-President (President-Elect) of the Society of the Study of Psychiatry and Culture.  He is the past Chair and current Historian of the Federation of Chinese American and Chinese Canadian Medical Societies.  He is the current Chair of the Ontario Chapter of the Association of Contextual Behavioral Science. He is enthusiastic about art, and dabbles in various expressions of art including sketching, painting, and piano playing. He is a supporter of the arts, and is a Board Member of the Little Pear Garden Dance Company.

March 2, 2016

Anxiety and the Gift of Imagination. A new clinical model for helping children understand and manage anxiety

According to the U.S. Dept of Health and Human Services, anxiety disorders are the most common mental health problem occurring during childhood and adolescence (2010).  In the U.S. 13% of children and adolescents experience some kind of anxiety disorder.  The Public Health Agency of Canada 2002 reports that in Canada 6% of children have an anxiety disorder serious enough to require treatment.  In spite of anxiety being a debilitating condition that can prevent a child from participating in many of the critical aspects of childhood, including school attendance as well as recreational activities, many children are not motivated to receive psychotherapeutic help, preferring instead to use avoidance as their main defense against uncomfortable anxiety states. From the adult perspective, this is not a viable solution and creates many secondary problems. Dr. Alter will focus on a therapeutic formulation of anxiety that has worked extremely well for hundreds of children in her private practice. She will explain her discovery of the link between imagination and anxiety, and how this new understanding can be used effectively for the treatment of anxiety. This new approach starts and ends with an enhancement of self-esteem and puts children in a place where they are motivated to use many of the tools and strategies that have been developed by others.  You will also learn how children’s anxiety is different from adults’.  As well you will learn how children’s thinking is different from adults’ which will assist you in helping children with many other problems besides anxiety. Key Learning Points:

•               Understand and appreciate the difference between children’s and adult’s thinking processes

•               Understand the differences between children’s and adult’s anxieties

•               Make the connection between anxiety and imagination

•               Implement a concrete step-by-step approach to applying this new understanding of anxiety

•               Incorporate some effective strategies into your clinical practice to manage children’s anxiety

•               Find a new way to work with children around anxiety that enhances their self-esteem and empowers and challenges them to face their problems and their fears

•               Discover why motivating children to make changes is key to effective  clinical practice and find new ways to increase their motivation for change

Dr. Robin Alter was born in New Jersey and received her undergraduate degree from Skidmore College, Saratoga Springs, New York. She received her Master’s and Doctoral degree from the University of Florida in Gainesville. She then moved to Toronto, Canada, where she has been working in children’s mental health since 1980.

She has been employed by two of the largest children’s mental health centre in the Toronto area for over 34 years— the Hincks-Dellcrest Children’s Centre and Blue Hills Child and Family Centre. She also works with Anishnawbe Health Toronto, providing fetal alcohol assessments for the people of the First Nations community. She has taught psychology at York University. She maintains a private practice with Alter Stuckler and Associates in Thornhill, Ontario. She is trustee with the Psychology Foundation of Canada. She gives many public lectures to parent groups, teachers and principals, and has been on numerous radio and television programs talking about children’s mental health issues.

Her second book, Taming the Anxiety Monster: A Workbook for Kids, will be published by New Harbinger in the fall of 2015. You can find out more about

Dr. Alter by visiting her website: http://www.docrobin.com/

April 6, 2016

Finding Familiarity in a New Frontier: Psychotherapy for Adults with Autism Spectrum Disorder

Despite the increased numbers of children and adults being diagnosed with Autism Spectrum Disorders (ASD) in Ontario, and the knowledge that at least 1% of the adult population has ASD, relatively little attention has been given to the provision of support and treatment to these individuals and their families. Individual, couple, group and family psychotherapy, core components of a lifespan approach to intervention, will be discussed in this session. Considering the presentation of ASDs, Dr. Stoddart will highlight the issues that ongoing psychotherapy that can be useful in addressing, and some of the challenges that are unique to this group, reflecting on his practice of 25 years. Key Learning Points:

•               Identify Ontario trends in youth and adult ASD diagnosis

•               Understand the psychosocial and mental health issues that can be addressed in the context of psychotherapy

•               Articulate the lifespan challenges common to youth and adults living with ASD, from entry into adulthood to aging with ASD

•               Increase knowledge of resources and interest in working with this group

Dr. Kevin Stoddart is Founding Director of The Redpath Centre and Adjunct Professor, Factor-Inwentash Faculty of Social Work, University of Toronto. Since the early 1990s, his clinical focus has been children, youth and adults with primarily Asperger Syndrome and the co-morbid social and mental health problems that affect them. His second book with Drs. Burke and King entitled “Asperger Syndrome in Adulthood: A Comprehensive Guide for Clinicians” was published by Norton Professional Books (2012). He is Co-Chair of the Ontario Working Group on Mental Health and Adults with ASD and the Ontario Partnership for Adults with Autism and Asperger.