BC PsyChologist J o u rn a l o f t h e B C Psych o l o g i c a l A s s o ciati o n Vo lu m e 6 • Is su e 4 • FALL 2017
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BOARD OF DIRECTORS
PRESIDENT Marilyn Chotem, Ed.D., R.Psych. VICE-PRESIDENT Paul Swingle, Ph.D., R.Psych. TREASURER Murray Ferguson, D.Psych., R.Psych. DIRECTORS Ted Altar, Ph.D., R.Psych. Sofia Khouw, M.A., R.Psych. Noah Susswein, Ph.D., R.Psych. Martin Zakrzewski, Psy.D., R.Psych.
Table of Contents 5
Letter from the President
Letter from the Executive Director
BCPA News & Events
From Here to the Future: Hallmarks of Adult Functioning Donald Hutcheon, C.Psychol. (U.K.), R.Psych. Evan Hutcheon, B.Sc. (Hons.), Masters Candidate
Psychologists: Trapped or Called? Kim Dawson, Ph.D., R.Psych.
Counselling and Psychotherapy with Punjabi Sikhs: Socio-Cultural Considerations Robinder P. Bedi, R.Psych. Amritpal Singh Shergill, R.Psych.
Board Statements 2017
Proposed Changes to the BCPA Constitution and Bylaws: Explanatory Notes
Constitutional Amendments Referendum Ballot 2017
BCPA Annual General Meeting & Psychopharmacology Update: Adults and Older Adolescents Workshop Registration Form
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Letter from the President M a rily n Ch o t e m , Ed. D, R. Psych .
Marilyn has been on the Board of Directors of the BC Psychological Association since 2011. She was a member of the MSP Taskforce Committee prior to joining the Board. She was the primary contributor to the proposal for Integrating Psychological Services into Primary Health Care with proposed funding from MSP. Her interest in being on the board is to increase accessibility of psychologists to the people who need psychological services most, yet lack the financial means to receive them. She has been doing psychotherapy in BC since 1978 in a variety of settings including addictions, child and youth mental health, adult mental health, adult eating disorders, EAP and private practice. She has a part-time private practice in West Vancouver working with individuals, couples and families with a variety of presenting concerns. www.marilynchotem.com.
D e a r Co l l e ag u e s ,
Fall is a time to reflect as we begin fresh starts. By the time you read this, it may not be so fresh, and the weather may have turned grey and wet. Nevertheless, BCPAâ€”the Voice of Psychology in BCâ€”is looking back on the past yearâ€™s achievements, and forward to a fresh start with new board members starting in November 2017. Over the past year, we met with the Health Sciences Association regarding strategies to improve salaries for psychologists in the public sector. Salaries that acknowledge the level of training and unique expertise of registered psychologists is sorely lacking in BC. In one Health Authority, registered nurses with a Bachelor of Science degree who are at the top of their pay scale get $4 less per hour than registered psychologists with an average of ten years post-secondary education, a doctoral degree, and the most training in evidence-based assessments and treatments of all the mental health professions. Psychiatrists get paid three to four times what psychologists are paid, despite often relying on the services and expertise of psychologists to perform their work, and having far fewer years of training in mental health and substance use treatments. BCPA has worked to bring registered psychologists up the priority ladder with the Health Employers Association. Psychologists are now in third place priority beneath clerical workers and physiotherapists. We will continue to meet with HSA to provide information and advocate for prioritizing psychologists for a market adjustment (salary and benefits review) that would lead to filling positions for Psychologists and retaining those hired. We have also been liaising with the Ministry of Health both to get new information from the Ministry, as well as to
reiterate the cost effective benefits of increasing access to registered psychologists in public health services. We are promoting the use of psychologists as specialized service providers in evidence-based assessments and treatments, particularly for the population of people with complex physical and mental health problems who use the most services. We are also recommending psychologists be used in positions of training, supervision, and program evaluation overseeing disciplines with lesser qualifications in service delivery. The elephant in the living room continues to be funding and funding models. There is evidence for the cost offset of psychological services, but a paradigm shift has to occur first. We are hopeful that shift is starting. We are also optimistic about the change of government. We have sent letters to the new Minister of Health, Mr. Adrian Dix, and the new Minister of Mental Health, Ms. Judy Darcy. We hope to meet with both of them this fall to educate them on the training, skills and cost savings psychologists could bring to the health care system in BC as experts in Mental Health and Substance Use. BCPA is fortunate to have an Adler Psy.D. student, Ms. Vanessa Epp, joining the Advocacy Committee. She will be doing research related to the opioid crisis in BC and helping BCPA identify ways Psychologists can be of assistance in addressing this crisis. The Advocacy Committee has identified that the most important task for the Committee is to educate government, unions, employers and the public on the extensive and rigorous training of psychologists, as well as skills unique to psychologists that do not overlap with other professions. We also need to educate people on the value of being a regulated profession with ongoing requirements for continuing education and maintaining competencies.
Our Annual General Meeting will be held on November 17th, 2017, at which time we will be saying goodbye to board members whose terms are up and gaining new board members. It is my intention to have a strategic planning meeting in January 2018 to identify interests and priorities for the new Board to focus our energies and future achievements. As always, we welcome new members to our committees and Board. Without new members, we are limited in what we can accomplish. Also, with the Baby Boomers aging out of the profession, the need for younger members on the Board is essential if BCPA is going to continue serving the best interests of psychologists and the public in BC. As John F. Kennedy said, “And so, my fellow Americans, ask not what your country can do for you; ask what you can do for your country.” Psychologists are small in number. We need to strengthen to a critical mass and work together to advance and preserve psychology in BC. Please consider joining a committee or the Board as an opportunity to help yourself and your profession. Sincerely,
Marilyn Chotem, Ed.D., R.Psych. President, BCPA
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Letter from the Executive Director ri ck ga m b re l , b . Co m m . , LL B .
The Executive Director of the BCPA. Mr. Gambrel has a Bachelor of Commerce in Finance and a Law Degree from UBC. Prior to working at BCPA, he was a trial lawyer for over 30 years, as well as Managing Partner of a number of law firms. He is Past President of both the Trial Lawyers Association of BC and of White Rock Concerts, one of Canada’s leading classical music presenters. Contact: email@example.com
have been another busy time at BCPA for both Board and staff.
T h e su m m e r a n d e a rly fa l l
Membership renewals for our 2017-2018 membership year (which began on September 1st) have been coming in at a record pace, and we thank you for that. There truly is strength in numbers, allowing our association to do more to advance the cause of good psychological health for all British Columbians. With the fall season comes our new program of workshops. On September 29th we had the well-attended Mind Over Matter: The Hidden Influence of Psychology on Well-Being and Performance workshop with Dr. David Ballard of APA from Washington D.C. We are also excited to say that we have Dr. John Preston coming to present Psychopharmacology Update: Adults and Older Adolescents. This November 17th workshop is sure to sell out, as last year’s did, so please register early. We have two more excellent workshops scheduled in the New Year: Anger Modification: Cognitive, Behavioural, and Affective Approaches presented by Dr. Ephrem Fernandez on April 13th, and Promoting Self-Recovery from Substance Misuse and Gambling Problems with Brief Motivational Interventions presented by Dr. David Hodgins on May 11th. Our Ethics Salons also resume this fall. Please check the BCPA website for dates, locations, and topics. Our Board Members reconvened their monthly meetings in September as volunteers doing the important work of the association. Even though Board nominations are closed, you can still help advance the cause of psychology by volunteering for a BCPA committee. It is rewarding and enriching work. Our Advocacy Committee will be advancing the cause of psychology with submissions to our new provincial government, and our Community Engagement Committee will be preparing for Psychology Month in February and responding to ongoing requests for media interviews. Our
Membership Committee will be reaching out to members and non-members through surveys and focus groups to hear how BCPA can serve them better. Please call me for more information on how to join a BCPA committee. As I continue into my fifth year as Executive Director, I am so very pleased with the state of BCPA. Membership is at an all-time high and growing, the finances also strong, and I have the benefit of fine, talented and passionate staff – Priya Bangar, Sarika Vadrevu and Celine Diaz. I also represent BCPA nationally and internationally on a number of bodies. I am the BCPA delegate to the national Council of Professional Associations of Psychology (CPAP), as well as one of six members of the governing body of the BMS brokered national professional liability insurance program. Also, I am Chair of CESPPA, the 60-member strong group of psychological association Executive Directors. I am the first Canadian Chair of CESPPA in its long history. I believe that with strong Advocacy and Community Engagement work, member discounts on our excellent workshops and the best professional liability coverage at the best price—along with our email forum, referral service and group health and welfare plans—membership in BCPA is more valuable than ever. And with your record-setting renewals, you seem to agree. So if you have renewed, I thank you. If you have forgotten to renew, we will be glad to help you either online or over the phone, to ensure that all the benefits of BCPA membership continue.
Rick Gambrel, B. Comm., LLB. Executive Director, BCPA
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Psych o ph a rm aco l o gy u pdat e : a d u lt s a n d o l d e r a d o l e s ce n t s wo rk s h o p
Presented by Dr. John Preston 9:00am – 4:30pm Friday November 17th, 2017 @ Holiday Inn Vancouver Centre (711 W Broadway)
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Presented by Dr. Ephrem Fernandez Save the Date: Friday April 13th, 2018
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From Here to the Future: Hallmarks of Adult Functioning
D onald Hutcheon , C . Psychol .
e t t l ag e (1990) h a s d e s crib e d a s t ru c t u r a l
fr a m e wo rk us e d t o e x a min e a d u lt h o o d. These include: a) granting of adult privileges, such as the right to vote; b) the assumption of adult responsibilities, such as parenthood; c) the fulfillment of developmental tasks, such as the achievement of intimacy and mutuality in a gratifying sexual relationship; d) the transformation of adolescent into adult psychological characteristics, such as gaining an objective view of the self; and e) the attainment of adult-level structural development, such as an ego ideal attuned to reality. Settlage further posits that psychic structure formation occurs throughout the life course. Attaining adulthood is the outcome of the early formation and continuing evolution of the regulatory structures of human personality. More specifically, mature adulthood is an ideal toward which we strive in a lifelong developmental progression.
Subsequently, the hallmarks of adult functioning include: identity, a persistent sameness within self and in relationships with others; responsibility and accountability, with regard to oneself and others; loyalty, allegiance to one’s friends and loved ones; fidelity, faithfulness to one’s chosen work, beliefs, and causes; morality, compliance with the goal values that are achieved with honesty and good will; ethicality, a higher level commitment transcending moral restraint and encompassing idealism. The qualities of persistent sameness and steadfastness do not imply closure of development, according to Settlage, rather, as attained and to be attained structure, they are also subject to further development, as mentioned below.
(U. K .), R.Psych .
Dr. Don Hutcheon has a private practice in Port Coquitlam and also works in Chilliwack at Brian Atkinson & Associates since 2013. Evan Hutcheon , B . Sc .(Hons .), Ma sters candidate
Evan Hutcheon is a graduate student in the Biomedical Physiology-Kinesiology Graduate Department at Simon Fraser University. His Master's research is on hypoxsic effects on attention at high altitudes.
The transition from adolescence to young adulthood and the subsequent achievement of full adulthood are placed in the context of structural development as a lifelong process. In this process, the formation of basic regulatory structure begins in earliest childhood, evolves through successive stages, and continues in adulthood. The hallmarks of adult functioning are the result of the culmination of lifelong structural development. If the past is kept open, or re-opened to new developmental relationships, the highest possible levels of adult morality, ethicality and commitment remain attainable. If ways can be found to enhance the potential for adult development, the quality of individual life can be much improved. The Diagnostic Process A general process of assessing adults seeking treatment includes the nature of development in midlife and later adulthood, as older patients have been reported to seek therapy for the following phase-specific reasons (King, 1980): a) fear of diminution or loss of sexual potency; b) fear of loss of effectiveness in the workplace; c) concerns about retirement; d) anxieties about marital relationships in the “empty nest”; e) awareness
It is essential to view the self in adulthood as dynamic and changing.”
of aging, illness, and the resulting dependency on others; and, f) growing awareness of the inevitability of personal death. King further suggests that when entering therapy with this age group, it is useful to explore these issues through a developmental history of the life cycle. Of note: detailed developmental histories are routine in the evaluation of children, but not of adults. This neglect may be as a result of the respective therapists underestimating the developmental processes playing a role in the adult’s behaviour. By using the concepts of adult developmental stages, tasks, and lines to frame questions and understand responses, the therapist is more apt to trace the patient’s experience from the time of conception to the present. These data are then integrated with the information obtained from the history of the present problem, family history, and psychological or neurological testing to provide insight into the symptomatology and to plan the most effective therapeutic intervention. Adult Development Stages Nemiroff and Colarusso (1990) suggest that adult developmental history may be organized in two ways: first, a chronological description of adult developmental stages and tasks, providing continuity with the childhood developmental history; second, a delineation of adult developmental processes; that is, singling out major themes for more comprehensive examination. The therapist may then conceptualize the material in both ways, integrating data as the evaluation proceeds. More than fifty years ago, Erikson (1963) divided adulthood into four broad stages: early (ages 20-40); middle (ages 40-60); later (ages 60-80), and late-late (80 and beyond). Nemiroff and Colarusso state that the deficiencies of this model include: limited knowledge of adult developmental processes (particularly those in late-late adulthood), the absence of biological demarcators to designate the beginning and end of phases, and the tendency of major tasks to overlap stages (e.g., becoming a parent at 18, 45, or 60). Adult Developmental Tasks The concept of adult developmental tasks that utilize the thoughts and usually the actions of adults is a flexible, open-ended way to organize diagnostic thinking. By dividing the tasks into groups generally corresponding to the four developmental stages, the clinician who is attentive to the tasks related to a particular age cohort (e.g., middle adulthood 40-60) to that phase of development will increase their chances of understanding the patient. This is because the patient, and perhaps the therapist as well, is undoubtedly trying to engage and master (or avoid) one or more of the following issues: the aging process in the body; the increased awareness of time limitation and
personal death; the illnesses or deaths of parents, friends, and relatives; the changes in sexual drive and activity; the markedly altered relationships with parents, young adult children, and a maturing spouse; the assessment of career accomplishment and the recognition of falling short of personal goals; and planning for retirement. Of note: many of the symptoms presented by patients in this age group are expressed in terms of these tasks or are partially caused by a failure to have engaged them successfully. Adult Development Lines Since development is lifelong, Nemiroff and Colarusso (1985) introduced a concept of developmental lines for adulthood across developmental phases: a) intimacy, love, and sex; b) the body; c) time and death; d) relationship to children; e) relationship to parents; f) mentor relationship; g) relationship to society; h) work; i) play; and j) finances. They provide an example of the developmental line of intimacy, love and sex which may be summarized as follows. In the late teens and twenties, building on the base of adolescent sexual experimentation and fantasy, each individual finds under normal circumstances, a partner, learns to use the body comfortably as a sexual instrument, and develops the capacity for intimacy – the ability to care for the partner at least as much as for the self. In the twenties and thirties, the urge to invest exclusively in one partner and begin a family, including adoption, is engaged. Midlife brings the challenge of accepting the diminution of sexual drive in the male partner and the self, and a redefinition of relationships with the partner and children. In later years, many individuals face the loss of a partner, unavailability of sexual partners, and the need to forge sustaining ties with friends, children, and grandchildren The use of this developmental line allows the clinician to trace the patient’s experience in these areas across the adult years, relating current and past experience, and anticipating future progression or fixation. Generally, chronological and phase markers are used and are more clearly defined with child development than in adulthood, which spans many more years and contains a much wider variety of experience. As a consequence, significant, normal variation will be noted along each adult developmental line. Nonetheless, a certain orderliness and predictability are evident, determined by the processes of biological aging that underlie adult development. Of note: adult developmental arrest is also useful in the diagnostic process. Phase-specific stimuli to development occurs in adulthood, and development may be arrested in the face of adult developmental tasks. Important to this concept is the
new emphasis on the adult past (along with the childhood past) in history-taking (Colarusso & Nemiroff, 1979,1981; Shane, 1977). In a more open-ended view of development, the genetic approach takes on a longitudinal dimension incorporating experiences that occur in all phases of life. Thus, in addition to the patient’s childhood and adolescence, the therapist must consider middle-age experience as well.
Lastly, as described above, it is essential to view the self in adulthood as dynamic and changing, suggesting the term “authentic” to characterize the mature adult self because it describes the capacity to accept what is genuine within the self and the outer world. In this regard, the capacity for authenticity emerges from the developmental experiences of both childhood and adulthood.
R e fe r e n ce s
Colarusso, C. A., & Nemiroff, R. A. (1979). Some observations and hypotheses about the psychoanalytic theory of adult development. International Journal of Psycho-analysis, 60, 59-70. Colarusso, C. A., & Nemiroff, R. A. (1981). Adult development: A new dimension in psychodynamic theory and practice. New York, NY: Plenum. Erikson, E. H. (1963). Childhood and society, 2nd ed. New York, NY: W.W. Norton. King, P. H. (1980). The life-cycle as indicated by the transference in the psychoanalysis of the middle aged and elderly. International Journal of Psycho-Analysis,61,153-161. Nemiroff, R. A., & Colarusso, C. A. (1985). The race against time: Psychotherapy and psychoanalysis in the second half of life. New York, NY: Plenum. Nemiroff, R. A., & Colarusso C. A. (1990). Frontiers of adult development in theory and practice. In R. A. Nemiroff and C. A. Colarusso (Eds.), New dimensions in adult development (pp. 97-124). New York, NY: Basic Books, Inc. Settlage, C. F. (1990). Childhood to adulthood: Structural change in development toward independence and autonomy. In R. A. Nemiroff and C. A. Colarusso (Eds.), New dimensions in adult development (pp. 26-43). New York, NY: Basic Books, Inc. Shane, M. (1977). A rationale for teaching analytic techniques based on a developmental orientation and approach. International Journal of Psycho- Analysis, 58, 95-108.
The BC Psychologist is the quarterly publication of the BC Psychological Association. The publication is distributed to members of the Association who live throughout BC, and is also mailed to all registrants of the College of Psychologists of BC every July. f o r pre vi o us is su e s o f t h e b c psych o lo g ist, pl e a s e visit:
Psychologists: Trapped or Called? Kim Dawson , PH . D. , R. Psych .
Dr. Dawson earned his Ph.D. in Biopsychology at the University of Waterloo in 1989. Shortly after, he worked with First Nations at the Nicola Valley Institute of Technology in Merritt. After a couple of years engaging young offenders in substance abuse counselling, he respecialized in clinical psychology and claimed the coveted title “Registered Psychologist” in 2004. He later moved with his family to Kelowna where he continues to run a private practice for individuals and couples. He has recently co-founded a charity whose mission is to help traumatized youth and homeless dogs become more confident, capable, and contributing members of their community.
Moments of extreme vulnerability in treatment can expose the interdependence of self-interest and altruism."
ike m a n y o t h e r h e l pin g pr o fe s si o n a l s ,
in a cycle of gains and losses which, like any other job, can wear us down. After describing this cycle, several methods of coping are suggested, including promoting a self-sustaining interest in our own health. Several discussion questions are also offered, centering on the core issue of whether we are trapped or called into our role as psychologists. psych o l o g is t s c a n fe e l t r a ppe d
Imagine a world where no one, not friends or family, or even children, can enjoy support without paying dearly. In this place, caring is always contingent on varying modes of payment. Here, indifference, bribery, and slavery, are commonplace. Now, imagine another world where psychologists aren’t needed because everyone is treated with gratitude, compassion, and forgiveness. In this world, people sit together peacefully until problems are resolved through genuine trust and collaboration with all agendas openly expressed. Psychologists are caught between these two places, one harsh and unforgiving, the other warm and altruistic. When trying to persuade those who see only ugliness that this is still a beautiful world, at times we fail, our rose-coloured glasses thrown to the floor by someone literally steeped in terror, whose only escape from despair is to end this life. Moments of extreme vulnerability in treatment can expose the interdependence of self-interest and altruism. "This life is hardly worth living," says the client. The psychologist appeals to the client’s self-interest. "How have you endured this suffering for so long?" Holding a tone of gentle patience, the life-sustaining value of caring relationships with children, friends, and family has the chance to resurge to the client’s awareness. Utter helplessness is momentarily cured. In each moment, the psychologist has the potential to fail this victim. In this moment, with each breath, the helping professional witnesses raw terror and listens to the voice of pain and how it so desperately needs to be heard. Appreciating the gift of mutual trust, the psychologist participates and shares in a victim’s albeit momentary recovery of a sense of self from the dark abyss of lonely alienation. The empathic psychologist can join with the client’s loss, pain, and helplessness, yet this joining does not overcome the harsh reality of the client's life. Nor does it prevent the psychologist from charging for services rendered. We are all victims of the vulnerability to rejection, pain, and death inherent in this gift of life. Though some may disagree, I believe we are privileged to have both worlds in this one life. In my opinion, our profession should be devoted to uncovering a validating word, a connection, and being present at the moment that exhausted bleeding
fingertips begin sliding down into oblivion, just when the cycle of vulnerability starts all over again. At the risk of being pulled into the abyss ourselves, psychologists stop being bystanders. By doing so, motivated by a desire to help and acquire some remuneration, we reach out to act for the public good. We psychologists are called to accept our vulnerability to the social trap of immediate pleasures and to face the slippery slope toward damaging consequences (Dawson, 2000; Platt, 1973; Summers and Dawson, 1999). In our oftenhumbling efforts to treat and help the most vulnerable and demoralized among us, we also pursue our own selfinterests, for example, by being financially compensated. Who among us is not tempted to court burnout in pursuit of financial gain? Yet, on the other hand, if we don't look after our own financial well-being, we can become less effective at helping others. Doctor, heal thyself. There are methods to make the cycle easier to bear, less likely to succumb to self-destruction. Probably all methods require the practice of acceptance and psychologists can benefit from these like anyone else. Some cultivate acceptance through a mindfulness practice. With suffering being present in our lives, it is possible to lighten the burden by differentiating the thought of suffering from the sensation of pain. Following Kabat-Zinnâ€™s (1990) mindfulness-based
stress reduction, simply noticing the sensation of pain can circumvent the tendency to add more suffering with negative thinking. Even while cultivating mindfulness, though, clinical work often requires more energy and attention than one practitioner can manage. Some psychologists delegate to staff, refer to colleagues, maintain physical health, see their own counsellor, and still end up with compassion fatigue, or worse. This writer farms out some of the healing responsibility to therapy animals who clients may perceive as unconditionally accepting (Dawson, 2017). I believe being trapped and called are coexistent in our helping profession. Although we are trapped in a privilegebased economic system which compels us to charge for our professional services, we are also called to sustain the well-being of several future generations. If this call were made more intentionally in our practices and our daily lives, could more responsible decisions be made for the benefit of the public good, or would the colonial emphasis on individual privilege push back? How do culture, race, gender, or privilege enter into decisions which qualify individuals or communities for mental health or psychological services? Which incentives encourage psychologists to promote privilege and which promote speaking out for the public good?
R e fe r e n ce s
Dawson, K. (2017). Helping young people find meaning and compassion: Some benefits of learning to train dogs. BC Psychologist, 6 (1), 17-19. Dawson, K.A. (2000). Meta-theoretical situational modelling of collective decision-making and human responsibility. In S. B-S. K. Adjibolosoo (Ed.), The Human Factor in Shaping the Course of History and Development (pp. 43-68). Lanham: University Press of America. Kabat-Zinn, J. (1990). Full Catastrophe Living. New York: Bantam Dell. Platt, J. (1973). Social traps. American Psychologist, 28, 641-651. Summers, C., & Dawson, K.A. (1999). The psychology of political decision making and aboriginal rights in Canada. In C. Summers and E. Markussen (Eds.), Collective Violence: Harmful Behaviours in Groups and Governments (pp. 68-93). Lanham: Rowman and Littlefield.
Counselling and Psychotherapy with Punjabi Sikhs: Socio-Cultural Considerations R o b in d e r P. B e d i , r. psych .
Dr. Robinder (Rob) P. Bedi, R. Psych. is an assistant professor in the Department of Educational and Counselling Psychology and Special Education at the University of British Columbia. He also works parttime with Chuck Jung Associates at their office in Surrey, BC, where he serves an ethnically diverse set of rehabilitation patients with their mental health issues. A m rit pa l sh e r g il l , r. psych .
Dr. Amritpal Singh Shergill, R. Psych. works in private practice in Surrey, B.C., focusing on individual and family therapy, rehabilitation psychology, and psychological assessments. He provides psychological services in both Punjabi and Hindi.
Although most would identify the Punjabi-Sikh culture as collectivistic, the nature of North American training is premised on many individualistic notions."
n d ivid ua l s o f Pu n ja b i e t h ni c d e s ce n t w h o f o l l ow t h e sikh re li g i o n a re a pr o min e n t a n d g r owin g
cu lt u r a l g r o u p in BC who could benefit from culturally adapted mental health treatments (Ahluwalia & Pellettiere, 2010). What follows is a brief summary of some culturally-responsive adaptations that have been promoted for this population. The information provided is drawn from a review of published peer-reviewed scholarly literature and based on case studies, empirical research, and clinical commentary. Certain, sometimes impractical, modifications have been reported to be useful (e.g., language fluency, client-counsellor ethnicity matching) and some advanced indigenous theoretical models have been developed to guide clinical practice (e.g., Sandhu, 2004; Singh, 2008). However, our focus here is on those adaptations that could be readily incorporated by the average psychologist who is willing to first obtain some basic Punjabi-Sikh religiocultural knowledge and information about acculturative and ethnic identity formation processes, and then engage in active self-awareness activities of oneself as a culturally conditioned being.
There are certainly limits to constraining our article to peer-reviewed, published literature given the sparsity of empirical research with this ethnic group (Bedi, in press). For example, since there is so little published on this under-researched topic, much of the pertinent knowledge resides in clinical expertise amongst those relatively few who have substantial clinical experience with this group of clients. Therefore, these modifications are best considered to be a pool of hypotheses because there exists a host of moderating and mediating variables that likely affect their efficacy (such as ethnic minority identity development, religious adherence, acculturation, individual personality, and timing). We acknowledge that there is the potential for these suggestions to create or reinforce stereotypes about this group. However, we believe that the potential for increasing cultural competence and service effectiveness outweighs this risk. Communication Styles Based on their research, Nayar and Sandhu (2006) recommend that the professional should seek to match culturally-influenced, generational thought forms and communication styles. For India-born grandparents, they suggest focusing on the extended family, collectivistic statements, concrete phases, using limited affective and abstract language, discussing concerns in an impersonal manner, adopting a concrete problem-solving approach, turning to them for their wisdom, adopting a story-telling approach and viewing knowledge as permanent and unchangeable. For parents who immigrated to Canada, they suggest focusing on the self in the collective, including positioning individualistic desires within the family context, using concrete phases, using limited affective and abstract
language, sharing objective facts, adopting a problemsolving approach, forming a directive doctor-patient type of relationship, providing psycho-education, and viewing knowledge as something passed down or on. For Canadianborn children, they suggest focusing on self and collective, promoting critical thinking in navigating their Indian and Canadian cultures, using abstract concepts, working to develop insight, and focusing on self-exploration. The reader is referred to Nayar and Sandhu for a vignette demonstrating these intergenerational communication styles in family counselling, as well as for the rationales underlying these recommendations. Shariff (2009) also provides guidance via a case study of family counselling that provides alternative pathways for navigating intergenerational challenges between those raised in Canada and those raised in India, largely premised on variations in ethnic identity and cultural experiences. For example, she proposes providing psycho-education to parents born in India about Canadian society and drawing on cultural values held in common, such as the importance of education, to motivate individuals to be more open to considering Canadian cultural differences. She also advocates for examining ethnic identity development as a core feature of the work with all Canadian-born Punjabi Sikhs, as they are necessarily pulled between two ethnic cultures.
However, Ahluwalia and Zaman (2010) warn that, due to past experiences of being culturally misunderstood (e.g., mislabeled as a Hindu), some Punjabi Sikh individuals can react with suspicion or feel judged by those who focus too much on religion too soon in the therapeutic process. Although most would identify the traditional Punjabi-Sikh culture as a collectivistic one, the nature of North American training in counselling and psychotherapy is premised on many individualistic notions, which can unknowingly and subtly creep into the therapeutic process by the very nature of the questions that we ask (or do not ask). Many of our therapeutic questions assume a high level of personal autonomy or individualistic choice which run counter to collectivistic notions and pseudo-deterministic cultural beliefs such as God’s will, fate, and destiny (Ahluwalia & Alichandani, 2013). A psychologist has to be acutely aware of one’s own deep-rooted cultural conditioning in order to identify such an individualistic bias. A wonderful selfreflection after a negative outcome is bravely provided in Horne and Arora (2013) for those seeking an exemplifying case of this.
Although it is particularly characteristic of those who have emigrated to Canada, it is relatively common for Sikh individuals to talk about their issues in a depersonalized and existential manner, regardless of immigration status (Bedi & Domene, 2015; Sandhu, 2005). This tendency could be related to the cultural norm of maintaining family honour (izzat), to indigenous healing traditions such as gidda (a Punjabi women’s folk dance in which they sing, dance, and theatrically act out common familial conflicts), or to the common practice of discussing life while cooking together in a communal Sikh temple kitchen (Bedi & Domene, 2015; Sandhu, 2005). It is important to note, however, that change can still be facilitated without the client always taking explicit verbal responsibility or “owning” all aspects of the problem (for example, see case study in Bedi & Domene, 2015).
It is understandable that many psychologists may find it frustrating to work with the apparent helplessness expressed by some Punjabi Sikh individuals who draw upon the concepts of karma and kismet (fate based on past deeds and destiny) and believe that change is only possible if God wills it. However, such a perspective could still be validated and empathy could still be provided for the defeat that the client feels for being impaired by such life circumstances (Bedi & Domene, 2015). However, invoking these constructs does not automatically negate the role of personal and social agency, but rather requires its placement within the Punjabi Sikh religio-cultural framework. Counselling and psychotherapy can still proceed effectively by not directly challenging these beliefs, but rather by working to help the client reframe thinking, cope with inherited misfortune, and learn how thoughts can influence our behaviour (see Sandhu, 2004 for a case example. Alternately, see Sandhu (2009) for some sample religious scriptures that provide guidance on how to undo bad karma, which could be shared in a respectful fashion).
Cultural Concepts Given the high average level of religiosity amongst Punjabi Sikh individuals (Ahluwalia & Alimchandani, 2013; Rana & Sihota, 2013; Thandi, 2011) and despite the high amount of reservations amongst mental health professionals to work directly with religion (Dhillon, 2015), it can often be beneficial to explore the potential relationship between the client’s concerns and religio-cultural expectations.
In using any intervention, cognitive reframes that draw upon socio-cultural-theological metaphors, values, and symbols are more likely to be useful with this group. Some specific examples recommended in the literature include reframing issues in terms of helping attain higher levels of education and career success (Shariff, 2009), strengthening the family (Thandi, 2011), heroism/martyrdom (Ahluwalia & Alichandani, 2013), and fate/destiny (Mani, 2005). Use of BC Psychologist
indigenous folklore stories can also be a welcome strategy (see Sandhu, 2004 for an example of how to use such concepts to illustrate the impact that beliefs and thinking can have on our feelings and physical reactions, which is a core tenet of CBT). Clinical Strategies and Interventions According to many authors (e.g., Shariff, 2009), theoretical orientations that emphasize a short-term, concrete and problem-solving approach seem most in line with the expectations of many Punjabi Sikh individuals (especially those who still identify strongly with their traditional cultural values). Although family counselling and psychotherapy is often mentioned as the most culturally consistent overall (e.g., Sandhu, 2005; see Shariff, 2009, for a case study), many Canadian-born Punjabi Sikh individuals reject this (e.g., see case in Bedi & Domene, 2015). Based on Sandhu’s (2004) comparative analysis of Sikh spiritual traditions and popular theoretical orientations, he proposes that many concepts of existential theory are consonant with the Sikh religion. These include (but are not limited to) a focus on universal human concerns, the proposition that anxiety and suffering are an unavoidable condition of life, and using the inevitability of death to make life more meaningful (see Sandhu, 2009 for a specific example on how to reframe addiction as a symptom of an existential and spiritual crisis for Punjabi Sikh individuals). Sandhu (2009) also demonstrates how CBT can draw upon cultural content but hold true to the central premises of disputing faulty thinking, restructuring cognitions, controlling maladaptive thinking, and demonstrating how thinking influences behaviour. He further suggests the use of Socratic Dialogue (a CBT approach) to guide the client through understanding the concern as an existential/ spiritual issue. Shariff (2009) also draws heavily on CBT’s cost-benefit analysis to navigate ethnic identity issues and help resolve family conflicts which often revolve around family honour. Shariff (2009) further proposes solutionfocused therapy’s exception questions as particularly
useful in navigating ethnic identity conflicts and Bedi and Domene (2015) share a case study using solution-focused methods with a Canadian-born Punjabi Sikh individual. Further, Sandhu (2004) implies that the use of an integrative framework drawing upon specific consonant concepts from eight differences theories may prove helpful (please see Sandhu, 2004 for more information). Goal-Setting As family is very impactful on well-being and is often considered central to decision-making processes of Punjabi Sikh individuals, even amongst those born in Canada (Mani, 2005; Shariff, 2009), individualistic goals should often take into account the potential impact on the extended family (Bedi & Domene, 2015). When client goals are not in line with familial goals, in order to maximize success, time should usually be devoted to strategizing how to defy familial wishes in the most respectful manner possible, seeking allies within the larger extended family network, working to maintain or improve the family’s social standing in the community, and lessening the aversive consequences on the community (Bedi & Domene, 2015; Mani, 2005). Research shows that during times of distress, many Punjabi Sikh individuals turn to their religion (e.g., Morjaria-Keval, 2006), although this is clearly influenced by acculturation level. As such, micro-goals that promote spiritual exploration/ activity are often indicated, such as consulting a Sikh elder, visiting a Sikh Gurdwara (temple), doing Sewa (volunteering at a Sikh Gurdwara or with a religious agenda), becoming baptized as a Sikh, reading Sikh scriptures, practicing religion more diligently, educating others about the Sikh religion, and meditation (Ahluwalia & Alichandani, 2013; Ahluwalia, Walo-Roberts, & Singh, 2015; Ahluwalia & Zaman, 2010; Morjaria-Keval, 2006; Sandhu, 2009; Thandi, 2011). In closing, presented above is guidance to assist those in working more effectively with Punjabi Sikh clients. We hope psychologists find this information useful for increasing their cultural clinical competence.
R e fe r e n ce s
Ahluwalia, M. K., & Alimchandanai, A. (2013). A call to integrate religious communities into practice: The case of Sikhs. The Counseling Psychologist, 41, 931-956. Ahluwalia, M. K., & Pellettiere (2010). Sikh men post-9/11: Misidentification, discrimination, and coping. Asian American Journal of Psychology, 1, 303-314. Ahluwalia, M. K., Walo-Roberts, S., & Singh, A. A. (2015). Violence against women in the Sikh community. In A. J. Johnston (Ed.) Religion and men's violence against women (pp. 399-408). New York, NY: Springer. Ahluwalia, M. K., & Zaman, N (2010). Counseling Muslims and Sikhs in a post 9/11 World. In J. Ponterotto, J. Casas, L. Suzuki, & C. Alexander (Eds.). Handbook of multicultural counseling (3rd ed.) (pp. 467-478). Thousand Oaks, CA: Sage. Bedi, R. P. (in press). Integrating traditional religio-cultural healing into counselling and psychotherapy with Punjabi Sikh clients in North America. Global Mental Health. Bedi, R. P., & Domene, J. D. (2015). Counseling and psychotherapy in Canada: Kamalpreet’s Story. In R. Moodley, M. Lengyell, R. Wu, and U. P. Gielen (Eds.), Therapy without borders: International and cross-cultural case studies (pp. 141-148). Washington, DC: American Counseling
Association. https://doi.org/10.1002/9781119222781.ch18 Dhillon, K. (2015). Acculturation, spirituality and counseling Sikh men living in Britain. In G. Nolan & W. West (Eds.), Therapy, culture and spirituality (pp. 188-207). New York, NY: Palgrave MacMillan. Horne, S. G., & Arora, K. S. (2013). Feminist multicultural counseling psychology in transnational contexts. In E. N. Williams, & C. Z. Enns (Eds.), The Oxford handbook of feminist multicultural counseling psychology (pp. 240-252). Oxford, UK: Oxford University Press. Mani, P. S. (2005). Perception of supports and barriers: Career decision-making for Sikh Indo-Canadian young women entering the social sciences. Canadian Journal of Counselling, 39, 199-211. Morjoria-Keval, A. (2006). Religious and spiritual elements of change in Sikh men with alcohol problems: A qualitative exploration. Journal of Ethnicity in Substance Abuse, 5, 91-118. Nayar, K. E., & Sandhu, J. S. (2006). Intergenerational communication in immigrant Punjabi families: Implications for helping professionals. International Journal for the Advancement of Counselling, 28, 139-152. Rana, R., & Sihota, S. (2012). Counselling in the Indo-Canadian community. In M. del Carmen, M. H. France, & G. G. Hett (Eds.), Diversity, culture and counselling: A Canadian perspective (2nd ed., pp. 114-137). Calgary, AB: Brush Education. Shariff, A. (2009). Ethnic identity and parenting stress in South Asian families: Implications for culturally sensitive counselling. Canadian Journal of Counselling, 43, 35-46 Sandhu, J. S. (2004). The Sikh model of the person, suffering, and healing: Implications for counsellors. International Journal for the Advancement of Counselling, 26, 33-46. Sandhu, J. S. (2005). A Sikh perspective on life stress: Implications for counseling. Canadian Journal of Counselling, 39, 40-51. Sandhu, J. S. (2009). A Sikh perspective on alcohol and drugs: Implications for the treatment of Punjabi-Sikh patients. Sikh Formations, 5, 23-37 Singh, K. (2008). The Sikh spiritual model of counseling. Spirituality and Health International, 9, 32-43. Thandi, G. (2011). Reducing substance abuse and intimate partner violence in Punjabi Sikh communities. Sikh Formations, 7, 177-193
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Board Statements 2017
we had five positions opening on the Board of Directors of the BC Psychological Association (BCPA). We have one new and four returning Board Members. WE WANT TO CONGRATULATE the following candidates who have been elected to the BCPA Board by acclamation. We also thank our returning Board Members for their continuing commitment. T his y e a r,
MARILYN CHOTEM , E D. D. , R. PSYCH .
K a m a l jit K . Sid h u, Ph . d. , R. PSYCH .
I am just completing my second three-year term on the BCPA Board of Directors, and one year as President of the Association. It has taken time to learn the ropes and I want to continue the work started. Continuity of projects and relationships with various alliances is important to achieve the goals of the Association. We continue to work on issues of recruitment and retention, access to psychologists, educating the public and other professionals on the unique training and skills of psychologists, and more. It would be my pleasure to serve another term on the BCPA Board.
I have been a registered psychologist in private practice in the Delta/Surrey area since 2001 providing psychological, counselling, and consulting services in English and Punjabi. Previously, I was a high school teacher and school counsellor in BC. Since entering the field of psychology 27 years ago, my passion has been to provide multi-lingual/ diversity sensitive public mental health education via workshops, conferences, and presentationsâ€”particularly to those disadvantaged by funding, mental health stigma, socio-cultural, or other barriers. Recently, I have been involved with the BCPA February Psychology Month Presentations, Ethics Salons, and the Continuing Education committee. I hope to continue promoting our profession and work towards further optimizing our professional ability to meet the mental health needs of our diverse populations.
PAUL G . SWINGLE , PH . D. , R. PSYCH . ,
Having just celebrated my 53 year mark as a Ph.D. level psychologist, I was mindful not only of how far we have progressed as a profession, but also the need for facilitating public awareness of the very special skills we have for remedying a very broad spectrum of conditions. Psychologists who are truly talented make it look easy so we have a myriad of me-tooers who purport, and apparently believe, that they are in our league. My motivation for accepting nomination is that I would like to help bring clarity to public understanding of our profession. S o fia Kh o u w, R. PSYCH .
Since I joined the Board, and now towards the end of my three-year term, I feel like I have not had enough time to fulfill the vision that I had for becoming part of the Board of Directors. Nonetheless, I have gained governance experience through my involvement as a director for the past seven months. I feel invigorated to be working alongside my colleagues to improve the profession of psychology in BC. My vision is that more people in the community can know more about what we do and the benefits we can bring to their lives.
M a r tin J. Z a kr z e ws ki , Psy. D. , R. PSYCH .
I currently serve as the Director of Psychology for BC Mental Health and Substance Use Services. My responsibilities include overseeing the provision of specialized psychological serves across the province within the agencies of BCMHSUS. I began my tenure on the BCPA Board of Directors beginning in February of 2017, and currently serve on the Advocacy Committee. Continued membership on the BCPA Board will strengthen my ability to effectively advocate for the profession and to help ensure that psychologists are appropriately recognized for their significant contributions to the health and well-being of individuals and groups across British Columbia.
Proposed Changes to the BCPA Constitution and Bylaws: Explanatory Notes IM P ORTANT: T his y e a r, t wo s pe cia l re s o lu ti o n s t o a m e n d t h e B CPA Co ns tit u ti o n a n d By l aws a re b e in g pre s e n t e d.
At this year’s Annual General Meeting (AGM) on November 17th, 2017, two special resolutions to amend the BCPA Constitution and Bylaws are being presented. Members are entitled to vote on these proposed amendments, either in advance by mail or in person at the AGM. The results of this vote will be ratified at the AGM. This form contains an explanation of the proposed constitutional amendments and an official ballot on the backside. Instructions:
1. Remove this ballot from the magazine and complete it (see backside). 2. Place the ballot into the smaller envelope enclosed with this copy of the BC Psychologist. Complete the declaration on the outside of this envelope and seal it. 3. Place the small envelope into the larger self-addressed envelope (also enclosed) and return it to BCPA so that we receive it prior to the Annual General Meeting on November 17th, 2017. Please ensure that you allow enough time for postal delivery. This year, BCPA seeks to amend two sections of the Association bylaws:
1. Section 25: Currently, BCPA members elect Board Members to a 3-year term each. The Board is recommending that the term for Board Members be changed to a 2-year term, commencing at the next AGM. The Board feels that this will allow more members to feel comfortable running for the Board. Members can stand for reelection.
2. Section 24: The Board is recommending the creation of an elected student seat on the Board. The Board feels that this will allow for better communication both to and from the doctoral level student community in BC, and will allow the Board to better address the needs of this important part of our psychological community. A full copy of the BCPA Bylaws can be found on our website at: https://www.psychologists.bc.ca/content/about-us
* Note: You must be logged in to your BCPA account in order to see them.
Constitutional Amendments Referendum Ballot 2017 Pl e a s e m a rk yo u r ba l l o t wit h X’s n e x t t o yo u r re s p o ns e f o r e ach A m e n d m e n T.
Part 5 Section 25(1) shall be amended by repealing the following:
Part 5 Section 24 of the bylaws shall be amended by adding the following:
“25(1) As of the time of the Annual General Meeting in 2010, each newly elected director shall begin service of a term of three years. The directors’ terms of office shall be staggered such that each year either two or three of the terms of office shall expire at the time of the Annual General Meeting.” And replacing it with: "25(1) The directors shall be elected by the Annual General Meeting and each director shall serve a term of two (2) years. The directors’ terms of office shall be staggered such that each year either two or three of the terms of office shall expire at the time of the Annual General Meeting.”
“24(3) The Directors may include one member who is a student affiliate of BCPA in good standing." "24(4) a Student Affiliate must be currently enrolled in a doctoral level psychology program at a CPA-accredited1 or APA- accredited2 university in British Columbia or at an institution authorized under the BC Degree Authorization Act3 to grant or confer a degree in British Columbia.”
Do Not Agree
Do Not Agree
CPA-accredited programs can be found at http://www.cpa.ca/accreditation/CPAaccreditedprograms APA-accredited programs can be found at http://www.apa.org/ed/accreditation/programs/index.aspx 3 The BC Degree Authorization Act can be found at http://www.bclaws.ca/civix/document/id/complete/statreg/02024_01 1
BCPA Annual General Meeting & Psychopharmacology Update: Adults and Older Adolescents Workshop Presented by Dr. John Preston Friday, November 17th, 2017 9:00AM – 4:30PM @ Holiday Inn Vancouver Centre 711 West Broadway, Vancouver, BC V5Z 3Y2 Continuing Education Credits: 6 About the Workshop Significant new developments as well as controversies have taken place in psychopharmacology during the past few years. Medical students choosing psychiatry as a specialty have dropped by 50% in the past 10 years; with fewer psychiatrists, more prescribing now occurs in primary care. This necessitates more training in this area for both nonprescribing psychological and health care professionals to facilitate collaboration with both psychiatrists and primary care prescribers.
This workshop addresses: • “What the drug companies don’t want you to know” – the pluses and minuses of the role played by “Big Pharma” • Cannabis pros and cons • Potential problems with suicidality in children, teenagers and young adults treated with antidepressants • New problems identified with the use of melatonin • New diagnostic criteria for bipolar spectrum disorders (DSM-5 and ICD-10/11) • Empirically derived treatment guidelines for major depression • Experimental treatments for PTSD • New studies on over-the-counter products such as St. John’s Wort, Omega-3 fatty acids, folic acid, melatonin, chamomile and SAM-e • The role of psychotropic drugs in protecting and healing the brain (neuro-protection)
Learning Objectives 1. Develop better skills related to diagnosing psychiatric disorders and understand the five major factors that commonly derail treatment 2. Become familiar with new approaches to the medication treatments of common disorders 3. Appreciate the limitations of pharmacologic treatments and the need for integrated approaches (combined use of medications and psychotherapy) 4. Understand the use of over-the-counter products and their limitations About the Presenter John Preston, Psy.D., ABPP is professor emeritus with Alliant International University; Sacramento campus. He has also taught on the faculty of UC Davis, School of Medicine. Dr. Preston is a psychotherapist but has also taught psychopharmacology and neuroscience classes for the past 37 years. He is the author or co-author of twenty-two books, five of which are psychopharmacology texts. He is the recipient of the California Psychological Association’s Distinguished Contributions to Psychology Award and the Mental Health Association’s President’s Award. Dr. Preston has lectured in the United States, Canada, Africa, Europe, and Russia. Cancellation Policy: Cancellations must be received in writing by November 13th, 2017. A 20% administration fee will be deducted from all refunds. No refunds will be given after November 13th, 2017. How to register for this workshop • Mail this form to: BC Psychological Association 402 – 1177 West Broadway Vancouver, BC V6H 1G3 • Fax 604–730–0502 or Call 604–730–0501 • Go online: http://psychologists.bc.ca BC Psychologist
BCPA Annual General Meeting & Psychopharmacology Update Workshop Registration Form Regular Registration (Oct 1st – Nov 13th, 2017) q Regular price $270.90 (incl. GST) q BCPA Members and Affiliates $197.40 (incl. GST) Parking q I will be bringing a vehicle and require parking
GST # 899967350. All prices are in CDN funds. Please include a cheque for the correct amount, not postdated, and made payable to “BCPA” or “BC Psychological Association”. If you prefer paying by credit card, please register online. Workshop fee includes handouts, morning & afternoon coffee, and lunch. Free Parking is available. Participant information is protected under the BC Personal Information Act.
Meal Requirements q Regular meal q Vegan meal q Special needs or allergies (please include details below)
Workshop Materials q I would like to receive a paper copy of the materials q I would like to receive an electronic copy of the materials * This will help BCPA reduce its environmental impact and administrative costs, as well as increase its efficiency in member services
annual general MEETING WILL BE HELD from 12pm–1pm q
I will attend the workshop and the AGM
I will attend the AGM only (BCPA members only)
I agree to the Cancellation Policy (required)
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"Presenting is a chance to educate the public about your profession, debunk some myths, and challenge yourself to do something good for the community you live in." – Kim Dawson, Ph.D., R.Psych., Psychology Month 2017
Psychology Month 2018
An annual campaign to raise awareness about the role of Psychology in shaping mentally healthy communities. Interested? Contact Priya at email@example.com
"I think my colleagues in BCPA should all consider volunteering in the future. Psychology Month was a steamroller kind of opportunity; I didn't realize it would lead to a lot of media interviews on the radio as well as on TV." – Kamaljit K. Sidhu, Ph.D., R.Psych., Psychology Month 2016
"Psychology Month was an opportunity to raise awareness on topics that I am passionate about. The media interviews helped me reach people I would not have been able to reach otherwise." – Kasim Al-Mashat, Ph.D., R.Psych, Psychology Month 2017
Published on Oct 13, 2017
Learn about socio-cultural considerations in counselling and psychotherapy, the hallmarks of adult functioning, and how to balance altruism...