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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 7 • Is su e 4 • FALL 2018


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BC Psychologist mission statement

The British Columbia Psychological Association provides leadership for the advancement and promotion of the profession and science of psychology in the service of our membership and the people of British Columbia. PUBLICATION DATES

January 15 | April 15 | July 15 | October 15

EDITOR IN CHIEF

Ted Altar, Ph.D., R.Psych. Assistant Editors

Marian Scholtmeijer, Ph.D., LLB. Paul Swingle, Ph.D., R.Psych.

PUBLISHER

Cherie Payne, BA, LL.B

SUBMISSION DEADLINES

November 15 | February 15 | May 15 | August 15

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Members and affiliates enjoy discounted rates. For more information about print and web advertising options, please contact us at: communications@psychologists.bc.ca

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#402 – 1177 West Broadway, Vancouver BC V6H 1G3 604.730.0501 | www.psychologists.bc.ca info@psychologists.bc.ca ADVERTISING POLICY

The publication of any notice of events, or advertisement, is neither an endorsement of the advertiser, nor of the products or services advertised. The BCPA is not responsible for any claim(s) made in an advertisement or advertisements mailed with this issue. Advertisers may not, without prior consent, incorporate in a subsequent advertisement, the fact that a product or service had been advertised in the BCPA publication. The acceptability of an advertisement for publication is based upon legal, social, professional, and ethical consideration. BCPA reserves the right to unilaterally reject, omit, or cancel advertising. To view our full advertising policy please visit: www.psychologists.bc.ca DISCLAIMER

The opinions expressed in this publication are those of the authors, and they do not necessarily reflect the views of the BC Psychologist or its editors, nor of the BC Psychological Association, its Board of Directors, or its employees. Canada Post Publications Mail #40882588 COPYRIGHT 2018 © BC PSYCHOLOGICAL ASSOCIATION

ART DIRECTOR

Louis Marta-Widjaja

Executive director

Cherie Payne, BA, LL.B

Education Coordinator

Sarika Vadrevu

Administrative Assistant

Alexina Picard

BOARD OF DIRECTORS

PRESIDENT Marilyn Chotem, Ed.D., R.Psych. VICE-PRESIDENT Martin Zakrzewski, Psy.D., R.Psych. TREASURER Sofia Khouw, M.A., R.Psych. DIRECTORS Ted Altar, Ph.D., R.Psych. Zarina Giannone, M.A. Michael Sheppard, Ph.D., R.Psych. Kamaljit Sidhu, Ph.D., R.Psych. Paul Swingle, Ph.D., R.Psych.


BCPA News & Events Membership Renewal: •

your 2018-2019 BCPA membership online at www.psychologists.bc.ca or complete the renewal form enclosed with this journal and mail it to BCPA with a cheque.

Pl e a s e Re n e w

Table of Contents

Upcoming Events: •

5

Letter from the President

6

Letter from the Executive Director

Presented by Dr. Marty Klein Friday, October 19th, 2018

7

BCPA's 80th Anniversary Celebration Dr. Eva De Haas

W h y a re s o m e

8

Time for Brief Therapy? Mike Webster Ed.D. R. Psych.

10

Diagnostic Challenges When Evaluating Organization Effectiveness Dr. Donald Hutcheon C. Psychol. (UK)., R. Psych. #1421

W h e n se x g e t s co m pli c at e d : in n ovativ e a ppr oach e s t o in fid e lit y, p o rn o g r a ph y, & dys fu n c ti o n wo rk s h o p

psych o t h e r a pis t s m o re

e ffe c tiv e t h a n o t h e rs? Co re ta s k s o f psych o l o gy wo rk s h o p

Presented by Dr. Don Meichenbaum Friday, November 30th, 2018

Get Involved: •

in BCPA Committees' activities and are thinking of getting involved, please contact us by phone or email: admin@psychologists.bc.ca

13

Lessons From The Mental Training Of Athletes Dr. Derek Swain, RPsych.

16

Are We Ready for the Silver Tsunami? Complexities of Late-life Depression Marci D. Moroz M.A., R.Psych.

If yo u a re in t e re s t e d

Submit Articles: •

W e a re a lways l o o kin g f o r

for the BC Psychologist. The deadline for the Winter 2018 issue is November 15th. For further details, contact us at: communications@psychologists.bc.ca

19

Client Handout on Anger Management Dr. Ted Altar, Ph.D., R.Psych.

23

Membership Application & Renewal Form | 2018-2019

25

Workshop Registration Form | Fall 2018

w rit e rs


Letter from the President M a rily n Ch o t e m , Ed. D, R. Psych .

Dr. Marilyn Chotem completed her Ed.D. in Educational Psychology and Counselling at McGill University in 1990. She has been a Registered Psychologist in BC since 1980. Her career began in substance abuse/dependence treatment programs in 1978. Since 1983, she has worked with diverse populations in a variety of settings, such as community mental health centers, hospital psychiatry and private practice.

D e a r Co l l e ag u e s , I hope everyone had some rest and

The Advocacy Committee looks forward to resuming in September

recreation over the summer and that the autumn will bring opportunities

2018. The first meeting will focus on creating a strategic plan with the

for fresh starts. BCPA began September with the fresh start of a new

help of our new Executive Director to increase access to psychologists.

Executive Director, Ms. Cherie Payne. Cherie comes to us with a law

The committee will also continue working on increased coverage for

degree and 20 years experience in government relations, advocacy, and

psychologists through extended health benefit plans and improved fee

board experience. She is a natural leader and a dynamic personality. She

rates with third party payers. We are also working with unions to improve

comes with fresh energy and a vision for advancing psychology in BC. In

salaries and benefits for psychologists in public service to address

particular, she is passionate about improving access to psychologists

recruitment and retention problems.

and sees the current political climate as favourable. Please join me in welcoming Ms. Payne!

Dr. Ted Altar, Chair of the Continuing Education Committee, organized two workshops for the fall. The first has Dr. Marty Klein speaking on “When

Mr. Rick Gambrel, BCPA Executive Director from August 2013 to July 2018,

Sex Gets Complicated: Innovative Approaches to Infidelity, Pornography, &

was “head hunted” by an organization that offered him considerable career

Dysfunction”. This workshop will be on October 19, 2018 from 8:30 am to

advancement and a better salary. Shortly before Rick left, our Education

4:30 pm. On November 30, 2018, Dr. Donald Meichenbaum’s topic will be:

and Event Coordinator gave six-weeks notice that she was returning to

“Why Are Some Psychotherapists More Effective than Others? Core Tasks

England at the end of August 2018 for one year. Fortunately, Ms. Sarika

of Psychology”. Our Annual General Meeting will occur over lunch the day

Vadrevu, our former Executive Assistant (extraordinaire) assumed Priya’s

of the Meichenbaum workshop. Both workshops will be at the University

position. Next, our Communications and Advertising Coordinator gave

Golf Club.

two weeks notice, which added a third position for which we advertised, shortlisted and interviewed candidates. The process was outside of our

The Continuing Education, Diversity sub-committee is chaired by Dr.

skill sets, and it was a tremendous relief to hand over the hiring of the last

Kamaljit Sidhu. It is having its second meeting this fall to continue forming

position to our new Executive Director.

plans for the workshop. The objective will be to learn salient histories of diverse populations, respectful ways to communicate with diverse

The loss of three staff members in short succession raised serious

populations, sensitivity to visible and non-visible minorities, and relevant

questions, Feedback from staff was that the salary was inadequate for the

information related to assessment and treatment of diverse populations.

cost of living. Prior to the resignations, the board had voted to increase two

The challenge is to balance breadth and depth. We will keep you posted as

full-time administrative staff positions to $25/hour beginning in the 2018-

plans unfold. Lastly, the Community Engagement Committee is working on

2019 fiscal year, which started September 1, 2018. Unfortunately, they

finding speakers for the free public talks in February 2019 for Psychology

gave notice before we were able to tell them about the raise. This is still

Month.

modest for the amount of responsibility these positions entail. The staff and board consistently make every effort to reduce costs and increase revenue

As always, please consider joining a committee. All committees can benefit

so that we can pay our staff cost-of-living salaries without raising members’

from more members, and members benefit from what committees are able

dues.

to do. It’s fun!

BCPA began in 1938. Unfortunately, there are no records other than

Respectfully submitted,

the start date. Nevertheless, Rick Gambrel thought this was cause for celebration, and the Board agreed. The Membership Committee organized the event with the help of Ms. Priya Bangar, former Education and Event Coordinator. The Membership Committee is also working on creating regional networking opportunities for psychologists, such as, morning breakfast meetings with fellow psychologists in your community.

Marilyn Chotem, Ed.D., R.Psych. President, BCPA

BC Psychologist

5


Letter from the Executive Director Cherie Payne, BA, LLB.

The Executive Director of the BCPA. Ms. Payne has a Bachelor of Arts in History from McGill University and a Law Degree from Osgoode Hall Law School. She brings 20 years of experience in health policy, advocacy and government relations. Ms. Payne is also a former elected Vancouver School Board Trustee and Legislative Assistant to a federal Minister of Health in Ottawa. Contact: cherie.payne@psychologists.bc.ca

I am thrilled to greet you through this fall’s

issue of BC Psychologist. I joined BCPA on September 5th and it has been a busy and exciting start. I thank the Board for their confidence and warm welcome and I look forward to serving your professional and continuing education needs through the Association in the months and years to come. I come to BCPA with 20 years of experience in advocacy, policy and government relations. I have served as Legislative Assistant to a federal Minster of Health and worked as a health policy advocate for clients large and small in Vancouver, across the country, and overseas. I welcome the opportunity to leverage those skills and experiences on behalf of registered psychologists in BC. BCPA has a proud history on which to build. In September we celebrated the 80th anniversary of the association. It was an opportunity to hear from Bob Wilson, the very first registered psychologist in the province and Wolfgang Linden, past chair of the Canadian Psychological Association, about the foundations of our organisation, the struggles to be recognised by the provincial government, and the successes we’ve won. We also heard from Board member and UBC PhD candidate Zarina Giannone on the future of the profession and the role of psychologists in supporting a changing society – strong roots and a bright future.

6

Fall 2018

On October 1st, Ms. Giannone joined Dr. Patrick Meyers to deliver a presentation on depression to a full house at the Central Branch of the Vancouver Public Library. And as I write, staff are hard at work finalising the logistics for our first continuing education workshop of the fall with Dr. Marty Klein October 19th. Going forward, we are poised to build on the work of the ICBC advocacy committee to expand our public education and advocacy reach. We have hired three new staff members to replace the outgoing team, each with strong skills and a fresh enthusiasm for the work of BCPA. It is a season of transition, renewed energy, and an opportunity for strategic planning into the new year. We have accomplished a great deal over the past six weeks. It has been a period of bustling activity and opportunities for connection and learning. Thank you for being engaged members of the profession. I am looking forward to the work ahead.

Cherie Payne, BA, LLB. Executive Director, BCPA


BCPA’s 80th Anniversary Celebration by Dr. Eva De Haas

I

t wa s a pre t t y in tim at e a ffair . O n a r a i n y T h u r s d a y e ve n i n g, S e pte m b e r 20, 2018, a b o u t 5 0 fo l k s,

m a i n l y p s y c h o l o g i s ts, s o m e w i t h t h e i r s p o u s e s, a n d s t a f f

H e t h e n ex p r e s s e d h i s s u r p r i s e w h e n h e l e a r n t t h a t t h e l i v e b a n d t h a t fo l l o w e d t h e s p e e c h e s c o n s i s te d e n t i r e l y of p s y c h o l o g i s ts, n e u r o p s y c h o l o g i s ts to b e ex a c t.

f r o m t h e B C PA m a d e t h e i r w a y to t h e I t a l i a n C u l t u r a l C e n t r e i n e a s t Va n c o u ve r to c e l e b r a te t h e 8 0 t h a n n i ve r s a r y of t h e

I t c e r t a i n l y d i d n ot t a ke l o n g fo r “ Pe n n i n g to n H a l l ”,

B C P s y c h o l o g i c a l A s s o c i a t i o n. I t w a s a l ove l y o p p o r t u n i t y

c o n s i s t i n g of D r s. N i c k B o g o d, G l e n n H a l e y, I v a n To r r e s,

to m i n g l e a n d c h a t w i t h c o l l e a g u e s a n d B C PA s t a f f, to p u t

a n d M a r t i n Z a k r ze w s k i, to g et fo l k s u p f r o m t h e i r t a b l e s a n d

fa c e s to n a m e s t h a t o n e m a y of te n o n l y s e e i n a s i g n a t u r e

b u s t i n g s o m e ex p r e s s i v e a n d i m p r e s s i v e m ov e s. We w e r e a

l i n e, a n d a l s o to m e et o u r n e w E xe c u t i ve D i r e c to r, M s.

p r et t y d i v e r s e a n d w i l d c r o w d o n t h e d a n c e f l o o r ! S o m u c h

C h e r i e Pa y n e.

f u n! I t w a s a p e r fe c t w a y to r o u n d o u t a s o c i a l a n d s p e c i a l e v e n i n g. M a n y t h a n k s to a l l of y o u w h o m a d e t h i s e v e n i n g

T h e m e a l s e r ve d b y t h e I t a l i a n C u l t u r a l C e nt r e w a s

h a p p e n . . . a n d f u n!

d e l i c i o u s a n d to o k d i et a r y p r efe r e n c e s i n to a c c o u nt. A f te r a n i n t r o d u c t i o n b y o u r c u r r e n t p r e s i d e n t, D r. M a r i l y n C h ote m, i n d i v i d u a l p s y c h o l o g i s ts p a i d t r i b u te to h o n o u r B C p s y c h o l o g i s t s w h o h a ve m a d e a p o s i t i ve m a r k fo r o u r p r ofe s s i o n, i n c l u d i n g D r s. J e a n n e L e B l a n c, R a n d y Pa te r s o n, a n d Wo l fg a n g L i n d e n. R e g i s t r a nt N o. 1, D r. B o b W i l s o n, a n d D r. Wo l fg a n g L i n d e n, fo l l o w e d w i t h s p e e c h e s t h a t w e r e n ot o n l y i n fo r m a t i v e a n d e y e - o p e n i n g b u t a l s o ve r y e n te r t a i n i n g. T h a n k y o u s o m u c h, B o b a n d Wo l fg a n g, fo r s u p p o r t i n g ( I k n o w t h a t w e c a n n ot “p r ov e” h y p h ot h e s e s) t h e i d e a t h a t w e p s y c h o l o g i s t s c a n n ot o n l y b e k n o w l e d g e a b l e a n d e d u c a te d b u t w e c a n a l s o h a v e f u n! I n fa c t, o n e s p o u s e of a p s y c h o l o g i s t j o k i n g l y c o nf i d e d to m e t h a t h i s p a r t n e r h a d w a r n e d h i m h o w a b u n c h of p s y c h o l o g i s ts o n a n i g h t l i ke t h i s c o u l d b e a n “i nte r e s t i n g ” b u n c h, i.e., i n t r ove r te d a n d n ot ve r y s o c i a l.

D r. Wo l f g a n g L i n d e n & D r. Ev a D e H a a s

D r. M a r y l i n C h o t e m w i t h A d l e r U n i v e r s i t y P s y D S t u d e n t s . L e f t t o r i g h t : M s . M a r l a Ko r e c k y, M s . N a r d e e n A w a d a l l a , D r. M a r i l y n C h o t e m .

"P e n n i n g t o n H a l l" l e f t t o r i g h t : D r s . G l e n n H a l e y, I v a n To r r e s , Mar tin Zakr zewski, Nick Bogod BC Psychologist

7


Time for Brief Therapy? by Mike Webster Ed.D. R. Psych.

I

recently completed the CPBC online workshop

entitled, "Lessons from the Past and Prepping for the New Reality". The module pertaining to collaborative care and the integration of psychological services into Primary Health Care was of great interest to me. Three of our esteemed colleagues, Drs. Amy Janek, Leora Kutner, and Tricia Tang (workshop presenters) made a compelling case for a different approach. It was asserted by them that traditionally trained psychologists needed something more to make a valued contribution to collaborative care. We were encouraged by them to move out of our consultation rooms and to enter a variety of client related systems: the family, the school, and the community to name only three.

Moreover, as J. Grenier states, "Primary care psychologists must be aware that they are a resource for patients and the team, and that this resource is limited and must be managed judiciously. Traditional one hour weekly sessions may not be the norm. Sessions preferably need to be focused, and some may last 15-30 minutes. Reports and notes must be short and to the point, and serve as a vehicle for communication and collaboration with physicians and the team" (Grenier, 2010).

In addition, "[Primary Care] psychologists understand and develop skills in systemic thinking (e.g., appreciating the health care, community, cultural, and family contexts" (McDaniel and deGry, 2014). It is within this climate of a focus on systems, time limits, and collaboration that I would like to respectfully suggest, that it is time for brief therapy in Primary Care. The brief therapy that I am familiar with is Solution Focused Brief Therapy (SFBT). This approach was developed at the Brief Family Therapy Centre in Milwaukee Wisconsin and outlined initially by Steve deShazer (1985;1986). Steve deShazer and his colleagues were strongly influenced by the group at the Mental Research Institute, in Palo Alto California, and by the tenets of Family Therapy (O'Connell, 1998). As the seminal thinkers of SFBT, deShazer and his spouse Insoo Kim Berg , were also heavily influenced by the well known psychiatrist Milton Erickson M.D. Dr. Erickson believed strongly in the uniqueness of individuals and individual coping styles. This perspective became the underlying foundation of SFBT. Solution focused therapy is rooted in post modern

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constructivist thought (deShazer, 1985; O'Hanlon and WeinerDavis, 2003). Post modern constuctivist approaches are built on the premise that there is no single absolute and objective truth. Rather, what is viewed as reality is a subjective construction based upon the client's interactions with the world, meaning made of life experiences, and (unique) personalized interpretations of ambiguous stimuli and events (Nichols and Schwartz, 2004; White and Epston, 1990). The main difference between SFBT and other therapeutic approaches is the focus on solutions not problems (deShazer, 1985). This follows from the belief that all problems do not have one objective definition or cause. Solution focused therapists believe that an in depth understanding of the problem is not necessary in order to change it. The problem and its' solution may not even be related. Using caution not to reify client's problems, therapists concentrate more on those times when the problem is absent, reduced in severity, or on the context in which the client is generally coping better with it. The therapeutic focus is on what the client is doing differently at those times. Solution focused therapists concentrate on those behaviours and attempt to expand on them (O'Hanlon and Weiner-Davis, 2003). In addition this strength based approach assumes that change is constant. A significant part of the "game plan" then, is to aid clients in naturally occurring change, generate new perspectives on problems, identify strengths, and find parsimonious solutions that work (Berg and Miller, 1992). One of the major advantages of SFBT can be grasped in the metaphor of the "judoki" (the judo player). When clients come to therapy as "looky-loos", or at the insistence of someone else (the "reluctant dragon"), and lacking in motivation, considerable time can be saved in side-stepping resistance and denial and turning them back on the client to create a legitimate "customer". Therapists will often label clients as unmotivated or resistant based on the incorrect assumption that all clients should enter treatment as "legitimate customers". Instead, solution focused therapy accepts clients where they are, at the same time believing that all clients are "covert customers". This belief now allows the therapist to assume a positive stance in the therapy (and to save significant amounts of time). Flushing out "covert customers" requires the therapist to join with clients, where they are, and to collaborate with them on therapy goals. Rather than confronting what appears to be denial, the therapist delineates the goal and works with the client to figure out how to make it happen (which in most cases encompasses the more realistic goal). I think the jazz trumpeter, Miles Davis, got the idea when he said in an interview, "I don't lead musicians man. They lead me. I listen and learn from what they can do best".

to e a r t h" a p p ro a c h, a n d w h o d o n ot f i t we ll i n a n a p p ro a c h t h at d we ll s o n t h e c o g n i t i ve, o r af fe ct i ve c o m p o n e nts of a p ro b l e m. F i n a ll y, as c li e nts a re v i ewe d as t h e ex p e r ts o n t h e i r ow n b e h avi o u r, t h e a p p ro a c h c a n wo r k we ll w i t h t h o s e f ro m a n u m b e r of di f fe re nt c u l t u r a l b a c kg ro u n d s. T h e m a j o r c r i t i c i s m s of S F BT h ave b e e n t h at t h e a p p ro a c h l a c k s b ot h a fo u n d at i o n a l t h e o r y a n d st ro n g e m p i r i c a l s u p p o r t. G i n g e r i c h a n d E i s e ng a r t (20 0 0) rev i ewe d t h e li te r at u re a n d c o n c l u d e d t h at t h e rev i ew p rov i d e d s u p p o r t fo r t h e ef f i c a c y of S F BT, b u t di d n ot p e r m i t a d ef i n i t i ve c o n c l us i o n. T h ey s u g g e ste d t h at t h e m et h o d o l o g y u s e d i n f u t u re st u di e s s h o u l d b e st re n g t h e n e d to p rov i d e m o re c o n c l u s i ve ev i d e n c e of S F BT 's eff i c a c y. T h ey a l s o wa r n e d t h at w h il e t h e li te r at u re rev i ew was c o m p l ete, i t was li m i te d to E n g li s h l a n g u a g e st u di e s; a n d i t was p o s s ib l e t h at re leva nt u n p u b li s h e d a n d n o n- E n g li s h st u di e s we re m i s s e d.

References B e r g , I . K ., a n d M i l l e r, S . D., ( 19 9 2 ) W o r k i n g w i t h t h e P r o b l e m D r i n k e r : A s o l u t i o n o r i e n t e d

d e S h a z e r, S . ( 19 8 5 ). K e y s t o S o l u t i o n i n B r i e f T h e r a p y. N e w Yo r k : N o r t o n d e S h a z e r, S ., B e r g , I . K ., L i p c h i k , E ., N u n n a l y, E ., M o l n a r, A ., G i n g e r i c h , W. a n d W e i n e r-

D a v i s , M . ( 19 8 6 ). B r i e f T h e r a p y : F o c u s e d S o l u t i o n D e v e l o p m e n t . F a m i l y

P r o c e s s , J u n e.

G r e n i e r, J., ( 2 0 10 ) P s y c h o l o g y o n t h e F r o n t L i n e o f P r i m a r y C a r e . P s y n o p s i s , W i n t e r, V o l .

3 2, N o.1.

G i n g e r i c h , W. J. a n d E i s e n g a r t , S . ( 2 0 0 0 ). S o l u t i o n F o c u s e d B r i e f T h e r a p y : A R e v i e w o f

O u t c o m e R e s e a r c h . F a m i l y P r o c e s s , 3 9 (4 ): 47 7- 4 9 8 .

L i n t o n , J. M . ( 2 0 0 5 ). M e n t a l H e a l t h C o u n s e l l o r s a n d S u b s t a n c e A b u s e Tr e a t m e n t : A d -

vant ages, dif ficulties and practical issues to solution focused inter ventions.

J o u r n a l o f M e n t a l H e a l t h C o u n s e l l i n g . ( O c t .), V o l . 2 7, I s s u e 4.

M c D a n i e l , S . H . a n d d e G r y, F.V. ( 2 0 14 ). C o m p e t e n c i e s f o r P s y c h o l o g i c a l P r a c t i c e i n

P r i m a r y C a r e. A m e r i c a n P s y c h o l o g i s t , V o l ., 6 8, N o.4, 4 0 9 - 42 9.

N i c h o l s , M . P., a n d S c h w a r t z , R .C . ( 2 0 0 4 ). F a m i l y T h e r a p y : C o n c e p t s a n d M e t h o d s .

A d di t i o n a l a d va nt a g e s i n c l u d e t h e e m p h as i s o n t h e c lie nt 's st re n g t h s, a n d t h e re a li t y t h at S F BT c a n b e u s e d ef fe ct i ve l y w i t h a va r i et y of c li e nts a n d p ro b l e m s (m il d to m o d e r ate l y s eve re). I t wo r k s we ll fo r t h o s e c li e nts (a n d c u l t u re s) w h o p refe r a fast, "n o n o n s e n s e", "d ow n

a p p r o a c h . N e w Yo r k : W.W. N o r t o n .

B o s t o n: P e a r s o n: A l l y n a n d B a c o n .

O ' C o n n e l l , B . ( 19 9 8 ). S o l u t i o n F o c u s e d T h e r a p y. L o n d o n: S a g e P u b l i c a t i o n s . O ' H a n l o n , W. H . a n d W e i n e r- D a v i s , M . ( 2 0 0 3 ). I n S e a r c h o f S o l u t i o n s : A N e w D i r e c t i o n i n

P s y c h o t h e r a p y. N e w Yo r k : W.W. N o r t o n .

W h i t e, M ., a n d E p s t o n , D. ( 19 9 0 ). N a r r a t i v e M e a n s t o T h e r a p e u t i c E n d s . N e w Yo r k : W.W.

Norton

BC Psychologist

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Diagnostic Challenges When Evaluating Organization Effectiveness Dr. Donald Hutcheon C. Psychol. (UK)., R. Psych. #1421

H

iring a management consultant to evaluate an organization’s effectiveness requires the incumbent

diagnostician to determine which model and methods to utilize, followed by how to manage the consulting process. When interviewing a consulting professional, a starting point in the interview should be to introduce questions to determine the depth/breadth of knowledge and experience of the consultant. There are good MBA’s and bad Industrial-Organization psychologists and vice versa – the old saying “buyer beware” is to be rigorously followed when paying for competence in these matters. For instance, beginning practitioners will need first-hand experience in diagnosis and consulting processes and further training in organization analysis and research methods to develop the ability to make these judgements themselves. In addition, most consulting practitioners contracted to evaluate an organization’s effectiveness will face three potential dilemmas (Harrison, 1994) • • •

There are good MBA’s and bad Industrial-Organization psychologists and vice versa – the old saying “buyer beware” is to be rigorously followed when paying for competence in these matters

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The Goals Dilemma – addressing modest objectives that can be obtained quickly and easily versus “chasing” ambitious objectives that require more effort and have more risk; The Political Dilemma – searching for benefits that will satisfy all members of the client organization versus providing selective benefits; The Professionalism Dilemma – maintaining strict professional standards versus responding to personal needs and interests.

Addressing the aforementioned potential dilemmas before beginning a project, allows the practitioner – consultant to be better equipped to deal effectively with the developing relationship with the client-boss. As negotiations with the client-boss progress, the beginning stages of the dreaded word “politics” emerges, as the consultant searches for ways to clarify the issues highlighted by these major dilemmas mentioned above. This practice helps to ensure that mutually compatible expectations are achieved with the client-boss. Of note: The dilemmas can only be resolved provisionally and partially. As a result, the consultant will need to reconsider them as the diagnostic project unfolds and changes occur in the consultant’s needs/expectations and in those of the clientboss. This “give and take” interaction can become tricky business if left in the hands of an inexperienced consultant (remember buyer beware). More specifically, the impact of organizational stress in the change process, follows several stages and, if left unexamined, can lead to reduced organization effectiveness (Quick, Quick, Nelson, & Hurrell, 1997). As stated by Quick et al, Primary prevention hopes to modify the organizational stressors that may eventually lead to employee distress. Secondary prevention aims at changing individual stress responses to necessary demands. Tertiary prevention attempts to minimize the amount of individual and organizational distress that results when organizational stressors and resulting stress responses have not been adequately controlled. For example, multiple-reporting relationships (a stressor) might lead to chronic anxiety (a stress response) and, in turn, leads to absenteeism (an organizational consequence of distress). In this case, primary


prevention would attempt to simplify the reporting relationships. Secondary prevention might address the problem by providing a program of relaxation training (e.g., Progressive Deep Muscle Relaxation) to help alleviate signs of tension among affected employees. Tertiary prevention might include an employee counseling program designed to help employees cope with conflicting expectations. The “preventability quotient” depends on the nature of the demands, the characteristics of the employee, and the organizational resources available in the situation. Now, moving on, the stage of prevention (i.e., primary, secondary, tertiary) is often situationally determined. Occasionally, it is not possible to change a demand or reduce an employee’s vulnerability to the demand, which then indicates that tertiary prevention is most appropriate. It appears that what is preventable at each stage may be as much a function of circumstances as of rational choice. That being stated, there are available at each stage of prevention, individual and organizational interventions. Let’s proceed. Organizational-level Interventions

At the organizational level, primary prevention is aimed at controlling the number of stressors and their intensity. Although the secondary and tertiary stages of prevention are not ignored at the organizational level, a greater number of individual methods of preventive stress management are available for primary prevention. Tertiary prevention within the organization is concerned with minimizing the organizational costs and the individual discomfort, disability and frank manifestations of too much stress for the employees. At the organizational level, this usually takes the form of crisis intervention, addressing through evaluation what is causing the problem, whereas at the individual level, it often consists of traditional medical and traditional psychotherapy intervention. Individual-level Interventions

At the individual level, primary prevention is intended to help individuals control the frequency and intensity of the stressors to which they are subjected. The goal is not to eliminate stressors, but to reduce the frequency and intensity of stressors. When the stress response is elicited too frequently or too strongly at work, organizational and individual distress becomes inevitable. Conversely, when the stress response is not elicited frequently enough, lethargy, as well as lack of growth and adaptation, occur. Obviously, either extreme is to be avoided and an optimal level of stress is to be sought. Secondary prevention is directed at controlling the stress response itself and includes efforts to optimize the intensity of each stress response an employee experiences. Low-intensity employee stress responses may provide insufficient impetus for adaptability and growth, whereas high-intensity responses

may lead to sudden illness or other serious individual consequences. Each employee has their own level of stress tolerance; the optimum intensity for one employee may not be optimum for another. External Factors

Lastly, diagnosticians can make a major contribution to organizational effectiveness by helping decision-makers (client-boss) identify the external conditions that affect their organization. In conjunction, Harrison (1994) suggests assessing current tactics for managing environmental relations, by utilizing the following guidelines to enhance a thorough diagnosis of environmental relations. This should be a “no brainer” exercise for a competent consultant. Again “buyer beware” if there is a challenge to this procedure and/ or the consultant falters in performance of this very important component of advancing organization effectiveness: a) Identify the key conditions of the organization’s task environment in which external sources will play a significant role (e.g., markets, industry-wide conditions such as budget constraints, relevant technical and scientific conditions, labour laws/regulations and the behavior of competitors; b) Assess the organization’s strategic position in its environment in terms of its ability to obtain resources and dispose of outputs on favorable terms (Andrews, 1971; Porter, 1980). Strategic advantage often derives from the ability to provide a service that is superior in quality, terms of delivery (flexibility) and cost to the consumer. Organizations need to exploit their distinctive capacities to the fullest; c) Describe the main organizations with which the client organization interacts and its relation with them. In regards to the field of psychology this might be examining the organization’s interdependence with the Provincial Ministry which oversees a myriad of competing clinics under its authority. Lateral as well as hierarchical links should be aggressively evaluated to increase resource power in the particular client organization; d) Evaluate the major units of the client organization and the supervisors who handle the external contacts. This includes for example, public relations; fundraising, and staff recruitment; e) Evaluate the demands and pressures stemming from the environment and the resulting opportunities and problems facing the organization. More specifically, external groups or conditions can influence the organization to behave in a certain way. In addition, consultants should evaluate the degree or predictability of important environmental developments; BC Psychologist

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f) Evaluate the organization’s responses to external problems and demands and its efforts to discover and take advantage of opportunities. The consultant should evaluate the concrete actions taken in response to external demands and the implications of these actions for organization-environment relations. The client-boss of the organization should be directed, if they need reminding, to respond to external pressures by making internal adjustments, or by intervening in the environment to reduce pressures or shape demands at their source;

The consultant should identify allies within the organization who want change to occur and appreciate the consultant’s efforts; encouraging the concept of “dignity of risk”

g) In conjunction with (f), the consultant should assess the effectiveness of current responses to the environment. This requires evaluating internal adjustments and environmental interventions in terms of agreed-upon effectiveness criteria; h) Identify external trends that are creating new problems and opportunities or are likely to affect the client organization in the future. By monitoring developments in the general environment, consultants can sometimes anticipate and plan for likely impacts on the client organization’s immediate task environment. To be frank, no one can predict external developments adequately. However, consultants who follow “developing trends” may more readily take advantage of emerging opportunities and prepare to cope with emerging threats; and i) Identify ways to improve the management of current environmental relations and possible response to anticipated developments. The consultant should help the client-boss find ways to enhance current tactics for managing external relations. This might require the client organization to reorganize by making basic changes in its structure, processes, technology, resource acquisitions and allocations and even its culture. In conjunction, the client organization can be influenced to reduce external constraints by redefining its goals and strategies to allow one or more of its domains to be altered (e.g., mixing its products and services). Lastly and to repeat the obvious, a consultant’s role and subsequent intervention to reduce organization difficulties can be summed up with the following points of reference kept in mind. The consultant’s language has the power to influence others’ priorities and actions. The consultant should identify allies within the organization who want change to occur and appreciate the consultant’s efforts; encouraging the concept of “dignity of risk” in other words, promoting prudent risk-taking in ventures that have minimal risk for failure; embracing a “go between” role between senior management/mid management/ line staff continually improving fluency in assessing the organizational dynamics. Thank you for your attention and I hope you enjoyed the article.

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REFEREN CES A n d r e w s, K . (1971). T h e c o n c e p t o f c o r p o r a t e s t r a t e g y.

H o m e w o o d, I L: D o w-J o n e s, I r w i n.

H a r r i s o n, M.I. (19 9 4). D i a g n o s i n g o r g a n i z a t i o n s: M e t h -

o d s, m o d e l s, a n d p r o c e s s e s . ( S e c o n d E d.).

T h o u s a n d O a k s, C A : S a g e P u b l i c a t i o n s .

P o r t e r, M. (19 8 0). C o m p e t i t i v e s t r a t e g y: Te c h n i q u e s f o r

analy zing indust ries and competitors.

N e w Yo r k , N Y: F r e e P r e s s .

Q u i c k , J.C., Q u i c k , J.D., N e l s o n, D.L., & H u r r e l l, J. J.

(19 97 ). P r e v e n t a t i v e s t r e s s m a n a g e m e n t i n

O r g a n i z a t i o n s . Wa s h i n g t o n, D.C: A m e r i c a n

P s y c h o l o g i c a l A s s o c i a t i o n.


Lessons From The Mental Training Of Athletes Dr. Derek Swain, RPsych.

T

he mental abilities of concentration,

composure, and confidence are crucial for success in everything we do. School, work, relationships, sport, and general life challenges benefit from these abilities. While our mental abilities may vary according to circumstances and challenges, we can learn to pursue excellence by enthusiastically focusing on learning and growth through disciplined action to make determined change in our lives. The way athletes train is a prime example of highly focused disciple and determination. Mental training involves learning to better manage our thoughts, feelings, and behaviours in order to enhance our performance. It involves consistent work with rewards that move us toward peak performance in sport as well as other life pursuits. This work includes focusing on what is controllable, breathing effectively, visualizing success, reflecting on performance, dealing with failure, and having a sense of humour and perspective. It also includes the four most important skills that employers are seeking in future employees: leadership, communication, collaboration, and time management. In short, mental training teaches more efficient ways of selfmanagement. Some of these lessons are noted below. When we choose to be a peak performer in sport, school, or work, it is important to set goals which are realistic, satisfying, and challenging so that we are internally drawn toward work that will improve performance. And coaches, teachers, and supporters should provide encouragement to help remind us of our strengths, potential, and what is important to us.

Excellence or mastery is an elusive goal because it is never completely attained. There is always more to achieve or better to accomplish. But it is the excitement and challenge of the continuing pursuit that motivates the most successful people. “Throughout my athletics career, the overall goal was always to be a better athlete than I was at that moment – whether next week, next month or next year. The improvement was the goal. The medal was simply the ultimate reward for achieving that goal.”

To persist with the pursuit requires acceptance that goals such as awards or championships are not the end themselves but markers of progress towards mastery. “Figure out for yourself what you want to be really good at, know that you’ll never really satisfy yourself that you’ve made it, and accept that that’s okay.”

Robert Reich, former U.S. Secretary of Labor

The pursuit of mastery is a pain, requiring grueling passion and perseverance for long-term goals over many years. The pursuit involves five steps: • • • •

There are a great many factors that go into ‘winning’, often capricious events that do not adequately reflect performance. Simple luck is a huge factor! It is important that success is not defined as a single elusive dimension that may not appropriately measure performance. Ultimately it is the continuing pursuit of excellence that really counts. And that pursuit involves learning an attitude of discipline and sustained energy.

Sebastian Coe, two-time Olympic gold runner

Deliberate practice with the sole objective to improve performance; Repetition, repetition, and repetition in proper practice to hone the skills; The pursuit of constant, critical feedback so that you know what you are doing and what you need to improve; Ruthless focus on where you need help, improving weaknesses; Preparation for a process which will be mentally and physically exhausting, which is why so few people commit to it.

“We are going to relentlessly chase perfection, knowing full well we will not catch it, because nothing is perfect. But we are going to relentlessly chase it, because in the process we will catch excellence.”

“The attitude with which we approach the situation can determine

Vince Lombardi, NFL coach.

our success or failure.”

Peyton Manning, NFL quarterback.

“Your mind makes everything else work.” Kareem Abdul-Jabbar, NBA star.

Successful people develop consistent and productive habits. Habits consist of knowledge, which allows us to know what to do; skill, which is the ability to know how to do it; and desire, which is the motivation to do it and repeat it.

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“Take care of the little things! It’s about doing things, taking care of details, looking after yourself and your team that allows greatness to be possible.”

John Wooden, UCLA basketball coach.

“If you want to change the world, start off by making your bed. If you make your bed every morning, you will have accomplished the first task of the day.”

U.S. Admiral William H. McRaven.

Athletes and others seeking to improve their mental performance need to build a strong sense of self-awareness of what works for them. Keeping a journal to track their state of mind and how it correlates with performance is helpful. From a physiological point of view, excitement and anxiety exhibit in similar ways, such as shortness of breath, increased heart rate and sweaty palms. Much of it comes down to whether the situation is framed as exciting or threatening. The trick is not to eliminate the butterflies in your stomach but to get them to fly in formation. “Among the top 100 (tennis) players, physically there is not much difference… Its a

Novak Djokovic, professional tennis player

mental ability to handle the pressure, to play well at the right moments.”

Successful people enthusiastically make the best of every situation, consistently putting in the hard work and making sacrifices in order to realize their aspirations. Success often means doing things that others fail to do. Confidence comes through the conscious repetition of skills, building ‘muscle memory’, so that in competition, you perform the skills automatically, responding to circumstances without conscious thought.

Ironically, perfectionism is self-defeating and counterproductive, leading to less success than expected.

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Whether it is in sport or in career, self-improvement involving commitment, diligence, and hard work is a good thing, but some people take this to unhelpful extremes. Perfectionism is about unrealistic standards and ways of thinking about oneself. Performance becomes intertwined with the sense of self so that, in the face of perceived failure, perfectionists are not just disappointed but judge themselves too harshly, assume guilt and shame for who they are, and express anger. Ironically, perfectionism is self-defeating and counterproductive, leading to less success than expected. Perfectionistic avoidance, denial of mistakes, and blame make it harder for people to take risks, to learn, to adapt, and to reach their goals. Trying and failing, making and admitting mistakes are essential to learning and lead to improved performance. “I am not a perfectionist, but I like to feel that things are done well.” Footballer Cristiano Ronaldo “Success is the ability to go from one failure to another with no loss of enthusiasm.”

Winston Churchill

Superior athletes need to develop mental toughness - the ability to surpass complacency, working harder and harder with resilience to failure and adversity, in a relentless and disciplined pursuit of long-term goals. It involves


taking responsibility for what can be controlled, disregarding what cannot be controlled, learning from experience, and making no excuses. Instead of whining, complaining, blaming, criticizing, or sulking, it involves supporting and encouraging others. An inner-strength bank account helps people to remain positive and proactive in the most adverse of circumstances. This strength is built by doing whatever is hard over and over again, particularly when you don’t feel like doing it. Mistakes are an opportunity to learn – to improve. Failure is a wonderful teacher if we learn the lessons and act on them.

In an earlier career, Registered Psychologist, Dr. Swain earned

300 games. Twenty-six times, I’ve been trusted to take the game winning shot and missed. And that is why I succeed.”

Michael Jordan, NBA all-star

While not everyone will be interested in maximizing the physical performance to which athletes aspire, the principles used in the mental training of athletes can help others achieve better performance in the numerous challenges of daily living.

a Master’s degree in Physical Education and was a physical education teacher and later, a college athletic director and basketball coach. Now in semi-retirement, he has returned to that earlier passion and volunteers as the team psychologist for the UBC Thunderbirds Men’s Basketball team. More information on this topic is available on his website: www.drswainpsychologist.com

“I’ve missed more than 9,000 shots in my career. I’ve lost almost

From a physiological point of view, excitement and anxiety exhibit in similar ways, such as shortness of breath, increased heart rate and sweaty palms. Much of it comes down to whether the situation is framed as exciting or threatening. The trick is not to eliminate the butterflies in your stomach but to get them to fly in formation.

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Are We Ready for the Silver Tsunami? Complexities of Late-life Depression Marci D. Moroz M.A., R.Psych. “ M a ny p e o p l e t h i n k t h a t d e p r e s s i o n i s s o m e t h i n g yo u j u s t h a ve t o l i ve w i t h w h e n yo u g e t o l d e r, b u t i t ’s n o t .” - To m B o s l e y

s e r v e a s t h e p o i n t of e n t r y to m e d i c a l s e r v i c e s fo r p a t i e n t s w i t h m e n t a l h e a l t h c o n c e r n s ( A PA , 2014; C h ote m, C a v e, S e h r b r o c k & G a m b r e l, 2015; G r e g g, F i s ke & G a t z, 2013; M a h a p a t r a, S h a r m a, & K h a n d e l w a l, 2015; S h a r m a, & K h a n -

T

h e ‘ silv e r t su n a mi ’ is a m e ta ph o r u s e d to

d e l w a l, 2015). H o w e v e r, t h e r e i s a te n d e n c y to p r i o r i t i ze

d e s c r i b e p o p u l a t i o n a g i n g (G l i c k s m a n, 2012). A g i n g i s a n

p h y s i c a l c o n d i t i o n s ov e r m e n t a l h e a l t h i s s u e s (O v e r e n d, B o -

a s p e c t of d i ve r s i t y t h a t i s s u b j e c t to “c u l t u r a l l y a c c e pt a b l e”

s a n q u et, B a i l e y, F o s te r, G a s c oy n e & L e w i s, 2015). A c c o r d i n g

p r e j u d i c i a l b e l i ef s t h a t n e g a t i ve l y i n f l u e n c e t h e l a te r y e a r s of

to O v e r e n d et a l ’s s t u d y, p h y s i c i a n s a c k n o w l e d g e d t h a t t h e y

l i fe, w h e n o l d e r a d u l t s h a ve l e s s p o l i t i c a l i n f l u e n c e a n d fe w e r

w o u l d n o r m a l i ze d e p r e s s i o n i n o l d e r p e o p l e d u e to a l i m i te d

r e s o u r c e s. O n e a s p e c t of p r e j u d i c i a l b e l i ef s a s s o c i a te d w i t h

a m o u n t of c o n s u l t a t i o n t i m e, fe w r efe r r a l o pt i o n s, a n d l o n g

a g i n g i s r e s e a r c h t h a t s u g g e s ts m a j o r d e p r e s s i o n i s n ot a s

w a i t t i m e s. B u t S i n c l a i r (2013) s u g g e s ts t h e p r o b l e m w i t h

c o m m o n i n o l d e r a d u l t s ( D i n e s et a l. 2014) i n c o n t r a s t to t h e

p h y s i c i a n r efe r r a l i s n ot o n e of i n i t i a t i n g m e nt a l h e a l t h t r e a t-

m a j o r i t y of s t u d i e s t h a t c o n c l u d e l a te -l i fe d e p r e s s i o n ( L L D)

m e n t, b u t h a v i n g b et te r t r e a t m e n t to i n i t i a te, c i t i n g t h e l a c k

i s u n d e r- r e c o g n i ze d d u e to a s y s te m i c d i s c r i m i n a t i o n t h a t

of s u f f i c i e n t t r a i n i n g i n g e r i a t r i c p s y c h i a t r y a n d a s h o r t a g e of

d e v a l u e s o l d e r a d u l t s a n d c o n t r i b u te s to a l a c k of e q u i t a b l e

s p e c i a l i s ts fo r t h i s a g e c o h o r t.

t r e a t m e nt e v i d e nt a m o n g m o s t h e a l t h c a r e p r ov i d e r g r o u p s, a f fe c t i n g t h e d e l i ve r y of s e r v i c e s, a n d i n c r e a s i n g t h e p o s s i b i l -

F e w m e n t a l h e a l t h p r ofe s s i o n a l s r e c o g n i ze t h a t t h e d i a g n o s i s

i t y of m i s d i a g n o s i s ( A PA , 2014; K n i g h t & Pa c h a n a, 2015; H a n

a n d t r e a t m e n t of L L D r e q u i r e s a n u n d e r s t a n d i n g of t h e c u -

& R i c h a r d s o n, 2015).

m u l a t i v e ef fe c ts of a l i fet i m e of s t r e s s a n d t h e ef fe c t t h a t h a s o n t h e a g i n g b r a i n. L L D i s t h e r e s u l t of g e n et i c v u l n e r a b i l i t i e s

A c o m p l ex h ete r o g e n e o u s d i s o r d e r i n a d u l ts a g e d 6 5 a n d

a n d b r a i n c h a n g e s ov e r a l i fet i m e t h a t to o f r e q u e nt l y e l u d e s

o l d e r, L L D i s h i g h l y a s s o c i a te d w i t h d i s a b i l i t y, c o g n i t i v e i m-

d ete c t i o n d u e to a g i n g s te r e ot y p e s a n d a l a c k of h e a l t h c a r e

p a i r m e nt, r e d u c e d f u n c t i o n a l i t y, i n c r e a s e d h e a l t h c a r e u t i l i -

r e s o u r c e s. A c c o r d i n g to a 20 02 A PA p o l l, 6 9 % of p s y c h o l o -

z a t i o n a n d s u i c i d e r i s k ( B h a l l a & B u t te r s, 2011). D e p r e s s i o n

g i s ts r e p o r te d h a v i n g s o m e i n te r a c t i o n w i t h o l d e r a d u l t s i n

s e v e r i t y i s t h e l a r g e s t p r e d i c to r of s u i c i d e i d e a t i o n i n o l d e r

p r ofe s s i o n a l p r a c t i c e b u t m o s t fe l t i n a d e q u a te l y t r a i n e d to

a d u l ts, w h i c h m a ke s o l d a g e h i g h l y a s s o c i a te d w i t h s u i c i d a l

w o r k c o m p ete n t l y w i t h t h i s a g e c o h o r t ( Ze r a n s k i & H a l g i n,

a c ts w i t h fe w e r w a r n i n g s of i n te n t, a n d i s of c o n c e r n b e c a u s e

2011), m e a n i n g t h a t m a n y o l d e r a d u l t s a r e d i a g n o s e d a n d

t h e n e w e s t c o h o r t of a g i n g a d u l ts, t h e b a b y b o o m e r s, h a v e

t r e a te d b y g e n e r a l i s ts w h o a d m i t to g a p s i n k n o w l e d g e w i t h

t h e h i g h e s t s u i c i d e i n c i d e n c e of a n y p r e v i o u s g e n e r a t i o n

t h i s p o p u l a t i o n ( H o l ze r et a l., 2012).

(C a v a n a u g h & B l a n c h a r d- F i e l d s, 2015; Ke n n e d y, 2015). A l s o

Fu r t h e r c o m p l i c a t i n g t h e i d e n t i f i c a t i o n of L L D i s t h e fa c t t h a t

n ote w o r t h y i s t h a t t h e m a j o r i t y of o l d e r a d u l ts w h o d i e d b y s u i-

a g e i s m h a s b e e n e v i d e n t a m o n g m o s t h e a l t h c a r e p r ov i d e r

c i d e s a w a p h y s i c i a n w i t h i n a m o n t h p r i o r to d e a t h, a fa c t t h a t

g r o u p s, a f fe c t i n g t h e d e l i v e r y of s e r v i c e s, i n c r e a s i n g t h e

s u p p o r ts p r e ve nt a t i ve i nte r ve n t i o n s ( M o o d y, 2010; A PA , 2014).

p o s s i b i l i t y of m i s d i a g n o s i s, a n d c r e a t i n g a s y s te m i c d i s c r i m i-

A c c o r d i n g to C o n w e l l (2014) t h e l et h a l i t y of s u i c i d e b e h a v i o r i n

n a t i o n t h a t d e v a l u e s o l d e r a d u l ts a n d c o n t r i b u te s to a l a c k

l a te r l i fe i n vo l ve d t h e i n c r e a s e d f r a i l t y t h a t m a d e o l d e r a d u l ts

of e q u i t a b l e t r e a t m e n t a n d l o w e r e d ex p e c t a t i o n s fo r p o s i t i v e

s u s c e pt i b l e to d e a t h b y a n y s e l f-i n j u r i o u s a c t, a s w e l l a s t h e

c l i n i c a l o u tc o m e s c a l l e d t h e r a p e u t i c n i h i l i s m ( A PA , 2014; H a n

fa c to r of i s o l a t i o n t h a t m a d e o l d e r a d u l ts a t te m pt i n g s u i c i d e

& R i c h a r d s o n, 2015; K n i g h t & Pa c h a n a, 2015).

l e s s s u b j e c t to d ete c t i o n o r r e s c u e. T h e g a te - ke e p i n g r o l e of p r i m a r y c a r e p h y s i c i a n s p l a y s a T h e l a r g e s t g e n e r a t i o n to r e a c h a d u l t h o o d h a s b e e n a g i n g,

c e n t r a l r o l e i n m o s t h e a l t h c a r e s y s te m s a n d i s a s s o c i a te d

p u t t i n g p r e s s u r e o n p u b l i c h e a l t h s y s te m s t h a t d o n ot h a v e t h e

w i t h i m p r ov e d c o o r d i n a t i o n a n d o u tc o m e s of t r e a t m e nt i f a d-

t r a i n e d p r ofe s s i o n a l w o r k fo r c e to s e r ve t h e d e m a n d fo r m e n t a l

d i t i o n a l g u i d e l i n e s a n d t h e u s e of m o r e c o m p l ex i nte r v e nt i o n s

h e a l t h s e r v i c e s i n t h i s a g e g r o u p ( H o l ze r, Zw e i g & S i e g e l,

a r e i n c l u d e d (S i ko r s k i, L u p p a, Ko n i g, Va n d e n B u s s c h e & R i e -

2012). A g a p i n t h e p r ov i s i o n of h e a l t h c a r e s e r v i c e s fo r m e n t a l

d e l- H e l l e r, 2012). B u t i t i s e v i d e n t t h a t t h e u s e of p s y c h ot h e r-

h e a l t h p r o b l e m s t h a t a d d r e s s e s t h e s p e c i f i c n e e d s of o l d e r

a p y h a s d e c l i n e d a n d t h e u s e of p s y c h ot r o p i c m e d i c a t i o n s

a d u l t s i s s u p p o r te d i n t h e l i te r a t u r e (G o n c a l ve s, C o e l h o, &

h a s i n c r e a s e d i n t h e o l d e r a d u l t a g e g r o u p (G u m, H i r s c h,

B y r n e, 2014; L i p p e n s & M a c ke n z i e, 2011). A s p r i m a r y p h y s i-

D a u tov i c h, F e r r a n te, & S c h o n fe l d, 2014). I n fa c t, o l d e r a d u l t s

c i a n s a r e u s u a l l y t h e f i r s t to h e a r p r e s e n t i n g c o m p l a i nts, t h e y

a r e t h e l e a s t l i ke l y of a l l a g e g r o u p s to r e c e i v e p s y c h ot h e r a p y

16

Fall 2018


o r a c o m b i n a t i o n of p s y c h ot h e r a py a n d p s y c h ot r o p i c m e d i c a t i o n, b u t t h e y h a v e t h e s a m e o r h i g h e r r a te s a s ot h e r a g e g r o u p s fo r p s y c h ot r o p i c m e d ic a t i o n t r e a t m e nt a l o n e. G o n c a l ve s, C o e l h o a n d B y r n e (2014) s t a te t h a t t h e l i ke l i h o o d of g et t i n g a d e q u a te m e n t a l h e a l t h t r e a t m e n t d e c r e a s e s w i t h a g e a n d t h e o d d s of d r o p p i n g o u t of m e n t a l h e a l t h t r e a t m e n t ( b ot h p s y c h ot r o p i c m e d i c a t i o n t r e a t m e nt a n d p s y c h ot h e r a py) i n c r e a s e s w i t h a g e. I t i s n ote d t h a t p a r t i c i p a nt s i n t h e i r s t u d y s e l d o m r e p o r te d fe a r of b e i n g s t i g m a t i ze d a s a r e a s o n fo r n ot s e e k i n g t r e a t m e n t a n d t h e y c o n c l u d e t h a t o l d e r a d u l ts h a d b e c o m e m o r e o p e n to m e nt a l h e a l t h p r o b l e m s a n d t r e a t m e n t. T h e i r f i n d i n g i s i n c o nt r a s t to ot h e r s t u d i e s t h a t s u g g e s t s t i g m a c o n t i n u e d to n e g a t i v e l y i nf l u e n c e a t t i t u d e s a n d i n te n t i o n s a b o u t t r e a t m e n t i n o l d e r a d u l ts ( N i u & A re a n, 2015). C h o i, D i N i t to, & M a r t i (2015) s t a te t h a t a l a c k of s p e c i a l t y t r e a tm e nt, a t t i t u d i n a l b a r r i e r s, a n d s y s te m -l e ve l b a r r i e r s ( i n c l u d i n g t h e c o s ts of t r e a t m e nt a n d l a c k of i n s u r a n c e) l i m i t t h e u s e of m e n t a l h e a l t h s e r v i c e s fo r o l d e r a d u l t s.

Unt il p s yc hologi s t s a re publicl y f unde d in C a nad a t here w ill never be p a r i t y bet we en phy sic a l a nd ment a l he a l t h

A U.S. g ove r n m e nt- c o m m i s s i o n e d r e v i e w fo u n d g o o d e v i d e n c e t h a t p s yc h ot h e r a p y i s ef fe c t i ve fo r o l d e r a d u l ts ( Ke n n e d y, 2015) m a k i n g i t c l e a r t h a t a g e i s n ot a b a r r i e r to t r e a t m e n t, n o r d o e s i t p r e d i c t a p o o r o u tc o m e ( A PA , 2012; K n i g ht & Pa c h a n a, 2015). E v i d e n c e -b a s e d p s y c h o l o g i c a l t r e a t m e n t h a s b e e n fo u n d to h a ve m o d e r a te to l a r g e ef fe c ts i n o l d e r a d u l ts, w h o g e n e r a l l y p r efe r c o u n s e l l i n g to m e d i c a t i o n ( M a h a p a t r a, S h a r m a & K h a n d e l w a l, 2015). D e s p i te e v i d e n c e t h a t t r e a t m e n t i s ef fe c t i ve, L L D i s d i f f i c u l t to t r e a t fo r m a n y r e a s o n s i n c l u d i n g a l a r g e n u m b e r of c o m o r b i d p h y s i c a l a n d m e n t a l h e a l t h c o n d i t i o n s, c u m u l a t i ve ex p o s u r e to a d ve r s e ex p e r i e n c e s, s y m p to m s e v e r i t y, a l a c k of p o s i t i ve r e s p o n s e to a n t i d e p r e s s a n t m e d i c a t i o n, i n a d e q u a te s o c i a l s u p p o r t, s u i c i d e i d e a t i o n, a l c o h o l o r d r u g a b u s e, a n d r e c u r r e n t d e p r e s s i o n ( B r i e r e, 2013; Ke n n e d y, 2015; M a h a p a t r a et a l., 2015). T h e r e a r e a l s o i s s u e s of c o m p l i a n c e a s o l d e r a d u l ts h a v e t h e i r o w n a g e i s m b i a s e s t h a t m a ke t h e m r e l u c t a n t to m a ke t h e c h a n g e s s u g g e s te d i n t h e r a p y o r g i v e t h e i r b e s t ef fo r t d u r i n g s c r e e n i n g te s ts ( K n i g ht & Pa c h a n a, 2015). M e n t a l h e a l t h c a r e h a s s te p p e d f u r t h e r i n to a m e d i c a l m o d e l w h e r e t r e a tm e nt g o a l s fo c u s o n r e m i s s i o n of s y m pto m s c h a l l e n g i n g p s y c h o l o g i c a l t r e a t m e nt s to b e m o r e e v i d e n c e -b a s e d, t r a n s p a r e n t a n d p r e s c r i pt i v e ( We s te r h of & B o h l m e i j e r, 2012). E v i d e n c e -b a s e d t r e a t m e n t m o d a l i t i e s fo u n d ef fe c t i v e fo r L L D i n c l u d e c o g n i t i ve b e h a v i o u r a l t h e r a p y, p r o b l e m s o l v i n g t h e r a p y, r e m i n i s c e n c e a n d l i fe r e v i e w t h e r a py, b r i ef p s y c h o d y n a m i c t h e ra p y a n d i nte r p e r s o n a l t h e r a py ( M o r g a n, 2015). O n e of t h e p r o b l e m s w i t h

Marci has been a registered

e v i d e n c e d-b a s e d t r e a t m e n ts h a s b e e n t h e i r c o m p l ex i t y, w h i c h l i m i ts t h e

psychologist since 2002.

n u m b e r of c l i n i c i a n s c o m p ete n t to d e l i ve r t r e a t m e n t ( N i u & A r e a n, 2015). A s t h e p o p u l a t i o n c o nt i n u e s to a g e w i t h a d va n c e s i n l o n g e v i t y, t h e r e i s i n c r e a s e d u r g e n c y fo r e v i d e n c e -b a s e d m e n t a l h e a l t h t r e a t m e n t fo r L L D. U nfo r t u n a te l y, s e r v i c e s p r ov i d e d b y p s y c h o l o g i s ts a n d ot h e r m e n t a l h e a l t h p r ofe s s i o n a l s o u t s i d e of h o s p i t a l s et t i n g s (w i t h t h e exc e pt i o n of p s y c h i at r i s ts) h a ve n e ve r b e e n c ove r e d u n d e r C a n a d a’s u n i v e r s a l h e a l t h c a r e p r o g r a m. C h ote m (2017 ) c o n c l u d e d t h a t u n t i l p s y c h o l o g i s ts a r e p u b l i c l y f u n d e d i n C a n a d a t h e r e w o u l d n e ve r b e p a r i t y b et w e e n p h y s i c a l a n d m e n t a l h e a l t h s u g g e s t i n g t h a t a c c e s s to p s y c h o l o g i c a l a s s e s s m e n t a n d t r e a t m e n t w i l l c o nt i n u e to b e l i m i te d to t h o s e w h o h a ve ex te n d e d h e a l t h i n s u r a n c e c ov e r-

In 2012, she migrated west and started a private practice in the South Okanagan where she specializes in evidencebased treatment. Marci graduated from CalSouthern University in 2017 after completing a doctoral project - Late-Life Depression: Complexities in Diagnosis and Treatment. She is concerned about the lack of available resources needed to address mental health issues, especially in the aging population referred to as the ‘silver tsunami’.

a g e, a n d t h o s e w i t h f i n a n c i a l m e a n s. S i n c e p s y c h o l o g i s ts s p e n d m o r e t i m e w i t h e l d e r c l i e nt s, t h e y a r e i n a b et te r p o s i t i o n t h a n t i m e -p r e s s u r e d p h y s ic i a n s to d ete r m i n e w h i c h m e d i c a t i o n s, i f a n y, a r e n e c e s s a r y. BC Psychologist

17


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0 3 62-2

S i ko r s k i, C., L u p p a, M., Ko n i g, H., Va n d e n B u s s c h e, H., & R i e d e l - H e l l e r, S. G. (2012). D o e s G P t r a i n i n g i n d e p r e s s i o n c a r e a f fe c t

o u tc o m e? - A s y s te m a t i c r e v i e w a n d m e t a- a n a l y s i s. B M C H e a l t h S e r v i c e s R e s e a r c h, 12. h t t p://d x.d o i.o r g /10.118 6 /1472- 6 9 6 3 -12-10

S i n c l a i r, L. (2013, J a n u a r y 18). I m p r o v e m e n t u r g e d i n c a r e o f o l d e r d e p r e s s e d p a t i e n t s [O n l i n e fo r u m c o m m e n t]. R e t r i e v e d f r o m h t t p://

p s y c h n e w s.p s y c h i a t r y o n l i n e.o r g.p r ox y1.c a l s o u t h e r n.e d u /d o i / f u l l /10.1176 /a p p i.p n 2013.1b 8

We s te r h o f, G . J., & B o h l m e i j e r, E. T. (2012). L i fe s to r i e s a n d m e n t a l h e a l t h: T h e r o l e o f i d e n t i f i c a t i o n p r o c e s s e s in theor y and

i n te r v e n t i o n s. N a r r a t i v e Wo r k s, 2(1). R e t r i e v e d f r o m h t t p s:// j o u r n a l s.l i b.u n b.c a / i n d ex.p h p / N W/a r t i c l e / v i e w/19 5 01/2115 3

Ze r a n s k i, L., & H a l g i n, R . P. (2011). Et h i c a l I s s u e s i n e l d e r a b u s e r e p o r t i n g: A p r o fe s s i o n a l p s y c h o l o g i s t ’s g u i d e. P r o fe s s i o n a l

P s y c h o l o g y: R e s e a r c h a n d P r a c t i c e, 42(4), 29 4- 3 0 0. h t t p://d x.d o i.o r g /10.10 37/a 0 023 625

18

Fall 2018


Client Handout on Anger Management Dr. Ted Altar, Ph.D., R.Psych. I c a n d e a l w i t h i t, a n d a s l o n g a s I ke e p m y c o o l, I ’m i n

D o n o t l e t yo u r a n g e r b e s t r o n g e r t h a n yo u. A l wa y s b e

c o nt r o l ”, “ I t i s to o b a d t h a t t h i n g s d i d n ot t u r n o u t t h e

s t r o n g e r t h a n yo u r a n g e r.

wa y I w i s h t h e y d i d, b u t i t i s n ot t h e e n d of t h e w o r l d ”,

A

lt h o u g h it is n at u r a l t o b e co m e a n g ry,

“ I w i s h p e o p l e w o u l d d o m o r e a r o u n d t h e h o u s e, b u t i t

h o w w e ex p r e s s o r c o p e w i t h o u r a n g e r i s s o m et h i n g

i s n ot fa i r fo r m e to s a y t h a t t h e y n e ve r d o a ny t h i n g.”

w e m u s t l e a r n. F i r s t, i t h e l p s to a c c e pt t h a t i n p r i n c i p l e,

2. “ S h o u l d ” s t a te m e nts. We t u r n o u r w i s h e s a n d p r efe r-

n o b o d y m a ke s yo u a n g r y. Yo u m a ke yo u r s e l f a n g r y.

e n c e s i nto u n r e a s o n a b l e d e m a n d s w h e n w e s a y t h i n g s

O t h e r p e o p l e c a n o n l y a n n oy yo u, i r r i t a te yo u, s a d d e n

to o u r s e l ve s l i ke, “ E ve r y b o d y s h o u l d a l wa y s t r e a t m e

yo u, o r d i s a p p o i nt yo u (a n d m a y b e p hy s i c a l l y h u r t yo u).

w i t h r e s p e c t!”, “ N o b o d y s h o u l d e ve r c a l l m e n a m e s!”,

O t h e r p e o p l e, h o w e ve r, d o n ot a c t u a l l y m a ke yo u a n g r y;

“ L i fe s h o u l d a l wa y s b e fa i r ”. W h i l e o n e h o p e s t h a t ev-

ot h e r w i s e w e w o u l d b e c o nt r o l l e d b y t h e ot h e r o r t h e s i t u-

e r y b o d y w o u l d b e r e s p e c t f u l, k i n d a n d d e c e nt a l l t h e

a t i o n l i ke p u p p ets. Yo u m a ke yo u r s e l f a n g r y b y h o w yo u

t i m e, t h e y s i m p l y a r e n ot. To b e h o n e s t, n e i t h e r a r e

p e r c e i ve a n d e va l u a te t h e s i t u a t i o n, b y t a l k i n g yo u r s e l f u p

w e. T h e r e i s n o p o i nt i n d e m a n d i n g s o m et h i n g to b e

i nto a n g e r, by b e l i e v i n g t h a t i n a p p r o p r i a te ex p r e s s i o n s of

t h e c a s e w h e n i t i s n ot t h e c a s e. I n s te a d, s i m p l y b e

a n g e r a r e a c c e pt a b l e w h e n t h e y a r e n ot, a n d b y fa i l i n g to

m o r e a c c u r a te a n d fa i r a b o u t t h i n g s. S a y to yo u r s e l f

exe r c i s e s e l f- c o nt r o l. T h e m o r e yo u a c t o u t yo u r a n g e r,

s o m et h i n g l i ke “ I w i s h p e o p l e w e r e m o r e fa i r, b u t i n t h i s

t h e m o r e yo u b e c o m e a n a n g r y p e r s o n. T h e g o o d n e w s i s

w o r l d t h a t i s n ot g o i n g to h a p p e n. At l e a s t I w i l l b e fa i r

t h a t yo u c a n a l s o t h i n k a n d t a l k yo u r s e l f d o w n i nto c a l m-

e ve n i f ot h e r p e o p l e a r e n ot a l wa y s g o i n g to b e fa i r ”,

n e s s. T h e m o r e yo u exe r c i s e s e l f- c o nt r o l o n yo u r a n g e r

“ I t i s to o b a d t h a t m y p a r t n e r i s s o m et i m e s i n c o n s i d e r-

t h e m o r e, yo u b e c o m e a r e a s o n a b l e, fa i r-m i n d e d a n d s e l f-

a te, b u t n o b o d y i s p e r fe c t a n d m a y b e w e b ot h n e e d to

c o nt r o l l e d p e r s o n.

i m p r ove o u r c o m m u n i c a t i o n s k i l l s.” D o n’ t b e a “s h o u l dh e a d ” b u t i n s te a d r e p l a c e w i t h t h e w o r d s, “ I p r efe r ”, “ I wa nt ”, o r “ I w o u l d l i ke.”

T h e f i r s t p e r s o n yo u h u r t w i t h a n g e r i s yo u r s e l f. A m a j o r c a u s e of h e a r t d i s e a s e i s a n g e r. T h e i m m u n e s y s te m i s

3. P u t t i n g o u r s e l ve s d o w n. We m a ke o u r s e l ve s fe e l b a d

a l s o d e p r e s s e d. T h e n ex t p e r s o n yo u h u r t i s u s u a l l y t h e

w h e n w e s a y to o u r s e l ve s, “ I ’m s t u p i d ”, “ I c a n’ t d o i t ”,

p e r s o n yo u l ove t h e m o s t.

“ N o b o d y l ove s m e”. I n s te a d, s i m p l y b e m o r e a c c u r a te a n d s a y “ E ve r y b o d y m a ke s m i s t a ke s i n c l u d i n g m e”, “ I

S u p p r e s s i n g yo u r a n g e r i s n ot t h e s a m e a s l e a r n i n g h o w

d o n’ t n e e d e ve r y b o d y ’s l ove a n d a p p r ova l to b e a g o o d

to d e a l w i t h yo u r a n g e r. Yo u n e e d to t h i n k a b o u t w hy

p e r s o n”, “ I m a y n ot b e a b l e to d o i t n o w, b u t w i t h l ots of

yo u b e c a m e a n g r y, a n d h o w to c a l m l y a n d c o n s t r u c t i ve l y

p r a c t i c e I c a n i m p r ove.”

s o l ve t h e p r o b l e m. Other thought distor tions behind anger can include: T h r e e C o m m o n R e a s o n s w h y r e l a t i o n s h i p s g o b a d l y.

1. We b e c o m e d efe n s i ve a n d u nfa i r l y o r u n d u l y c r i t i c a l. 2. We d o n ot a c c e pt t h e ot h e r ’s p o s i t i ve i nf l u e n c e t h a t t h e y m i g ht b e t r y i n g to h a ve o n u s.

1. 2. 3. 4. 5.

O v e r g e n e r a l i z a t i o n

e.g., “ H e i s a l w a y s d o i n g t h a t ”

I n f l a m m a to r y l a b e l l i n g

e.g., “ H e i s a s t u p i d j e r k !”

D e m a n d i n g n e s s

e.g., " M y w a y i s t h e o n l y w a y!”

Simplistic cause

e.g., “ I t i s s o l e l y h i s / h e r fa u l t ”

B e i n g t h e v i c t i m

e.g., “ T h i s i s n ot fa i r ” ( T h a t

b e i n g p l e a s e d w h e n t h e ot h e r p e r s o n i s b e i n g g e n e r-

m a y b e s o, b u t t h a t d o e s n ot

o u s, k i n d a n d u n d e r s t a n d i n g.

j u s t i f y y o u a l s o b e i n g u nfa i r

through anger)

3. We ex p e c t m o r e o r t h e s a m e f r o m t h e ot h e r i n s te a d of

Three common ways we talk ourselves up into angr y:

1. M a g n i f i c a t i o n ( Te r r i b i l i z i n g, Aw f u l i z i n g, I c a n’ t t a ke i t a ny m o r e!). We m a ke t h i n g s w o r s e fo r o u r s e l ve s w h e n w e ex a g g e r a te a n d s a y to o u r s e l ve s: “ T h i s i s a w f u l!”,

A n g e r i s a S TO P S i g n . A n g e r i s a STO P s i g n. W h e n yo u s e e re d, yo u a re to sto p!

“ T h i s i s te r r i b l e!”, “ I c a n’ t s t a n d i t!”, “ Yo u a r e u nfa i r!”, " Yo u a r e a @!$ # @@!!” I n s te a d, s i m p l y b e m o r e a c c u r a te a n d s a y to yo u r s e l f, “A l t h o u g h t h i s i s u n p l e a s a nt,

BC Psychologist

19


Is this going to matter to me 5 year s from now? S T O P b e i n g a n g r y b y c a t c h i n g y o u r a n g e r e a r l y.

T h i n k a b o u t t h e r e a s o n s fo r yo u r a n g e r a n d c h a l l e n g e a ny

I f t h e a n s w e r i s “n o”, t h e n i t i s n ot i m p o r t a nt e n o u g h to g et

i r r a t i o n a l r e a s o n i n g.

m a d a b o u t. I f t h e a n s w e r i s “ ye s”, t h e n i t i s to o i m p o r t a nt

O b s e r ve yo u r s i t u a t i o n, h o w yo u fe e l, a n d wa nt yo u r e a l l y

to d e a l w i t h w h e n yo u a r e a n g r y s i n c e n o b o d y w h o i s a n g r y

w a nt. O b s e r ve h o w t h e ot h e r m a y b e fe e l i n g a n d w h a t t h e y

c a n b e c l e a r-h e a d e d, fa i r a n d r e a s o n a b l e. B e l o w a r e s o m e

m i g ht wa nt w h i c h i s g o o d fo r t h e m to wa nt.

a d d i t i o n a l s e l f i n s t r u c t i o n s to h e l p yo u t h r o u g h t h r e e t y p e s

P l a n w h a t to d o a n d h o w to b e s t m a n a g e t h e s i t u a t i o n i n-

of d i f f i c u l t s i t u a t i o n s.

s te a d of l et t i n g t h e s i t u a t i o n m a n a g e yo u. What to say to yourself in general T h e P a r a d ox o f D i s a g r e e m e n t

I f yo u to o q u i c k l y d i s a g r e e w i t h a c r i t i c i s m t h a t ’s i n a c c u -

r e s p o n s i b l e. I n s te a d of a n g e r, I n e e d to t r y a m o r e ef-

r a te, u nfa i r a n d u nt r u e, yo u m a y i m m e d i a te l y p r ove t h a t t h e c r i t i c i s m i s t r u e. I f yo u a g r e e w i t h t h a t p a r t of a p e r s o n a l

N ot h i n g i s a c c o m p l i s h e d by b l a m e, eve n i f t h e y a r e fe c t i ve s o l u t i o n.

I f I a m s t i l l a n g r y to m o r r o w, I w i l l d e a l w i t h i t t h e n, b u t

c r i t i c i s m t h a t i s t r u e, t h e n t h e i n a c c u r a te, u nfa i r a n d u n-

fo r n o w I w i l l fo c u s o n c a l m i n g d o w n a n d b e c o m i n g

t r u e p a r t of t h e c r i t i c i s m i s c o nt r a d i c te d b y yo u r fa i r n e s s i n

r e l a xe d.

a g r e e w i t h w h a t yo u c a n a g r e e w i t h a n d a c k n o w l e d g e.

M y a n g e r p u s h e s p e o p l e a wa y a n d d o e s n ot te l l t h e m t h a t I c a r e. I n e e d to s h o w m y c a r i n g i s a m o r e l ov i n g m a n n e r.

Five Methods for Managing Anger 1. D e l a y e.g., t i m e o u ts; n ot b l u r t i n g o u t w h a t f i r s t c o m e s

to m i n d f r o m a n g e r, etc. Wa i t a fe w s e c o n d s a n d a s k yo u r-

The per son who I have the most dif ficult y with is maybe the

s e l f b efo r e r e a c t i n g o r a n s w e r i n g, •

W h a t d o e s t h e ot h e r p e r s o n r e a l l y m e a n?

H o w d o I w a nt to r e s p o n d?

W i l l m y r e s p o n s e h e l p to r e s o l ve t h e c o nf l i c t ?

p e r s o n I h a ve t h e m o s t t o l e a r n f r o m . I can only influence others. I cannot demand that people act t h e wa y I wa n t t h e m t o a c t .

2 . Change your thinking:

What to say to yourself when you know that a conflict

a . T h i n k FAT ( Fa i r, A c c u r a te, Tr u t hf u l ) t h o u g hts.

will soon occur:

Fa i r: B e fa i r a n d c o m p a s s i o n a te i n yo u r t h i n k i n g a b o u t

A c c u r a te: B e a c c u r a te a b o u t yo u r c o nt r i b u t i o n to t h e

Tr u t hf u l: S a y w h a t yo u r r e a l l y m e a n, n ot w h a t a n g e r

I d o n ot h ave to g et a n g r y o r d efe n s i ve. I k n o w h o w to p o l i te l y l i s te n.

p r o b l e m. •

T h i s m a y a n n oy, d i s a p p o i nt o r s a d d e n m e, b u t I k n o w h o w to d e a l w i t h i t.

t h e ot h e r p e r s o n.

E a s y d o e s i t. R e m e m b e r to ke e p c a l m a n d b e k i n d a n d u n d e r s t a n d i n g of t h e ot h e r p e r s o n.

te l l s yo u to s a y. b. T h i n k i n a l o v i n g w a y. T h i n k t h e m o s t l ov i n g a n d g e n -

What to say to yourself when somebody is get ting an-

e r o u s t h o u g hts a b o u t yo u r p a r t n e r w h e n yo u s t a r t fe e l i n g

gr y or being rude to you:

a n g e r. (e.g., t h i s i s t h e m ot h e r/ fa t h e r of m y c h i l d r e n.) P u t

A s l o n g a s I s t a y c a l m, I a m i n c o nt r o l.

yo u r a n g e r a s i d e a n d r e m e m b e r t h e g o o d t h i n g s a b o u t t h e

S t a y c a l m a n d b r e a t h s l o w l y. I w i l l n ot g et a n g r y o r f r u s t r a te d.

ot h e r p e r s o n yo u a r e g et t i n g a n g r y w i t h. H e /s h e i s n ot p e rfe c t b u t h e /s h e i s t h e l ove of m y l i fe. T h i s i s t h e p e r s o n I

T h e r e i s n o p o i nt g et t i n g a n g r y; c a l m d o w n.

d e e p l y l ove a n d w h o h a s fo r g i ve n m e m y w o r s t b e h av i o u r s.

I w i l l n ot l et t h i s p e r s o n b r i n g m e d o w n o r m a ke m e a n g r y.

M y p a r t n e r d e s e r ve s t h e b e s t f r o m m e, n ot m y w o r s t. •

a r g u e a b o u t w h a t I d i s a g r e e w i t h.

3 . U s e S e l f- I n s t r u c t i o n s t o H e l p Yo u r s e l f C o n t r o l Yo u r

Anger

I w i l l a g r e e w i t h w h a t I c a n a g r e e w i t h. I d o n ot n e e d to

A s e l f-i n s t r u c t i o n i s w h e n w e c o a c h o u r s e l ve s t h r o u g h a

F o r s o m e b o d y to t a l k to m e l i ke t h i s, h e /s h e m u s t b e ve r y u n h a p py.

d i f f i c u l t s i t u a t i o n. W h a t w e w o u l d s a y to o u r s e l ve s i s s i m i l a r to w h a t w e w o u l d s a y to a g o o d f r i e n d i n o r d e r to h e l p h i m

What to say to yourself when you find yourself get ting

o r h e r t h r o u g h a c o nf l i c t. T h e m o s t i m p o r t a nt s e l f-i n s t r u c-

f r u s t r a t e d o r a n g r y.

t i o n yo u c a n s a y to yo u r s e l f, a n d o n e w h i c h yo u m u s t l e a r n

Ta ke a d e e p b r e a t h a n d s t a y c a l m.

to r e m e m b e r to a s k yo u r s e l f e a c h t i m e, i s:

T i m e to r e l a x a n d s l o w t h i n g s d o w n.

G et t i n g m a d w i l l n ot h e l p; s l o w d o w n.

I ’m g et t i n g a n g r y a n d I m u s t n o w c a l m m y s e l f d o w n.

20

Fall 2018


I w i l l t r e a t m y s e l f a n d t h e ot h e r w i t h r e s p e c t b y r e m a i n i n g c a l m.

M a y b e w e a r e b ot h r i g ht a n d w r o n g. I w i l l t r y to s e e w h e r e h e /s h e i s r i g ht.

O ur t a s k in li fe i s not to add to t he unf a ir ne s s a nd i f po s sible, to add s ome muc h ne e de d c omp a s sion, ju s t ic e a nd goodne s s.

4. Time out.

I f yo u c a n n ot s to p yo u r s e l f f r o m g et t i n g a n g r y w i t h t h e ot h e r i n t h e s i t u a t i o n, p o l i te l y exc u s e yo u r s e l f. A s k fo r a t i m e o u t, l et t i n g t h e ot h e r k n o w t h a t yo u d o wa nt to f i n i s h t h e c o nve r s a t i o n w h e n yo u a r e a b l e to b et te r l i s te n by f i r s t c a l m i n g d o w n. a . S t o p r e p e a t i n g t o y o u r s e l f t h e n e g a t i v e t h o u g h t s . Tr y

to t h i n k t h i n g s t h r o u g h fa i r l y a n d d o n ot r e h e a r s e a n d c yc l e n e g a t i ve t h o u g hts a n d u s e s w e a r w o r d s i n yo u r t h i n k i n g. b. U s e D i s t r a c t i o n a n d d o s o m e t h i n g e l s e f o r a w h i l e d u r i n g t i m e o u t . E.g., p l a y a n o n-v i o l e nt v i d e o g a m e, g o

fo r a wa l k, etc. c. R e l a x : C h a n g e yo u r p hy s i o l o g y f r o m te n s e a r o u s a l to -

w a r d s b e i n g c a l m a n d r e l a xe d. E.g., u s e s l o w d e e p b r e a t h s, m e d i t a t i o n, etc. 5. Forgiveness

Pe o p l e w i l l s o m et i m e s d i s a p p o i nt yo u, a n d s h o w d i s r e s p e c t b y b e i n g i n a t te nt i ve, i n c o n s i d e r a te o r r u d e, a n d p e o p l e m a y eve n i nte n d to i n s u l t o r b e h u r t f u l. F o r g i ve n e s s i s n ot a b o u t fo r g et t i n g o r c o n d o n i n g b a d b e h a v i o u r f r o m ot h e r s b u t i t i s r e a l l y a b o u t U N D E R STA N D I N G s o t h a t w e c a n f r e e o u rs e l ve s f r o m c a r r y i n g r e s e nt m e nt o r g r u d g e s a n d h u r t. W h e n yo u c a n u n d e r s t a n d m o r e d e e p l y w hy t h e ot h e r o r yo u r s e l f a r e b e h av i n g b a d l y, i t i s u s u a l l y e a s i e r to fo r g i ve t h e i r m i st a ke s a n d f l a w s o r l i m i t a t i o n s i n t h e i r p e r s o n a l i t y. We d o n’ t a g r e e w i t h b a d b e h a v i o u r a n d w e l e a ve i t w h e r e i t b e l o n g s i n s te a d of c a r r y i n g i t a r o u n d. M u c h of l i fe i s u nfa i r, a n d s o m e u n j u s t l y s u f fe r t r e m e n d o u sl y, b u t o u r t a s k i n l i fe i s n ot to a d d to t h e u nfa i r n e s s a n d i f p o s s i b l e, to a d d s o m e m u c h n e e d e d c o m p a s s i o n, j u s t i c e a n d g o o d n e s s. H o l d i n g o nto a n g e r i s u nfa i r to yo u r s e l f a n d t h i s o n l y a d d s r a t h e r t h a n s u b s t r a c ts f r o m t h e u nfa i r n e s s of t h e w o r l d.

Re fe re n ce s:

To fo r g i ve, i t h e l p s to a c c e pt t h e fo l l o w i n g t w o B i t te r P i l l s

M a t t h e w M c K a y e t a l. (2 0 0 3) W h e n a n g e r h u r t s (2 n d e d ). ( N e w

w e m u s t s w a l l o w:

1. E x a m i n e yo u r o w n c o m m u n i c a t i o n s. We r e yo u c a l m,

r e a s o n a b l e, fa i r a n d u n d e r s t a n d i n g? N o b o d y g ets i t r i g ht a l l t h e t i m e a n d 2. R e m i n d yo u r s e l f t h a t fo r m o s t of t h e t h i n g s w e c o m p l a i n a b o u t, a l s o s o m e w h e r e a n d s o m e h o w w e o u r s e l ve s

H a r b i n g e r P u b l i c a t i o n s)

M a t t h e w M c K a y e t a l. (19 9 6) W h e n a n g e r h u r t s y o u r k i d s: A p a r e n t s G u i d e. ( M J F B o o k s)

M a t t h e w M c K a y & P e t e r R o g e r s (2 0 0 0). T h e A n g e r C o n t r o l Wo r k

b o o k . ( N e w H a r b i n g e r P u b l i c a t i o n s) W h e n A n g e r H u r t s

W i l l i a m s, J a n i c e e t a l. (2 0 0 0). A n g e r p r o n e s s p r e d i c t s c o r o n a r y

h e a r t d i s e a s e r i s k . C i r c u l a t i o n, 101:2 0 3 4 -3 9.

h ave c o nt r i b u te d to t h e s i t u a t i o n.

BC Psychologist

21


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Fall 2018


2018 / 2019 Membership Application FEATURE MEMBER BENEFITS Regular Rate

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$200

$70 (26%)

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a I am a registrant of the College of Psychologists of BC, or I am a retired registrant of the College of Psychologists of BC. a If any limitations are put on my practice, or my registration is suspended or cancelled by the College of Psychologists of BC, I agree to notify BCPA within five working days. a Referral Members: if there are any limitations, terms or conditions to my registration to practice psychology, I agree to modify my practice accordingly, and apply these limitations to all referrals received through BCPA. a Referral Members: I agree to review my referral settings online quarterly for accuracy of contact information, geographical areas of service, and areas of practice. a I agree to review and adhere to the E-mail Forum Guidelines, and I understand that they can be found online at www.psychologists.bc.ca/content/e-mail-forum I have read, understood, and agreed to all applicable declarations listed above.

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Workshop Registration Form | Fall 2018 Why Are Some Psychotherapists More Effective than Others? Core Tasks of Psychology Presented by Dr. Donald Meichenbaum Friday, November 30, 2018 8:30AM – 4:30PM @ University Golf Club House 5185 University Blvd., Vancouver, BC V6T 1X5 Continuing Education Credits: 6 Research on psychotherapeutic outcomes indicate that some therapists achieve better treatment outcomes and have fewer dropouts from therapy. This workshop will begin with a consideration of the "state of the art" of psychotherapy and then consider what distinguishes so-called "expert" psychotherapists from others. It enumerates the core tasks of psychotherapy and the nature of the feedback-informed deliberate practice required to achieve lasting changes in clients. A Case Conceptualization Model of risk and protective factors that informs both assessment and treatment decision-making will be offered. A Constructive narrative strengthsbased perspective will be demonstrated using video cases. How to spot "hype" in the field of psychotherapy will also be presented. Learning Objectives 1. Enumerate and implement the Core Tasks of Psychotherapy that "expert" therapists use 2. Employ a Case Conceptualization Model that informs both assessment and treatment decision-making 3. Spot "hype" in the field of psychotherapy and become a more critical consumer 4. Engage in deliberate practice in order to improve one’s level of psychotherapeutic expertise About the Presenter Donald Meichenbaum, Ph.D. is Distinguished Professor Emeritus from the University of Waterloo, Ontario from which he took early retirement 22 years ago. He is presently Research Director of the Melissa Institute for Violence Prevention in Miami, Florida (Please see www. melissainstitute.org). He is one of the founders of Cognitive behavior therapy and in a survey of clinicians he was voted “one of the ten most influential psychotherapists of the 20th century”. He has received many honors including being the Honorary President of the Canadian Psychological Association. He has presented in all of the Provinces in Canada and in all 50 U.S. States, as well as internationally. He has published extensively and his latest books are "Roadmap to Resilience" and "The Evolution of Cognitive Behavior Therapy: A personal and professional journey with Don Meichenbaum." His workshops are noted for the combination of critical-mindedness, practical clinical applicability, and humor. He will use video case presentations to demonstrate ways to implement the core tasks of psychotherapy. Attendees will receive a detailed handout of ways to conduct deliberate practice to improve their level of psychotherapeutic expertise.

Register Early to save $24! How to register for these workshops: • Mail this form to: BC Psychological Association • Fax 604–730–0502 or Call 604–730–0501 BC Psychologist 402 – 1177 West Broadway Vancouver, BC V6H 1G3 • Go online: http://psychologists.bc.ca

25


Why Are Some Psychotherapists More Effective than Others? Core Tasks of Psychology Early Bird Registration q Regular price q BCPA Members and Affiliates

(July 13 – Sept 15, 2018) $246.75 (incl. GST) $173.25 (incl. GST)

Regular Registration q Regular price q BCPA Members and Affiliates

(Sept 16 – Nov 26, 2018) $270.90 (incl. GST) $197.40 (incl. GST)

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 Confirmation q I will attend this workshop q I agree to the Cancellation Policy (required) Cancellations must be received in writing by November 26, 2018. A 20% administration fee will be deducted from all refunds. No refunds will be given after this date.

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Fall 2018

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BC Psychologist Fall 2018  

BC Psychologist Fall 2018