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 8 • Is su e 1 • win t e r 2019
Updated to include a new scoring option for the DSM-5 Symptom Scales.*
*DSM-IV-TR scoring still available for online and software options.
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Presented by Dr. Mary Lou Randour & Dr. Maya Gupta Thursday, April 12th, 2019
Table of Contents 5
New BCPA President Elected
Letter from the Executive Director
Psychology and Community Mental Health Services in the Province of British Columbia, 1962-1989: A Personal and Historical Perspective Keith E. Barnes, Ph.D., R. Psych. (Retired)
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Mental Health and Housing: Providing Primary Care on the Front Lines in Vancouver's Downtown Eastside Laura MacKinnon, MD, CCFP Christy Sutherland, MD, CCFP, dABAM
Grief: It’s Not Just For Dying Anymore! Martin Phillips-Hing, Ph.D.
Hard to Say I’m Sorry: How to Make It Easy H. Elise Reeh, Ph.D.
Workshop Registration Form | Winter 2019
New BCPA President Elected k a m a l jit K . sid h u, Ph . d. , r. psych .
Dr. Sidhu is Director of Dr. K. K. Sidhu, Registered Psychologist, & Associates. She has over 30 years of combined experience as an educator, school counsellor, and registered psychologist in private practice. Dr. Sidhu began her professional career as an educator in the British Columbia public school system prior to embarking on her career in psychology in 1990. Dr. Sidhu earned a Ph. D. in counselling psychology in 2000 from the University of British Columbia It is my pleasure to serve as President of the BCPA for the upcoming year. I look forward to working collaboratively, with our membership, Board Members, Executive Director, Ms. Cherie Payne, and staff to promote the goals of our organization and support the efforts of our various communities. I encourage all BCPA members to consider volunteering on one of the BCPA communities. It is a wonderful opportunity to promote our profession to the public and government, connect with professional colleagues, and gain a broader perspective on what is happening with psychology in British Columbia and Canada. For more information, please contact the BCPA office. As you begin this New Year, I wish you all the best in your professional and personal lives, and hope that you achieve the goals you set for yourself.
At t h e B CPA A n n ua l G e n e r a l M e e t in g o n N ov e m b e r 30 2018 , B oa r d m e m b e rs e l e c t e d D r. K a m a l jit K . Sid h u Pr e sid e n t o f t h e A s s o ci at i o n .
Kamaljit K. Sidhu, Ph.D., R.Psych. President, BCPA
BCPA Official Ballot At t he A nnu a l Genera l Meet ing on November 30t h we pa ssed a mot ion to vote on increa sing t he su ggested market rate for ps ycholog ists in BC f rom $2 0 0/50 min session, to $2 25/50 min session. Plea se let u s k now if you are in favour of t he increa se in su ggested market rate for ps ycholog ica l ser v ices in BC . Plea se note t hat t hese rates are only su ggested ser v ice rates a nd t hat you are by no mea ns requ ired to cha nge your c urrent ser v ice fees. Once you have completed your ba l lot. Plea se af f i x su f f icient posta ge a nd ret ur n to t he BC Ps ycholog ica l A ssociat ion by Febr u ar y 2 0t h, 2 019.
Yes , incre a se the sug g e sted r ate
No, maintain the current r ate
Letter from the Executive Director Cherie Payne, B.A., 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: email@example.com I am very excited that this winter’s BC Psychologist
explores issues in mental health and social justice. From the Okanagan, to Vancouver Island, to Metro Vancouver, our members are supporting British Columbians to work through family challenges, severe mental illness, and to create healthy home and work lives. How can psychologists’ expertise contribute to the joint effort of British Columbians from other sectors who are working to build healthy communities? Across B.C., there are disparities in how much access to healthy options individuals and communities have. Food, exercise, a balance between work and rest – all are impacted by income, the affordability of local housing, population density, infrastructure, and whether there are community amenities nearby. Children raised in poverty face more health challenges, from chronic illness to suicide, than those raised in more affluent homes. And the effort to pay for housing, food, and basics is also stressful for their parents. Social services and community supports provide the foundation upon which psychologists’ work with individual clients can yield the best results. Institutions devoted to the common good are key partners in efforts to support positive mental health. In this issue, you will read insights from Dr. Laura MacKinnon and Dr. Christine Sutherland of the Portland Hotel Society regarding the links between mental health, housing and homelessness. The Portland Hotel Society is a non-profit organization that provides housing, harm reduction, primary care, and advocacy to those poorly served in Vancouver’s downtown eastside and in Victoria. It is one of B.C.’s largest provincial partners on social services, with annual revenue over $36 million. Dr. MacKinnon and Dr. Sutherland’s experience on the front lines of addiction care, mental health treatment, and wrap around social services provides a valuable case study 6
for those interested in how to turn policy into action. I am also encouraged by the historical and regional links made by former BCPA President Dr. Keith Barnes. B.C. was the first province in Canada to implement community mental health services. Up until the early 1960s, the practice of psychology was almost exclusively confined to Victoria, Vancouver, Burnaby, at Riverview Mental Hospital, and Crease Clinic in the Fraser Valley. Equitable access to mental health services is important for every region of B.C. Of course, British Columbians are not the only ones grappling with questions of how best to support positive mental health at the systemic level. In the UK, government has appointed a Minister of Loneliness who is tasked with investing in shared institutions devoted to the common good. From public libraries, to NHS funding for doctors to write social prescriptions for patients to attend arts events, exercise, or music classes, the UK is undertaking targeted interventions to reduce social isolation. For registered psychologists, this is all good news. Psychotherapy is a vital tool to help individuals tackle mental health challenges. Societies that make concrete upstream efforts to build and sustain environments that maximize residents’ health multiply the benefits of psychologists’ work. I hope you will enjoy this issue of the BC Psychologist and continue discussing some of these issues at upcoming workshops, pub nights, Psychology Month events, and on the BCPA membership forum.
Cherie Payne, BA, LLB. Executive Director, BCPA
Psychology and Community Mental Health Services in the Province of British Columbia, 1962-1989: A Personal and Historical Perspective by Keith E. Barnes, Ph.D., RPsych (Retired)
After emigrating to Canada in February of 1957,
Dr. Keith E. Barnes lived "in the bush" for five months in remote forest camps accessible only by foot and pack horse. In 1976 Dr. Barnes was elected President of the B.C Psychological Association and in the 1979/80 academic year, he was a Visiting Scholar in the Psychology Department at Stanford University. Dr. Barnes was the full-time psychologist at the Kelowna Mental Health Center until he was appointed the center's Director in 1974. In 1986, he was also Acting Director of the Okanagan/Kootenay Mental Health Region of the province.
As the new building would not be available for at least six months, our two offices were located in a local dental building. There was no furniture and one telephone, so, as no psychological test equipment had been ordered, I went to a friend's workshop and built myself a desk.
p until the early 1960s, the practice of psychology was almost exclusively confined to the cities of Victoria, Vancouver, Burnaby and at Riverview Mental Hospital and the Crease Clinic in the Fraser Valley. In 1961, Judge Emmett Hall was appointed by the Canadian Federal Government to be Chairman of a Royal Commission on Health Care in Canada (Royal Commission on Health Services, 1961 to 1964). Although Judge Hall's final report was not published until 1964, enough information was released earlier for the government of B.C. to go ahead and develop a province-wide program of community mental health services. The driving force behind such a program was two-fold: the complete lack of any form of mental health services outside the Lower Mainland and the ever-burgeoning number of clients in Riverview Hospital and the Crease Clinic who could not be released to their home communities because of a complete lack of follow-up services.
In 1961 the Ministry of Health created a separate mental health services division with a brand new deputy minister, Dr. "Tommy" Tucker, who established the framework for the province's community mental health services, based on an integrated multi-disciplinary team approach1. Initially, the "team" was to consist of a full-time psychiatrist, psychologist, psychiatric social worker and mental health nurse. At a later date, the team would also include a residential care social worker, an occupational therapist and a community-care nurse. Essentially, the province was divided into five major regions: Vancouver Island, the Fraser Valley, the Okanagan, the Kootenays and the North, with the Okanagan designated as the first region to be staffed. The central site selected for the region was Kelowna, which was not without its controversy, as the local rivalry between the major communities in the region was fierce and highly competitive (I suspect, that in the last analysis, Kelowna was selected because it was the hometown of the premier, W.A.C. Bennett). The actual mental health center was to be located on the second floor of the local public health unit, which, of course, did not actually exist in 1961 and had to be designed, built and opened sometime in 1962.
The Okanagan Regional Mental Health Center: The Early Years The ORMHC opened on August 08, 1962 with a full-time team of two: Psychiatrist, Dr. Frank McNair as Director, formerly Director of the Crease Clinic and Director of the Burnaby Mental Health
T h i s a p p r o a c h w a s q u i t e r e v o l u t i o n a r y i n 19 61 a s t h e r e w a s n o e m p i r i c a l e v i d e n c e o n t h e e f f i c a c y o f s u c h i n t e g r a t e d
t e a m s e r v i c e s t o p e o p l e w i t h m e n t a l d i s o r d e r s . To d a y, t h e e f f i c a c y o f s u c h s e r v i c e s h a s b e e n v e r y w e l l d o c u m e n t e d b y t w o v e r y r e c e n t a r t i c l e s, o n e p u b l i s h e d i n t h e M o n i t o r o n P s y c h o l o g y ( S e p t e m b e r, 2 018) a n d t h e o t h e r i n a s p e c i a l i s s u e o f t h e A m e r i c a n P s y c h o l o g i s t ( Vo l. 73, N o 4, 2 018).
The task before the two of us was both formidable and enormous, not only in terms of delivering clinical services and educating a public with little or no knowledge of what being "mentally ill" really meant, but also because of the total lack, with the exception of public health nurses, of any form of community support services, i.e., no trained counselors in the schools no special education departments in the school districts and no psychiatric nurses in the local hospitals. So, the role of a
clinical psychologist was very much multi-functional in these early years. And, although there were the usual diagnostic assessments to carry out and follow-up treatments to perform there were also many other roles to fill - as an educator, consultant to other community agencies (public health nursing, probation and family court services, social welfare services, and, especially, school district staff). In addition to carrying out these roles, there was the requirement of providing mental health services to the other major communities in the region, which meant the organization and development of "traveling clinics." With Kelowna as the base center, the two of us traveled each month to Kamloops (2-days), Vernon (2-days), Penticton (2-days), and one day each to Salmon Arm and Revelstoke. This schedule was grueling and involved very long days, as professional government employees were required to be at their place of work at 8:30 am until 5:00pm, so, for example, to reach Kamloops by 8:30 am we would have to leave Kelowna no later than 6:00 am. On top of this 7.5-hour day, we would frequently have evening educational meetings on mental health services and the treatment of the mentally ill to a variety of service clubs and other community groups. Over the next twelve years, community mental health centers would be built in all of these communities, with the exception of Revelstoke, and the traveling clinics gradually discontinued as the new centers were fully staffed.
The Kelowna Mental Health Center Today, it is hard to visualize how primitive or nonexistent mental health services were outside of the Lower Mainland in 1962, so the learning curve for the two of us was pretty steep. Apart from the Deputy Minister, there were no consultants in Victoria with any expertise in
Center, and myself as the psychologist, plus a half-time secretary/receptionist. As the new building would not be available for at least six months, our two offices were located in a local dental building. There was no furniture and one telephone, so, as no psychological test equipment had been ordered, I went to a friend's workshop and built myself a desk. Looking back, after so many years, it is hard to believe just how unprepared we were to deliver any form of mental health service2. For starters, our catchment area was huge, running from Osoyoos in the south to Kamloops and Revelstoke to the north. The center's original mandate was to provide a full-range of services to the towns of Penticton, Kelowna, Vernon, Kamloops, Salmon Arm and Revelstoke. Essentially, these communities, having never received any form of mental health services before, had no idea what to expect. Many of the residents in these towns had never heard of psychiatrists, psychologists, psychiatric social workers or mental health nurses, let alone knowing what they did! Consequently, many of the citizens were suspicious and apprehensive of what we there for and the possibility of "crazy" people being allowed to live in their communities. Such a frame of mind was completely understandable given the enormous stigma attached to any form of "mental illness" at the time and the fact that, in the past, people with major mental disorders, once identified, were immediately sent to Riverview, rarely to be seen again.
The task before the two of us was both formidable and enormous, not only in terms of delivering clinical services and in educating a public with little or no knowledge of what being "mentally ill" really meant, but also because of the total lack, with the exception of public health nurses, of any form of community support services,
I n a s e n s e, t h i s s i t u a t i o n w a s v e r y s i m i l a r t o t h e o n e I h a d e x p e r i e n c e d f i v e y e a r s e a r l i e r a s a n e w i m m i g r a n t t o a n e w
c o u n t r y w h o h a d t o l e a r n t h e v a l u e s a n d n o r m s o f a n e w c u l t u r e, o n l y t h i s t i m e, i t w a s t h e v a l u e s, n o r m s a n d c u l t u r e o f r u r a l c o m m u n i t i e s i n t h e I n t e r i o r o f t h e p r o v i n c e.
how to deliver community mental health services, nor were there any "experts" in the rest of Canada either, as B.C. was the first province in the country to implement such services. Hence, there were no official guidelines from Victoria and the two of us were sometimes faced with having to make things up as we went along. Two of the major questions we were confronted with very early on were: what do you do with acutely disturbed clients who require inpatient care but are no longer eligible to be sent to Riverview unless they require "high security" placement? Similarly, where do you house clients who have been in Riverview, some of them for many years, but who now want to return to their home communities? Our answer to these two questions was the establishment of a psychiatric unit on the grounds of the Kelowna General Hospital and a residential care program in the local area. The psychiatric unit opened in the spring of 1963; it contained five beds and had originally been built as a nurses' residence, but was no longer in use. It was the first psychiatric unit in B.C. to be attached to a general hospital and was under the direction of Dr. Frank McNair. It was an ideal place in the sense that it had five separate bedrooms, a large kitchen and large separate dining and living rooms, the latter complete with a piano. The nurses were well trained and the unit had access to both physiotherapy and occupational therapy from the hospital itself. There were ward rounds each week, which I attended, as needed, and a monthly social evening dinner, hosted in either the McNair house or mine. Towards the end of the year, at one of our "social" evenings, the nurses raised the issue of not wearing uniforms as they believed they reinforced the medical model of mental illness, which they felt was counter-productive for nearly all of the clients being admitted to the unit. Both Frank and I endorsed this suggestion and there was unanimous agreement to discontinue wearing nursing uniforms. What Frank and I had not anticipated was the huge negative reaction to this change by the rest of the hospital nursing staff and for months afterwards the nurses on the unit were shunned in both the hospital cafeteria and everywhere else in the main building.
Apart from the Deputy Minister, there were no consultants in Victoria with any expertise in how to deliver community mental health services, nor were there any "experts" in the rest of Canada either, as B.C. was the first province in the country to implement such services.
The residential care (boarding-home) program was an essential part of the center's treatment of clients with serious and persistent mental disorders being released from Riverview Hospital who were unable to live with their families or independently. In 1962 the government's long-term care program did not exist and would not come into being until 1974. Hence, the only type of accommodation available, at the community level, was private boarding homes. There were no licensing requirements apart from meeting fire safety regulations set by the city's fire department and sanitation, food and building regulations set by the public health department. Most of the people staying in these facilities were elderly, frail and no longer able to care for themselves. We called a meeting with the facility owners to see if any of them would be prepared to take in some of our clients and a number of them agreed to do so. They also had to agree to our requirements for care, including the hiring of an activity worker and implementing certain social programs. From our perspective, we knew this program would not be successful in keeping such clients in our community
By 1974, community mental health centers had opened in Kamloops, Vernon, Penticton and Salmon Arm and our days of traveling clinics finally ended. At the same time, Kelowna's population had expanded from just over 13,000 in 1962 to almost 52,000 and there were now substantially more community support services available, especially in the school district, which now had trained counselors and special-ed teachers in most of its schools. There was also a special-ed department headed up by an educational psychologist, for which I provided consultation. My role within the center had changed substantially, too. I was now spending a great deal of my time on community research and program evaluation both within the center itself and outside in the community. Some of the research projects included: an evaluation of a therapeutic work experience program for clients with serious and persistent mental disorders, the design and evaluation of a special behavior modification classroom for elementary school students, a preschool play program for children attending public health nursing clinics, a dental health program for parents resisting getting their children in for preschool dental clinics, an evaluation of the Denver Developmental Screening Test (DDST) being used by all public health nurses in the district and a normative study of the Jansky Screening Index, which was proposed for use in the local school district. Also, in 1974, my role changed again when Dr. McNair retired and I was appointed director of the Kelowna Mental Health Center. Now I was spending more of my time on administration and program development and very rarely on direct clinical services. Two programs I was pleased to help develop at that time was a program for the elderly within the center and, in conjunction with the local chapter of the Canadian Mental Health Association and the center's occupational therapist, a "community clubhouse" open to all the members of the community suffering from some form of mental disorder.
REFEREN CES H a l l, E. M. (19 6 4). R o y a l C o m m i s s i o n o n H e a l t h S e r-
v i c e s (19 61-19 6 4). O t t a w a , O n t a r i o, C a n a d a :
Q u e e n's P r i n t e r.
M c D a n i e l S u s a n H & E d u a r d o, S a l a s, E d i t o r s . (2 018).
T h e S c i e n c e o f Te a m w o r k . A m e r i c a n P s y-
c h o l o g i s t, 73. 3 0 5 - 6 0 0.
We i r, K i r s t e n. (2 018). W h a t M a k e s Te a m s Wo r k ? M o n i-
t o r o n P s y c h o l o g y. S e p t e m b e r, 2 018, 4 6 -5 4
without two additional staff workers - a residential care social worker to coordinate the placement of our clients in suitable accommodation and provide client consultation - and a full-time occupational therapist to design social programs and train activity workers in client management. In addition to these two new staff positions over the next year we were also able to fill the other two members of our team - the psychiatric social worker and the mental health nurse.
By 1974, community mental health centers had opened in Kamloops, Vernon, Penticton and Salmon Arm and our days of traveling clinics finally ended. At the same time, Kelowna's population had expanded from just over 13,000 in 1962 to almost 52,000 and there were now substantially more community support services available
Mental Health and Housing: Providing Primary Care on the Front Lines in Vancouver's Downtown Eastside Laura MacKinnon, MD, CCFP Christy Sutherland, MD, CCFP, dABAM
he rate of people experiencing homelessness in Vancouver
has increased by a dramatic 40 percent in the last 4 years, relative to a 6.5 percent population growth (Homeless Count in Metro Vancouver, 2017). Unsurprisingly, homeless people live with higher rates of mental illness, poor health, and all-cause mortality (Fazel, Khosla, Doll, & Geddes, 2008; Zivanovic et al., 2015). As a family physician in Vancouverâ€™s downtown eastside, I witness the intense physical and mental health stresses that are associated with living on the streets. In my experience, and reflected in literature, housing is a crucial first step in stability and wellness for people experiencing homelessness (Gaetz, Scott, & Gulliver, 2013). I work on the front lines in a clinic that is embedded within a subsidized housing complex that uses a Housing First framework. Housing First is a harm reduction housing model that is gaining international traction. The fundamental principle of the Housing First model is rooted in the philosophy that housing is a basic human right (Gaetz, Scott, & Gulliver, 2013). Proponents of this model advocate that housing should not be contingent on housing readiness requirements such as participation in mandatory programmes or goals of abstinence. They believe that immediate access to permanent housing creates opportunities for people to move forward and that people do better when they have access to community-based services that nurture well-being and social integration.
is a family physician that works with the Portland Hotel Societyâ€™s primary care team and in community health clinics in Vancouverâ€™s downtown eastside. She also works for Carrier-Sekani Family Services, providing primary care to various First Nations in northern BC, and does occasional hospitalist medicine in the lower mainland. Dr. Laura MacKinnon
Canadian literature supports a Housing First approach for people with severe mental illness (Aubry et al., 2016). Access to permanent, low-barrier housing with optional supports improves quality of life and community functioning for folks with a high burden of mental illness. Housing First models are associated with greater food security, decreased use of emergency departments and shelters, and decreased rates of psychiatric hospitalizations (Kerman, Sylvestre, Aubry, & Distasio, 2018). There are lower incarceration rates for people living within a Housing First framework, which reduces costs for the justice system. Housing people also reduces HIV risk behaviours (Aidala, Cross, Stall, Harre, & Sumartojo, 2005). The outcomes for those with and without comorbid substance use disorders are equally positive for residents of Housing First (Urbanoski et al., 2017). For homeless people with substance use issues or concurrent disorders, housing is associated with decreased substance use and a decrease in relapses from periods of abstinence (Fitzpatricklewis et al., 2011). Likely related to comorbid physical illness, older adults with mental illness living within a Housing First framework, relative to younger adults, have superior quality of life and mental heath (Chung et al., 2018).
Dr. Christy Sutherland is the
Medical Director of the Portland Hotel Society where she leads clinical teams who are embedded in low barrier, harm reduction projects. She is the Education Physician Lead with the BCCSU, a member of the St Paul’s Addiction Medicine Consult Service, and the lead physician for the Rapid Access to Consultative Expertise (RACE) line. She received her MD at Dalhousie University and completed her Family Medicine Residency at UBC in 2010. Dr. Christy Sutherland was nominated for Canada's 2018 Family Physicians of the Year award in October.
The team relies heavily on each other’s strengths to provide cohesive, wrap-around care for residents. Clinic services at ASC are offered on a voluntary basis and often include visits in the residents’ homes
There are various models of Housing First programs that are providing low barrier housing in a growing number of Canadian cities (Gaetz, Scott, & Gulliver, 2013). The building I work in is called the Alexander Street Community (ASC), and it houses 140 people using this framework. ASC is one of 21 buildings operated by the Portland Hotel Society (PHS), a nonprofit organization that provides housing, harm reduction, primary care, and advocacy to those poorly served in Vancouver’s downtown eastside and in Victoria. I am a member of a group of family physicians with a passion for addiction medicine that work for PHS primary care. Family physicians with the PHS offer primary care in low barrier residential buildings in Vancouver’s downtown eastside and Victoria, managed alcohol programs, within an injectable opioid agonist treatment program as well as our primary care clinic. We are involved in research, provide novel communitybased treatments for people with opioid use disorders, and provide placements for students and physicians seeking training in primary care and addiction. The clinic at ASC has a multidisciplinary team that includes a social worker, three nurses, a pharmacy nurse dedicated to medication administration, mental health workers, home support staff, peer supports, the building manager and a psychiatrist. The team relies heavily on each other’s strengths to provide cohesive, wrap-around care for residents. Clinic services at ASC are offered on a voluntary basis and often include visits in the residents’ homes. We work in close partnership with various mental health community teams to care for the residents with the highest burden of mental illness. Staff help to identify client needs and offers individualized care on a spectrum of acuity. For instance, we provide urgent care to people in crisis, on discharge from hospital, and help to get residents to appointments. Recently, a 62-year-old man with severe opiate use disorder left the hospital against medical advice after a major surgery because his cousin, and best friend, died from a presumed overdose. He was using illicit opiates through his peripheral IV line and became very ill from complications. He was too devastated by his loss to care about his own health. As a team, we were able to support him through his grief, stabilize him medically, and coordinate his voluntary return back to hospital when he was ready. The team at ASC also assists with long-term goals such as employment, food security, and re-connection with families and loved-ones. We’re helping an older woman to move back to her home province so that she can live closer to family. After decades of living with substance use disorder, she has abstained from all illicit substances for over 5 years. Her physical health and executive functioning have dramatically improved; she has even stopped smoking cigarettes. She nurtures everyone around her and deserves an opportunity to do so for her daughter and grandchildren. The clinic hosts several wellness groups and health education sessions. The building has support from a variety of individuals and community agencies that offer a range of activities to residents such as art therapy, First Nations cultural learning opportunities, beekeeping, and pool playing. We celebrate birthdays and holidays. We also honour the lives of residents who pass away with ceremony: a ritual that’s performed too often as a result of the ongoing opioid poisoning epidemic.
The opioid crisis affects everyone in this community. Everyone knows several people who have died by overdose, often including close friends, partners, and family members. Most people have saved lives using naloxone to treat someone who has overdosed. I would say that the majority of opiate users in my practice have overdosed at least once, sometimes resulting in serious and often permanent health consequences (i.e. stroke). Too many people continue to die. For context, in September 2018 there were 128 suspected drug overdose deaths in BC (BC Coroners Service, November 2018). This equates to 4.3 deaths per day of the month, which is a 38% increase from the number of deaths occurring in September 2017. My first patient who died from an overdose was a kind, older man who had been living with an opiate use disorder for most of his life. A few days before his death, I spent part of my last encounter with him trying unsuccessfully to convince him to keep the little income he had instead of making regular donations to the charity Operation Smile. He sadly died from a fentanyl overdose in his room alone, like the large majority of people who have died by overdose in BC (at least 69%)(BC Coroners Service, September 2018). We’ve had several overdose deaths at ASC this year. Deaths in the building are devastating for the community. They affect everyone that lives, visits, and works at ASC in individual ways. Grief is complicated. ASC is hosting its first art show in the spring and the residents decided the theme was in honour of their lost loved ones. Other residents were upset by this, viewing it as another reminder of the death that plagues their community. For similar reasons, it’s hard to know how long to keep memorial posters on the wall. This community shares the lived experience and trauma of repetitive, sudden losses of loved ones. Their collective grief and the honour they show for those who have passed away is remarkable.
This community shares the lived experience and trauma of repetitive, sudden losses of loved ones. Their collective grief and the honour they show for those who have passed away is remarkable
My work in the downtown eastside has shown me that there should be an easier flow within the housing system where homeless and vulnerably housed people can move along a housing continuum from a low-barrier, high support model to a more independent model. For instance, the young, healthy, employed man who hasn’t used illicit substances in 18 months and uses extra push-ups to boost his mood when he’s feeling low would definitely thrive in a different setting. Alternatively, the frail, elderly woman with multiple medical co-morbidities and severe alcohol use disorder cannot safely be housed at ASC. However, coordinating placement for her in a long-term care facility has been highly challenging (and so far unsuccessful) because she is in a managed alcohol program (see: https://www.phs.ca/project/community-managed-alcoholprogram/). Ideally, there would be more options for people once they are ready to move forward from Housing First models. I am hopeful because mental health and housing have become emerging priorities for all levels of government in BC and Canada. Unprecedented levels of funding have been committed to expand supportive housing and mental health initiatives in BC over the next decade (BC Budget and Fiscal Plan, 2018). Housing is a human right that, even in one of Canada’s richest cities, we fail to provide to some of our most vulnerable citizens. Housing First offers a solution that provides a safe, low barrier space as well as the opportunity to connect with community and primary care. Note: stories of patient experiences have been changed to protect their identities. BC Psychologist
Re fe re n ce s: A i d a l a , A ., C r o s s, J. E., S t a l l, R ., H a r r e, D., & S u m a r t o j o, E. (2 0 0 5 ). H o u s i n g S t a t u s a n d H I V R i s k B e h a v i o r s : I m p l i c a t i o n s f o r P r e v e n t i o n a n d P o l i c y, 9 (3).
h t t p s: //d o i.o r g / 10.10 07/s10 4 61- 0 0 5 -9 0 0 0 -7
A u b r y, T., P h, D., G o e r i n g, P., P h, D., Ve l d h u i z e n, S., A d a i r, C. E., … P h, D. (2 016). A M u l t i p l e - C i t y R C T o f H o u s i n g F i r s t W i t h A s s e r t i v e C o m m u n i t y Tr e a t
m e n t f o r H o m e l e s s C a n a d i a n s W i t h S e r i o u s M e n t a l I l l n e s s, (24), 275 –281. h t t p s: //d o i.o r g / 10.1176 /a p p i.p s .2 014 0 0 5 87
B.C. C o r o n e r s S e r v i c e. (2 018, S e p t e m b e r ). I l l i c i t D r u g O v e r d o s e D e a t h s i n B C: F i n d i n g s o f C o r n e r s’ I n v e s t i g a t i o n s. w e b s i t e: h t t p s: // w w w 2.g o v.b c.c a /a s
s e t s /g o v/ b i r t h - a d o p t i o n - d e a t h -m a r r i a g e - a n d - d i v o r c e /d e a t h s /c o r o n e r s - s e r v i c e /s t a t i s t i c a l / i l l i c i t d r u g o v e r d o s e d e a t h s i n b c -f i n d i n g s o f c o r o n e r s i n v e s t i -
g a t i o n s -f i n a l.p d f
B.C. C o r o n e r s S e r v i c e (2 018, N o v e m b e r ). I l l i c i t D r u g O v e r d o s e D e a t h s i n B C J a n u a r y 1, 20 0 8- S e p t e m b e r 3 0, 2018. w e b s i t e: h t t p s: // w w w 2.g o v.b c.c a /a s
s e t s /g o v/ b i r t h - a d o p t i o n - d e a t h -m a r r i a g e - a n d - d i v o r c e /d e a t h s /c o r o n e r s - s e r v i c e /s t a t i s t i c a l / i l l i c i t- d r u g.p d f
B.C. M i n i s t r y o f F i n a n c e. (2 018). B u d g e t a n d F i s c a l Pl a n 2018/19 -2020/21. [170 5 - 6 071]. w e b s i t e: h t t p s: // w w w.b c b u d g e t .g o v.b c.c a / 2 018 /d e f a u l t .h t m B.C. N o n - P r o f i t H o u s i n g A s s o c i a t i o n a n d M.T h o m s o n C o n s u l t i n g. (2 017 ). 2017 H o m e l e s s C o u n t i n M e t ro Va n c o u v e r. P r e p a r e d f o r t h e M e t r o Va n c o u v e r
H o m e l e s s n e s s P a r t n e r i n g S t r a t e g y C o m m u n i t y E n t i t y. B u r n a b y, B C: M e t r o Va n c o u v e r w e b s i t e: h t t p: // w w w.m e t r o v a n c o u v e r.o r g /s e r v i c e s /
r e g i o n a l - p l a n n i n g / h o m e l e s s n e s s / r e s o u r c e s / P a g e s /d e f a u l t . a s p x
C h u n g, T. E., G o z d z i k , A ., L a z g a r e, L. I. P., To, M. J., A u b r y, T., F r a n k i s h, J., S t e r g i o p o u l o s, V. (2 018). H o u s i n g F i r s t f o r o l d e r h o m e l e s s a d u l t s w i t h m e n t a l
i l l n e s s : a s u b g r o u p a n a l y s i s o f t h e A t H o m e / C h e z S o i r a n d o m i z e d c o n t r o l l e d t r i a l, 8 5 – 9 5. h t t p s: //d o i.o r g / 10.10 0 2 /g p s .4 6 8 2
F a z e l, S., K h o s l a , V., D o l l, H., & G e d d e s, J. (2 0 0 8). T h e P r e v a l e n c e o f M e n t a l D i s o r d e r s a m o n g t h e H o m e l e s s i n We s t e r n C o u n t r i e s : S y s t e m a t i c R e v i e w
a n d M e t a- R e g r e s s i o n A n a l y s i s, 5 (12), 1670 –16 81. h t t p s: //d o i.o r g / 10.1371/ j o u r n a l.p m e d.0 0 5 0 2 25
F i t z p a t r i c k- l e w i s, D., G a n a n n, R ., K r i s h n a r a t n e, S., C i l i s k a , D., K o u y o u m d j i a n, F., & H w a n g, S. W. (2 011). E f f e c t i v e n e s s o f i n t e r v e n t i o n s t o i m p r o v e t h e
h e a l t h a n d h o u s i n g s t a t u s o f h o m e l e s s p e o p l e : a r a p i d s y s t e m a t i c r e v i e w, 1–14.
G a e t z, S., S c o t t , F., & G u l l i v e r, T. (2 013). H o u s i n g F i r s t i n C a n a d a S u p p o r t i n g C o m m u n i t i e s t o E n d H o m e l e s s n e s s H o u s i n g F i r s t i n C a n a d a : S u p p o r t i n g
C o m m u n i t i e s t o E n d H o m e l e s s n e s s.
K e r m a n, N., S y l v e s t r e, J., A u b r y, T., & D i s t a s i o, J. (2 018). T h e e f f e c t s o f h o u s i n g s t a b i l i t y o n s e r v i c e u s e a m o n g h o m e l e s s a d u l t s w i t h m e n t a l i l l n e s s i n a
randomized controlled trial of housing first.
U r b a n o s k i, K ., Ve l d h u i z e n, S., K r a u s z, M., S c h u t z, C., S o m e r s, J. M., K i r s t , M. G o e r i n g, P. (2 017 ). E f f e c t s o f c o m o r b i d s u b s t a n c e u s e d i s o r d e r s o n
o u t c o m e s i n a H o u s i n g F i r s t i n t e r v e n t i o n f o r h o m e l e s s p e o p l e w i t h m e n t a l i l l n e s s, 137–14 5. h t t p s: //d o i.o r g / 10.1111/a d d.13 9 28
Z i v a n o v i c, R., M i l l o y, M. J., H a y a s h i, K ., D o n g, H., S u t h e r l a n d, C., K e r r, T., & Wo o d, E. (2 015 ). I m p a c t o f u n s t a b l e h o u s i n g o n a l l - c a u s e m o r t a l i t y a m o n g
p e r s o n s w h o i n j e c t d r u g s, 1– 8. h t t p s: //d o i.o r g / 10.118 6 /s128 8 9 - 015 -1479 -x 14
Grief: It’s Not Just For Dying Anymore! Martin Phillips-Hing, Ph.D.
wo u l d e s tim at e t h at ov e r h a l f o f t h e clie n t s I see in my pr i v ate pra c t ice (a du lt, out pat ient) who have b een d ia g nosed w it h a m ajor d epressi ve episo d e (MDE) a re not a c t u a l l y d epressed , but a re g r ie v ing. W hen p eople t h in k of g r i e f t he y autom at ica l l y tend to t h in k of d eat h . Howe ver, g r ief a nd loss appl y to f a r more sit u at ions, su ch a s sepa rat ion/d i vorce, a nd loss of hea lt h, work, f ina nces, hop es a nd d rea m s, e tc. I w i l l t r y to d emons t rate why t h is m isd ia gnosis of ten o cc u rs a nd why it ’s imp or t a nt to d if ferent iate b e t ween d epression a nd g r ief […b ecau se t he inter vent ion is d if ferent !].
I m p ove r i s h e d vo c a b u l a r y f o r s a d n e s s In h is b o ok , Be yon d D e pr e s s i on (2 0 0 9), Chr istopher D ow r ick st ates, “ The word ‘g r ief ’ ha s cha nged it s mea ning qu ite d ram at ica l l y in t he pa st 50 0 yea rs, f rom a genera l a ssu mpt ion of l ife ’s ha rd sh ip a nd su f fer ing to a sp ecif ic reference to t he emot ions a sso ciated w it h t he loss of a close f r iend or f a mi l y memb er ” (p.118). He p oint s out e x a mples t a ken f rom t he O x f or d Engli sh D i c t i onar y wh ich su gges t t hat in 1 435, Eng l ish myst ic R icha rd Rol le refer red to ‘ hong y r, thir s t , c al d & nak ydne s & othe r g r e u ys [ g r i e f s] of thi s warl d ’, a s a n “ ine v it able, nat u ra l a nd ba sic pa r t of t he hu m a n cond it ion” (p.118). Howe ver, b y t he 17 t h cent u r y, g r ief is s t a r t ing to b e connec ted w it h t he loss of lo ved ones in genera l (e.g., t heir d e pa r t u re on a t r ip), a nd , b y t he 19 t h cent u r y it app ea rs to b e more sp ecif ica l l y a sso c iated w it h t he d eat h of lo ved ones.
Dr. Martin Phillips-Hing, (R. Psych #1361). is the acting Associate
Director of the Clinical Psychology Centre at SFU. He has been in private practice for 20 years in Langley and Abbotsford working with individuals and couples experiencing anxiety, depression, grief, anger, relationship and other concerns. Martin has previously worked as a prison psychologist; a contractor for Provincial forensics conducting sex offender treatment groups throughout BC; conducting group therapy with Fraser Health; and, as a clinical supervisor for a community service agency. Martin is an Oral Examiner for the CPBC and is currently on the Advocacy committee for the BCPA.
In a d d it ion, D ow r ick c ites references wh ich conclu d e t hat t he word ‘happ y ’ is u sed approx imatel y t hree t imes more of ten in Eng l ish t ha n t he word ‘sa d ’. He a rg u es t hat if ou r vo cabu l a r y a cc u ratel y ref lec t s – a nd is cong r u ent w it h – ou r emot iona l world , t hen we have su f f ic ient word s to d escr ib e ou r l ived e x p er ience. Howe ver, if ou r vo cabu l a r y for sa dness, loss, a f f l ic t ion, m iser y, m isfor t u ne, e tc. b ecomes imp o ver ished rel at ive to ou r emot iona l e x p er ience, we a re l i kel y to a ssu me t hat ou r pa inf u l emot ions a re e v id ence of “ p ersona l ab er rat ion, d e v ia nce, or d isea se, rat her t ha n a n ine v it able pa r t of t he hu m a n cond it ion” (p.119).
D i a g n o s t i c s y m p t o m ove r l a p W hy a re cl ient s m isd ia g nosed w it h a m ajor d epressive episo d e when t he y m ay more a cc u ratel y b e g r ie v ing a loss? Pa r t of t he problem is how we d ia g nose d epression. Most cl inicia ns a re f a m i l ia r w it h t he DSM-5 d ia g nos t ic cr iter ia for a n MDE . In genera l , it is f i ve, or more, of t he fol low ing s y mp tom s du r ing a t wo -week p er io d ; (1) d epressed mo o d ; (2) d im inished interes t or plea su re in a c t i v it ies; ( 3) sig nif ica nt BC Psychologist
cha nge in weig ht ; (4) insom nia or hy p er-som nia ; ( 5) ps ychomotor a g it at ion or re t a rd at ion; (6) f at ig u e or loss of energ y; (7) feel ings of wor t hlessness or e xcessi ve or inappropr iate g u i lt; (8) d im inished abi l it y to t h in k or concent rate, or ind ec isiveness; a nd , (9) rec u r rent t hou ght s of d eat h or su ic id a l it y. If we consid er a sig nif ica nt loss (e.g., t he d eat h of a sp ou se, b ecom ing a qu a d r ipleg ic, e tc.), we ca n see t hat 7 of t he 9 s y mptom s for a n MDE a re id ent ica l w it h g r ief ! The g r ie v ing p erson w i l l l i kel y e x p er ience a d epressed mo o d , problem s w it h sleep a nd app e t ite, l a ck of plea su re in a c t i v it ies, f at ig u e, problem s concent rat ing a nd a g it at ion. The on l y t wo s y mptom s wh ich tend not to o verl ap for someone solel y e x p er ienc ing g r ief a re feel ings of wor t h lessness a nd su ic id a l it y. A s t he d ia g nosis of MDE on l y requ ires f i ve s y mptom s (a nd t he 7 s y mptom s for g r ief a re t he mos t com mon ones), it is ea s y to see why a f ter a br ief sel f-rep or t checkl ist w it h a f a m i l y physic ia n, m a ny p eople w a l k out w it h a d ia g nosis of d epression a nd f requ ent l y a prescr ipt ion for a nt i- d epressa nt s.
Grief is the normal human reaction to l o s s , n o t a p s yc h o p a t h o l o g y If d epression a nd g r ief were s y nony m s for t he sa me e x p er ience t hen it d o esn’t m at ter what we ca l l it . Howe ver, t he y a re not s y nony mou s. Gr i e f i s the nor m al hum an r ea c t i on t o l o s s: it is not a ps ychopat holog y. We a l l inst inc t ivel y k now how to g r ie ve. To obser ve t h is, w a l k up to a to d d ler a nd t a ke aw ay t heir lol l ip op. The y w i l l clea rl y e x press t heir g r ief rega rd ing t he loss of t heir ca ndy. Th is rea c t ion is ob v iou sl y more se vere in sit u at ions, su ch a s, d i vorce, ca ncer or losing a job. There is a n at t a ch ment to a n objec t or p erson a nd when t hat at t a ch ment is se vered , t he g r ief rea c t ion is init iated . Genera l l y, t he on l y t ime g r ief b ecomes a problem is when we in h ibit or repress t he emo t ions a nd d on’t a l low ou rsel ves su f f ic ient t ime. Ty pica l l y, t here a re t wo pr im a r y t herap e ut ic ‘ inter vent ions ’ for g r ief; (1) nor m a l i ze t he g r ief e x p er ience, a nd , (2) e x tend t he t imel ine for how long p eople b el ie ve g r ief shou ld t a ke. Firs t, it ’s imp or t a nt to nor m a l i ze t hat t he p erson is simpl y e x p er iencing a n u nd ers t a nd able resp onse to a loss. Cou nt less cl ient s have s t ated how mu ch of a rel ief it is to have t heir s y mptom s concept u a l i zed a s g r ief, a nd to nor m a l i ze t he feel ings t he y have b een e x p er iencing (e.g., “ I t hou ght I w a s cra z y, or some t h ing w a s w rong w it h me ” ). 16
Second , a sig nif ica nt loss t a kes a m inimu m of a yea r to g r ie ve. Th is is b ecau se we tend to mea su re t h ings in c ycles a nd we w i l l e x p er ience ‘ f irst s ’ t hrou ghout t he yea r (e.g., t he f irst bir t hd ay or Chr ist ma s w it hout t he p erson, t he f irst Va lent ines Day, e tc.). It isn’t p ossible to f u l l y g r ie ve a loss in Ju ne, b ecau se we ca n’t f u l l y k now how it w i l l feel du r ing t he hol id ays in si x mont hs when t here is a n empt y cha ir at t he t able. Usu a l l y, ou r so c ie t y w i l l a l low t wo to t hree mont hs to g r ie ve a d eat h, or ot her sig nif ica nt loss, a nd t hen e x p ec t t he p erson to “ mo ve on”. Th is is premat u re a nd of ten lea d s to t he p erson repressing t heir feel ings, resu lt ing in u nnecessa r y emot iona l d ist ress.
S o w h a t a b o u t d e p r e s s i o n? A t t he 2 0 05 Evolut ion of Ps ychot herap y conference, A a ron Beck st ated , “ It ’s unf or t unat e th at d e pr e ss i on i s c on s i d e r ed a mo od di sor d e r b e c a u se it ’s mor e a c c ur at ely a thought di sor d e r ”. Beck w a s clea rl y not st at ing t hat it is a t hou ght d isord er in t he sense of ps ychosis or losing tou ch w it h rea l it y. R at her, d epressed feel ings a re of ten t he resu lt of d istor ted cog nit ions or t h in k ing er rors wh ich m ay lea d to a n emot iona l o ver-rea c t ion to a sit u at ion. Th is is when cl ient s w i l l b eg in to end orse t he s y mptom s of wor thl e s s ne s s a nd s ui c i d alit y. The v a st cog nit iveb ehav iou ra l t herap y l iterat u re rega rd ing d epression sp ea k s for it sel f a nd is b e yond t he scop e of t h is a r t icle. Howe ver, t he more you id ent if y loss (a nd t he a ccompa ny ing g r ief resp onse) in you r cl inica l work, t he more it w i l l b ecome e v id ent what shou ld b e seen a s nor ma l g r ief versu s what is a rea c t ion du e to d istor ted cog nit ions.
R at her, d epressed feelings are of ten t he resu lt of d istor ted cognit ions or t hink ing errors which may lead to a n emot iona l overreac t ion to a sit u at ion.
L e a r n i n g t o g r i eve i s a n e c e s s a r y l i f e s k i l l A t a recent present at ion, I a sked how m a ny p eople ha d e ver e x p er ienced at lea s t one sig nif ica nt d eat h of a lo ved one. Approx im atel y 8 0% put up t heir ha nd . I a sked how m a ny ha d e x p er ienced at lea s t t wo signif ica nt d eat h s – 4 0% ha d . Three sig nif ica nt d eat hs? Approx im atel y 2 0% . I t hen a sked how ma ny p eople ha d e ver e x p er ienced at lea st one sig nif ica nt loss in a rel at ionsh ip, hea lt h, f ina nces, work , hop es & d rea m s, id ent it y or a ny ot her m ajor a rea – 10 0% put up t heir ha nd . How ma ny ha d e x p er ienced t wo or more losses in t hese a rea s? Ap prox im atel y 9 8% . Three sig nif ica nt losses in t hese v a r iou s a rea s? St i l l o ver 9 0% ha d ! Th is is why it is imp or t a nt to help ou r cl ient s e x pa nd t heir d ef init ion of g r ief f rom simpl y t he d eat h of a lo ved one, to t he w id e v a r ie t y of losses e x p er ienced on a more reg u l a r ba sis. A s we go t hrou gh l ife, it is nat ura l a nd com mon to e x p er ience losses of some k ind . A s a resu lt, I f ir m l y b el ie ve t hat l ear ning t o g r i e ve c on s t r u c t i vely i s a nec e s s ar y lif e sk ill. In f a c t, it shou ld probabl y b e t au ght in h igh scho ol l i ke ot her l ife sk i l l s, wh i le a d olescent s a re prepa r ing to d ea l w it h c u r rent a nd f ut u re losses wh ich cons t it ute t he ine v it abl e , nat ur al an d b a s i c p ar t of the hum an c ondit i on.
Re fe re n ce s: B a r b e r, C. (2 0 0 8). C o m f o r t a b l y n u m b: H o w p s y c h i a t r y i s m e d i c a t i n g
a n a t i o n. N e w Yo r k , N Y: V i n t a g e B o o k s .
C o n r a d, P. (2 0 07 ). T h e m e d i c a l i z a t i o n o f s o c i e t y: O n t h e t r a n s f o r m a-
t i o n o f h u m a n c o n d i t i o n s i n t o t re a t a b l e d i s o rd e r s. B a l t i
m o r e, M D: T h e J o h n H o p k i n s U n i v e r s i t y P r e s s .
D o w r i c k , C. (2 0 0 9). B e y o n d d e p r e s s i o n: A n e w a p p r o a c h t o u n -
d e r s t a n d i n g a n d m a n a g e m e n t – 2 n d e d i t i o n. N e w Yo r k ,
N Y: O x f o r d U n i v e r s i t y P r e s s .
G r e e n b e r g, G . (2 010). M a n u f a c t u r i n g d e p re s s i o n: T h e s e c re t h i s t o r y
o f a m o d e r n d i s e a s e. N e w Yo r k , N Y: S i m o n & S c h u s t e r.
H o r o w i t z, A . (2 0 0 2 ). C re a t i n g m e n t a l i l l n e s s. C h i c a g o, I L: T h e U n i -
versit y of Chic ago Press.
H o r o w i t z, A . & Wa k e f i e l d, J. (2 0 07 ). T h e l o s s o f s a d n e s s: H o w
p s y c h i a t r y t r a n s f o r m e d n o r m a l s o r ro w i n t o d e p re s s i v e
d i s o r d e r. N e w Yo r k , N Y: O x f o r d U n i v e r s i t y P r e s s .
K u b l e r- R o s s, E. (19 97 ). O n d e a t h a n d d y i n g: W h a t t h e d y i n g h a v e t o
t e a c h d o c t o r s , n u r s e s , c l e r g y a n d t h e i r o w n f a m i l i e s. N e w
Yo r k , N Y: S c r i b n e r.
Wo r d e n, J.W. (2 018) G r i e f c o u n s e l i n g a n d g r i e f t h e r a p y: A h a n d
b o o k f o r t h e m e n t a l h e a l t h p r a c t i t i o n e r – 5t h e d i t i o n. N e w
Yo r k , N Y: S p r i n g e r P u b l i s h i n g C o m p a n y.
Corrections & Clarifications The Editors want to sincerely apologize to Dr. Marci Moroz and to the readers for the last sentence mistakenly added to the article in the last edition of the Journal titled, “Are we ready for the Silver Tsunami? Complexities of latelife depression”. The last sentence was one of the editors’ suggestions and should not have been printed and it is certainly not the view of the writer. Dr. Marci would like it to be known that she is aware that medications are outside of our scope of practice. Psychologists do not have the training or responsibility to determine that need, and she is very comfortable working collaboratively with physicians about antidepressant medication, leaving the responsibility in their capable hands. She is hopeful that the concluding sentence of her article (not her own words) does not result in an incorrect assumption about who she is or how she works. Erratum: The listed author of the article on Client Handout on Anger Management in the Fall, 2018 issue should read only as “Ted Altar, Ph.D., R.Psych.”
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Hard to Say I’m Sorry: How to Make it Easy Dr. H. Elise Reeh, Ph.D. ca n br ing a n ot her w ise s t rong rel at ionsh ip to a g r ind ing ha lt . O f ten t he t ra nsg ression is a sig n t hat some t h ing w a s not work ing wel l in t he rel at ionsh ip in t he f irs t pl a ce. Ins tea d of a l low ing t he t ra nsg ression to ter m inate t he rel at ionsh ip, you ca n help t he rel at ionsh ip to hea l a nd g row. Here a re eight steps t hat ca n b e fol lowed to m a ke ap olog i zing ea sier a nd genu ine: r a n s g re s si o n s in a re l ati o ns hip
1 . O n l y ap olog i ze if you genu inel y feel sor r y for what you d id (Scher & Da rle y, 19 9 7). If you a re ju s t say ing t he word s to t r y to end conf l ic t, it may ma ke t he sit u at ion worse. A l so, you ca n not ap olo g i ze for someone el se ’s t ra nsg ressions. 2 . W hen p eople a re tel l ing you what you d id a nd what emot iona l impa c t you r b ehav iou r ha d on t hem, l is ten w it h empat hy a nd genu ine c u r iosit y (Shore y & Sp ol len, 2 018) rat her t ha n rea c t ing d efensi vel y Im a g ine t hat you r m ind is a clea r wh ite b oa rd (e.g. not h ing is on you r m ind ; d on’t t h in k ab out what you w i l l say ne x t e tc.). L e t t he p erson w r ite her/h is messa ge on t h is wh iteb oa rd . 3. Fo c u s on t he impa c t of t he t ra nsg ression on t he p eople you hu r t , not on you r intent ions. (A lt hou g h you probabl y d id not intend to hu r t p eople, you d id , so you r intent ions a re not a s imp or t a nt a s t he impa c t s on ot her p eople.) 4 . The ap olog y shou ld inclu d e a ck nowled g ing what you d id w rong. W hat you a re ap olog i zing for need s to b e ob v iou s. It m ay a l so inclu d e t ha n k ing t he p erson for br ing ing t he issu e to you r at tent ion
if t he t ra nsg ression w a s not some t h ing ob v iou s or not some t h ing of wh ich you were aw a re. 5. A ccept resp onsibi l it y (Moha m med , A b du lA meer, & Hu mei, 2 01 3) a nd u se word s t hat show you t a ke resp onsibi l it y. a) For e x a mple, d on’t say “sor r y t hat happ ened or o cc u r red .” Say “ I ’m sor r y t hat I d id _ _ _ _(na me sp ecif ic a c t ion).” b) D on’t u se t he word s "but a nd if " b ecau se t hese word s ca n negate a genu ine messa ge. D on’t say: “ I ’m sor r y if t hat hu r t you , I ’m sor r y you feel t hat w ay, I ’m sor r y but I d id n’t mea n to hu r t you .” Say, “ I ’m sor r y t hat I hu r t you (or upse t you , v iol ated you r t r u st, e tc.)” Use empat hy to show how you r a c t ions a f fec ted t he p erson. 6. Com m it to not rep eat ing t he a c t ion a ga in. Ex pl a in what you w i l l d o to pre vent d oing so a ga in. Say “ I w i l l not d o t h is a ga in b y ….” 7. Tr u st ca n b e rebu i lt u sing t h is for mu l a : Re l iabi l it y o ver T ime = Tr u st . St a r t rebu i ld ing t r u st a nd a ccept t hat it is a long pro cess. For e x a mple, say you w i l l d o some t h ing , d o what you say, a nd d o it hu nd red s of t imes. In t h is w ay, t r u st ca n b e rebu i lt . 8. A s t he v ic t im of a t ra nsg ression, it is imp or t a nt to d e velop forg iveness rat her t ha n hold ing onto g r u d ges. Forg iveness is d ef ined a s le t t ing go of t he intense feel ings a sso ciated w it h t he t ra nsg ression. Forg iveness d o es not mea n t hat you w i l l forge t t he t ra nsg ression. L ea r n to forg ive b y rea li zing e ver yone ma kes m ist a kes a nd t hat ot her w ise
L ear n to forg ive by rea l izing e ver yone ma kes mista kes and t hat ot her w ise good d ecisionma k ing sk il l s can be a ltered by st ress, pain, substances etc. Foc u s on t he ne w behav iours and t he rebu ild ing of t r u st instead .
go o d d ec ision-m a k ing sk i l l s ca n b e a ltered b y s t ress, pa in, subs t a nces e tc. Fo c u s on t he ne w b ehav iou rs a nd t he rebu i ld ing of t r u s t ins tea d . 9. Have a n op en conversat ion ab out you r rel at ionsh ip dy na m ics. D isc u ss what work s wel l a nd what d o es not . For e x a mple, a m a n we â€™l l na me Joh n te x ted h is w ife â€™s b es t f r iend , who we w i l l na me Na nc y, a f ter a n e vening of d r in k ing w it h h is f r iend s. Joh n told Na nc y t hat he w a s at t ra c ted to her. The ne x t mor ning , he w a s sho cked t hat he sent t h is te x t . A f ter some d isc u ssion, Joh n rea l i zed t hat t he rea son he w a s at t ra c ted to Na nc y w a s b ecau se she genuinel y l is tened to h im a nd he felt h is w ife d id not . A f ter couples cou nsel l ing , com mu nicat ion b e t ween Joh n a nd h is w ife g reat l y impro ved . A f ter w a rd s, t he y worked on s t reng t hening t heir rel at ionsh ip a nd work ing on forg i veness rat her t ha n fo c u ssing on t he t ra nsg ression a nd ha rb ou r ing resent ment . By of fer ing a genu ine ap olog y, l is tening a nd a ck nowled g ing t he pa in cau sed , rebu i ld ing t r u st, hav ing a n op en a nd hones t conversat ion ab out what w a s m issing in t he rel at ionsh ip in t he f irs t pl a ce, a nd a d d ressing t he problem, you a re t a k ing imp or t a nt s teps in hav ing you r rel at ionsh ip f lou r ish a ga in.
Dr. H. Elise Reeh has been a Registered Psychologist since 1996. She has a private practice in Mission BC. She sees adult clients for a variety of issues including those mentioned in this article.
Re fe re n ce s: M o h a m m e d, A ., A b d u l -A m e e r, & H u m e i, A . (2 013). T h e E f f e c t o f
Gender and Status on the Apology Strategies Used by
A m e r i c a n N a t i v e S p e a k e r s o f E n g l i s h a n d I r a q i E F L U n i v e r-
sit y Student s. Research on Humanities and Social Sci-
e n c e s, Vo l 3 (2 ),
S c h e r, S. J., & D a r l e y, J.M., (19 97 ). H o w E f f e c t i v e A r e t h e T h i n g s
P e o p l e S a y t o A p o l o g i z e? E f f e c t s o f t h e R e a l i z a t i o n o f
t he Apology Speech Act. Journal of Psycholinguistic Re-
s e a r c h, 2 6 (1), 127-137.
S h o r e y, J.M.& S p o l l e n, J. J. (2 018). A p p r o a c h t o t h e p a t i e n t . A c -
c e s s e d t h r o u g h U pTo D a t e d a t a b a s e. (n o D O I a v a i l a b l e).
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Workshop Registration Form | Winter 2019 What every psychologist should know about the link between animal abuse and family violence Presented by Dr. Mary Lou Randour & Dr. Maya Gupta Thursday, April 12, 2019 8:30AM – 4:30PM @ University Golf Club House 5185 University Blvd., Vancouver, BC V6T 1X5 Continuing Education Credits: 6 Sponsored by: Chuck Jung Associates (chuckjung.com)
Register Early to save $24!
After a critical review of the research on animal abuse and its link to other types of interpersonal violence, this workshop also outlines policies that were changed in response to this link. Practical suggestions are offered of how to address animal abuse in interviews and treatment, as well as getting help for children who engaged in or witnessed animal abuse. The dialectic between confidentiality and reporting is covered, as well as recommendations for changes in professional policies and practices. The workshop will provide a combination of short lectures, small group exercises, and larger group discussions and will use case examples to facilitate learning. Learning Objectives 1. Participants will be able to cite at least three research studies on the topic of the link between animal abuse and family violence 2. Participants will be able to cite at least three policies that were changed because of knowledge about the link between animal abuse and family violence 3. Participants will gain knowledge about interviewing techniques for identifying animal abuse 4. Participants will be able to identify and compare at least three treatment options for children and adults who have engaged in animal abuse 5. Participants will be able to recommend at least one change in professional policies or practice About the Presenters Dr. Mary Lou Randour, a psychologist, is a Senior Advisor for Animal Cruelty Programs and Training, Animal Welfare Institute, Washington, D. C. She received a Ph.D. from the University of Maryland, as well as a NIMH Postdoctoral Fellowship. In addition, she was a Clinical Fellow in Psychology at Cambridge Hospital, Harvard Medical School, and is an Adjunct Professor in Psychiatry at the The Uniformed Services University of the Health Sciences. She is the author of handbooks such as A Common Bond: Child Maltreatment and Animals in the Family, as well as AniCare Child, a treatment approach for children who abuse animals. Dr. Randour has published articles in numerous professional journals as well as written chapters for edited volumes. Her latest contribution “The Psychology of Animal Abuse Offenders,” co-authored with Dr. Maya Gupta, appears in the book Animal Cruelty: A Multidisciplinary Approach to Understanding. In her career, Dr. Randour has worked for a federal research-funding agency and enjoyed a private practice for almost 20 years. She now devotes her knowledge of psychology to advance animal protection and its connection to human welfare. Dr. Maya Gupta earned her BA from Columbia University, and both her master’s and PhD in clinical psychology from the University of Georgia. Her primary area of expertise is animal cruelty and its connections to other forms of violence. She previously served as Executive Director of Ahimsa House, a Georgia nonprofit organization providing statewide services for victims of domestic violence who are concerned about the safety of their animals. She has spoken, consulted, and trained nationally and internationally on the development and evaluation of similar programs and community-level initiatives. She also served as the Executive Director of the Animals & Society Institute, a nonprofit working to improve and expand knowledge about human-animal relationships in order to create safer and more compassionate communities. She has also contracted for animal welfare organizations on program development and evaluation, served as a consultant for research projects on human-animal interaction, and provided expert witness services for animal cruelty cases.
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
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February is Psychology Month! Free Public Presentation Schedule for 2019 BCPA is hosting free public presentations in February for Psychology Month, an annual campaign that raises awareness about the role of Psychology in shaping mentally healthy communities.
From enhancing your personal resilience to strengthening your relationships, thereâ€™s bound to be something that interests you. Check out the presentation schedule below and donâ€™t forget to spread the word!
persis tin g pain and h ow to manag e yo ur chro nic pain Tuesday, February 5, 2019 | 7:00pm-8:00pm Dr. Patrick Myers, R.Psych. & Ms. Lynnaea Northey Port Moody Public Library* 100 Newport Drive, Port Moody
S trivin g Fo r Perfec tio n Versus S trivin g Fo r E xcellen ce Thursday, February 21, 2019 | 7:00pm-8:30pm Dr. Patrick Myers, R.Psych. & Dr. Linda Stull, R.Psych. Dunbar Community Centre 4747 Dunbar St, Vancouver
Tuesday, February 19, 2019 | 7:00pm-8:30pm Dr. Patrick Myers, R.Psych. & Ms. Sarika Vadrevu Vancouver Public Library - Renfrew Branch 2969 E 22 Ave, Vancouver
B e the B e s t Versio n o f Yo urself Saturday, February 23, 2019 | 11:00am-12:30pm Dr. Sara David, R.Psych. Dunbar Community Centre 4747 Dunbar St, Vancouver
mind fulne ss: An effec tive way to red u ce s tre ss and in cre a se well- b ein g Thursday, February 7, 2019 | 7:00pm-8:00pm Dr. Erika Horwitz, R.Psych. Port Moody Public Library* 100 Newport Drive, Port Moody
Mind fulne ss fo r Re silient Teenag ers Sunday, February 24, 2019 | 3:00pm-4:00pm Dr. Kasim Al-Mashat, R.Psych. Centre For Mindfulness Canada** 107-3711 Delbrook Ave, North Vancouver
The superp ower o f love: H ow to unle a sh it & up g r ad e yo ur rel atio nships in o ur dis co nnec ted wo rld Monday, February 11, 2019 | 7:00pm-8:30pm Dr. Rotem Regev, R.Psych. Vancouver Public Library - Central Branch 350 West Georgia Street, Vancouver Helpin g Child ren Cha se Away Wo rry: Und ers tandin g and Managin g Anxie t y in Child ren Tuesday, February 12, 2019 | 7:00pm-8:30pm Ms. Semiramis du Sautoy, RCC & Ms. Beverly Kort, R.Psych. Burnaby Public Library - McGill Branch 4595 Albert Street, Burnaby Monday, February 25, 2019 | 7:00pm-8:00pm Ms. Samiramis du Sautoy, RCC & Ms. Sofia Khouw, R.Psych. Port Moody Public Library* 100 Newport Drive, Port Moody Enhan cin g re silien ce & psych o lo gical well- b ein g Saturday, February 16, 2019 | 1:00pm-2:30pm Dr. Alina Sotskova, R.Psych. Vancouver Public Library - Britannia Branch 1661 Napier Street, Vancouver Presentations are hosted in association with our community partners: Vancouver Public Library, Port Moody Library, Dunbar Community Centre, Burnaby Public Library and Richmond Public Library. *Call venue to register due to limited seating ** Pre-registration is required, please visit www.drkasimalmashat.com
H ow to b eco me a mental he alth amba ssad o r (En g lish & Mandarin) Tuesday, February 26, 2019 | 4:00pm-5:30pm Dr. Rosa Wu, R.Psych. Richmond Public Library* 100-7700 Minoru Gate, Richmond Le arnin g Ab o u t g end er id entit y in Child ren and Yo u th An y where Thursday, February 28, 2019 | 7:00pm-8:30pm Dr. Wallace Wong, R.Psych. Vancouver Public Library - Kitsilano Branch 2425 MacDonald Street, Vancouver Mind fulne ss Ba sed S tre ss Red u c tio n (MB SR) Saturday, February 16, 2019 | 11:00am-12:30pm Dr. Kasim Al-Mashat, R.Psych. Centre For Mindfulness Canada** 107-3711 Delbrook Ave, North Vancouver Thursday, February 28, 2019 | 7:00pm-8:30pm Dr. Kasim Al-Mashat, R.Psych. Centre For Mindfulness Canada** 107-3711 Delbrook Ave, North Vancouver Ask A Psychologist: Staying Connected Thursday, February 7, 2019 | 7:00pm-8:30pm An interactive evening with experts on marriage, family, and social relationships. Panelists (R.Psych.): Dr. Patrick Myers, Dr. Anna Khaylis, Dr. Michael Sheppard, Dr. Rotem Regev, and Dr. Marilyn Chotem. Vancouver Public Library - Central Branch 350 West Georgia Street, Vancouver
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