Online Courses and CE: We offer a series of online educational programs for professionals and the public. Visit us here for previews and discounts on our online programs.

Follow PsychologySalon on Facebook: Become a fan of the PsychologySalon page; updates will appear in your news feed.

Looking for a therapist? We have eleven registered psychologists in our clinic, and we are accepting new clients. For information, visit www.changeways.com.

Tuesday, 27 November 2012

The Cost of Wilderness Rescue - And Wilderness Fear

Equipped, but not overly so.

On Sunday I went on the year's inaugural snowshoe in the mountains north of Vancouver.

Winter is now upon us, and with it all of winter’s traditions.

  • Someone will go hiking just before a blizzard hits, and will be found next spring. 
  • Young (and almost invariably male) skiers will sneak into the backcountry and need to be rescued. 
  • Snowmobilers will attempt highmarking and predictably trigger avalanches from which they will need to be dug out.

And down in the cities, people will snort at their foolishness and repeat the refrain that those who go out of safe boundaries ill-equipped should be billed the cost of their rescue.

I will be one of the ones rolling my eyes at some of the stories (“Safety equipment? Umm, we had a cell phone…”), sorely tempted to join the chorus. Bill them! Leave them! Serves them right! Give them a Darwin Award!

Hopefully I will hold back.

Canada is a more urbanized country even than the USA. Increasingly, Canadians live within their cities and seldom venture out. Those who do are often regarded strangely. “Bit of a loner. Likes the bush.” And those who go out there, beyond the television screens and the cell reception, seem to be doing something both pointless and foolish. If something goes wrong, well, why is that my problem?

But we seldom hear calls for a cessation of funding to rescue people from other mishaps – many of which are caused by our own actions.
Snowshoeing, downtown Vancouver in background.

  • The person caught in a motor vehicle accident while driving to the supermarket 4 blocks from home.
  • The person who suffers a heart attack after eating at fast food restaurants daily for many years.
  • The person who dutifully works 16 hours a day at their desk job, striving to pay off the mortgage on the family home, and lapses finally into depression.
  • The person who remains safely ensconced at home, watching others live fictionalized lives on television, and trips on an unpopped kernel of corn.

Stand at the entrance to an Emergency Room at any major hospital and interview each person who arrives. We can find a way to blame almost anyone for their misfortune. “Well if you knew she had strep throat, why did you kiss her?”

So why the smirks and calls for repayment from those who run into trouble in the backcountry? Perhaps it is because the social norms are changing. Wilderness travel, backpacking, backcountry skiing are becoming marginalized rather than valued. It’s easy to criticize those other people, not like me, who get into trouble doing things I would never do.

We have begun to fear our country. Once a much-loved asset, the wilderness is now a threat.  It’s a dangerous place that only a few outdoor-expedition geniuses are qualified to handle.

But perhaps the greatest threat to Canada – and the world – is the assault on our natural environment. How can we expect people to care for something they have never seen, something they fear, something that seems to want to kill them? For people to appreciate what we have, they must see it and walk through it. Then they might be more inclined to think before destroying it.

We are in no danger of bankrupting ourselves looking for young people who venture beyond their abilities. We are in much greater danger of irrevocably damaging our environment – and our physical and mental health – by ignoring the consequences of our lifestyles on the world and on ourselves.

Sure we need better training. We need to remind people that the mountains are not equipped with safety rails nor are they designed by Disney. We should be encouraging more wilderness education as a standard part of our school system.

But we don’t need to encourage even more fear of the natural world than our urban dwellers already have.

Sunday, 25 November 2012

Practice: Marketing your business

How do therapists get clients? There are thousands of therapists out there. How do they decide on you?

Here's an article on the subject from the New York Times:

http://www.nytimes.com/2012/11/25/magazine/psychotherapys-image-problem-pushes-some-therapists-to-become-brands.html?pagewanted=1&_r=2&smid=go-share&

Tuesday, 20 November 2012

Resources: The Core Program in PDF


Sometimes the mind-numbingly obvious escapes us. Or at least it does me.

For years we have been selling Changeways Clinic therapy protocols from our website at www.changeways.com in hard copy format. This necessitates printing the manuals, creating the enclosed CD-ROMs with the reproduction masters for clients, then sitting and listening to CBC while stuffing the insert sleeves with the disks.

But, frustratingly, Paypal in Canada (unlike the US) only allows you to define one shipping rate for a product, so we can't use it to sell copies to folks from the UK, Australia, and elsewhere. They've had to use our print-copy order form and fax it to us. And the shipping to locations overseas is exorbitant.

And how do we produce the hard copies? By uploading the pdf files to our local printer.

"So," anyone with two neurons that still fire would ask, "Why not make the electronic pdfs available for purchase via email?" No shipping cost, no inventory to keep, and near-instant delivery of the product.

Well, don't ask me why this was never done before. My only defence is that other projects have sometimes gotten in the way of sensible and convenient upgrades to our website.

At any rate, we now have the Core Program protocol for the group treatment of depression available in pdf format. As a matter of fact, we have it in three formats:

  • USLetter, Imperial Spelling. Canada uses the same standard paper size as the USA, so our original manuals are all USLetter, but in the Imperial Spelling (or at least the Mid-Atlantic version used in Canada) that our American cousins find so quaint. Behaviour, centre, colour, etc.
  • USLetter, US Spelling. We get a lot of orders from the USA, so we went thru the documents at nite at our center (okay, only "center" is actually correct) and altered the spelling to standard US.
  • A4 Paper, Imperial Spelling. Most of the world uses the A4 paper format, taller and narrower than USLetter, so we reformatted our Imperial version for A4. Imperial purists in the UK may object that we don't go all the way (our program is still a program, not a programme), but we're mostly there.

All versions are the same price and are emailed out the moment our Workshops and Products Coordinator comes to the office, which means within a max of 2 business days.

For $55.00 Canadian, the purchaser gets the full pdf of:

Core Program Participant Manual for clients, 94 pages
Core Program Clinician's Guide providing therapists with instruction on how to run the program, 220 pages.

And:

Quick Reference. Large font note-form reminder pages to help therapists keep themselves on track during each session. 42 pages.
Goal Setting Form for Clients.
Goal Setting Form for Clinicians.
Group Attendance Form.
Thought Challenging Form, Portrait Style.
Thought Challenging Form, Landscape Style.
Participant Feedback Form.
Therapist Feedback Form.
Clinician's Guide Feedback Form.

And:

Permission to reproduce all materials designed for clients, for as many of the purchaser's own clients as they wish. The Clinician's Guide can also be reproduced for other clinicians working from the same agency at the same address.

For $20, purchasers can also get a copy of an audio MP3 with eight hours of lecture content to supplement the Participant Manual. These talks can be reproduced for the purchaser's own clients as a way of supplementing the group, bringing clients up to speed when they miss a session, and as an instructional aid when using the materials with clients on an individual basis.

Umm, fine, but what is the Core Program?


The Changeways Core Program is a group therapy protocol for the treatment of depression. In a practical and psychoeducational format, it assists clients in the development of self-care and depression management skills. It is the most widely used depression group protocol in Canada.

The delivery format is flexible, but it is most frequently used as a once-per-week eight-to-ten session closed-ended outpatient group. Some private practitioners and inpatient hospital settings have adapted it as an open-ended format.

What does the Core Program cover?

The emphasis is on providing specific, research-based strategies for dealing with life problems. Behavioural activation is a core of the program. Clients are invited to set and review personal goals in every session of the group, "stirring in" other concepts and strategies as they are presented. The contents include:

  • Identifying problems and transforming them into goals for change.
  • Behavioural activation strategies:  Breaking goals down into manageable steps.
  • Learning about stress.
  • The signs, symptoms, and causes of depression.
  • The effects of diet, exercise, sleep habits, caffeine, and drugs and alcohol.
  • The importance of building recreation into one's daily life.
  • Strategies for developing a more satisfying social life.
  • An introduction to assertiveness skills.
  • Identifying negative and self-defeating thought patterns.
  • Learning to think in a more balanced and realistic manner.
  • Preventing mood problems from becoming unmanageable.

Where do I order that again?

At the Changeways Clinic website, notably on the product page here. We also have a training workshop for clinicians interested in presenting the program coming up in Vancouver in September 2013 - information on this and all other scheduled training programs here. Plus, we are in the process of developing an online CE course for therapists on the Core Program; expect further announcements about this when it goes live.

We're working on a similar distribution format for our other products, including our popular Being There Communication Skills protocol.  Stay tuned.

Tuesday, 13 November 2012

Social Anxiety: Find the Landmine!

Especially during exposure exercises.

Almost everyone has social anxiety. Take us to a formal reception where we don’t know anyone, and watch the heart rate rise. Put us on a stage with a set of notes and a hostile audience and see what happens.

Like most fears, social anxiety exists on a continuum. Beyond a certain point the fear becomes disabling – preventing the person from reaching his or her deeply-held goals and wishes.

The treatment for just about any unhelpful fear is the same: approach the feared situation, tolerate the anxiety, and stay there long enough for the anxiety to fade (in a process we officiously call habituation), replaced (usually) by boredom.

To this we usually add an examination of the belief system. This can be complicated, but usually boils down to “What is it that you imagine happening, how likely is that, really, and how bad would it be if it did?” From there the thing can become enormously complicated, but that’s the nub.

Effective treatment depends on our ability to identify the real fear. If we believe that our agoraphobic client who avoids shopping malls fears shopping, then we might create an exposure task involving a browse through the Amazon website. And we would almost certainly get nowhere, because agoraphobia is not at all a phobia of the agora, nor is it a fear of shopping. It is usually a fear of specific internal bodily sensations developing in situations from which it might be difficult to escape.

One problem is that the person himself or herself often isn’t too clear about what they fear. Ask a socially anxious client what they are afraid of, and you will often hear “job interviews, public speaking, social events.” If you ask what it is about these situations that seems fearful, you can hit a wall. “I just don’t like them; never have.”

Left unexplored, this would pull therapists to suggest exposure tasks like attending small social events and working upward. And this might be helpful. But often we will get no improvement, and clients will report a feeling of relief when the tasks are over that does not translate into a reduced anticipatory fear. They feel like they have traversed a minefield without being blown up, but this does not reduce the fear of minefields in the least.

Why not? Because the client was never afraid of minefields. They were afraid of mines.

We have to figure out the nature of the landmines that the client fears within social situations. And they often have difficulty telling us.

That’s an awfully long leadup to a tiresomely obvious tip, I’m realizing. My own anxiety about appearing foolish in this forum is waking up and looking furtively around. Which, of course, makes posting it a perfect exposure exercise.

See enough people with serious social anxiety, and you know darned well what they’re afraid of. But things go better if you get it from them, and every so often you are surprised. A simple question will usually crack open the cognitive shell:

“Imagine we were to make you utterly invisible, then send you to a party – exactly the type that you say you are most afraid of. No one can see you. How would you feel?”

The usual answer is that the person would feel much better, plagued only by a residual anxiety that the invisibility spell might wear off. This tells the therapist – and the self-surprised client – that they aren’t afraid of parties after all. They are afraid of something that might happen at parties – something that depends on them being visible to others.

“I’m afraid of doing something stupid – like dropping food on the floor or having my fly down, or not being able to think of anything to say.”

But none of this is true either.

“Have any of those things ever happened when you were alone? How did you feel?”

“Oh, fine.”

“So it depends on you doing something that seems foolish to you, and them seeing it. What would happen if they did?”

And here we get the reality. Our socially anxious person isn’t afraid of social situations at all, nor of being awkward. They’re afraid of other people seeing and possibly negatively evaluating their performance. Consequently, simply exposing the client to a social situation is unlikely to produce impressive results – unless we expose them to what they really fear: making errors visibly in front of others and risking – or, even better – receiving negative evaluations.

The further down the anxiety chain that we can structure our exposure exercises, the better. Not just going to the party, but doing something awkward. Not just doing something awkward, but doing it so someone notices. Not just having them notice, but letting them develop a negative evaluation of us. And surviving that.

It’s not always possible to go all the way. Most of us are unwilling to do things that will make our bosses even more convinced that we are idiots, no matter how therapeutic the task might be. But usually we can come up with something that gets us far enough to dissolve some of the irrational fear. Look as though you are about to hand the boss a report, then confess an error – “Oh, I haven’t included the appendix at the end – I’ll add that and get this to you later.”

Most effective social anxiety exposure work involves making at least some deliberate errors while entering moderately feared situations. Deliberateness, of course, is critical. “I seem to make errors constantly and the fear never gets any better.” It is the voluntary performance of social errors that helps. Stumble on the way into the cinema. Spill your coffee at Starbucks. Mis-button your coat before going into a store. Make your hand shake as you hand over money. Confess your anxiety before commencing your talk.

Know the true nature of the landmine you fear. Then jump on it.

Thursday, 8 November 2012

PsychologySalon Talks for 2013 at VPL

We have now confirmed the 2013 schedule for PsychologySalon talks for the public at Vancouver Public Library.

All talks start at 7 pm and are held in the Alice MacKay Room of the Main Downtown Branch of the Library (below concourse level).

Tuesday March 26 - Out of the Blue: The Nature and Treatment of Major Depression. With Dr Randy Paterson.

Tuesday May 28 - Superhero Psychology 101: Understanding the Appeal.  With Dr Lindsey Thomas.

Tuesday September 24 - The Vision Project: Setting - and Reaching - Your Life Goals.  With Dr Randy Paterson.

Tuesday November 26 - How to be Miserable: 12 Brilliantly Effective Strategies.  With Dr Randy Paterson.

Mark your calendar!  Hope you can make it.

Tuesday, 6 November 2012

Reviews: Why "The Secret" Gives Me Hives

Wish hard enough and the trees will plant themselves.

One of the advantages of writing a blog is that it gives you an outlet for the occasional spleen-venting.  One of my pet peeves of the past few years has been the popularity (now waning, thankfully) of The Secret, a set of ideas presented in a DVD and book by Rhonda Byrne, formerly an Australian reality television show producer.  If what follows seems a bit, well, cranky:  that’s an accurate impression of how I sometimes feel.

What is The Secret?

First, The (supposed) Secret is no secret.  It’s based on the idea that when you concentrate on something happening in the near future, you influence the actual probability of that event happening. Adherents also call this the “Law of Attraction” – which actually isn’t a law, just an odd idea.

So if you concentrate with all your heart on that BMW you might just get it, whereas if you expect things to go badly, they will. And this is independently of the influence of your thoughts over your behaviour – so it’s not just that if you want to be wealthy you’ll work hard and define your goals. The universe will respond to your desires and give you what you anticipate. Apparently.

The actual exercises invoked to shift the universe one’s way vary from proponent to proponent.  Reading them, it’s hard to escape the sense (despite denials) that the core idea in each case is “wishing will make it so.”

The fact that it isn’t a secret actually isn’t a big deal for me.  It’s not uncommon to say that the secret of investing is to buy undervalued stocks and sell overvalued ones, that the secret of goal setting is to identify distant goals then focus on the immediate steps toward them, that the secret to a long relationship is to overcome the natural temptation to guess what your partner is thinking and instead communicate. None of these ideas is guarded with lock and key; they are available to anyone. So if something that has sold millions of copies cannot reasonably be called a “secret,” who cares?

So what’s my problem?

Well, where do I start? I imagine it's obvious that I don't actually believe this idea. It doesn't fit my experience, it doesn't appear to fit the lives of my clients or friends, and it doesn't make logical sense when you follow it through to its conclusions. But fine: Lots of people believe things that I don't, and I don't blog about them.

Partly, The Secret doesn’t seem to have worked well for its developers. Look up the Wikipedia article on the subject, then the Wikis on the various people connected with the film. The few years since it was produced have not been kind to many of these people.

To be sure, informing people that “wishing will make it so” is an excellent way to make money, and the books and DVD have been estimated to have pulled in many millions.  But it would appear that the developers of the film and related products did not take care to envision future harmony amongst themselves.

It’s also not Eastern wisdom, despite frequent claims to the contrary. Anytime someone wants to get bogus credibility for an idea, they say it’s from an Eastern wisdom tradition. This is as silly as saying that it is from Northern or Southern wisdom, but in any case the Secret is a purely Western-based idea.

And: The Secret is portrayed as a selfish, consumeristic self-enrichment tool.  The film portrays case after case of people wishing for wealth, jewelry, clothes, cars – and never anything for the broader world. No one seems to hope for anything good to happen to anyone else, and it doesn’t seem to enter anyone’s head to envision a world without AIDS, global warming, hunger, or the American Republican party.

And then there’s OCD

I treat people who suffer from obsessive compulsive disorder. Many people with OCD have spontaneous intrusive unpleasant thoughts, like throwing the baby off the balcony, fondling the rear of the person ahead of them in line, a relative’s plane crashing in flames, or hepatitis germs spreading on the kitchen counter and infecting everyone in the house.

These thoughts are typically produced by the person’s attempt to suppress them: they try not to think of pink elephants and as a result are obsessed with pink elephants. And they often worry: What if my having the thought means it will come true, or somehow makes it come true?

The Secret is like pouring gasoline on this cognitive fire: If you envision your mother developing cancer, you might bring it about. This makes it more important for them to suppress such thoughts, which makes them all the more insistent. Not true and not helpful. Thanks, Rhonda.

And quantum nonsense

Adherents of the Law of Attraction also make frequent reference to the idea of “Quantum Healing.” There truly is something remarkable about this term, as uttering it serves as an off-switch for critical thought within much of our culture.

Richard Feinman famously said that if you think you understand quantum theory, you don’t understand quantum theory. Legions of nonphysicists nevertheless claim not only that they understand the theory, but also that they are able to make use of it (without the benefit of the physicists’ expensive colliders and other equipment) to change people’s lives.

The fact that quantum theory has little to do with self-improvement is no great impediment. Because so few people know anything significant about quantum theory, using the word “quantum” effectively shuts off debate and increases receptivity to whatever is said next. “Ah, this person has studied quantum mechanics, which is way beyond me; they must know what they’re talking about.”

Then there’s blaming the victim

I see other people whose lives have not gone well.  In fact, I have made it my life’s work to deal with negative outcomes.

In the negative, The Secret seems both false and unhelpful.

Worry does not appear to increase the likelihood of negative events happening – at least not directly.  A standard therapeutic exercise is to have a person list all of their worries over the past year or more. When they’ve finished the therapist then asks them to place a check mark beside everything that actually happened.

The point is to realize just how much of our time is spent envisioning negative futures that never arise. In fact, people often realize that the truly awful things that have happened to them are things that they never anticipated. We all have negative thoughts constantly that can surely make us miserable, but that do not produce reality in themselves.

I seem to have spent a great deal of my own life anticipating and envisioning possible catastrophes around every corner, but the disasters I envision never seem to come true. The stressful events that have happened have almost invariably been things I had never considered possible.

In the positive sense, The Secret also seems false and unhelpful.

Unrealistic positivity is as much a problem as negativity. Bankruptcy, excessive debt, and foreign wars are often the product of positive thinking. George W. Bush appears to have been a great positive thinker: we don’t need the help of other nations, we can cut taxes and increase expenditures and it will all work out, we can invade a country and expect to be greeted with open arms, the levees will hold even if we don’t fund their maintenance. The result was a profound weakening, possibly now irreversible, of the most powerful nation on earth. Mr Romney seems cuts from similar delusional cloth: We can spend more on the military, cut the taxes of the very rich, and the budget will be balanced.

At the level of the individual, positive envisioning can be destructive as well. “This time he won’t hit me.” “I can do the same thing as all those other times, but the result will now be better.” “Even though this person closely resembles my previous abusive partners, they’ll be different.” “This business idea is sure to make me a fortune.” “I won’t get addicted.” “I won’t get caught.” “I can still drive with four beers, and the traffic is light anyway.”

And inappropriate absolution.

The Secret absolves us of responsibility for one another.

The bad things that have happened to sub-Saharan Africa are not the product of colonialism, bad governance, western weapon sales, or misfortune; it is the result of the populations of these nations calling negativity upon themselves. The people who died in the Holocaust? They inadvertently brought it on themselves. The hungry, the poor, the ill? Not our problem, not our responsibility.

Is there any reality in The Secret?

Actually, I think there is. Envisioning what you want might help in two ways. First, the universe might magically rearrange itself to give it to you. I don’t believe that this happens, for reasons expressed above, but people can judge this one for themselves.

Second, clearly envisioning our goals may influence our behaviour in subtle ways to help us to achieve them. It is something of a cliché to say it, but we are unlikely to arrive at our destination unless we know where we hope to go.

Some of this is obvious. Knowing that I want to become fluent in French may encourage me to sign up for courses, spend time with French-speaking friends, and visit French-speaking countries – all of which may help transport me to my goal.

But there are subtle effects as well. Simply writing down one’s goals seems to make their achievement more likely. For many years I have made it a habit to sit down on my birthday and write down some goals for the year ahead. Often I have set the page aside and haven’t looked at it again for quite some time, only to discover it and realize that I have achieved much of which I had hoped to do. Look:  the hall closet really is cleaner, the bathtub has now been replaced, there is a new computer system for the clinic assistant.

“Aha” the proponents of the Secret will cry. “You’re criticizing the very principle that you are using!” I doubt it. I think that the act of formulating a direction, a trajectory, in my mind results in a fairly natural (as opposed to supernatural) selection of activities likely to take me in that direction. When I look at the goals I have actually achieved, it seldom seems like the universe has simply tossed a bone my way. I published a book because I wrote a proposal and sent it to a publisher. I got more fit because I made exercise a priority. I increased the number of trees in the orchard because I called the nursery and ordered some seedlings.

Things happened which were outside my control, surely. The nursery had the trees I wanted; the publisher liked my book idea. But I don’t need to invoke secret machinations of the universe to explain these events. Coincidences occur, people’s goals mesh, and some things work out. Many (actually most) of the things I envision (other books, other directions for the orchard, other lecture invitations) don’t materialize. With clients I often suggest one of my own life principles: Most things don’t work. That’s why we have to try a lot of things.

What we don’t need to do is sit on the couch, dreaming and waiting for the doorbell to ring.