Leading Perspectives Magazine Issue One

A MAGAZINE BY JACK HIROSE & ASSOCIATES | JACKHIROSE.COM

Treatment Shouldn’t Feel Like Punishment Our highly personalized

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MENTAL HEALTH & EDUCATION | ISSUE #1 | APRIL 2019

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THE PURPOSE OF

WORRY & HOW TO MANAGE IT

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HIKIKOMORI SYNDROME: PSYCHOTHERAPY FOR LAUNCHPAD ISSUES IN EARLY ADULTHOOD

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EXECUTIVE SKILLS: CURRENT STATE OF THE FIELD

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Message From the Editor

HIKIKOMORI SYNDROME

Dear Colleagues, It is my pleasure to launch our new magazine Leading Perspectives, a mental health and education focused magazine. This magazine is targeted towards not only professionals in the field, but parents and community members. We are all affected in some way by mental health and education issues. These articles are intended to shed new light on these topics and highlight various perspectives from leaders in the field.

PSYCHOTHERAPY FOR LAUNCHPAD ISSUES IN EARLY ADULTHOOD Randy Paterson, Ph.D., R.Psych

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he challenges of adulting appear to be growing. For the past ten years I’ve made it a practice at professional workshops to conduct a brief survey. I ask if people are seeing young people seemingly stuck at the transition between adolescence and adulthood - isolated, anxious, under employed or unemployed- and having great difficulty finding a way forward. I can count on a majority of the hands going up. In North America we often refer to this population by the vaguely pejorative term “failure to launch”. “Delayed launch” might be more appropriate. A similar phenomenon has been observed in culture after culture, and nowhere has it achieved more notice, more clinical attention, and more public awareness than in Japan, where these individuals are known as “hikikomori.” In online forums this term is catching on internationally, and shows signs of becoming the dominant self-description - more so than the British NEET (Not in Education Employment or Training) or the clever-butinsulting “adultescent” or “kidult.” This population does not fit snugly within any of our existing clinical categories - perhaps better so, because over-pathologizing them is unlikely to be helpful. Many meet criteria for social anxiety disorder or avoidant personality, internet addiction is often a good possibility, and in extreme cases a diagnosis of agoraphobia looks tempting. These individuals - everywhere noted to be more often male than female - are typically overwhelmed by the demands and expectations of adulthood, are fearful of the display of their inadequacies, and tend to retreat into the safety of home, bedroom, internet, and gaming. Few responsibilities, but fewer friends, and little happening in the realms of either work or romance. What’s the problem? Ask this question in Vancouver or Toronto and housing prices inevitably come up. But the problem isn’t necessarily one of not leaving the parental home and it seems prevalent regardless of where one 10 LEADING PERSPRECTIVES

looks. Economic stagnation for young workers, excessively high expectations of early jobs, lack of self-care skill development, helicopter parenting, an induced phobia of failure, the mistaken idea of confidence as a prerequisite for action, a societal push to “Live your passion!” when few young people know what that might be, and other factors all seem to be involved. Clinically these are challenging cases. We strive to return many of our clients to a premorbid level of functioning - but these individuals have never had a fully independent adulthood and so they struggle to develop one from scratch. Worse, their therapy is often initiated and paid for by parents against whose control they rebel. The task for the clinician is to access clients’ own wishes for their future, independent of the expectations of others, and to help them break these down into manageable changes they can enact. Common treatment elements include lifestyle management, skill development, assertiveness training, cognitive work, career planning, social life enhancement, behavioural activation, weaning from internet, and most of all, exposure therapy and anxiety tolerance training. In my upcoming workshops in Calgary and Vancouver I’ll provide case examples across a range of presentations, discuss the various risk factors and how a knowledge of these for a particular client can guide treatment, suggest how to integrate family in treatment - and when to avoid doing so- and provide a set of strategies to help clients find and grow their own adult life. The ideas covered should prove useful for the range of such clients - from the completely isolated individuals locked in their bedrooms to the struggling twenty-something navigating the challenges of early career and relationships. As most of us have discovered, adulthood is not rocket science and ideally is not the endless cycle of drudgery that some of our clients imagine. We can help them seize their future and build a satisfying next chapter in their lives.

Table of Contents THE PURPOSE OF WORRY: How It Helps, When It Hurts and What to Do About It

About the Author Randy Paterson, Ph.D, R.Psych. is a psychologist and the founding director of Changeways Clinic, a private psychotherapy service in Vancouver BC. He is the author of How to be Miserable: 40 Strategies You Already Use, The Assertiveness Workbook, Your Depression Map, and Private Practice Made Simple. He is the lead author of Canada’s most widely used group treatment program for depression, co-author of the online Antidepressant Skills Workbook, and creator of multiple manuals and resource guides for clinicians. In addition to his clinical work, Dr Paterson provides educational training programs for mental health professionals across Canada, internationally, and online on topics including diversity awareness, communication skills, positive psychology, and treatment strategies for mood and anxiety disorders.

We are hoping you will take the time to read the articles contained in this magazine or pass it onto an individual who you think will benefit from the ideas and strategies contained in the articles. I have approached our faculty of presenters and asked whether they were willing to share their knowledge and insights by contributing an article to our magazine. Boy, was I surprised! We have tons of exciting new content coming your way in this issue and the issues to launch throughout this year.

Donald Altman, M.A., LPC

Margaret Wehrenberg, Psy.D.

Many of you may know me as an event organizer who specializes in continuing education training. What you may not know is that I myself had previously worked as a frontline professional in the mental health field and worked in various settings including outpatient clinics, group homes, schools and correctional facilities. My experience as a counsellor, parent and event organizer throughout the past 35 years has given me unique insights into the topics that you may find useful. This was our first attempt at putting a magazine together. As with any new undertaking, we realize that we have a long way to go and a lot to learn to create a magazine that individuals will find to be useful, informative, interesting and thought provoking.

RECLAIMING REFLECTION & THE POWER OF PAUSE

P.6

P.4

P.10

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EXECUTIVE SKILLS: Current State of the Field Peg Dawson, Ed.D., NCSP

HIKIKOMORI SYNDROME: Psychotherapy for Launchpad Issues in Early Adulthood Randy Paterson, Ph.D., R.Psych

I hope you enjoy our new magazine. Happy reading! COVER Issue #1 May 2019

Sincerely, Jack Hirose, M.A.

EDITORS Jack Hirose & Laura Hirose ART DIRECTOR Daniel Yu PHOTOGRAPHY istockphoto.com

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Issue #1 | May 2019 3

WHY DO WE SEEM TO HAVE SO LITTLE TIME TO REFLECT OR JUST TAKE A BREATH? The irony is that the more we try to do—and the more that technology fills up all the spaces of our day—the more worries and anxiety we have. As a result, there’s less time we may have for pausing, reflecting, and getting centered and tapping deeper joy. That’s why my new workshop, Reclaiming Reflection and the Power of Pause: How to Help Clients Be More Present provides tools and techniques that help us regain the lost ability to pause, slow down, and reclaim those moments that give us a sense of deep connection with others, and with ourselves.

THE PURPOSE OF

WORRY & HOW TO MANAGE IT Margaret Wehrenberg, Psy.D.

ave you ever experienced the Las Vegas Effect? It’s a term I coined to illustrate the 24/7, instant gratification and impulsivity response that is more and more typifying daily life. Yes, there’s no question that speed makes all kinds of things more convenient (or so we’re told). Activities that once took hours, such as shopping for groceries and buying clothes, are now accomplished remotely by pressing a few buttons. It’s all good, right? Well, there’s nothing innately wrong with getting things done faster. But if we’re saving so much time through all these conveniences, why do we feel so stressed-out and dissatisfied? It’s as if we’re running on a treadmill and just can’t stop. And the treadmill is running faster and faster!

4 LEADING PERSPRECTIVES

By using mindfulness as I teach it, I like to think that any of us can shift our lives in a more present and accepting way by taking a vow of fidelity to the ordinary moment. CAN YOU BE FAITHFUL TO THIS MOMENT JUST AS IT IS RIGHT NOW— WITHOUT TRYING TO RESIST IT, REJECT IT, OR PUSH IT AWAY? When you think about it, you can be faithful to many small, ordinary but sublime things that occur each moment. For example, as you read this, notice the next breath. Even when writing an email or texting, you can do so with fidelity to the ordinary moment—sensing the weight and texture of the phone in your hand, seeing the colors on the screen, and feeling how your fingers type out your message—while also knowing if your message comes from a place of love or reactivity. Walking, you can be faithful to the movement of the body, the arms, the legs, and the feet—without letting your mind be somewhere else, far, far away and disconnected from the body. HERE ARE 5 WAYS TO RECLAIM REFLECTION AND PAUSE FOR THE ORDINARY MOMENTS OF YOUR DAILY LIFE. THESE ARE ALL PART OF THE 6 HOUR CE WORKSHOP.

About the Author Margaret Wehrenberg, Psy.D., is a coach and therapist, an author, and an international trainer and speaker on topics related to psychotherapy for anxiety and depression, stress management and optimizing anxiety for achievement. She is a practicing psychologist, coaching for anxiety management and providing psychotherapy for anxiety and depression disorders. She has been a trainer of therapists for 25 years, and she is a sought-after speaker, consistently getting the highest ratings from participants for her dynamic style and high quality content.

RECLAIM EACH ORDINARY MOMENT The practice of pausing to notice life’s ordinary moments has some very ancient roots in different traditions. It was in the 6th century that Italian monk St. Benedict wrote a slender book that described how monks should live in a cooperative and spiritual community. The Rules of St. Benedict instructed monks to take a vow of conversatio morum, which roughly translates as “a conversion, or change, of life.” In today’s world, that change means slowing down and living a more mindful, spiritual, and purpose-filled life. This timeless prescription for living is still useful today. But how often do we “reject” or push away this moment—thinking it is not good enough or simply not what we expected or wanted? This is, at its root, the cause of a lot of suffering.

About the Author Donald Altman, M.A., LPC, is a psychotherapist, former Buddhist monk, and award-winning author of over 15 books on mindfulness. He is a featured expert in The Mindfulness Movie and is profiled in the Living Spiritual Teachers Project. His new book about the power of pause is Reflect: Awaken to the Wisdom of the Here and Now. Visit: www.MindfulPractices.com

1. PRESENCE WITH THE BREATH When you lose presence, or fidelity, to the moment, you can always reconnect by taking a nice, satisfying breath. Breathe into your belly, and exhale very slowly. Ask yourself: Is this breath yesterday? Is it tomorrow? With a single breath you regain fidelity to the moment. Breath teaches the essence of nonattachment; try to hold on to any breath too long and you’ll faint!

you might like him or her to behave and act differently. Even if you believe this individual to be the most difficult person in your life, get curious. Open your eyes, your ears, your senses, and all the pores of your body. Hear beyond the words; listen with the dimensions of emotion and empathy. Don’t just look, but see into the person’s eyes, face, and being in this ordinary moment. Imagine each person as a moveable tree on two feet. Notice and appreciate each tree with amazement, for there is no other like it in the entire universe. 3. PRESENCE WITH THE SENSE BODY The body is a cornucopia of the Here and Now. The problem is we often get stuck in the brain’s “default mode network” where you start spinning stories and experiencing anxiety. I’ll show you—using a practice I call “Palm the Present Moment,” how to drop out of the busy mind and into the body’s sensational symphony of vitality, feelings, and aliveness. This practice even uses the breath to carry away any negative emotions or body tightness down the legs and out through the feet where they are deposited in the earth for recycling. Whatever feelings are in the body — sadness, grief, loss, anxiety, depression, frustration, loneliness — you’ll learn to view them as the body’s wisdom telling you that something in your life needs to change. This practice concludes by having you settle into the body, then basking the entire body in the warm glow of gratitude for all that it does for you on a daily basis. How wonderful! 4. FIDELITY WITH WALKING Soften and become flexible when walking. Move like a cat. Notice all the body’s movements, the lifting of each foot, how each leg swings forward, how each foot lowers and presses into the ground, the suppleness of the ankles, and how the body shifts its weight from one side to the other. Above all, when walking, just walk. There’s nothing else to do, really. So long as your body is pointed in the right direction, you won’t get lost. Dare yourself to bump into something, but it’s almost impossible when you have fidelity to walking. We will focus specifically on mindful walking, so consider this a warm-up! And always remember: Walk to be here, not to get there. 5. PRESENCE BY PAUSING Get in the practice of just pausing to notice the ordinary moment around you. Maybe you are in the car, at a coffee shop, or in line at a store. Pause, take a breath, and take a mental snapshot of this moment. Let yourself savor this precious moment—for another one exactly like it will never come again. By pausing, you steep yourself in the here and now. Like those tickets at the carnival say on the reverse side: “You must be present to win.” I hope you join in and experience the power of pause and how reflection can change so many things for the better!

2. PRESENCE WITH ANOTHER Soften up and receive another person with your presence. Let go of your prejudices and expectations about this person, and how Issue #1 | May 2019 9

To be truly alive is to feel one’s ultimate existence within one’s daily existence. —Christian Wiman, My Bright Abyss

RECLAIMING REFLECTION & THE POWER OF PAUSE Donald Altman, M.A., LPC

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nxiety is a normal human reaction. It is what you feel when you are faced with uncertainty. When you do not know what is going on or what you should do about it, you react to that state of ambiguity with a feeling of anxiety. That is a sensation no one likes. What makes anxiety pass? Resolving the ambiguity! That unpleasant feeling prompts mental activity. When you can figure it out - what is happening or what to do about it - then the feeling of anxiety goes away and you are relieved. Although you may have work to do or have to fix a problem, the anxiety about it is finished. However, when people suffer an anxiety disorder, the parts of their brains that are involved in that normal anxious reaction are instead working overtime. Then the feeling of anxiety persists beyond the ambiguity. In fact, it can be present before any uncertainty and then an anxiety disorder - literally a neurological function - creates the nagging sense that something is wrong. Plagued by a sense that there is something wrong or simply feeling uncomfortable ‘free floating anxiety’ your helpful brain (that wants an explanation for every feeling you have) goes on a search to figure out what might be the source of that anxiety. You begin to worry about what could be wrong now or in the future or what went wrong in the past. Worry is the natural response to anxiety. Trying to figure out what is wrong or what to do, you start to think over all the possible reasons you feel anxious. Rest assured, you will inevitably find one that works! However, because that reason you have found is not the cause of feeling anxious, your brain continues to worry in an effort to relieve anxiety. Worry then makes the anxiety worse as the negative emotional state of worry makes you more anxious. You might rethink the one problem you found or move on to find other potential sources of anxiety. Thus rumination and ‘serial worrying’ become the hallmarks of an anxiety disorder. There is a lot you can do about this. You can use your brain to change your brain. In your ‘thinking brain’ you can decide that the problem you are rethinking is not the real problem. You can decide to ‘not believe everything you think’. This is a conscious, determined choice to disbelieve the sensation of anxiety that feels so real.

YOU WILL ALSO HAVE TO USE YOUR THINKING BRAIN TO STOP AND INTERRUPT THE WORRYING. AS THEY SAY IN THE 12 STEP PROGRAMS, THIS PROCESS IS SIMPLE, BUT IT ISN’T EASY. 1. You must ask yourself, “Do I need this thought?” Your answer must be, “No! This thought is useless to me.”

4. A caution here - do NOT go through the reasons you should stop. That just reengages the worry. Go back to #1.

2. You then need an immediate replacement for the negative thought. Each day, take a brief moment to decide what you prefer to think about and when the unnecessary worry pipes up, you interrupt it, telling yourself to “Stop!” and replace it with the preferred thought.

5. The hard part is doing this every time the worry pops into your head. You might need some expert ideas to achieve this persistence in the face of such distress, but controlling anxiety is doable over time.

3. The thought replacement can be something pleasant or even just a reminder to turn your attention back to the task at hand, but it helps if you remind yourself every morning what you intend to focus on this day.

There are many ways to use your brain to change the brain of anxiety, and understanding this process is the first step to lifelong change.

ATTEND WORKSHOPS Presented by Margaret Wehrenberg, Psy.D. 2 Day Intensive: The 10 Best-Ever Anxiety Management Techniques Winnipeg - April 24 & 25, 2019 Edmonton - May 27 & 28, 2019

Richmond - May 23 & 24, 2019 Charlottetown - July 3 & 4, 2019

The 10 Best-Ever Depression Management Techniques Charlottetown - July 5, 2019 More Info: JACKHIROSE.COM 8 LEADING PERSPRECTIVES

Issue #1 | May 2019 5

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Peg Dawson, Ed.D., NCSP, received her doctorate in school/child clinical psychology from the University of Virginia. She worked as a school psychologist for 16 years in Maine and New Hampshire, and since 1992 has worked at the Center for Learning and Attention Disorders in Portsmouth, New Hampshire, where she specializes in the assessment of children and adults with learning and attention disorders. Along with her colleague, Dr. Richard Guare, she has written several books for parents and professionals on the topic of executive skills. Peg is the 2006 recipient of the National Association of School Psychologists’ Lifetime Achievement Award.

Peg Dawson Ed.D., NCSP

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6 LEADING PERSPRECTIVES

• I’ve also found that more parents and professionals are making the link between these skills that underlie school success and brain development. In my presentations, my audiences really respond to the notion that these skills are situated in specific regions of the brain (the frontal lobes). When I explain how brain processes such as myelination and pruning affect brain development, this helps people both understand how executive skills develop and why it takes them 25 years to reach full maturation. I’ve found that when I can help parents understand that these skills are tied to brain development, they are not only less likely to blame their kid, they’re also less likely to blame themselves for their child’s developmental lag. This gives them more hope and therefore more energy to focus on constructive solutions.

About the Author

CU

of Virginia, but he went on to do a post-doc in neuropsychology at Children’s Hospital in Boston, and as I was describing these issues, he said, “Peg, those are executive skills.” That was my first introduction to the term. Dick and I then decided we wanted to know more about them—how they develop across childhood, what’s going on in the brain, how do they impact school performance, and most important, because he and I are both school psychologists by training, how do you help kids with weak executive skills become more successful students. We then began writing books, and our goal was to make both the books and the information in them accessible to as wide an audience as possible. Which is why we’ve written books

• Secondly, I’ve begun to see that the concepts and vocabulary associated with executive skills are beginning to replace more pejorative terms such as “lazy,” “unmotivated,” or “not working to potential.”

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N E X E RR

hen my colleague and I started talking and writing about executive skills, somewhere back in the late 80’s and early 90’s, we felt like we were voices in the wilderness. People didn’t know what we were talking about—heck, I didn’t even know what I was talking about. When I introduce myself at workshops, I tell people I got interested in executive skills through working with kids with ADHD when I transitioned from the public schools to a clinic setting. As I started working with that population more extensively, I quickly realized that ADHD went beyond problems with attention or hyperactivity/ impulsivity, or both I remember talking with my colleague Dick (Dr. Guare) about them. Dick and I both did our doctoral work at the University

• First of all, it has become well-established knowledge that there is a significant link between executive skills and school achievement. There is good research to support this link, especially when we use “real world” assessment and outcome tools.

K D L S IE

E E V TH

I F O T E T U A T C S E T

HERE ARE SOME OF THE LEAPS FORWARD I’VE SEEN THE FIELD TAKE SINCE I FIRST STARTED THINKING AND WRITING ABOUT EXECUTIVE SKILLS:

directed at both parents and professionals that address executive skill challenges in childhood, adolescence, and adulthood. After a while, we weren’t having to stop and explain what we meant when we used the term. This wider recognition of executive skills can’t be attributed to our books, although I admit to smiling with pleasure and surprise the first time a parent said, in answer to my question about what brought her to my office, “I’ve been reading Smart but Scattered, and you’ve described my child.” At the same time we were doing our work, people like Peter Isquith and his colleagues were creating norm-referenced rating scales (i.e. the BRIEF) that enabled us to capture these skills and to distinguish kids who were on target in their executive skill development from

those who were lagging. And as the technology available to measure what’s happening in the brain became way more sophisticated, we began to see brain images that show how executive skills develop over time. Now, unlike when we started, neuroscientists have come to recognize that executive skills take a minimum of 25 years to reach full maturation—and longer in individuals with neurodevelopmental problems such as ADHD or Autism Spectrum. From there, the research on executive skill development began to explode. Which has given us a much better understanding of how and when these skills emerge and what influences their development across childhood. All of this has opened up opportunities to incorporate this knowledge into education policy and practice.

• And finally, I’m encouraged that more and more schools have begun to tackle the challenge of the variability in executive skills of kids at every grade level, including significant weaknesses in some students. They are thinking about ways to teach these skills. I have been particularly encouraged by the efforts some educators have made to embed executive skills deeply into the school’s curriculum and have accumulated some great examples of this. Over the last several years, I’ve been privileged to share what I’ve learned about executive skills through my clinical work and the research I’ve tracked. More than that, by conducting seminars throughout the United States and Canada and by consulting with countless schools, I’ve had the opportunity to work with people on the front lines—teachers, therapists, speech pathologists, occupational therapists, school counselors and school psychologists. I’m in awe of the work these people have done to translate their understanding of executive skills into practical strategies to help students find ways to strengthen or work around their executive skill challenges in order to achieve more success in school. I’m grateful for the experiences these professionals have shared with me, since I get to pass this knowledge along to others.

ATTEND WORKSHOPS Presented by Peg Dawson, Ed.D., NCSP Smart But Scattered: Strengthening Executive Skills in Children and Adolescents

Brain-Based Learning, Behavioural Challenges & Mental Health: Educator’s Conference

Toronto - May 2, 2019 Calgary - May 10, 2019 Saskatoon - May 15, 2019

Toronto - April 30 - May 2, 2019 Calgary - May 8–10, 2019 Saskatoon - May 13–15, 2019

More Info: JACKHIROSE.COM Issue #1 | May 2019 7