Psychologica: COVID-19 Issue by OACCPP

Psychologica

Adaptation & Resiliency (COVID-19 Double Edition)

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Board of Directors

Staff

Suzanne Dennison

Maryann Istiloglu Executive Director T: (416) 298-7333 ext. 202 E: executive-director@oamhp.ca

President

Jane Alway

President Elect, Chair of Governance & Risk Management

Liana Palmerio-McIvor Vice-President, Chair of Public Policy

Adam Terpstra

Treasurer

Sue TassĂŠ

Past President, Chair of Nomination

Laura Ducharme

Chair of Certification

Laura Liebrock

Chair of Ethics & Professional Conduct

Naim Assemani

Chair of Professional Development

Ruth Taylor Operations Manager T: (416) 298-7333 ext. 206 E: operations@oamhp.ca Jacqueline Lacroix Professional Development Manager T: (416) 298-7333 ext. 208 E: services-coordinator@oamhp.ca Samantha Younan Communications Specialist T: (416) 298-7333 ext. 203 E: communications@oamhp.ca Marisa Pasut Project and Events Coordinator / Interim Membership Coordinator T: (416) 298-7333 ext. 201) E: membership@oamhp.ca

Directors at Large

Patrick Beedling Jennifer Thomson Christina Crowe Jan Lobban-Shymko Katharine De Santos Michael Decaire Caroline Schnitzen Koekkoek

The Ontario Association of Mental Health Professionals (OAMHP) does not support, endorse or recommend any method, product, clinic, program or person mentioned within its magazine, newsletter, or website. It provides these vehicles as a service for your information only. The reader is responsible for confirming details and verifying accuracy of claims. Listings do not imply endorsement or recommendation of any service on the part of the OAMHP. Neither does the OAMHP endorse any claims, ideas, alleged factual information, or theoretical positions provided by contributors to Psychologica. Copyright: The Editorial Board of Psychologica welcomes and encourages authors to resubmit articles published in our journal for publication elsewhere or for duplication for teaching purposes. Authors, however, must seek the approval of the Editorial Board beforehand. If approval is granted, the author should contact the Editor of Psychologica for a copy of the official and final version of the article. 3

CONTENTS 05 Presidentâ&#x20AC;&#x2122;s Message by Suzanne Dennison 06

A Word from the Editor by Stephen Douglas

IMPACT (OF COVID-19)

09 A Pandemic of Grief by Suzanne Duc 12 A Clarion Call to Action: An interview with Dr. Roger McIntyre to discuss COVID-19, unemployment, and suicide. by Stephen Douglas 17

The impact of the COVID-19 in children and families in high conflict separation by Dilcio Dantas Guedes

Therapist Heal Thyself: Strategies for preventing burnout in 2020 by Elizabeth Scarlett

23 Personal Reflections: Thoughts on racism in the midst of a pandemic by Naomi De Gasperis 24 The New Intimacy by Allan Hirsh

STORIES OF RESILIENCY 25

Storytelling, Modelling, and Resiliency by Allan Hirsh

29 Growing in the Face of Change by Laura Ducharme 31 What Coping with Cancer Taught me about COVID-19 by Claire Edmonds 34

Anxiety-Reducing Survival Tips for Mental Health Providers by Shalyn Dussiaume

ADAPTATIONS

Life on Hold: Finding paths to help clients discover resiliency during uncertain times â&#x20AC;&#x201D; a Cognitive Behavioural approach by Valery Belyanin

38 Engaging mindfulness and compassion during a period of crisis by Anna Woo 41 Unexpected benefits from practicing video-therapy by Mary Ann Saltstone 42 Between the Screens: Strategies to improve the efficacy of video conferencing by Claire Edmonds 47

Lessons in Improvisation: Adapt ing to on-line program delivery by Naomi Tessler

Puzzle Therapy

Presidentâ&#x20AC;&#x2122;s Message

by Suzanne Dennison RP, DCS, (cert)OAMHP

Welcome to the Double Issue of Psychologica! As many of you are aware, usually our fall issue centres around the theme of our annual conference. This year, given that we are living in unprecedented times, we felt it would be remiss not to focus this edition on the worldâ&#x20AC;&#x2122;s most pressing matter. It has been overwhelming to see the sheer volume of articles in this issue and the many members who got involved. From writing and editing, to creating artwork for our COVID-19 themed issue, it seems as though, if nothing else, the past months were rife with creativity. With all of us effected in one way or another, the articles in this issue provide us with opportunities to reflect on our personal and professional struggles and triumphs over the course of this year as we continued to serve the needs of our clients and our communities. As an association, we have made adjustments to meet a changing environment, while remaining steadfast about our goals. We pivoted events, supported other groups when we could, and carried on our advocacy work, continuing to meet with government and key stakeholders to ensure your voices were heard even in the midst of the chaos of change. Our efforts are ongoing as we continue to push for the recognition and value that our membership offers in relevant and effective mental health services to communities across our province.

We are just coming off of our annual conference, where for over two weeks, we gathered (virtually) to learn how we could better support those often underserved within our field. I hope your eyes were as opened as mine to the gaps we need to address and to the new ways in which we can help. This issue marks my last as President and the last with our Editor, Stephen Douglas. I know I speak for everyone, when I say that Stephen has been the heart and soul of this magazine over his tenure as editor and we thank him for all of his work and dedication. Please know that as always, we continue to solicit and welcome your feedback. I encourage you to reach out with any questions or comments you would like to share. It has been a pleasure watching this publication grow over my tenure as President and I look forward to continuing to read it. Sincerely, Suzanne Dennison

A Word from the Editor

by Stephen Douglas, MA, RP, (cert)OAMHP Hello to all our members and readers, Eras are defined by issues that have a common impact upon a majority of the population. 2020 has born far-reaching issues that both unite and divide us. How we respond as a profession and as a nation will define us. Each of us — our clients, our colleagues, our family members, ourselves — has been affected by the global COVID-19 pandemic. According to a survey released by the Canadian Mental Health Association (CMHA) in May, 58% of Ontario residents believe that their mental health was negatively affected by the COVID-19 pandemic, 69% believe Ontario is headed for a ‘serious mental health crisis’ as a consequence, and 77% believed that more mental health supports will be necessary to help society manage. That same month, a study released in the Lancet projected suicides as a consequence of the impact of COVID-19 on unemployment alone could lead to an increase of 27.7 per cent to Canada’s annual average of deaths by suicide — about 4,000 per year — in both 2020 and 2021. As Dr. Jonathan Moult wrote, even if only a small percentage of people have coronavirus, “100 percent of us are psychologically affected by it.” More recently, a study released in July by the Centre of Excellence on Post-Traumatic Stress Disorder suggested that healthcare workers on the front lines of the COVID-19 pandemic are at risk of severe stress that could cause longterm psychological damage, citing examples leading to guilt, moral injury, fear and shame, urging doctors, nurses, lab technicians, and mental health workers to practice self-care through nutrition, exercise, social connection, and professional support. 6

The coronavirus pandemic further escalates many previously existing mental health stressors issues. Isolation and job insecurity are expected to exacerbate rates of alcoholism. Nearly one in four Ontario residents recently polled were consuming more alcohol, cannabis, or tobacco since the pandemic hit. Maternal mental health experts are anticipating an increase in post-partum mood disorder, noting that simple acts like going to the grocery store become for more anxiety-producing than ever before. More recently, evidence has begun to reveal the structural inequities in our supposedly universal health system during this global health crisis, particularly with respect to race. Data released by Toronto Health on July 10th, 2020 indicated that the rate of infection in Toronto’s northwest (932 cases per 100,000 people) was almost four times higher than in the rest of the city (238 cases per 100,000). The relationship between the determinants of health impacted by systemic racism — unequal starting points and unequal access to health services, financial burden, nature of employment, freedom to work from home, homelessness, all factors that lie beyond an individual’s biology and behaviours — and infection rates of COVID19 could not be more clear. So we put out a call to our members. And how you responded! In total, we were able to include 14 articles in this edition, making it the most substantial edition of Psychologica to date. Yet it was not the volume of submissions but rather the quality of writing that stood out. I believe you will find each contribution worthy of careful reflection.

The first section includes five articles that explore the impact of COVID-19; Suzanne Duc has provided a valuable essay on grief, in an interview with Psychologica Dr. Roger McIntyre offers a clarion call to the looming mental health crisis nationwide, including the anticipated escalation in rates of suicide, Dilcio Guedese shares his observations and insights into the impact on children and families, Elizabeth Carey-Scarlett provides caution concerning professional burnout, and Naomi De Gasperis has written with insight and self-awareness concerning her thoughts on racism in the midst of a pandemic. Four articles comprising the second section focus on empowerment and resiliency, from Allan Hirsh’s use of storytelling to model resiliency, and Laura Ducharm identifying steps to foster resiliency, to Claire Edmonds personal account how coping with cancer helped her to manage the uncertainty of COVID-19, along with Shalyn Dussiaume’s “survival tips.” Our third and final section features adaptations to therapeutic models and methods our contributors have identified. Valery Belyanin exploring of a Cognitive Behavioural approach, seeking an effective model of treatment during COVID-19, Anna Woo engaging MindfulnessBased Cognitive Therapy along with Compassion Focused Therapy, Mary Ann Saltstone’s adaptation, discovering unexpected benefits to virtual therapy, Claire Edmonds, offering good insights and practical advice in the use of virtual conferencing, Naomi Tessler, a facilitator of improvisational playback theatre. This last article features tips for working with large groups that may benefit readers who are considering a virtual resumption of group classes and programs. In the midst of this period of uncertainty, protests were sparked by the police murder of George Floyd, sweeping across the US, Canada, and ultimately around the world as citizens braved the COVID-19 pandemic and police violence to challenge racial and class inequalities. If individual, professionally, and nationally we were in denial before, our ignorance or passive response has been called to account. Systemic racism is real.

Racialized and marginalized people face institutional discrimination daily, reflected in a lack of diversity, inclusion, equity and equality in every arena of life. We must all acknowledge how systemic discrimination and barriers impacts upon issues like housing, social programs, health care, education, political power, and income. At the intersection of systemic racism and the COVID-19 crisis lie moral dilemmas for many front line workers who need to keep their frustration concerning inequities to themselves. Access to health care services, contrary to our egalitarian fantasy, is swayed by wealth. Exposure to risk during this pandemic has also revealed inequities in our economic system. In northwest Toronto, lower-income predominantly Black communities represented a disproportionate number of retail workers deemed essential (phase 1) relying on high-risk public transit. Rates, as noted above, spiked in that region of the city. At the time of this publication, acts of police brutality continue, and society is rightfully being pressed to respond. This will raise many questions for us as a profession. As a consequence of COVID-19, what impact do changes in the delivery of services through video-conferencing have upon access to care, as well as unforeseen impacts to quality of care and the therapeutic alliance? What privilegebased assumptions might we be making? What is our professional responsibility during such an important moment in history?

I hope as you read these questions and consider others, you might feel the inspiration welling up inside you to write on the topic our professional role regarding racism with the wisdom of your heart and experience, and send us your submission for the next edition. Together, as an association, we can co-author and help inspire a new way forward. I am grateful to the Editorial Committee: Brittney Mandryk, Kelly Quinn, and Valery Belyanin for their assistance and wisdom in reviewing our submissions and Samantha Younan, OAMHP’s Communications Specialist, for her positive spirit, creative ideas, and commitment to getting this publication out to your inbox. After three wonderful years, I will be stepping down from my role as Content Editor following this edition. I will gratefully continue to sit on the editorial committee and look forward to our next Editor’s new vision. As always, however, it is your contribution that we all are most grateful for. We are, most importantly, here to publish all the great insights and inspired narratives inside each of you …just waiting to be shared with the world. With my gratitude for your contributions and readership, Stephen Douglas

About the Editor Stephen Douglas maintains a Etobicoke-based practice offering individual psychotherapy, family and couples counselling. He also travels northward ten days a month at the invitation of the Band Health Authority to provide counselling for members of Sandy Lake First Nation.

Section 1

Impact (of COVID-19) A Pandemic of Grief by Suzanne Duc, RP Grieving is a painful internal process which is mitigated by social expression in the form of mourning. The pandemic has diminished the opportunity for many to mourn in a ritualized and socially supported way given the need for social distancing. The impact of these restrictions on the process of mourning is significant and is being expressed by clients currently seeking bereavement counselling. The pandemic has complicated grief in an unprecedented way and this may leave clinicians feeling unsure as they navigate the sorrow of those attempting to mourn in the aftermath of COVID-19. As a clinician I found myself questioning a previously held understanding of the nature and expression of grief and bereavement. Despite years of training and specializations in these areas, I have little to no frame of reference for pandemic bereavement experiences. I have listened with alarm recently to many traumatic situations described to me by my clients: necessary separations in hospital from their dying loved ones for their own safety, elimination of beautiful mourning rituals and support due to the need for social distancing, unwanted cremations, and virtual funerals. All of this is new. As you might imagine, managing these clinical uncertainties while simultaneously processing my own reactions to the pandemic and related stressors is a challenge. I have had to move my practice to an online platform of service delivery in a very short period of time. My clients are often meeting with me in their cars because everyoneâ&#x20AC;&#x2122;s children (including mine) are at home.

Everyoneâ&#x20AC;&#x2122;s stress level is heightened, including my own. This makes it harder to stay centered while doing the important work of psychotherapy and the heavy lifting that often accompanies grief work in particular. In my practice at present, I am treating many clients who have lost their spouses in the last year. Most were in long-term relationships and are struggling with the loss of beloved partners. Many were devoted caregivers up until the point of death. Some have lost their partners in stages to illness and dementia and others suddenly, to aneurysm, accident, suicide or COVID-19. I sit with them and listen to their pain and their oftconflicted memories while helping them filter out any toxic beliefs or unfinished business in order to find the meaning they need. It is demanding work but when it goes well, there is a lightness of spirit for my clients that ensues. In turn, I am buoyed up by their emotional release and relief. We will all face the loss of someone of importance to us during our lifetime. Fortunately, we are naturally equipped to handle the advent of death through the painful but necessary process of grieving.

This pandemic may also serve to stir up unresolved grief from the past. Our clients may fear that others will no longer have the patience nor desire to hear about their past losses during a period of such grave and imminent threat as COVID-19. Without the perceived permission to mourn, their grief may be internalized.

Grief is a private thing and is experienced subjectively. Mourning, by contrast, is the outward expression of grief. It is social, ritualized and an essential component to resolve grief, even though it is sometimes very hard for the bereaved person to articulate what they are going through. Grief and mourning go together and this is where the pandemic has caused problems. Our known ways of mourning have necessarily had to change for our own safety and in some cases, have been deferred or eliminated altogether. Those bereaved since mid-March, for example, have not been able to have more than 10 people in attendance at a loved oneâ&#x20AC;&#x2122;s funeral. They have also been denied the comfort of in-person visits from friends, family members, clergy, and community coming to pay respects with food, fellowship, and warm embrace. The pandemic has limited our access to the familiar ways we process our pain, adding an extra layer of complexity to the grieving process. In turn, grief reactions have been intensified as anxiety, isolation, illness, financial uncertainty, and limitations in personal freedoms and movement threaten our established ways of living and dying. Trauma begets trauma and many people may find their grief exacerbated by the worries and restrictions brought on by the state of the world as it is today. Everyone handles grief differently. There may be times ahead when our clients mourn freely in our presence and others when their emotional state becomes entangled and difficult to comprehend, especially when it arises from traumatic circumstances.

So, what can be done to help those in grief right now? As clinicians, we can do what we have always done and listen actively in session, in whatever format this may take, with open hearts and minds. We can hold the space, ask questions, hear stories, empathize and employ therapeutic use of silence. As always, we do not have to have the answers for those who seek our counsel. We have only to create the conditions for change through safe and effective use of self. Our role is to help clients uncover their own wisdom as it relates to healing what ails them. We do this by offering our unwavering focus on the issues that they want to talk about, ensuring that they feel heard, understood, and respected by us, that the techniques we use are a good fit for them, and that they leave their sessions feeling as though we are warm and competent practitioners who will hold their

hurts and secrets in the strictest confidence (Duncan, Miller & Sparks, 2011). In essence, while circumstances have changed â&#x20AC;&#x201D; and we need to understand the impact that has had upon our clients â&#x20AC;&#x201D; our approach remains consistent. The need for counselling may surge well after this pandemic has peaked. Now is the time for us to educate ourselves regarding the unique grief and bereavement it is bringing about. And when our clients call, we will be informed and ready. Reference: Duncan, B. L., Miller, S. D., & Sparks, J. A. (2011). The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy. John Wiley and Sons.

About the Author

Suzanne Duc is a registered psychotherapist and proud member of the OAMHP in private practice in Ottawa, Ontario. She is regularly consulted as an expert in the areas of grief, bereavement and trauma resolution and has delivered a multitude of presentations to the community, school boards, restorative justice inquiries and corporations on these subjects. Suzanne also delivers workshops focusing on the modalities of Traumatic Incident and Life Stress Reduction designed to teach healthcare practitioners how to resolve post-traumatic stress. In addition to providing psychotherapy for individuals, couples and groups, Suzanne also provides mediation, crisis intervention and critical incident stress debriefing services.

A Clarion Call to Action: An interview with Dr. Roger McIntyre to discuss COVID-19, unemployment, and suicide. in interview with our Editor We sat down over the safe distance of video conferencing recently with Dr. Roger McIntyre, M.D., FRCPC, Professor of Psychiatry and Pharmacology, University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at University Health Network to discuss his assessment of the state of mental health in amidst the current COVID-19 pandemic. Here are some thoughts he shared with us: PSY Hello, Dr. McIntyre. Thank you for joining us today. You recently co-authored a letter to World Psychiatry highlighting the correlation between employment and suicide (McIntyre & Lee, 2020). Could you highlight for us the concern you addressed? RM It begins with this current situation we’re in with respect to the global threat to mental health. I’ve often referred to it as a “triple threat”: anxiety about the virus, insecurity concerning finances, and the (impact of) quarantine and physical distancing. When we began to see this unfold in the early months of this year, it appeared to me that this was not only a viral pandemic, this was going to be a mental health pandemic. The reason why is that I began to think of lessons (we can take) from history. I specifically wanted to focus on the relationship between (mental health and) the economic shock, which is a consequence of unemployment. We’ve seen about 15 years of job creation eliminated in about six weeks in Canada, which is an unthinkable statistic, and the Statistics Canada unemployment rate is now approaching 14 percent. When we look at mental health broadly, the most robust association between macro-economics and mental illness is the link with suicide. If we go back to the Great Recession (2007–09), the Asian financial crisis (1997-99), and, of course, the Great Depression (1929-33), what we’ve observed is a fairly consistent relationship. 12

I call it the “one percent rule”; for every one percent increase in unemployment during these times that I mentioned, around the world in disparate economies there is a commensurate increase in suicide of one percent. Again, association, not causation, but highly replicated. PSY

It’s that consistent, is it?

RM It’s really consistent. And to add further merit to the association, interventions that governments put in place in some economies of Europe and also in Asia, like Japan, to mitigate some of the broader health risks of the economic shock during the Great Recession showed that government expenditures in specific areas reduced mental illness and suicide. So that provides further strength to the association.

Going back over 100 years, the father of sociology Émile Durkheim was a leader in trying to understand, from a social perspective, what contributes to suicide. He had a classic observation in the late 1800’s that people who identified themselves as of Protestant faith had a higher suicide rate than those who identified as of Catholic faith. His hypothesis was that it had something to do with social integration, that Catholics (at the time) were a more integrated group. The notion can be extended to work. When we are working, we not only have more economic security, but we have the framework, we have social connectedness, we have a sense of who we are, a sense of identity around us. So our analysis, which you made reference to that was based in the United Stated and replicated for Canadian data, effectively replicated the one percent rule. We took into consideration projected unemployment statistics. This included the previous trajectory. Canada has had a fairly stable suicide rate for 20 years or longer, there was an uptick during the Great Recession, as projected by the one percent rule, and then it came back down again. In the United States during the last 15 to 20 years the CDC (Centers for Disease Control and Prevention) reported a steady increase — in fact, about a 30% increase — in suicide rates. The opioid epidemic contributed to this. We needed to take into consideration what the trajectory was before the (COVID-19) shock and build that into the model, along with a few other assumptions. We were able to calculate on both sides of the CanadaUS border a (projected) increase in excess deaths due to suicide, based on a number of assumptions, one of which being where unemployment is going to go. Taken together, it really is a call to action. We all were concerned, of course, about our physical health during this time, but the World Health Organization identifies health as physical health, mental health, and social health. During the height of the time of the virus we had no choice but to have emergency measures, that’s very clear. I always say, when there is a tornado coming, you better run for cover. But we now have evidence, and the ability to make data-driven decisions.

The projection we did on suicide was not just a call to action but also an opportunity to inform policy briefs. What can we do as a society to make sure this (increase in suicides) doesn’t happen? This should not be a fait accompli. There are things that we can do. We learned from the Great Recession that there are things that were done that we can do to get ahead of this.

PSY Suicide rates are highly verifiable, that’s what makes them a really good measure. With our investment, with the Canada Emergency Response Benefit program, it’s not perfect of course, but significantly better than the financial support available in the US, would your model suggest that we will see lower increases in suicide rates? RM Yes, it’s a great point. The answer is yes. In the United States, when you lose your job you also lose your health insurance. That is a distinct difference between the Canadian employee and the American employee. And that only adds to the insecurity and concern. On the Canadian side, when you look at the federal government’s response with respect to wage subsidies, income support, forbearance on obligation not just for small business but also for tenants, these types of interventions have been shown to not just benefit mental health but possibly also (reduce) suicide. 13

In fact, during the Great Recession, the Japanese government reported that for every 1% increase in GDP spending that they directed toward health care resources, they were able to reduce (rates of) suicide 0.2% in Japan. So I think what you are hearing from the Canadian federal government is in many ways a ‘playbook’ as to how to do this with respect to the economic provisions, the forbearance on obligation.

This is the opportunity to provide more accessible, high quality coordinated care and psychiatric first aid for people who have mental illness in this country. If you actually break your leg or your bleeding profusely you run to your emergency room, as you should, and many emergency rooms across the country offer psychiatric first aid, but that’s not readily available in a lot of places. So I think that’s possibly a positive externality of this.

Also, what we need to be thinking about is that this event is actually affecting some groups very differently. The face-to-face economy is differentially affected here. And who works in the face-to-face economy? Typically women, as well as people who have less skilled jobs. When you look at the Oxfam survey that came out two weeks ago, in addition to women you have racial (minority) groups being disproportionately affected by this. Moreover, because of the economics, they may not have the advantage of having home support and people to help them out. So women are taking a disproportionate burden here, and people who are less economically advantaged, and minority groups. So I think there has been a textbook play on this. As we really try to be granular and precise, we really want to make sure we are divesting our activities, not just resources but activities, toward these more vulnerable groups. The Trudeau government has also allocated significant funding towards more virtual mental health care.

PSY So it sounds like you’re hoping to see an injection of some infrastructure to support mental health beyond what we had prior to COVID-19?

That’s essential, it’s sine qua non, because the mental health care system in this country, let’s call it what it is, it’s been pretty lousy for a long time. It’s really difficult if you have a son or daughter, or you yourself, if you have a mental illness, to get timely access to good care from a mental health perspective. There are pockets that are great, but as a general statement, we haven’t had a very accessible mental health care system and so my hope is that a positive externality of this will be what now appears to be (possible). We’re all digitalized now. 14

RM Absolutely. Said differently, we’re talking about suicide, which is not a mental illness, it’s a tragic behavioural outcome. 80% of people who commit suicide have depression. But depression’s not the only illness linked to suicide. There are others, like post-traumatic stress, drug and alcohol misuse, and others. The mental health care system — before (COVID19) — had not sufficiently addressed in a timely and high-quality way our health needs from a mental health perspective. Now what you have is a threat to mental health and an increase in the rates of mental illness. For example, in the United States there has been a 20% increase in the prescription of antidepressants in the last three months and a 30% increase in prescriptions for anxiety. We did a study in China showing about a 20% increase in depression. The list goes on and on and on. So we already have the early dark clouds of mental illness that are appearing. We have proxies of that. And those illnesses have not, prior to COVID-19 been addressed sufficiently with brick-and-mortar systems. So, yes, I hope that this does result in a reconfiguration of what we’re doing. It begins with the political will and the prioritization, because the needs weren’t met before and now the needs are greater. So it would seem to me that this is the time to act. And since the world has been forced to go digital, I think we’re there now. I think it can be a game changer for the provision of mental health in this country.

PSY That’s a great vision and aspiration. Hopefully that’s something we can rally all mental health professionals around. You also touched upon mental health indicators that would be less verifiable or less measurable. What are you seeing in the Mood Disorder Clinic that would be correlated to suicide but perhaps might go under the radar?

RM One of the issues that we’re hearing from lots of patients here in the Toronto area is the difficulty in accessing primary care. About 70% of depression care in Canada is actually delivered by family physicians and nurse practitioners, people in the primary care system. And for a variety of reasons, whether people have shut their clinics down or they’re partially shut down as they’ve gone virtual — part of this is people don’t know what’s happening, people are very fearful of going to their local clinic — what many people have been observing is that there has been a reduction in referrals coming from primary care to depression centres. That’s a very concerning paradox here. That’s a health systems issue. The second part is that among people who do have access, of course (that includes) people who see us (at the Mood Disorder Clinic), what we’re hearing is an intensification of depression.

We did another study in China where we looked at the effect of COVID-19 broadly in the general population, and then we began to look at sub-populations. When we looked at people who had preexisting depression, what we’ve observed is something that probably won’t surprise you; people who have pre-existing depression report a much greater degree of symptom intensification during this time when compared with people in the general population who do not have a pre-existing mental illness. The levels of symptom intensification reported that we capture with various rating instruments in our study are reaching and exceeding the threshold for what we would call clinically significant. One of the features about depression for people who have it is that amongst other things it really interferes with your ability to be more resilient to stressors. In fact, one of the ways that we try to treat depression is that we try to boost people’s resiliency. And people are more susceptible to these types of stressors. Now (COVID-19) is a terrible stressor for everybody, but especially for people who had difficulty adapting to some of the stressors, so this population is a bit more vulnerable. PSY It sounds like that also suggests there may be a long term tail that we need to be careful about, that after conditions change, after people return to work, we could still be dealing with the aftermath for quite some time. RM To quote Yogi Berra, “It’s hard to make predictions, especially about the future.” When it comes to predicting the pandemic of mental illness and suicide, many factors can help moderate here. As you can guess, I agree with the thesis that economics is the foundation, the bedrock of all health, not just mental health. If you wanted to predict the future with respect to suicide and mental illness, probably best not to talk to a doctor or a public health official. I would talk to an economist. The debates go on, is it going to be a V-shaped recovery, is it going to be a W, is it going to be a U, is it going to be all these letters, and who knows. But certainly it’s concerning. 15

It’s not only the unemployment rate, it’s how long you’re unemployed for. If you’re unemployed for a week, that’s obviously different than if you’re unemployed for two years. In keeping with what anyone would expect, that would be more hazardous. And we’re seeing some of the predictions coming from the Fed in the US and the Bank of Canada here, we’re hearing measured at best, probably somewhat dour recovery to the economy in the short term. Again, who knows? Let’s hope it bounces back. But that is a clarion call for mental illness priority, because again, economics of unemployment is tightly yoked to suicide and mental illness. So economics as they change positively or negatively, you see the commensurate change in suicide and mental illness. I think that we’re looking at a tsunami of mental health concerns. Unfortunately, I don’t think that it’s going to be a blip on the curve. This is going to go on for a little while. These aren’t meant to be dour projections, these are meant to say, ‘Let’s be prepared. Let’s modify this.” Patients are saying they’re having difficulty accessing their care provider, having difficulty getting their medications, supply chain hiccups, some provinces enacted 30 days maximum supplies of medications, a lot of patients are reporting feeling very isolated, reporting intensification of symptoms, so all of that is happening right now. But what I’m also hearing from a lot of patients that is a concern is that they’re not working, and not only that but they’ve now been reorg’d out of a job. Their job is gone. And so, in addition to having the difficulties that we’re all faced with, now they have this terrible uncertainty with respect to their economics. So I think we need to get ahead of this, and the evidence has shown that if we do, we can seriously prevent a lot of this. And so, it’s more of a call to action than it is a dour, apocalyptic kind of statement.

PSY I hear, within all the negative stories concerning the economic condition, that there is a lot that we can do. Is there anything, before we close, that you would say enheartens you? RM At this point, what’s really given me a hopeful thought around this is what we learned from the Great Recession. There were social measures put in place, and a variety of other individual measures put in place, that significantly mitigated the risk. So I don’t think we even need to get that creative. Let’s just learn from history and recapitulate what was done, and let’s just make it a priority. I’m starting to see some of this discussion taking place globally. I’m heartened by the fact that mental health appears to be enjoying, for the first time in my lifetime, an international priority of conversation, which I think is a great thing. PSY Well, I’m glad to hear that, and grateful for your time to share that message with us. As a profession, we can join in the effort to make that happen by being involved in the discussion, and perhaps a little political. Thank you very much for your time. Reference: McIntyre, R.S. and Lee, Y. (2020), Preventing suicide in the context of the COVID‐19 pandemic. World Psychiatry, 19: 250-251. doi:10.1002/ wps.20767

The impact of the COVID-19 in children and families in high conflict separation by Dilcio Dantas Guedes This brief essay explores the impact of COVID-19 as a disruptive event on children and families dealing with high conflict separation or divorce, proposing some clinical strategies to enhance the children and familiesâ&#x20AC;&#x2122; psychological immunity to this disruptive event. Approximately one-third of separated parents have high levels of constant hostility and tension towards the other parent (Anderson, et al., 2010). One study indicated that these experiences could lead to low self-esteem, increased sleep disorders, aggressive behaviors, and academic difficulties for the children (Fergusson, et al., 2014). Not surprisingly, there is an observable increase in demands for treatment of children manifesting aggressiveness, attention deficit, hyperactivity, and somatizations, (Schauder, 2009). For Borelle and Russo (2013), these manifestations are reactions that children develop to cope with their disruptive environments. After separation, parents often increase their productivity to a faster pace to help offset the decline in their financial position. A possible decrease of close interaction or prolonged periods of absence may leave children reliant on peers for emotional support. The subjective experience of family becomes, little by little, dispersed, and superficial, unless parents are careful to prevent this. The psychological consequence of this disruptive familial environment may translate into symptoms of apathy, boredom, low self-esteem, school phobia, transition phobia, guilt, or behavioural troubles at school (Schauder, 2009). Further, as a consequence of the COVID-19 pandemic on families dealing with high conflict separation or divorce, routines previously established, such as visitations, domestic rules, school, and extra-curricular activities may be put on hold or changed.

From this authorâ&#x20AC;&#x2122;s perspective, news about COVID-19 appears to overwhelm childrenâ&#x20AC;&#x2122;s emotional defenses because of its severity as well as our uncertainty regarding the timeline for our success in defeating it. Within my program, my colleagues and I are observing divorcing parents having increased difficulty protecting children from the disruption caused by the pandemic. Children are expressing a decreased tolerance to frustration, increasing worries about family members becoming sick, a fear of bacteria and viruses, and an increased reluctance to adhere to transition schedules, especially if a specific parent is preferred. Our observations support studies recently published concerning the impact of this pandemic. For instance, Jiao et al. (2020) and Wang et al. (2020) found that children who had experienced a prolonged period without going to school experienced a fear of asking about the epidemic or the health of family members, as well as insistent demands of physical contact, sleep problems, low concentration, and separation anxiety. Xie et al. (2019) investigated depressive and anxiety symptoms among students who were confined at home in Hubei province, China. They found that the prevalence of symptoms of depression and anxiety were higher than in other studies of SARS-related stressors. According to Lee (2020) and Golberstein et al. (2020) this pandemic worsened the mental health conditions of children and adolescents. 17

As psychotherapists and counsellors, it is important to facilitate processes in which families can engage to help promote consistency, predictability of caregiving, and the flexibility to adapt to the uncertainties of the current reality. In situations of high conflict separation, it is imperative to facilitate processing on the importance of the task of protecting children from the external disruptive experience caused by the interparental conflict and litigation matters.

• reinforcing the presence of the other parent in the child’s mind through memories, by supporting and facilitating phone and/or video calls when the child requires or when planned; • creating the space and time for individual and family play, to laugh, to share emotions, and to share creativity; • maintaining appropriate family structure, and discussing our expectations and agreements • maintaining adherence to court orders, including regularity of transitions; • creating context of hope and solidarity;

In terms of the COVID-19 impact, it is also important to educate and facilitate the development of strategies to mitigate the impact of the pandemic on the context of separation by: • learning ways of coping with constant personal interaction within the household (for example, renegotiating household rules, defining time for individual activities and common activities, identifying spaces for those activities, communicating needs for privacy) • decreasing the exposure to ultra-realism offered by media (for instance, avoid having TV or radio on news about the pandemic all the time, avoiding commenting about death numbers or sensationalist news) • offering “digested” truths, adapted to the child’s stage of development, to educate them on the pandemic and the new family dynamic; 18

In the context of high conflict separation, the risk of instability, lack of boundaries, and lessened parental empathy is compounded by the disruptive experience of the current pandemic. In the midst of COVID-19, therapists working with these families must focus on creating safe spaces for sharing the experience of each member. This approach can help build resiliency and support healthy new ways of interaction to restore a sense of belonging and emotional containment. References Anderson, S. R., Anderson, S. A., Palmer, K. L., Mutchler, M. S., & Baker, L. K. (2010). Defining high conflict. The American Journal of Family Therapy, 39, 1, 11–27. doi: 10.1080/01926187.2010.530194 Borelle, A. & Russo, S. (2013). El psicodiagnóstico de niños. Criterios de evaluación en las organizaciones neuróticas, psicóticas y límite. Buenos Aires: Paidós Chase-Lansdale, P. L., Cherlin, A. J., & Kiernan, K. E. (1995). The long-term effects of parental divorce on the mental health of young adults: A developmental perspective. Child Development, 66, 1614-1634.

Fergusson, D. M., McLeod, G. F., & Horwood, L. J. (2014). Parental separation/divorce in childhood and partnership outcomes at age 30. Journal of Child Psychology and Psychiatry, 55, 352–360. doi: 10.1111/jcpp.12107

About the Author

Golberstein, E., Wen, H., & Miller, B.F. (2020). Coronavirus Disease 2019 (COVID-19) and Mental Health for Children and Adolescents. JAMA Pediatrics. Published online April 14, 2020. doi:10.1001/jamapediatrics.2020.1456 Jiao, W. Y., Wang, L. N., Liu, J., Fang, S. F., Jiao, F. Y., Pettoello-Mantovani, M., & Somekh, E. (2020). Behavioral and emotional disorders in children during the COVID-19 epidemic. The Journal of Pediatrics, S0022-3476(0020)30336-X. doi: 10.1016/j. jpeds.2020.03.013 Lee, J. (2020). Mental health effects of school closures during COVID-19. Lancet Child Adolescent Health, https://doi.org/10.1016/ S2352-4642(20)30109-7 Schauder, C. (2009) Souffrances psychiques liées à la séparation conjugale, droit à l’enfant et postmodernité. La lettre de l’enfance et de l’adolescence, 78, 4, 13-18. doi:10.3917/ lett.078.0013. Wang, G., Zhang, Y., Zhao, J., Zhang, J., & Jiang, F (2020). Mitigate the effects of home confinement on children during the COVID-19 outbreak. The Lancet, 395, 10228, 945947. doi: https://doi.org/10.1016/S01406736(20)30547-X Xie, X., Xue, Q., Zhou, Y., Zhu, K., Liu, Q., Zhang, J., & Song, R. (2020). Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China. JAMA Pediatrics. Published online April 24, 2020. doi:10.1001/ jamapediatrics.2020.1619

Dilcio Guedes is a Registered Psychotherapist in Toronto, Canada. He holds a MA in Psychology (University Paris 10 – Nanterre/La Defense, France; and University of Fortaleza, Brazil). He is a counsellor at the Families in Transition Program at Family Services Toronto, a program. The Families in Transition Program supports the well-being of children who are experiencing significant change brought on by separation/divorce of parents. His research and teaching experiences, and practice have been focused socio-emotional development, attachment, child and adult psychoanalysis, and mental health. He is member of the Research Group Psychoanalysis and Disruptive (Universidad del Salvador/Argentinian Psychoanalytic Association, Buenos Aires) and PhD Candidate studying about how children represent their experiences of separation and divorce through drawings.

Therapist Heal Thyself: Strategies for preventing burnout in 2020 by Elizabeth Scarlett, RP Many mental health professionals are finding themselves increasingly exhausted, cynical, or ineffective in their work during this COVID-19 pandemic. Burnout can hide in plain sight. The good news is that there are practical internal strategies to help address it. These may require some deep reflection and adjustment, but offer a significant return on that investment. In 2019, the World Health Organization classified burnout as an “occupational phenomenon...resulting from chronic workplace stress that has not been successfully managed.” Adding to the usual stressors we experience, providers of mental health services have felt the significant demand of responding timely and appropriately to COVID-19 while also supporting anti-racism initiatives following the deaths of both George Floyd and Regis Korchinski-Paquet, among so many others, at the hands of the police. Our world is changing, public safety is on the forefront of everyone’s minds, particularly for vulnerable, marginalized, or racialized clients. These issues combine to make mental health support more essential than ever. And all the while, in the background, helping professionals face the threat of job burnout. How can we address this? Let’s take a step back and explore the origins and components of burnout. Burnout is not a new term for most mental health professionals. It was first coined in the 1970s by American psychologist Herbert Freudenberger. Since then many professionals, most notably Christina Maslach, have extensivelyV researched the syndrome. The Maslach Burnout Inventory (MBI) is a commonly used tool for measuring burnout by looking at three components: emotional exhaustion, depersonalization, and personal accomplishment. 20

Yet, there are very few practical interventions to prevent and cope with burnout. I myself took a 14-week mental health leave from work in 2018, during which I invested some time researching burnout and self-care. Online checklists fell short. While suggestions to get a massage, join a yoga class, and walk in nature are helpful to a degree, they didn’t improve my symptoms. In retrospect, I disregarded the signs of burnout for years. I felt exhaustion, cynicism, and sense of inefficacy building within me, but attributed them to one or another external cause. Efforts I attempted to combat these symptoms often backfired. For instance, I jumped into new projects, and. by doing so, increased my sense of overwhelm. I never lost my love for what I do, yet I found myself dreading going to work. At the end of the day, I would stare blankly at my computer screen as my case notes piled up.

The Burnout Hexagon The internal pressure was mounting. I ignored these symptoms until they became too painful to ignore and I finally acknowledged that I was experiencing burnout, with support and encouragement from my doctor, therapist, and loved ones. During my leave of absence, it became obvious to me that self-care was the primary method to prevent and heal burnout, but that self-care needed to go beyond the tasks that are just healthy or enjoyable. True self care needs to extend into one’s mindset and be driven by core values. I was trying to “fix” my burnout by external means. While the activities I chose were, and still are, a vital aspect of warding off burnout, internally deciding how I’m spending my energy, and shifting priority to putting my own needs first, made the real difference. I need to remind myself now, more than ever, of this lesson, especially since many of the external self-care options are greatly reduced during COVID-19. Burnout prevention has since become the focus of my practice, the Behavior Elevation Academy, which I now operate in collaboration with Dr. Julia Moore, Senior Director of the Centre for Implementation, developing courses and articles grounded in the latest research Here are five practical activities that have a broad appeal to therapists and their clients. They can be summed up by the word VITAL. V—Values Triangle: Personal core values are the foundation to burnout prevention. At the peak of a burnout, values can be easily overlooked. Summarizing your core values into a top three (a values triangle) creates a simple gauge for where to focus your energy when you are feeling distressed, overwhelmed, or detached. For example, my values triangle is simplicity, curiosity, and connection. I refer to this triangle as my “true north” to guide me back to what matters most to me whenever I find that I’m feeling out of sorts. Consider what values are here to help guide you.

I—Ideal day: This is a simple activity that helps to apply your core values into a vision of a future where you are thriving. Imagine that it is a few years in the future and your life is how you wish it to be. Now, in as much detail as possible, describe a typical day in this idealized life. This activity not only helps to set goals and harness the power of imagery, but also helps to tune in with what already is working well in your life. T—Time for self: Carving out time for yourself on a regular basis is the key to re-charging energy and overcoming exhaustion. As mental health professionals, we often become “other” focused. Being proactive about allowing time for reflection, planning, and acknowledging our accomplishments enhances our energy, focus, and sense of purpose. A—Acknowledge negative self-talk: This is one area that we as therapists may be academically knowledgeable about, but we don’t always personally apply it. Our cynicism is often encouraged by our negative self talk about ourselves and others. If we start by noticing our automatic thinking patterns, it is a key step to shifting them.

L—Limit obligations: One element of burnout is the sense of inefficacy. Many of us get lost in a never-ending to-do list and the many demands that sometimes cause us to feel unproductive. Addressing this means learning to say no, setting (and maintaining!) boundaries, and remembering that you are just one person. There is always more work to do and there are always more people to support. Yet think of the example we want to set for others. Moving away from a sense of self-sacrifice and toward self-compassion is a gift that starts with us and has a positive ripple effect to those around us.

About the Author

As you can see, these concepts are simple, and they need to be. When you’re in a state of overwhelm or burnout you don’t have the time or mental energy to take on much. However, these are all activities that, when regularly revisited, can help one thrive and avoid burnout. I will admit, over the past several months of self-isolation, while dealing with uncertainty about the future as well as undertaking a deep personal exploration about my own racism and white privilege, some old familiar burnout symptoms have started to show themselves again. Perhaps, though, this is a time of opportunity for many of us. Self-care is not limited to the actions we take, but also requires that we recognize our personal values and needs, and engage in self-compassionate inner-dialogue. Self-care is not something to fit in when we have time. As helping professionals, we have a responsibility and ethical obligation to take care of ourselves and refresh our energy so we can best support others. It is still a work in progress for me to recognize my own needs and “paying myself first” with self care, but I truly believe that more open discussion about this topic is an important step to ensure that the helpers are helping themselves.

Elizabeth (Carey) Scarlett is a Registered Psychotherapist with the CRPO based in Toronto, Ontario, with over 15 years experience in the mental health field. She specializes in serving clients with concurrent substance use and mental health concerns in a wide range of environments. She is especially passionate about her work providing trauma informed care, teaching suicide intervention strategies, and supervising new clinicians. With Implementation Scientist Dr. Julia Moore, Elizabeth is the co-founder of the Behavior Elevation Academy, offering blog posts, online courses, and resources geared toward moving toward thriving and away from burnout.

Personal Reflections: Thoughts on racism in the midst of a pandemic by Naomi De Gasperis, RP Lately the news has been relentless in delivering heartache. It seems that somehow in the midst of feeling raw and vulnerable in unprecedented ways, things are getting worse. But I believe in the power of timing. Perhaps COVID-19 served a greater purpose and has some hidden silver linings afterall. In many ways the pandemic helped prime our sense of social responsibility. It stripped us of a false sense of security and challenged us to grow beyond our comfort zone. Would we have felt so devastated by the murder of George Floyd if we hadn't already paused to listen to the struggles of communities beyond our own, to support one another? Holding space for the unbearable suffering of others can be hard to do. Yet in the enforced stillness of the pandemic, it was harder to ignore. I wonder if those of us who belong to the â&#x20AC;&#x153;dominantâ&#x20AC;? white culture would challenge racism so fervently if we had the usual distractions of work, bars, outlet malls, gyms, dating, and a great many other things we customarily pour ourselves into? Perhaps we needed to reach this painful threshold. Unfortunately, this isn't the first time a life is shamelessly lost because of racism. The emotional fatigue is palpable and has led to collective grief, but also awakening.

Maybe it took a pandemic to quiet us down and now that racism is shouting toward our tender fearful hearts, are we going to listen? As a woman, at times I have experienced being treated unfairly, however I've never considered myself privileged. Until now. I didn't grow up having to normalize being regarded suspiciously, unkindly and inhumanely. I don't know what it's like to live in fear because of the colour of my skin. Being born white afforded me the privilege of not knowing many hardships. I've tried to imagine the challenges that accompany growing up marginalized; it's not easy to weather the exhausting undercurrent of resentment that comes with feeling unsupported, misunderstood and unaccepted. George Floyd's death is a poignant reminder that many people have their basic needs under threat. Being treated humanely with decency and regard for one's life should not be a privilege. My job requires me to regularly seek out sensitivity training and each time, I'm surprised to find the sneaky biased filters that cloud my perceptions. Is it humbling? Yes. Is it necessary? Absolutely. As much as I strive for my work to be supportive to all people and inclusive of all genders and races, I understand that the minute I relax and assume I'm free of biases, I put myself and my clients at risk. 23

We need to let the pain of this tragedy move through us. We need to let our hearts break open and be freed of blinders, so we can do better. It's ok to weep or rant or reflect. It's ok to feel overwhelmed or deeply moved by the rioting scenes. Processing all of our feelings is important because if we continue to dismiss or minimize suffering, we risk disconnecting from our own humanity and the vulnerability that's necessary to detect the next right step.

Unfortunately, I often hear people defending their biases, especially these days. Claiming you're not racist because you have racially mixed friends or work with people of colour is like saying you're a feminist because you have daughters. It's tempting to want to clear ourselves of what's deemed unacceptable, but it's not always helpful in creating change. If we put our defensive responses down, we can approach racism with healing curiosity. One that allows each of us to nurture awareness and investigate our racially charged biases. We can begin asking questions like, "I wonder what built-in biases might be present in me? Is anything getting in the way of real understanding?" Weeding out our biases is ongoing work. We are never safe from slipping into unconscious beliefs because denial is a big part of our pathology. While it's important not to judge ourselves for what we inherited, it's equally important to not perpetuate it. As horrific as recent events have been, they're getting our attention and resonating with concerns that have been ignored for far too long. I'm confident that our collective racial lens is being challenged and exposed in a very necessary, timely way.

Just as illness serves to show us where we need to heal, grief and outrage reveal where rights need to be restored. We must put down our denial and welcome the difficult conversations. We need leadership that unites us through listening and understanding, rather than dividing us through defensiveness. We need to respond to the current events with long-term plans. Our schools need to do more than hold an assembly or assign a paper during Black History Month as though it's a part of our past. As Jane Elliott says, “People who are racist aren’t stupid, they’re ignorant. And the answer to ignorance is education.” Generational wounds linger deeply in invisible places, and the very first step in healing any trauma is to acknowledge it. We need to remember that words are powerful, they can uplift or tear down. When Thomas Jefferson referred to slavery as "a necessary evil” his words condoned unspeakable suffering. Minimizing the impact of systemic racism because of our existing legislation is akin to saying women stopped suffering domestic abuse because we no longer have ads from the 1950's that advise husbands to beat their wives to train them into obedience. The suffering of oppressed populations is real and ongoing. It's time to stop abandoning each other and show courage, literally, because the word courage derives from French, coeur, which means heart. This is a time to lead with heart, be brave and use our voices, our platforms, and our resources to attend to the suffering that our privilege for too long has blinded us to.

About the Author Naomi De Gasperis is a Gestalt-trained registered psychotherapist working in private practice in Toronto. Her work often includes mindfulness-based practices that encourage the use of awareness as a powerful, curative ally able to facilitate liberating shifts in perception. What she enjoys most about being a psychotherapist is empowering clients to live with presence, helping others to live undefined by past hurt and supporting a heart-inspired life that invites greater fulfillment.

By Allan Hirsh

Section 2

Stories of Resiliency Storytelling, Modelling, and Resiliency by Allan Hirsh, RP I am a storyteller. I probably was a Rabbi in a previous life. I might even be Rabbinical in this life. I tell stories to my clients about struggle and resiliency. I want them to know that we are all human and that we all face darkness at times. The narratives that I choose sometimes also have light, humour, and warmth. Instead of telling someone what to do, I would rather model resiliency through the characters in my story. I have had to cope with the challenges of the pandemic as you all have. Fragments of my history have been active in my mind and have been finding their way into my office stories. I know enough to hold back on very personal information when talking to a client, but I thought it might be illuminating to share with you my personal pandemic journey. With your permission, then, I will begin my story just over 40 years ago... In 1976, I moved from downtown Montreal into a log cabin near Powassan (population 1,200), about forty minutes south of North Bay. Although it was really my wifeâ&#x20AC;&#x2122;s idea to move to the country, she left me soon after I started building a house. By the fall of 1977, three weeks after the first snowfall, my two-storey, square Ontario farm house was finished, most of which I built myself. 26

It was not long afterward, however, that my truck died climbing a hill during a blizzard. For the next few weeks, I found myself a part-time single parent, stranded in the woods, short of money, and overall feeling stuck and depressed. In Montreal, there was always something to distract me. The sounds and sights of the city took me away from myself. In the woods, I was forced to confront my deeper issues. Over time, I realized that I really did like people and that hiding away in the forest was not the greatest solution to my need for approval nor my fear of failure. In the isolation, I had much too much time on my hands. In the desperation of boredom, I began to connect with parts of myself that affirmed my strength and rekindled my joy. As a kid I always liked doodling so I began to draw a cartoon each and every day as a challenge. I started making wood toys for my young son. Left over wood cuttings became part of collages and assemblages. When desperate, I would pick up my guitar and play some blues.

I learned that positive energy creates even more energy. Granted, sometimes coping is a trial and error thing. Coping is in the here and now; take it one day at a time, sometimes one hour at a time. Everything that made me stronger living in Powassan subsequently became an integral part of my being, helping to shape my life over the last 44 years. I moved to North Bay and created a life filled with love, creativity, community, service, and joy. Then, one day, ...boom! - the pandemic hit. My successful private practice slipped away to just a handful of phone sessions per week. The YMCA where I went every day for health and social contact closed. My yoga class for men ended. I love the guys in my class. Every month or so we would get together and talk. I miss that. My favourite restaurants were closed. No more movie theatres, antique stores, nor yard sales. Gone. Gone. Gone. I felt like I was back in the rust-out days of Powassan. Except this time around, I had some money saved up, a lovely partner, and, of course, Netflix.

After cleaning, fixing, and organizing everything in the house, I began to lose my momentum. I noticed inertia and the weight of depression begin to tug at me in the morning. Powassan had taught me to get out of bed, wash, dress, eat, and do something. Anything. If I could not think of what to do, I forced myself to get out the door and walk for at least 30 minutes. I could feel my mood shifting with each step. I had to laugh when everyone started freaking out over toilet paper. My parents had lived through the Great Depression and World War Two. Their parents fled Russia and Romania because people were hunting Jews. So we frequently talked about the importance of security and being prepared. Needless to say, like them, I always had extra toilet paper hidden away.

I began to look at old family photos and reconnect with my family history. My dad was in the service, and despite the fear and chaos of the time, my parents chose to marry in 1942 and reaffirm life. I read more about the London Blitz, how people coped with the relentless bombing of the city. Churchillâ&#x20AC;&#x2122;s words of defiance and hope became powerful and inspiring to me now, just as they were to millions of Britons then.

About the Author

Day by day, I noticed my inner strength begin to percolate. I found new routines to propel me forward. I set up exercise stations throughout the house. I found a growing momentum in my new life. Apparently, the lessons of Powassan still resonated for me. On this lovely day in June things feel much different. I can garden now. When I bike first thing in the morning it feels like the old days of last year. My workshop is open and I am creating sculptures. Iâ&#x20AC;&#x2122;m even occasionally risking my life setting out on an adventure to hunt for groceries. And, gratefully, my practice has become busier again. Every one of my clients has stories of struggle and resilience that relate to the times. I feel for them all. I am grateful that my heart is open and that I am able to be present in my work and my life. Storytelling helps me stay in that positive place. Thank you for reading this. Good luck in your journey.

Allan Hirsh is a Registered Psychotherapist in private practice in North Bay Ontario. He is a long time member and past board member of OACCPP. He is published cartoonist whose work has appeared in several books and periodicals. He is also a sculptor who has exhibited his found object assemblages in several art galleries in the North. The use of humour and creativity has helped Allan stay balanced and grounded throughout the forty-two years of his professional practice.

Growing in the Face of Change by Laura Ducharme â&#x20AC;&#x153;And, when you want something, all the universe conspires in helping you to achieve it.â&#x20AC;? Paul Coehlo â&#x20AC;&#x201C; The Alchemist Since March 11, each one of us has faced a new way of being. This time of isolation has forced change upon us, and for many, the experience of intense loss. This pause has also provided us with both the opportunity and distance to reflect on aspects of our lives that may need to be changed. If the only constant is change, embracing it when it arises may equip us with the resilience to overcome loss and maintain an openness to future opportunity. The morning of March 11th began for me with a mixture of hope and anxiety concerning an interview for a promotion within my organization. By the afternoon, all my personal angst was forgotten as discussions with my colleagues turned quickly to the World Health Organization (WHO) pandemic announcement. By the end of day, our office was in full emergency response mode with attempts to maintain a safe social distance our new priority. Within a week, a remote work-outof-home environment was my new reality. My private practice was forced into virtual mode and my family of five faced new realities which included job loss, school closure, hiring freeze, and a salary cut. With so much change and uncertainty, we were also given time to reflect, evaluate, appreciate, and plan. Together, these steps create a foundation for growth. Reflect - Our abrupt separation from people, commitments, and routines offers us a rare opportunity for personal reflection. A mindful attitude toward loss, change, and uncertainty develops resilience. Reflection can also be the impetus to leave behind what no longer brings us joy and to consider starting something new.

Evaluate - This requires us to identify sources of purpose and joy while recognizing obstacles to this fulfillment. An evaluation of our commitments, relationships, and beliefs may give us a sharper picture of what we want to modify internally, as well as externally. Appreciate - Most vital in the face of uncertainty is the power of gratitude. The practice of identifying and expressing our appreciation for the sources of our joy can shift our mindset, improve our health, increase our life satisfaction, and cultivate confidence to prepare us for change.

Reference Mitchell, K. E., Levin, A. S., & Krumboltz, J. D. (1999). Planned happenstance: constructing unexpected career opportunities, Journal of Counseling and Development, 77(2), 115-124.

About the Author Plan - With a focus on these assets as well as our past accomplishments and strengths, we can look to the future to consider things we have longed to do. The loss of a job or the end of a relationship can be the steppingstone to new directions and dreams. Life, it seems, rarely goes according to plan. One of my favourite career theorists, John Krumboltz, with his Planned Happenstance Theory (Mitchell, Levin, & Krumboltz, 1999) suggests that unplanned and chance events can lead to positive vocational outcomes. The term itself is an oxymoron as you cannot plan your happenstance, but you can capitalize on serendipity and seize chance opportunities through open-mindedness, flexibility, curiosity, tenacity, and optimism. Grow - Although the changes we have faced due to COVID-19 were imposed on us in an instant, growth is an internal process that takes time. Anxiety from uncertainty and sudden life changes can be a catalyst for growth. However, unlike change, growth is always positive. The inundation of the phrase â&#x20AC;&#x2DC;we are all in this togetherâ&#x20AC;&#x2122; is meant to comfort us with the knowledge that our anxiety, our challenges, and our condition is a shared experience. What may be more comforting is the discovery of our own way out of it through personal growth.

Laura Ducharme is a certified career development practitioner, psychometrist, and educator providing counselling for career seekers as well as vocational support for clients with disabilities. Her experience in the area of teaching and advocacy is diverse, with over 15 years of employment in public education and developmental services, while maintaining a full-time focus on her family. Currently, she promotes employment readiness skills to co-operative education students at the University of Windsor as well as career counselling and psychometric assessment in her private practice. Laura is currently completing her term as Board Member and Chair of Certification for the OAMHP.

What Coping with Cancer Taught me about COVID-19 by Claire Edmonds, Ph.D., RP My life has unravelled twice before. It’s been pulled apart and reconstituted in ways I could not have imagined, because of an errant string of DNA lurking deep within my genome. Like the novel coronavirus, never before encountered by the human body, a minuscule thread of protein can wreak havoc on the orderly functioning of the systems that sustain our lives. A strand of DNA, not quite alive, but certainly not inert, uses the cells of other organisms to further its intention. Its only conceivable goal is to replicate at all costs, even at the death of the host. Having had breast cancer almost 5 years ago and an unrelated but shocking diagnosis of ocular melanoma (eye cancer) 3 1/2 years after that, I know the capricious nature of untamed and uncontained DNA. I have lost body parts and vision, confidence, and perhaps most of all, the certainty that life will unfold as I might have expected. I have been changed.

The news each day requires us to square our shoulders, take a deep breath and enter, if not bravely, at least gamely. Danger seems to lurk everywhere; a seasonal sneeze is foreboding, a neighbourly wave becomes a potential vector and grocery shopping is an exercise in managing biohazards. What does the experience and expertise of a cancer patient have to offer?

Perhaps ironically, my career as a psychotherapist has focused on cancer patients. I have studied the effects of cancer on the minds, bodies and spirit’s of my clients. My therapeutic work is with those who seek to understand their emotional experience and expand into the places that have been altered within them; to reinvent their lives when dealing with the challenges of loss.

How does a person with cancer manage these uncertainties? First of all we develop a relationship with the numbers and then try to incorporate them into our choices. If chemo gives me a 3% advantage over death and a 1% risk of another potentially more fatal cancer, is it worth it to me? What is it I want to live for? What really matters to me? Is this suffering an investment in my future? We have to make it personal, not theoretical, moulding the numbers into what we value. In the face of so much uncertainty we may not know what the “right” decisions are until we can see the consequences in retrospect. For me, my choices evolved out of a credo of “no regrets” as best as I could formulate them. Will I regret eschewing chemo now in 5 years time? In the uncertainty that coronavirus presents, will I regret visiting that neighbour, will I regret not taking the warnings seriously? In essence, what do I need to feel safe, and for those around me to feel safe? We all have different tolerance to risk, ask any financial advisor; some investors can manage the wilder rides of day trading while others prefer guaranteed investments.

So, my education continues. I have learned many lessons and gained many insights. Perhaps the most salient of these is learning to live with uncertainty. The novel coronavirus has introduced an element of uncertainty unparalleled in our lives. Our few defences consist of isolation, hand washing and not touching our faces, seemingly inadequate weapons for such a formidable foe. Our lives have been turned upside down. Children are out of school, many workplaces have been shuttered, our hospitals are filling to capacity and many are struggling to meet their rent and buy food.

Fear is synonymous with cancer; it strikes at our beliefs that we are destined for a long and fruitful life. We are afraid of the treatments, losses and potential death. Learning to live with that fear is a major task for the cancer patient and their loved ones. Patients are barraged with statistics conjuring their future just as we are now being asked to consider our own risk for Covid-19. The numbers churned out by public health agencies only reflect those who have been tested and fails to include untested symptomatic people, or more importantly, the asymptomatic people. It is a numbers game of general trends that may, or may not, relate to your own future.

Cancer is a blow; it comes with little warning and shakes our deepest sense of safety. Control? I believe it is an illusion. Health strategies such as running, diet, meditation and mental health are now for my pleasure and growth, not a bid to control the outcome of my life. With the coronavirus, we can do the health behaviours we have been given; hand washing, not touching our faces and social distancing, but at some point, we must accept that chance is in the equation too. As in life, it is always a part of the ride.

We will be changed by this experience, reinvented by choice or by necessity, appreciating our connectedness on this planet and our responsibility to both ourselves and each other; breath by breath, moment by moment.

About the Author

How does one live between the numbers and within the limitations life is now giving you? Enduring cancer treatment requires a mindset of â&#x20AC;&#x153;smaller things,â&#x20AC;? where success is not measured by accomplishment but by breaths taken and moments experienced. Now, I count the small moments that make up a day; taking a walk outside, a perfect scrambled egg, a cup of tea, the sun shining through a window, the birds singing, connection with a friend, albeit at a safe distance. Now, when we are all wrenched from the soothing, reassuring rhythms of daily routine, what will be our grounding touchstones? Perhaps we can discover peace amidst the mayhem. So many of us have wanted a slower pace, and now that it is forced upon us we are at odds with it. How to fill a day? While perhaps clichĂŠd, each day is still a gift and we can adapt to our new realities. Keep a daily routine, home exercise, yoga, learn a new language, learn to paint, write, journal, draw, organize your cupboards, your life, make coffee dates with friends over Skype, rediscover the simple joys...homemade bread anyone? There is, at present, a science experiment on my kitchen counter that I hope to magic into sourdough bread. Like cancer, COVID opens doors to what really matters in our lives; taking care of loved ones while distancing, learning to spend time with family in new ways, being in the moment and grateful for the moments we have. We might also consider limiting our exposure to unsettling news. Just as a patient limits her intake of research, books and well-intended suggestions, be wary of your sources, discipline your news intake and take time to reach out to others who may be feeling isolated and alone, through a phone call or email.

Claire Edmonds earned a Ph.D. specializing in psycho-oncology from York University. She worked for over 20 years at Princess Margaret Cancer Centre as a clinical researcher in the Healing Journey Program. This program teaches coping skills such as progressive relaxation, guided imagery, healthy thought management, meditation and the spiritual quest, all within the context of a support group format. Research has shown that the program can enhance mood and quality of life in caregivers and patients and may even extend survival for some patients. As a Registered Psychotherapist, she now works at a variety of community cancer organizations, including Wellspring and the Canadian Cancer Society where develops programs and trains professionals. Claire has also coped with cancer herself, which has profoundly deepened her understanding of the cancer experience. She has a small private practice in Toronto, where she happily lives with her husband.

OAMHP & BECK INSTITUTE PRESENT

CBT FOR ANXIETY FEB 26-27, 2021

A 2-Da y Works h op on CBT inter ventions an d their applica ti on to th e tr eatment of anxiety disor der s, wi th pre sen ter Dr . Sh ona Vas

EARLY B IRD PRI CING ENDS NOVEMEBER 30 VISIT HTTPS://OAMHP.CA/CBT-FOR-ANXIETY/

Anxiety-Reducing Survival Tips for Mental Health Providers by Shalyn Dussiaume, M.A., RP When it comes to the anxiety generated by COVID-19, clients seek out counselling for guidance and symptom reduction. However, mental health providers are impacted by this pandemic just like everyone else. We too experience fear, anxiety, and worry about our safety and how this pandemic will impact our lives for the foreseeable future. Whether concerned about a decline in financial security or fearing for our own physical health, mental health providers are human too. Physiological changes accompany our anxiety. It is important to practice what we preach for our own health and well-being, along with that of our clients. Here are five simple but effective strategies that I can recommend to mental health providers (as well our clients) to help us navigate COVID-19:

Focus on the silver linings We may suddenly have time freed up to spend with our families, get to work on a project we have been thinking about for the past year but couldn’t follow through on because of obligations, catch up (via Zoom) with old friends, become a better cook, or learn a new language. And perhaps a gift is simply to take time to breathe. Prior to the pandemic we may have found ourselves preoccupied with the chaos of day-to-day life. With busy lives and responsibilities, it gets harder and harder to stop and smell the flowers - literally. Coping mechanisms As with general anxiety, it is important to have a set of tools to use when the anxiety cloud starts to peek its way through the trees. Time and time again we say, exercise is key to mental and physical health. This may seem cliché, but it is the truth. Exercise can release stressrelieving endorphins, as well as dopamine (“happy hormones”) and the sleep hormone serotonin. A walk outside in nature is one of the most calming, free, and easy forms of exercise almost anyone can do. And thanks to COVID, there is more time to dedicate to the things that keep us healthy — another silver lining. Stay Safe

Take precautions whenever and wherever necessary. As mental health providers we are obligated to do no harm. Therefore, if we have resumed in-person sessions, it is important to adapt our practice accordingly. We can wear masks and gloves, and offer them to our clients, have hand sanitizer readily available, and provide telephone or video options. This is a necessity, not an option, for those who have an identified vulnerability: people with medical conditions including heart disease, hypertension, lung disease, diabetes, or cancer, people with weakened immune systems from either medical condition or treatment such as chemotherapy, as well as older adults.

Knowledge Knowing that we have reduced the risk of transmission allows us to release our hypervigilance and focus on our clientâ&#x20AC;&#x2122;s emotional well-being. Self-care Although lived experience can be valuable to practicing psychotherapy or counselling, providing treatment is not effective if we are distracted by a need to calm our own anxieties rather than our clientsâ&#x20AC;&#x2122;. Selfcare looks different for everyone. A good tool to carry in our back pocket is a Care Card. This is a wallet-sized card to carry at all times, reminding us of the tools and techniques we like to use to reduce anxiety. This way, when anxiety arises, we are prepared. This, of course, also works well for our clients. When we are in a state of anxiety it can be difficult to remember our coping mechanisms, so having them written down and on hand is beneficial.

About the Author

Where are the latest updates coming from? In order to help inform our clients, we need to be up-to-date on developments concerning the pandemic. However, not all news is reliable, so consider the source. If it is not from a credible, scientific source, take it with a grain of salt. And be careful not to overload. Remember to take regular media breaks and engage in relaxation practices and pleasant activities, such as drawing, cooking, walking, or reading a book. Navigating through hard times, such as a global pandemic, we are all well advised to practice self-care alongside our clients. I hope you will find these simple steps helpful. Stay safe.

Shalyn Dussiaume is a Registered Psychotherapist and is currently working with a wide variety of clients with varying life issues. Her therapy models include using CBT (Cognitive Behavior Therapy) and DBT (Dialectical Behavior Therapy). Some of her clinical expertise includes treating depression, anxiety, postpartum stress, relationship issues, anger management, addiction, trauma, borderline personality disorder, and more. She has worked with children, teens, and adults, from various walks of life in Ontario, Canada; Nevada, USA; and Cornwall, England. She earned a Bachelor Honours Degree in Women Studies and Psychology from Laurentian University and she completed her Master of Counselling Psychology Degree through Yorkville University. She is a Registered member in good standing with the CRPO (College of Registered Psychotherapists of Ontario) and the OAMHP (Ontario Association of Mental Health Professionals). In her spare time, outside of her private practice work, she enjoys taking long walks in nature and taking her one-yearold son on outings. 35

Section 3

Adaptations Life on Hold: Finding paths to help clients discover resiliency during uncertain times — a Cognitive Behavioural approach by Valery Belyanin, Ph.D., RP I love cognitive-behavioral therapy (CBT) because it allows me to apply a structured approach to my client’s problems. Sensations, feelings, cognitions, behavior – these are the domains I analyse when clients wish to “make things the way they were.” These domains constitute their internal world. I also remember to consider external influences in their lives: their financial circumstances, job, housing, and people in close contact with them. Then the environment around each of us drastically changed. COVID-19 brought about fears for our own health, for the health of friends and relatives, and for the fate of humanity as a whole. Many people lost their jobs and their financial worries have deepened. The world we knew became a VUCA-world; V stands for vulnerable, U for uncertain, C for complex, and A for ambiguous. There was no way to predict the future, the coordinates were changing every day, along with the numbers of lives lost in the battle with the invisible enemy. I appreciate that CBT is straight-forward and goal-oriented. If I ask my clients what the problem is, they may answer that someone or something is doing something to them. I listen, then offer “Here is what it may look like within a CBT conceptualization. I can provide you with psychoeducation, resources, tools, and techniques to help you better manage the situation. What do you think?” And we move on. 36

When COVID-19 started, this dialogue changed. My client’s expressed more vague issues and their uncertainty grew. They did not know what to formulate their requests. They were expressing existential doubts such as, , “I am not living my life” and “I do not know what to do with my career.” I have helped clients through many similar types of crises before and always felt confident I could help. Yet now I was struggling to do so. Interestingly, none of my recent clients mentioned COVID-19 as an issue, though it was clearly contributing to all this stagnation and uncertainty. As a result of the pandemic, my clients became process- rather than goal-oriented. With so many interruptions to their work, their measure of achievement was diminished. Being a behaviorist, I am not sure how to measure process. I felt lost as a therapist.

Since March, I have been contacted by journalists both here and in Russia, where I was born and still lecture today. One recurring question is, “What will happen to the world after the pandemic?” I am not a prophet and it is difficult to make predictions, especially about the future, to quote Yogi Berra.

About the Author

I note, however, humans are generally better at problem solving than they are at problem preventing. What we can do is to change our behavior and adapt our dreams to our circumstances (I note, for instance, the recent surge of cooking recipe posts on Facebook!). So I reflect upon how best to help my clients reduce the anxiety they have regarding “the situation” (their common euphemism for the more alarming term, “pandemic”). Is it healthy anxiety that leads us to rush to the store and buy sanitizer for 99 cents, fearing the price may rise to $9.99? To someone who is affluent, perhaps not. For clients with precarious income, perhaps so. So we discuss how best to respond. And when the problem is bigger than any of us individually, like a global pandemic, we have done what we can do, and now must wait. So I ask my clients what “waiting” means for them? They may answer, “Hoping for the best,” or “Waiting until everything gets back to normal.”Then I offer an agentic answer; waiting is doing something until something hoped for happens.

Valery Belyanin has PhDs in Psycholinguistics, Theory of Language and Psychology of Personality. He worked as University professor in Russia and seven other countries. He published more than 100 articles and nine books. He is a specialist in psycholinguistics and criminal profiling. Being a Registered Psychotherapist he works with depression, anxiety and relationship issues, MVA and issues with the law. His main modality is Cognitive Behavioral Therapy.

What can we do now until COVID runs its course? I do not know where it will lead, so I am ready for the worst and hope for the best. That is what resiliency is.

Engaging mindfulness and compassion during a period of crisis by Anna Woo, RP Amid the COVID-19 pandemic, I found myself experiencing suffering. Overwhelmed by anxiety and worry about the state of the world, I felt sad, lethargic, and lacked motivation. I recognized this to be a state I shared with my clients.

Tears flowed when I explored the heaviness in my chest, a feeling I identified as sadness. I stayed up late at night watching television and dragged myself through each day with low energy and little motivation to engage in activities.

I personally find the practice of mindfulness — being, rather than doing, and accepting and allowing what is — to be of benefit during times of distress. Two approaches inform my mindfulness-based practice. I would like to share these with you, offering my thoughts with regard to their benefit in reducing stress and anxiety clients may be experiencing concerning COVID-19.

Recognizing that a depressive mood was setting in, I tried to engage in behavioural activation as I suggest to my clients. I sought to restore my motivation and self-compassion. In CFT six qualities of compassion are developed: sensitivity, sympathy, distress tolerance, empathy, nonjudgment, and care for well being. These are developed through the training of skills, including mindfulness, which promote selfcompassion, allowing one to engage with and alleviate distress (Irons & Beaumont, 2017).

Based upon Jonn Kabat-Zinn’s mindfulnessbased stress reduction programs, Zindel Segal, Mark Williams, and John Teasdale helped develop Mindfulness-based Cognitive Therapy (MBCT) (Segal et al., 2012). We can teach mindfulness to our clients through both our presence and instruction (Woods et al., 2019). Having an embodied presence means that, through meditation practice, we have an understanding of the causes of our suffering and acceptance of their presence. Compassion Focused Therapy (CFT), meanwhile, helps clients deepen their sense of compassion, defined as a sensitivity to suffering — one’s own as well as that of others — with a motivation and commitment to alleviate the suffering (Kolts et al, 2018). COVID-19 put both practices to the test. During meditation, my attention was frequently pulled away by overwhelming thoughts. My embodied presence was difficult to sustain as I experienced difficulty accepting my problems.

Now during my own meditation practice I connected to my compassionate self. In particular, I brought to mind three core qualities of compassion: wisdom, courage/ strength, and the motivation and commitment to be helpful (Irons & Beaumont, 2017). I allowed these qualities of compassion to expand and grow within me with each breath. For clients, I offer the following instructions to the responsive breathing space script (MBCT). After the exploration and allowing for intense sensation in the body, continue as follows: And now to further assist you with this difficulty, this challenging problem, I’d like to invite you to connect to your compassionate self. Perhaps placing a hand on your chest or your heart or your belly. Bringing to mind the qualities of compassion such as wisdom (pause), strength, courage (pause), commitment and motivation to work with this difficulty (pause). And as you breathe, allow these qualities of compassion to grow and expand within you.

For a longer practice, it can be helpful to expand on these qualities in your instructions, as follows: Wisdom: Your compassionate self is wise. It knows that life can be hard and that suffering is a part of life. Strength/courage: Your compassionate self is strong and courageous and is able to face difficulties that arise in life. Motivation: Your compassionate self is caring and motivated to work with your suffering. (Irons & Beaumont, 2017) On a personal level, I have found this more direct attention to my compassionate self to be helpful. However, my compassionate self was not always feeling so courageous, as it is a work in progress. I can share with you another meditation script to help develop courage: Coming into an alert yet comfortable position. Noticing the position of your feet, grounded to the floor, sit bones supporting your spine and back, chest is open and head is in line with your belly. Allowing your eyes to close if this is available to you. Bringing your attention to the sensations of breathing. Noticing the rising and falling of the belly for a moment. Then expanding attention to include the whole body.

Now intentionally slowing down your breathing and moving into soothing rhythm breathing. Breathing in for a count of 3, 4 or 5, slight pause, then exhaling for a count of 3, 4 or 5. Continuing at your own pace. In this exercise, we are going to further develop our sense of courage—one of the qualities of compassion. First let’s imagine the strength in courage, bring to mind the image of a mountain. The base is wide, rooted deep in the ground. It stands erect, strong, rising high into the sky. Now imagining you are the mountain. Your feet are rooted deep in the ground. Stable. Secure. Your body/spine is strong having endured the passing of the years, the changing of the seasons. Noticing now, how it feels to have this quality of strength in your body and mind. Next, bring to mind a time when it took courage for you to speak out. Perhaps you were in a meeting and you really wanted to communicate something, or say something to a friend, family member, coworker, stranger. Noticing how this feels in your body. Noticing what is going through your mind—thoughts, emotions. Maybe recalling how hard this was for you, yet you were able to find the courage to speak.

About the Author Next bring to mind a time when it took courage for you to act. Perhaps you were trying to swim, ride a bike, do a new exercise, run, drive a car. Noticing how this feels in your body and in your mind. Noticing the thoughts, emotions. You may even be aware of fear or resistance arising. Yes this was really hard, yet somehow your courage allowed you to work through the fears and resistance to act. Even if it was in just some small way. Noticing these qualities of strength and courage that are within you; a part of your self compassion. Feeling the qualities of strength and courage and taking a moment to let them sink in. Accessible and available any time needed, as part of your compassionate self. Managing anxiety, sadness and stress during these trying times will continue to be a challenge. For myself, I am hopeful that practices in mindfulness-based interventions and self compassion will continue to be beneficial in alleviating our suffering. References Irons, C. & Beaumont, E. (2017). The compassionate mind workbook. a step-by-step guide to developing your compassionate self. London: Robinson. Kolts, R., Bell, T., Bennett-Levy, J., and Irons, C. (2018). Experiencing compassion focused therapy from the inside out: A self-practice/ self-reflection workbook for therapists. The Guildford Press. Segal, Z.V., Williams, J.M.G., and Teasdale, J.D. (2013). Mindfulness-based cognitive therapy for depression (2nd ed). The Guilford Press. Woods, S.L., Rockman, P, and Collins, E. (2019). Mindfulness-based cognitive therapy: Embodied presence and inquiry in practice. Context Press.

Anna Woo is a Registered Psychotherapist and Writer. She has been working as a therapist for over 18 years and is currently working at a psychotherapy clinic in Toronto, Ontario. In 2017, she completed certification in Mindfulness-Based Cognitive Therapy (MBCT) though the Centre for Mindfulness Studies and the University of Toronto Factor-Inwentash Faculty of Social Work. She has been training in Compassion Focused Therapy (CFT) since 2018. Anna enjoys facilitating the MBCT group program and providing individual therapy to adults. Anna has published fiction and nonfiction works. She completed the Creative Writing program through the Humber School for Writers and is currently shifting her career to make more time for writing.

Unexpected benefits from practicing video-therapy by M.M. Saltstone, Ph.D., RP I have to keep reminding myself that “social distancing” is just a physical measure. When I venture out shopping for necessary supplies, like food, it feels almost unrecognizable….lines tell me where to stand, arrows tell me what direction to go in, a plexiglass wall separates me and the store clerk, employees are busy spraying every counter, door handle, conveyer belt, shopping cart, counting the number of people going in and out, everyone wearing plastic gloves and protective masks, the smell of disinfectant lingering in the air. Not at all the “normal” I know. I don’t have any lines in my office telling patients where to stand or any arrows. I don’t wear gloves or a mask. My office, like many of yours, has been closed since March 11, 2020. But I still see my patients over the “miracle” called the Internet. I call it a miracle because it did not exist when I first started my career in psychotherapy in the late 80s, at least not like it does now, and it benefits us more than I could have foreseen. During this pandemic and quarantine, the Internet has allowed humans to communicate with friends, relatives, physicians, and therapists to make those personal connections we all need as social beings. Personal distancing imperatives cannot deny us personal connection to one another. We simply innovate, by clapping our hands outside of our homes at 7:30 pm in Toronto/ 7:00 pm in Ottawa in support of health care workers, posting signs on our lawns, exercising or talking with neighbours in our yards and open spaces at appropriate distances, and so forth. That innovation includes the Internet. As a psychotherapist, it has allowed me into clients’ homes, spaces I could never have tread previously, gaining small insights into their lives beyond what I see or hear in my office. Their homes have become backdrops to our sessions, including their reno projects, gardens, pets, decor, and occasional unexpected glimpses of family members. I am invited into the world that lies beyond their presenting issue, and in some cases that increases my effectiveness.

Don’t get me wrong, my office is a great place. It is clean, bright, sanitary, complete with some tasteful décor, comfortable chairs, objects of interest (like our phrenology skull).But it is not my client’s home. Because it is the office of a professional, it can raise an invisible wall laden with doubt and insecurity. In their home, in contrast, they seem more comfortable to talk and to open up about things or events that they had not told me before. This suggests to me that allowing me into their home has made me seem more a visitor or ally than an investigator into their mental health issues. While I maintain a professional demeanor during these video sessions, it might make me seem more empathic, like a friend invited over for coffee. I am in their world and, perhaps, able to offer better solutions because I know a little bit more about how they live. In this sense it is quite insightful. After re-opening my office, I may choose to offer one or two sessions during the course of treatment using video therapy, if the client is comfortable doing so, to see if this sense of empathy and reduction in anxiety follows. This might be particularly effective during initial rapport-building sessions. 41

Donâ&#x20AC;&#x2122;t get me wrong, I do not think the fear of the pandemic itself has improved depressive symptomatology nor reduced anxiety in my patients or in the general public for that matter. To the contrary, it clearly has exacerbated fears for a great many. What I mean to say here, briefly, is that in our professional duties we rarely have had the opportunity to enter a patientâ&#x20AC;&#x2122;s home. But the necessity of using video therapy during COVID-19 has allowed us this window, one that has a three-fold benefit. First, it reframes and normalizes our exploration of their inner world. Secondly, if I may generalize from my experience, it can provide the therapist with insights difficult to achieve in our more sterile office setting. Finally, it adds a comfort to the therapeutic alliance akin to a neighbour dropping in for a cup of coffeeâ&#x20AC;Ś.but with a backpack full of knowledge as to how to help. Our invisible walls, during these moments, seem to vanish.

About the Author

Mary-Ann Saltstone has a Ph.D in Psychology. She is a Registered Psychotherapist in private practice in North Bay with her husband Rob, a psychologist. She spends her free time playing the piano, writing music for short films, walking northern trails, and playing with her three dogs, Scout, Baron and Sammy.

Between the Screens: Strategies to improve the efficacy of video conferencing.

by Claire Edmonds, Ph.D., RP Recent studies support the use of videoconferencing as a modality to deliver a variety of psychoeducational services (Campo, Bluth, Santacroce SJ, et al., 2017; Richardson, Reid, & Dziurawiec, 2015, GonzálezOrtega, Ugarte, Ruiz de Azúa, et al., 2016; Rotondi, Anderson, Haas, et al., 2016). The global novel coronavirus pandemic has necessitated the sudden and unprecedented adoption of videoconferencing, replacing inperson meetings for everything from medical visits, classes for school-aged children, and psychotherapy. Therapists everywhere are experiencing a sharp learning curve adapting our psychotherapy practices to the videoconferencing environment. I hope to summarize in this short paper some of the lessons I have learned along the way. Sharing strategies with one another, we all benefit as a profession. First, let’s take stock of some of the challenges we are encountering. Challenges in individual treatment As a psychotherapist I teach active listening skills to volunteers as well as professionals. I deeply appreciate the expertise that deep listening requires. When we listen we need to be sensitive to forms of expression such as timbre, tone, intonation, the rapidity of expression, breathing, gaps, pauses, and force. We are also aware of how the speaker presents to us, whether they are groomed, their posture and mannerisms, their general presentation and other impressions they give us. At the same time we are taking in a myriad of other non-verbal cues such as eye gaze, the tapping of a foot, or hand gestures. We are also highly attuned to the muscles of the face, particularly around the eyes and mouth that express subtle feelings like impatience, frustration, fear, anxiety, disgust, disdain and grief.

Overall impressions emerge, including engagement, disinterest, and truthfulness. When there are more than two people in the conversation, the skilled listener is also gauging the interactions in the room, who is aligning with whom, who is a leader, who is a follower, who is an external processor (speaking before ideas are fully formed), who is an internal processor (more likely to express fully-formed ideas)), and who is influencing the group process, that is, setting the tone. Together these cues, many of which are picked up at an unconscious level, create a gestalt or complex picture of the whole situation. What happens when the richness of all these interactions are channeled through videoconferencing? We lose a great amount of information, especially body language. It has been estimated that non-verbal cues comprise 80% of the information a skilled listener relies on(Young, 2009). In place of that wealth of information we are left with faces in little boxes, like the opening title to that 1960’s sitcom, The Brady Bunch. I have worked with psychoeducational groups as large as 30 people where the faces are about the size of postage stamps and cover two pages so that I have to scroll back and forth to view all the participants.

The image feeds we see are also subject to freezing and cutting out. Sometimes clients are frozen in a frame, looking very much like the face in the painting, The Scream, by Edvard Munch. A few seconds of interrupted video can feel like minutes, during which we are in the dark as to our client’s experience. When the feed reconnects we may be tempted to interpolate, that is assume what the client has said in the meantime, because asking them to repeat themselves can break the flow of their process. Our client too, may be embarrassed or uncomfortable to ask us to repeat ourselves after a break in the feed. Pauses in conversation can feel less spacious and more pressured. The client and therapist have to work not to interrupt one another. With some clients this comes more easily than with others.

Additional challenges in providing group programs online In group therapy, the facilitator is responsible for managing the overall process, identifying feelings that may be emerging in the group often unbeknownst to the participants, slowing down or speeding up the discussion and querying participants as to their understanding of the group’s proceedings and using multiple techniques and metaphors to explain concepts.

As humans, we are uncomfortable with incongruence, meaning a discrepancy between various sensory inputs. Think about how difficult it is to watch a poorly dubbed film when the actors’ mouth movements and facial expressions are out of sync with the dubbed voices. We want to see, hear and perceive congruency in order to easily process incoming information. Then of course there is the challenge of being conscious of a camera pointing at our faces, unrelentlessly highlighting every feature that we don’t like about ourselves. We may sometimes become so distracted by our own image that we forget that it is only when we look straight into the camera that the viewer feels that we are directly speaking to them. We must therefore manage our output, in terms of our own performance and self-presentation, not just the input from the participants. Further, clients coping with post traumatic stress disorder (PTSD) experience depersonalization, dissociation, numbing and nightmares, disturbed sleep as well as flashbacks (Van der Kolk, 2014). In my own work, people coping with cancer often have symptoms of trauma to a varying degree. When clients with trauma feel triggered, they may respond by ‘zoning out’, or depersonalizing, in order to defend themselves from feelings of terror. In face-to-face sessions, therapists can be aware of when a client depersonalizes, or has a panic attack and we can gently help them return to the present and focus on the moment. On screen it can be difficult to discern if a participant has depersonalized and requires the support of the therapist to down regulate. 4

With online group meetings, however, this process is interrupted. Smooth interchanges between groups of people rely on a variety of cues, both physical and verbal, that create a rhythm to the discussion. This is harder to attain during videoconferences. Traffic control becomes the priority. Each participant needs to remain on mute except for the speaker, because the ambient sounds of their environment are distracting for the participants and can obscure what is being said. Thus, each person must unmute their microphone when they talk and then re-mute when they are finished. This process can be cumbersome even with experienced users. There can be awkward silences as the host tries to elicit comments. The natural flow of conversation is replaced by a stop-and-start effect with the unwieldy management of microphones, particularly when the technology is new to participants. All of this leaves facilitators juggling to best interpret what people are saying.

Recommended adaptations for video counselling Notwithstanding these many challenges in the use of videoconferencing, my clients and group participants have given high ratings in their feedback. This is supported by the high attendance that we continue to see over 8- and 10-week programs. Clients who are in active medical treatment express appreciation for being able to attend online when they feel too unwell to come to the centre. On occasion they may not turn on their cameras so they are able to listen without worrying about how they look. Even when we experience technical difficulties the participants express their gratitude that we are trying to bring them support during these times of uncertainty due to COVID-19. Certainly, as a facilitator, I prefer to work in-person; it is a far easier and smoother process, with the added dynamism of spontaneous group engagement. Yet, as nonprofit providers acclimatize to post COVID-19 fiscal constraints, they may be less inclined to have brick-and-mortar offices with all the expenses that they incur. Online programming may be able to reach many more participants on the fraction of the cost as in-person groups. Given these possibilities, it is up to us to adapt to this brave new world. Here are some of the strategies I have found useful and can suggest to you when working online: • Be mindful of developing an alliance with your client by replacing the in-person contact with purposeful and intentional connection through the video. Look straight into the camera when addressing a client so that it appears you are looking straight at them. Speak to them specifically by using their name, e.g., “Lesley, I’m so glad you can join us. I imagine that this might feel like a new experience to you. I am here to guide you and support you through today, please let me know if there is anything I can do to help you feel more comfortable.”

Remind participants about confidentiality, that they need a quiet room that is private with a door so the comments and identities of other group members are kept private. Also, some online platforms use a waiting room feature in which you can identify the members you let in, and so no strangers are allowed into the group. Headphones can be helpful to enhance your concentration as a facilitator, and may be more comfortable than earbuds. Using breakout rooms where smaller groups meet on their own is useful for more intimate discussion. I prefer groups of three to four, and I ask one person per group to watch the time and ensure that everyone has an opportunity to share should they wish. The message function can be helpful, but I find it difficult at times to manage the messages, the group, as well as the content, so I often ask people to raise their hands to speak rather than use the messages. Messages can also leave some participants out of the loop, especially if they cope with any visual impairment. On the other hand, younger adults and adolescents may be more comfortable with the message function, and that may encourage their participation. So, get to know your group. Speak slowly and clearly, more slowly and clearly than usual. Be aware of your facial expressions. I smile more and look clearly into the camera, then back to the faces on the screen. It is more effortful than in person, because our natural charm, that we communicate with body language, will be missing. 4

Zoom fatigue is real, be aware of your energy level as you work online. I do my large groups in the morning and leave my individual clients (online) for the afternoon, after I have had a chance to restore my energy. Additional challenges and suggestions for providing online training As a trainer for oncological psychosocial interventions with professionals and volunteers, I find that online training sessions require much more input from me as the leader. Some participants become passive when facing a screen, perhaps because of the privacy it affords or simply as a consequence of its similarity to entertainment viewing. I have taken a variety of different tactics to encourage participants to actively engage. The most effective strategy has been to use the breakout room option on Zoom, giving each small group several questions to tackle together and then to report back to the larger group. I have also alerted the group to our expectations that we “co-create” our sessions, and that everyone’s experience, questions and comments are helpful to our process. Should the group continue to be passive, I may then directly challenge them to engage, call on people by name, use light humour (all I hear are crickets out there!), or allow for silence to encourage members to “pop up” with their comments. In conclusion, there is a wealth of knowledge and expertise being developed by psychotherapists as we make the transition to online modalities. We need a forum to share our ideas and insights with each other, so none of us are left to invent the wheel on our own.

References Campo, RA, Bluth, K., Santacroce SJ, et al. (2017) A mindful self-compassion videoconference intervention for nationally recruited posttreatment young adult cancer survivors: feasibility, acceptability and psychosocial outcomes. Supportive Care in Cancer, 25(6):1759-1768. González-Ortega, I., Ugarte, A, Ruiz de Azúa, S., et al. (2016) Online psycho-education to the treatment of bipolar disorder: protocol of a randomized controlled trial. BMC Psychiatry 16:452. Richardson, L, Reid, C.,& Dziurawiec, S. (2015). “Going the Extra Mile”: Satisfaction and Alliance Findings from an Evaluation of Videoconferencing Telepsychology in Rural Western Australia. Australian Psychologist, 50:252–258. Rotondi, A.J., Anderson, C.M., Haas, G.L., et al. (2016) Web-Based Psychoeducational Intervention for Persons With Schizophrenia and Their Supporters: One-Year Outcomes. BMC Psychiatry, 16:452. Van der Kolk, B. (2014). The body keeps the score: Mind, brain and body in the transformation of trauma, Penguin, UK. Young, M.E. (2009). Learning the Art of Helping (4th Ed) Pearson Education Inc., New Jersey.

About the Author Claire Edmonds earned a Ph.D. specializing in psycho-oncology from York University. She worked for over 20 years at Princess Margaret Cancer Centre as a clinical researcher in the Healing Journey Program. As a Registered Psychotherapist, she now works at a variety of community cancer organizations, including Wellspring and the Canadian Cancer Society where develops programs and trains professionals. Claire has also coped with cancer herself, which has profoundly deepened her understanding of the cancer experience. She has a small private practice in Toronto, where she happily lives with her husband. 4

Lessons in Improvisation: Adapting to on-line program delivery by Naomi Tessler, M.A. In times of discord and disconnect, Playback Theatre weaves storytelling, music, movement, improvisation, and great doses of intuition together with audiences for a restorative, community-building event. Created by Jonathan Fox and Jo Salas and their theatre troupe in New Paltz, New York in 1975, and now practiced across the globe, Playback offers an interactive and therapeutic form of improvisational theatre. Audience members are invited to share their stories for the performers to bring to life on-the-spot through improvisation. It serves to motivate self-expression, a sense of shared experience, and compassion, validating both the diversity and universality of their experiences. Our own company, Branch Out Theatre, is committed to theatre for social change and community building. We recently created an online Playback Theatre performance series welcoming audience members from around the globe to share their experiences during COVID-19. The themes explored revealed a great deal about our collective strength and resiliency. In this short summary, I am sharing some of the lessons learned in creating our new online practice. I hope they may be of benefit to others service providers engaged in interactive group programs during this pandemic and beyond. Adapting our practice As the Artistic Director/lead facilitator of Branch Out Theatre, I lead highly interactive public workshops, performances and community arts projects. My practice creates opportunities for participants and audience members to have their voices heard, their stories shared, embody their lived experiences, and rehearse creating change on- and off-stage.

When COVID-19 swept into our lives, I initially assumed that I would need to suspend my practice. The idea of transferring my work online was not even a thought in my mind. How could I build a sense of trust using an online platform? How could I create a safe space for openness and vulnerability to emerge? How could I build a sense of connection, play, and solidarity online? How do I even operate a zoom meeting? The combination of all these concerns along with my lack of online technical know-how made the first week of COVID-19 a time of professional confusion. Yet, even as the weight of social distancing set in, I was inspired by all the online events, shows and workshops that were popping up, and began to question whether it might be possible. As I read more and more stories about othersâ&#x20AC;&#x2122; experiences, my desire to offer a playback theatre performance online grew. COVID-19 was impacting people in so many different ways physically, mentally, socially, financially and spiritually. Playback has always been a pathway for me to bring people together to share, hear, see, and learn from each otherâ&#x20AC;&#x2122;s humanity. It felt like a transformative way to respond to the pandemic crisis. In our online rehearsal we quickly realized how great an adaptation would be needed to make our techniques work effectively on a video platform. To make it feel like we were acting together in one place, we had to practice even deeper listening and give each other more space to begin and end our movements and all dialogue. It was difficult to layer sound, so we needed to create space for our musician to open and close our techniques rather than play all the way through. We learned how to play with the screen as our stage and attempt to use closeness and distance from our cameras as metaphors for the layers of emotions we aimed to represent.

Soon we were ‘as ready as we’ll ever be’, a refrain I imagine common among workshop facilitators everywhere diving into this new online world. Our show was called: In This Together: an online playback theatre performance, with net proceeds going to Parkdale Community Health Centre’s initiative to support the homeless population impacted by COVID-19 in downtown Toronto and Parkdale Food Centre, a food bank in Ottawa. Strengthening our connection

To begin each show, and support our audience to land with us online, we invited all who wished to join us to take some deep, slow, relaxing breaths. This helped participants ground into the present moment and, slowly, open up to notice one another together in our ‘zoom room’. To help build that sense of connection, I invited everyone to reach out ‘across their screen’ (as we modelled how to approach the screen with our fingertips) and make a connection to one other person, ...and one other, …and again one other, … until they had reached out to as many folks as they could. This simple exercise evoked smiling and laughter, and a sense of ease was painted across the screen.

Our audience members had an array of diverse stories ranging from the shock that swept in to various parts of the world suddenly hit by outbreaks, neighbours supporting elders with shopping, the challenge of caring for parents and children while working out of home, social upheaval and varying support for or opposition to social distancing, feelings of deep isolation, conflicting messages and varying responses by country, the joy of re-discovering hobbies, the frustration of not being able to contribute more when limited by age, health, or economic necessity, the adventures of buying groceries during a pandemic...

The invitation

Acknowledgment

To share their stories, we invited audience members to message us in the chat and let us know they wanted to share. With each story shared, we invited the teller to stay on screen with our troupe, as they shared their story, then ‘black out’ (turn off their video), to watch their story ‘played back’, and then join us again on screen after the scene to ‘debrief’ their impression as well as correct anything misinterpreted. This also allowed the audience to have a chance to hear and see the teller’s response to our improvisation. Other than the teller, the rest of the audience was off-video throughout the show. This enhanced the focus on the actors.

Our final show (the third of three performances) was performed just six days after the murder of George Floyd and two days after the death of Regis-Korchinksi Paquet. We began this performance with a moment of silence, holding space to remember and honour each of them — a 49 year-old Black American man who had moved to Minnesota to get a fresh start, and a 29 yearold Indigenous-Black Canadian woman in need of mental health support.

This acknowledgment opened up a safe space for audience members to share their own personal stories at the intersection of racism and mental health. There was an ocean of feelings present surrounding the loss of these lives, each a poignant tragedy reflecting the differential and oppressive treatment experienced by visible minorities every day in our society. To play back these stories at a time of deep grief for all present, and for members of the Black community in particular, felt like a sacred responsibility in support of our audience. Wrapping it up At the end of each show, audience members were invited to write their feelings in the chat for us to reflect back in a final, moving scene. Hope. Connection. Community. Health for All. Equity. Justice. Laughter. Play… These are yearnings we all share. And for those readers who are facilitating their own online programs, I hope some of the lessons we learned along the way may inspire and support you. Adapt your method to the medium. Experiment with warm-ups to bring the audience in from the internet. Issues and concerns are changing from day to day, so be ready to adapt on the fly. And perhaps most importantly, don’t be afraid to leap without certainty. It’s a resilient new world. Mistakes can be made on the way to rebuilding our sense of community.

About the Author Naomi Tessler, M.A. is the Founder, Artistic Director and lead facilitator of Branch Out Theatre. She has been working with communities globally for 16 years, leading community arts workshops, projects and productions to motivate: creative play, community arts engagement, critical reflection, personal and collective transformation and rehearsal towards social change. As a graduate of the Masters of Arts program in Educational Theatre for Colleges and Communities, New York University, she is passionate about using theatre as a tool for encouraging self-empowerment, conflict resolution, social justice and well-being. She is the co-creator of the Creative Well Theatre Project which facilitates intensive arts programming with adults living with mental illness in Ottawa and culminates in a forum theatre play addressing the stigma attached to mental illness and the systemic barriers in the mental health system. Naomi is an avid guest facilitator with Carleton University’s School of Social Work. In addition to being a dynamic facilitator, Naomi also works as an actor, director, playwright, poet, singer, speaker, community arts mentor and Reiki Master. She believes in uniting communities through theatre to build bridges and break through barriers. www.branchouttheatre.com

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Contest Details 1. Open the pdf version of Psychologica on oamhp.ca. 2. Print and complete the Crossword puzzle. 3. Email your completed puzzle to communications@oamhp.ca with your name and phone number. 4. A winner will be drawn at random and contacted within 5 days of the contest closing date (Dec 31, 2020). 5. Must be a member of OAMHP to participate in the contest. For full contest details including rules and regulations, please visit oamhp.ca.

Across

Down

1 ____-19 6 To scratch or tear at 10 Borden and Trenton, for example 14 Skilled 15 All encompassing (prefix) 16 The ___ and the tortoise 17 Broken (Sp.) 18 An action that may do harm 20 Wear away at 22 Neither here, there, nor anywhere 23 Safe and effective use of self (acronym) 25 Worthless (adjective) 28 Univ. of Waterloo prog in psych, anthropology, and sociology (acronym) 31 Standardized test for admission to graduate school (acronym) 32 ___- and post-test, method to measure outcome 33 ___ and cry, a community clamour about a perceived wrong 34 Alcohol distilled from molasses 35 Current or former name for currency in several Mediterranean countries 37 Not will 38 Compass bearing from London, ON to Kingston, ON 39 Permit 40 An extension at right angles to the length of a building 41 City approx.. 500 KM ENE of TOR 42 Child’s description of a dog’s bark 43 The side sheltered from the wind 44 English as an international language (acronym) 45 Organ that facilitates hearing 46 Estimated arrival time (abbr.) 49 Do not resuscitate (acronym) 50 There is discussion currently to ___ many police forces, reallocating resources to improve health and social supports 52 Express oneself vocally and melodically 54 Agrees to a request 57 Participates in a type of art therapy 61 Sustained or supported movements in classical music (pl.) 63 Prepare for publication 64 Stake in a poker game 65 Endothelium-derived nitric oxide (abbr.), a chemical that triggers vascular changes associated with migraines 66 Person’s present condition 67 An action taken 68 Head of the faculty 69 An association of mental health professionals in Ontario (acronym)

1 To provide for the needs of 2 A lingering scent 3 Refuse to accept 4 Tablets that may be used for video conferencing 5 Delirium tremens (abbr.) 6 Someone trained to provide help with personal problems 7 K____P 8 In a different, more positive way 9 Remove oneself 10 Greek root word — to heal with one’s hands — deriv. from mythological centaur who learned the art of healing 11 PPE worn by physicians and nurses during 1 across 12 Undergarment dating back to 2500 BC worn by women of Crete 13 Social and emotional learning (acronym) 19 Be ___ Now, by Ram Dass 21 Electroencephalogram (abbr.) 24 Text slang: you are 26 A sulky and gloomy mood 27 Old ___, 1956 children’s novel 28 Educational track taken undergraduate prior to becoming a medical student 29 Term of affection for a parent’s sister 30 Two separate senses that converge, allowing us to detect the flavour of food 32 Psychotherapy, for one 36 International Labour Organization, a UN agency to advance economic and social justice for workers (abbr.) 39 Became aware of a feeling 45 Suffix meaning in the stage of forming 47 Seventh note in a musical solfège scale 48 “Yes, ___...,” a principle for actors to follow in improv 51 Played a role 53 Swedish environmental activist ___ Thunberg 55 The ___, marijuana-smoking comic character portrayed by Jeff Bridges in The Big Lebowski 56 Sicily’s active volcano 58 First male figure in the origin story of the Abrahamic religions 59 ‘It comes ___ the territory,’ meaning it is an inevitable part of the experience 60 See 62 Down 61 An emotion accompanying loss or disappointment 62 ‘___ ___ at a time,” meaning just focus on the next smaller thing to be done so you don’t feel overwhelmed (2 words, with 60 Down) 66 A conjunction used to infer the reason (what was previously mentioned) for what follows

Spring 2020 Answers We would like to thank everyone who participated in our spring crossword puzzle contest. The answers from our spring issue are below. We would like to congratulate the winner of our spring contest, Barbara Fish, who won a discount to our fall 2020 conference.

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Land Acknowledgment and Affirmation of Respect and Inclusivity We acknowledge that our place of work is on the ancestral traditional territories of many nations including the Chippewa, the Haudenosaunee, the Wendat, and the Anishnaabe, including the Mississaugas of the New Credit First Nation, and is now home to many diverse First Nations, Inuit, and MĂŠtis peoples. We acknowledge that treaties negotiated with these nations were in some cases conducted from positions of inequity, lacking good faith, interpreted in settler language, and arbitrated by settler laws when subsequent disagreement arose. Many subsequent actions by the settler culture imposed upon Indigenous peoples have caused trauma, individually, within family and community, and inter-generationally. Until a complete and meaningful reconciliation is reached, their healing journey, and consequently ours collectively, is not complete. We accord respect to all persons, regardless of age, political affiliation, religion, including people of colour, women, men, First Nations, Inuit, and MĂŠtis peoples, member of ethno-racial groups, people with disabilities, gay, lesbian, bisexual, transgender/transsexual people, and gender diverse persons, francophones and all persons whose first languages is not English.

Psychologica: COVID-19 Issue

Articles inside

Lessons in Improvisation: Adapt ing to on-line program delivery by Naomi Tessler

Between the Screens: Strategies to improve the efficacy of video conferencing by Claire Edmonds

Unexpected benefits from practicing video-therapy by Mary Ann Saltstone

Engaging mindfulness and compassion during a period of crisis by Anna Woo

Anxiety-Reducing Survival Tips for Mental Health Providers by Shalyn Dussiaume

The New Intimacy by Allan Hirsh

A Clarion Call to Action: An interview with Dr. Roger McIntyre to discuss COVID-19, unemployment, and suicide. by Stephen Douglas

Therapist Heal Thyself: Strategies for preventing burnout in 2020 by Elizabeth Scarlett

Personal Reflections: Thoughts on racism in the midst of a pandemic by Naomi De Gasperis

Coping with Cancer by Claire Edmonds

Growing in the Face of Change by Laura Ducharme

The impact of the COVID-19 in children and families in high conflict separation by Dilcio Dantas Guedes

A Word from the Editor by Stephen Douglas