Types of Problems

At the present time, the majority of my time in private practice has focused on providing counselling and psychotherapy to young people and adults (ages 9 to 75) dealing with the following types of difficulties:

Depression. Depression can affect children, adolescents, young adults, adults and older individuals. Most individuals dealing with depression will experience sad mood, a loss of pleasure and feeling of worthlessness, in addition to many other difficulties with sleep, appetite, libido, memory and concentration. Children (under the age of 10 or 12) will have difficulty expressing feelings of sadness and may express their difficulties through stomach aches and pains or through loss of interest and boredom. Adolescent unlike adults may express sustained feelings of frustration and anger instead of sadness. This means that adolescents dealing with a clinical depression need not show feelings of sadness. In addition, individuals who are depressed are also prone to overlooking good things that happen to them, and may even forgot the times that they did enjoy. They will have difficulty completing tasks, even those that used to be easy to do, and will frequently become overly harsh or critical of themselves, their own work as well as the people around them. One of the most difficult situations arises when individuals dealing with depression become very harsh or critical of themselves for being depressed or begin feeling that they have disappointed others for becoming depressed. Being depressed is difficult enough, being harsh on yourself for being depressed, makes it so much harder than it needs to be. We offer clients both Cognitive Behavioural Therapy and Interpersonal Therapy, which are designed to address many of the areas that are often affected when dealing with depression.

Anxiety. There are many different types of anxiety disorders, including Generalized Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder, Agoraphobia and Post Traumatic Distress Disorder, as well Generalized Anxiety Disorder, Social Phobias and Specific Phobias. Difficulties with anxiety tend to be more common in children than other difficulties, such as depression, but both anxiety and depression can co-occur. What most types of anxiety disorders share in common is a set of intense fears, worries, and pre-occupying negative thoughts which become so overwhelming and intense that they begin to affect the way you live your life. Although many of these fears and worries may begin with real experience, they can become so frequent and intense that people may begin to fear the actives, situations and people they once used to enjoy and look forward to. In many instances people can start to fear having the experience of fear itself. We offer clients Cognitive Behavioural Therapy, which was designed to change the way in which individual manage these fears and approach situations.

Relationship Difficulties. We work with both couples and individuals in learning how to better identify, discuss and resolve relationship difficulties, as well as the needs that frequently go unmet or unmentioned in difficult relationships. Relationships are supposed to a place for individuals to feel good about themselves, can feel special for someone else, where they can feel trusted, respected and loved. They are also the place where people can care for and take care of others. Most relationship difficulties arise when one member of a couple is no longer able to meet their basic needs within that relationship or no long feel good about themselves. We offer clients approaches based on Interpersonal Therapy, which is designed to help individuals learn how to say how they feel in a productive way and to find better ways to meet both their own needs and their partner's needs.

Work and Work Related Difficulties. At some point, everyone will experience a setback at work, either because of something  they did, something they did not or were not able to do or because of something that others did to them. For many, work is not just a job, career or source of income, but an import source of self-worth and pride. Set backs or even just difficulties getting along with others at work can threaten that source of self-worth, and lead to other difficulties, such as depression, anxiety and difficulties as home. We offer clients an approach that focuses primarily on (a) setting things right at work (which can include finding strategies to increase your performance as well as get along better with others) and on (b) managing your thoughts and feelings about your situation, which can be extremely debilitating and demoralizing.

School Difficulties. Many young people will experience difficulties with fitting in, difficulties with bullying or challenges learning or remaining motivated to learn. Difficulties fitting in and difficulties with bullying can also lead to a number of related problems, including depression, anxiety and self-worth. We work with young people to develop skills to better deal with fitting in and manage situations in which bullying can occur, as well as work with schools (as needed). Staying motivated throughout the school year usually becomes a challenge for most young people at some point. Indeed, finding new ways to make learning (and eventually work) interesting is a lifelong process. A loss of motivation can arise for several reasons, including learning difficulties, peer pressure, overwhelming expectations (whether from one's self or from others), as well as mood difficulties, such as depression and anxiety, or substance use problems. There are several different approaches to dealing with these kinds of challenges, which are tailored to the individual client, school and family circumstances.

Self-Worth Difficulties. It is generally understood that good mental health depends on (a) having fulfilling relationships, (b) being productive and successful at some activity, (c) being able to adapt to change and adversity. Being "productive and successful" does not mean having a good or well paying job. It means having a set of activities, interests, or leisure pursuits in which you feel you can do well and are valued for it. For many people, this is their job, but it is also the roles they fill (e.g., father, husband, friend or team mate), as well as the activities they enjoy (e.g., sport, volunteer groups, camera club), and the challenges that undertake and try to surmount. Improving self-worth and self-esteem is not merely how you think about yourself. It is about finding or discovering a set of activities, in which you can make a valued contribution for which you are recognized - both by yourself and by others. In working with clients to improve self-worth, We will help them to identify those activities (or tasks within activities, or a job, or a club) that are meaningful to them, help them find ways to experience their contribution as valuable, and when relevant help them to identify how their attitudes and beliefs may work to undermine their experiences and successes. Cognitive Behavioural Therapy can be very helpful in change the way in which individual approach and experience the activities, interests, and pastimes in life from which they can derive a sense of self-worth.

Dealing with Self Harm and Suicide. In Canada, suicide is the second leading cause of death among young people. Many people dealing with mood disorders, such as depression, will experience suicide thoughts while being treated for and recovering from their disorders. Recent research suggests that suicidal thoughts can be effectively managed with psychotherapy (especially for young people taking medication). Whether or not suicidal thoughts can be safely managed, can only be determined after a careful risk assessment, which considers both risk and protective factors, has been completed. We have worked effectively with young people and adults who have experienced suicidal thoughts while being treated for depression. Depending on the level of risk for suicide, suicidal thing may need to be managed under the care of a physician or through an admission to a hospital.

Self-harm is very different than suicidal thinking. As many as 1 in 5 young people will report some type of self-harm (that is not motivated by the intent to die). Although self-harm is extremely serious and carries with it a number of medical risks, it has not been strongly related to suicide. In fact, longitudinal data show that repeated self-harm increases the risk for suicide only marginally and only after long periods of time (10 to 15 years). For most young people, self harm functions as a strategy (although a poor one) for managing painful emotions. It is not meant to end one's life. Still, self-harm is a serious issue and does not exclude the possibility that an individual may also be suicidal. It is important that other risk factors, such as the presence of a clinic depression or a past history of suicide, be considered. We work with young people who are self-harming to develop new, more effective ways of managing painful emotions.

Pain. We are frequently reminded by the clients we work with that we have no idea what dealing with acute and chronic pain is like until you live it yourself. This is certainly true for pain as it is for many experiences in life. Still it is well understood that pain will usually affect every area of your life - your moods, physical mobility, your friendships, work and family life, as well as your outlook on life and your view of your own self worth. Most individuals experiencing acute and chronic pain experience a number of losses that can leave them feeling alone, depressed and hopeless. Successfully dealing with pain will depend on (a) working with your physician to optimize your pain management plan, (b) restoring or enhancing the social support you receive from others around you and (c) developing new strategies both mentally and physically to adapt to these new and often overwhelming challenges. When we start working with clients, most find it nearly impossible to image the day when they may be productive (in some way) again. One to the most important obstacles to overcome is the fear that recovery and retraining may fail as well as the feelings of worthlessness and despair. We offer clients both Cognitive Behavioural Therapy and Interpersonal Therapy, which are designed to address many of the areas that are often affected when dealing with pain, both the feelings of fear and worthlessness, as well as the experience of loss.

Exploratory Counselling. Although most individuals will begin counselling or psychotherapy as the result of experiencing some difficulty or distress in their lives, some individuals will be more interested in counselling to better understand the meaning or significance of some event(s) in their lives or the manner in which an important relationship in their lives works or how it has changed affected them. Developing a personal understanding of who you are, how events both recent and past have affected you is an important part of counselling, that needs to be balanced carefully with alleviating the distress and pain that brings most people to counselling at any given time, and improving the way in which people function throughout the day, in school, work and relationships. We work with clients to achieve all of these goals, as desired, to better manage and alleviate the symptoms they are experiencing (if any), to the level of functioning at school, work and in relationships (as needed), and to achieve a better understanding of the meaning and significance of events around them (as desired).