Thursday, January 28, 2010

Depression – The” D” word

Feelings of depression are a fairly common concern of people who come to counselling. Some researchers have noted that depression in the western world is almost reaching epidemic proportions and the age of first onset seems to be getting younger. Depression is a complex condition and it has biological and social aspects to it as well as psychological aspects. (I’ve referred to the bio-psycho-social approach to many client concerns in an earlier blog.)

In focusing on some of the more psychological aspects of what my client’s call “Depression”, I’ve noticed that depression has become the “D” word. But the word “depression” often hides more than it reveals. There are many different and oftentimes interrelated experiences that client’s refer to as depression. It can involve sadness, resignation, lethargy, and low mood. The dictionary definition of depression also includes a sense of “slowing down” or “pressing down” which can of course refer to the experience of depression or to other uses of the word –e.g. to depress the gas pedal. With depression, I often get the image that something or someone is contributing to the pressing or slowing down of a person. It then becomes the job of counselling to expose the culprit.

Depression is the “D” word for a number of reasons. Although one might argue that there is less stigma with experiencing depression since it has become so widespread – stigma still exists. People may admit to occasional bouts of small “d” “depression but will admit less frequently to big “D” Depression. The stigma goes something like this: Depression can sometimes suggest a failure of the individual to exert sufficient willpower or be lacking somehow in enough moral fiber to “get over” whatever might be troubling them. (These stigmas have no basis in reality and only serve to make things worse for the depressed person.)

Depression is the “D” word for another reason as well. Under the umbrella of depression, a counsellor may very well find a number of other D words hiding in the client’s experience. Notably, there seems to be a preponderance of “D” words involved in the experience of depression. A few that I have noted include discouragement, despair, disillusionment, dejection, disappointment, disenchantment, distress, discontent, dissatisfaction, distress and dissatisfaction.
While the word “depression” often confounds more than it reveals (other than the image of depression as pressing or slowing down), the other “D’ words are much more approachable in my attempts to understand and work with the experience of “depression”.


Thursday, January 21, 2010

The Bio-Psycho-Social Approach in Counselling

Like many counsellors, I tend to subscribe to what is called a bio-psycho-social model around many of the issues that bring people to counselling. What this means essentially is that human behaviour is very complex and that oftentimes there are biological, psychological and social factors involved. These factors are frequently inter-related and can be responsible not only for the creation of “the problem” but also with the genesis of a solution.

Depression is a good example of this phenomenon. At the biological level, factors such as decreased sunlight or genetic factors may play a role in depression. At this level, a solution such as exercise or anti-depressant medication may be part of the solution. Likewise, at the psychological level, the way we think about the events in our life may predispose us to depression. At this level, a solution such as counselling and learning to think and respond differently to the issues that life throws our way may be part of the solution. Finally, at the social level, there are a number of social factors related to our gender, age, marital status, minority status etc. that may predispose people to depression. At this level, solutions such as increasing one’s social supports or challenging oppressive social structures may be part of the solution.

Of course, because of our bio-psycho-social nature, “solutions” to depression, may involve strategies or interventions at one or more levels. Many people may need to try a number of options to find the right solution for them. There doesn’t seem to be a one size fits all approach for depression.

In talking with my counselling clients, I have noticed that people often think of antidepressant medication (biological) and/or counselling (psychological) as strategies to deal with depression. The combination of these two strategies can be very effective. What is less well-known is the impressive research literature supporting both exercise (biological) and/or mindfulness mediation (psychological/biological) as interventions for depression. While these two strategies do involve consistent effort and may require more of people’s time, they really are effective.

Counsellors who work from a bio-psycho-social perspective consider all of these aspects in the lives of their clients regardless of whether the issue is depression or some other concern that brings them to see a counsellor.


David Boudreau

Thursday, January 14, 2010

The Power of Expectations

Everyone knows that if you expect things to be one way that expectation can hugely affect the reality you experience. So if you are expecting to feel one way or another about a situation, then you will likely help make that happen. We can powerfully shape reality just by the ideas that we have about that reality. What may be less commonly known is that our expectations about other people specifically can actually impact their behaviour and ultimately perhaps shape their personality. This is sometimes called the Pygmalion effect and some interesting experiments have really brought home the power of this in real life. Over the holidays, I had a chance to read “ Sway” by Ori and Ram Brofman. In the book, they quote a very interesting experiment by a research team headed by Mark Snyder.

This is a brief recap of the experiment. Fifty-one women signed up for a study on communication. They were told that they would have a short telephone conversation with a man (unknown to them). The men received accurate biographical information about the women and a “fake” snapshot. Of the fake photos, half of the men were given photos of very pretty women and the other half were photos of women more ordinary in appearance. Before the phone call-men took an Impression Formation questionnaire. Men who had photos of pretty women expected to interact with sociable poised, humorous and socially adept women. The men, who thought that they would be talking to less attractive partners, thought that the women would be “unsociable, awkward, serious and socially inept”.

Researchers recorded the phone calls between the men and the women and then edited out the men's side of the conversations. The resulting clips of the women’s’ sides of the conversations were played to an independent group of people. These people were asked to evaluate the women using the same Impression Formation Questionnaire. They attributed the same positive traits to the women who the men in the study expected to be sociable poised, humorous and socially adept - based on their voices alone.

How could this have happened? The fake photos of attractive women and more ordinary women were randomly assigned to these men and had no basis in reality. Yet another group judged these women after the experiment to be more socially poised, humorous and socially adept. What apparently happened in this study is evidence of the “chameleon effect”. Once the men had formed the impression of these women, it affected every aspect of how they interacted with these women. They were more engaged, listened more actively, and generally were more immersed in the conversation.

When “the beautiful women” spoke with the men, they couldn’t help but react to the cues that the men were sending. Without realizing it, they took on the characteristics that the men had expected them to have. “What had initially been reality in the minds of the men had now become reality in the behaviour of the women. In other words, being thought of as beautiful made the women think of themselves as beautiful and exhibit “beauty” in their conversations.”

The implications of this experiment are enormous for understanding social phenomena such as prejudice and discrimination, labelling as well as the impact that our everyday assumptions and expectations of others have on their self concept and actions. If we happen to put a positive label on another person (i.e., smart, attractive, interesting), it will be enormously helpful for them actually becoming the person that you “expect” them to be. Repeated experiences like these would likely change brain structure making these personal attributes part of their personality. On the flip side, a negative or poor label can have devastating and crippling effects on self image and everything that flows in life from having a low self image. As a counsellor, I talk to people everyday where the effects of people’s negative expectations of them have indeed left their imprints. Some of the “work” of counselling is to find those positive attributes and strengths in people (that have been neglected or ignored by others). In “expecting” to see these qualities and in reflecting this reality to them, these clients like chameleons (or like Pygmalion), begin to transform.


David Boudreau

Thursday, January 7, 2010

Online counselling: The future is not so different than the past

Online counselling, online therapy, e-therapy, e-counselling, cybercounselling, virtual counselling and email counselling all describe the same thing - counselling services which are provided online. While some counsellors engage with clients through asynchronous or live chat online or through live webcam sessions, much online counselling is very similar to the lost art of letter-writing and journaling.

Anyone who has had the experience of letter-writing knows of the emotional intensity that can happen between people who are sharing their inner experiences by writing to each other. The letters can be every bit as intense (or more) as a face-to-face counselling session. Likewise, journaling can also be an intense, soulful and wonderful way of sorting out issues and experiences in our lives. Dialoguing with an online counsellor through writing and reflection is a powerful way of getting support and making changes.

Online counselling really helps in a number of ways. The letter writing that is part of online counselling is itself therapeutic. Writing about thoughts and feelings helps to make sense of them. And the research supports that a therapeutic letter can be as powerful as 4 to 10 face to face counselling sessions! Online counselling may have longer-term benefits since the client has a permanent record of correspondences to refer to as a reminder and support.

The anonymity of writing letters online may sometimes free people up to really “talk” about what’s on their mind. If you’ve ever experienced the intensity of a letter to a close friend or family member you will know how powerful letters can be. Online counselling sometimes allows a greater degree of intimacy because clients feel less inhibited to express their thoughts and feelings. This can be particularly important for people who have not experienced counselling before and are somewhat reticent about seeing a face-to-face counselor. Online counselling is also a natural and safe place to talk with people who are shy or who may feel embarrassed talking about difficult issues such as sexuality or addictions.

The convenience of online counselling is undoubtedly a strong factor explaining its increasing popularity. Online counselling appeals to people who may not be able to access counselling services or have very limited access because of their geography or because of mobility issues. Online counselling also appeals to people who because of child care, health concerns or time constraints would find it difficult to attend face-to-face counselling sessions. Finally, online counselling appeals to people because written communication allows people to reflect on their experience and express themselves in a way that doesn’t necessarily happen with face to face or telephone counselling. Finally, online counselling can be accessed without having to wait to schedule an appointment.

So while the internet technology and the idea of counselling happening through exchange of correspondences between counsellor and client is new, the power and intimacy of connecting through letters and the written word has been around for a long time.


David Boudreau

Saturday, January 2, 2010

New Year’s resolutions- Making Changes Successfully

I hope everyone is enjoying the holiday season. This is the time of the year that people often take stock of the past year and may be thinking about making changes in their lives for the coming year. While many of these changes are often well-motivated, unfortunately the changes are sometimes short-lived. Think of the number of people who join health clubs and gyms at this time of the year, trying to shed some of their excess holiday weight. Many of these people have “fallen off the wagon” before the month of January is out.

How do we successfully make changes in our lives? Psychologists James Prochaska and Carlo DiClemente studied people as they tried to make changes and found that people go through several distinct stages as they try to make a change. They also found that people need different types of help or support depending on the stage they are at. While this model is often used in treating addictions (aclohol, drugs, smoking, gambling), it has applicability to almost any type of problem.

The stages of change model identifies a number of stages that people experience when making any change. Some people who attempt to make a change in their lives may do so prematurely because they are really in the “contemplation” stage. They are thinking about making a change, but are really not ready to make it. You might hear them say "I know I have to stop what I'm doing, but I enjoy it." The person knows a change is needed but is really not ready to make the change. Before attempting to change, these persons need to seriously review and evaluate the pros and cons of continuing the behaviour and of changing it. They also need the reassurance that when they do decide on making the change that they will be able to do it.

With other people, they know that they have the strength to change, but they may not know how to go about it. These people are likely at the “action” stage. Talking to a counsellor at this stage or with others who have navigated similar changes may be helpful. People in this stage need to know that there are many options to go about making changes and some practical advice about making these changes may be helpful. It is also important that potential barriers to change are identified and that these people realize that initial “small steps” are the way to go. At this point, they can then begin to make changes by altering their behaviour, experiences or environment in order to deal with the problem(s).

Some people have already started down the path of change. They want to make the change and know how to go about it. During the “maintenance” stage, it is important to review successes and identify potential obstacles. "It’s a one-day-at-a-time struggle as people in this stage establish new behaviour patterns and try to sustain the change over the long term. These people are changing their ingrained habits and even changing their braining wiring.

I have found that this stage can be a particular vulnerable time for some people. If they slip up once or twice, they may give up and head back to the pre-contemplation stage. They may not try to change again for a long time or maybe never try again. Other people learn to see these slips as opportunities to grow more aware of factors that can cause a “relapse” and then take steps to deal with those factors. This is also an important time for counselling support and/or the support of someone who has successfully navigated this stage.

Knowing what stage you are at in the change process can help you identify what support and what strategies will ensure success in your efforts to make a life change.

Best regards,