familycounselling.net (Stephen Douglas)
2788 Lake Shore Blvd. West M8V 1H5 Toronto, ON, Canada

"We have to be willing to not know, to accept the limits of what we don't know, and to be comfortable with ...just finding out what's going to happen. The motto in Zen is to adopt a stance of 'beginner's mind', or a stance of not knowing. It is only through adopting a stance of not knowing that we can actually come to any real sense of reality. It's very difficult for a male growing up in North America to become comfortable with being uncertain. Part of the growth as a man i...s to let go of immature childish ideas like 'I should be confident all the time, I should be in charge, I should never be lost, I should be comfortable and confident in all situations.' All of that. As we mature, we men have to let go of that sort of nonsense, because it just doesn't serve us well. And it's completely false. There isn't a human being a live who can be comfortable and confident in all situations. To be human is to be vulnerable. To be human is not to be in control. To live life to its fullest is to feel the depths of uncertainty, the depths of not knowing, the depths of not being in control of what is swirling around us. Not knowing, not being sure, not having all the facts, not having a belief that I can have all the facts, has been very beneficial for me. It's very useful to me; useful in my relationships to other people, useful in relationship with myself." Aaron White "If your mind is empty, it is always ready for anything, it is open to everything." Shunrya Suzuki

Recently, Ontario researchers conducted a review to find out what digital technologies are being used to deliver mental health care. They also explored the relationship between digital technologies and compassionate mental health care. There are pros and cons to any method of delivering mental health services, whether individual or group, phone, online (video), or in-person, along with variations in approach taken by the mental health service provider. This review of 'grey ...literature' (reports, working papers, government documents, and white papers), confirmed that video, everything else being constant, can provide improved accessibility to compassionate services provided the therapist avoids barriers that can be created by this technology including poor quality (typically experienced as bandwidth 'freezing') and such auxiliary practices as automated responses. My client's feedback regarding the use of video counselling during COVID-19 is that they greatly appreciate the improved accessibility, flexibility of hours, and comfort of speaking from their own home (providing they have the privacy to do so) without any noticeable loss in effectiveness of service. The few exceptions I have noted in the early going have been attributable to 'broken' communication caused, as suggested above, by bandwidth difficulty. In these cases, I have refunded the fee. Technology is changing and we are all adapting as best we can. For the most part, clients in urban settings are getting upgrades to service that are accommodating a wide range of services and communications now being provided by video. Concern remains for those in remote (rural or northern) locations that we still very much need to address. https://www.eenet.ca//research-snapshot-delivery-compassio

The pandemic has highlighted how important people are for each other. Look out for friends and neighbours who are self-isolating and use video-calling to keep in touch with friends and family we cannot visit. UK-based social work blogger Martin Webber posted three podcasts about connection for World Mental Health Day, touching upon issues of barriers for mental health service users (podcast 1) including social inequality limiting access to the internet where many mental health services are provided today, the risk of asking for social connection and sharing vulnerability (podcast 2), and some challenges being experienced by mental health service providers themselves during COVID19 (podcast 3). The podcasts, titled Connecting People, are hosted by Sheffield performance artist Jess Gibson.

In short, this pandemic has challenged our ability to mentally function at our best, creating an underlying stress that impedes our sleep and the quality of choices we make and, at the end of the day, our sense of satisfaction with life. What can we do? Daily outdoor cardio exercise such as 30 min walking (or, in quarantine, alternating periods of sunshine on the porch or balcony with indoor exercise routines). Daily mindfulness practice to empty stress and calm the mind. Daily social contact with friends and family by video or phone, if not possible in person, to activate oxytocin the love hormone. And good sleep hygiene to help the brain 'take out the trash'.

I find it helpful for mental health to develop a good relationship with all of our emotions, understanding their purpose and finding good responses to them. Here is a podcast from CBC this week related to that topic. Quirks and Quarks host Bob McDonald spoke with author Eve Holland (Nerve: A Personal Journey Through the Science of Fear), who explored our current understanding of the important role fear plays in our lives. In this interview (click 'listen' 17:16 on this post f...rom CBC), she helps us understand how paralyzing fear can become problematic and techniques on memory retrieval being explored to help reset the storage of memory and change our future reaction to it however, without the emotion of fear altogether we would quickly imperil ourselves and likely die. Rather than attempt to banish or 'conquer' it we need to negotiate a good relationship with it. Holland shared this journey through her own fears with us. See more

Responding to the Premier of Ontario's announcement this week that in-person counselling is part of the first phase of opening up Ontario, the CRPO (College of Registered Psychotherapists) stated the following: "Given that the risk of infection continues to exist, in cases where you have the option of providing e-therapy or in-person therapy, we advise that you still choose e-therapy. If you choose to provide in-person care, you should be clear as to why you have made this de...cision. Please note that although the province may permit some businesses to reopen, this is not required. Members who believe that this would not be appropriate at this time are free to make their own judgment about when it is in the best interests of the client, the community and themselves to see clients again in person. The College continues to recommend that when practical and clinically appropriate in keeping with client's best interest, members are encouraged to provide services virtually rather than having clients receive psychological services in person." I concur with the College and am concerned by the Province's position. The use of secure video conferencing (I use either On Call, Medeo, or VirtualCare, depending upon the case specifics) has been established to be equally effective and both comfortable and accessible to most clients who have tried it out during the COVID-19 crisis. In most mental health profession offices, it would be difficult to maintain 2 m (6.5') distancing. Compounding shared use of furniture, the risk of infection aerosol spread in a closed interview room goes up significantly when the door is closed for 60 minutes. As well, there are further complications to consider in monitoring clients' access to the office via a shared waiting area. In 1918 we encountered a novel virus originating out of Kansas. After a global scare and effective distancing, incidence rates subsided and populations everywhere relaxed. That virus, later referred to as the Spanish Flu, quickly escalated again to levels far beyond the first wave and millions of people died. It is the second wave, not the first, that we remember today. Hegel wrote, "What we learn from history is that we learn nothing from history." Well, i believe we are capable of learning from our failure to learn. Let's get it right this time. I am ethically bound not to do harm to any client, so I will continue to offer psychotherapy services online for the next month and will make a decision moving forward at that time. I hope this explanation helps clarify my concerns about the Province's announcement and the reasoning for my decision to maintain my present therapeutic practice on video platforms. If you have any questions at all, please do not hesitate to reach out to me. #COVID19 #onlinecounselling #psychotherapy #ontario #OAMHP