Counselling Services Areas of Practice
Anxiety
Anxiety is the most common and treatable of all mental health conditions, despite the fact that it is one of the most uncomfortable and distressing. It is perhaps the most common reason why people attend my Downtown Vancouver therapy office.
One of the things that excites me most about helping with anxiety is that there are many possible solutions, depending on your symptoms, condition and situation. Options are a good thing. And the ultimate solution, however, is often to face whatever is making you anxious. While this knowledge can be liberating, it is often terrifying for people. It is normal to need support.
If your anxiety is longstanding and entrenched take heart: Some of the best gains I have seen in counselling are among people who have “hit bottom” with regard to their anxiety and are willing and motivated to undertake therapy. With anxiety treatment, the more you put into your homework outside of sessions, the more you can expect to get out of it.
Historically I have often utilized Cognitive Behavioural Therapy (CBT), a research-based method for treating specific anxiety symptoms, unless my clients are seeking a different therapeutic approach. Depending on the symptoms you are experiencing, we may choose from several or most of the following CBT techniques:
- Cognitive Restructuring – Challenging thinking patterns which feed anxiety and replacing them with realistic thoughts about your situation.
- Alternative Perspectives –Learning new ways of thinking about and conceptualizing your difficulties.
- Self-Refection – Increasing your awareness with regard to your own thoughts, feelings and behaviours about your situation: In order to change, we first need to identify the targets for change.
- Behavioural Techniques – Learning specific actions you can take to manage your anxiety. A common scenario would be learning techniques that you can apply in the moment to help reduce or eliminate panic attacks. Therapy also includes follow through with regard to your progress, and making adjustments to the therapeutic plan as needed.
- Graduated Exposure – rating the situations that make you anxious, from lowest to highest and then starting by facing the ones that make you least anxious while at the same time learning relaxation strategies (see below). We never progress to the next challenge until you feel completely comfortable with the current one you are working on.
- Relaxation Strategies to regulate your anxiety, particularly when you start to face situations that make you anxious.
- Lifestyle Considerations – regulating your general stress level: choosing healthy outlets which relieve anxiety, such as exercise, sleep, emotional support, prioritizing decisions and commitments. For those that want to minimize the effects of alcohol, caffeine, smoking and other drug use, we look at these factors too.
- Homework – testing the situations that make you anxious “in the field” outside of the office; taking notes, measuring results, etc. I often approach homework as an “experiment” to help you to determine whether the interventions are working for you.
An important aspect of the therapy is continuing with it between sessions. Not only do you get more value for your “therapeutic dollar,” you test what strategies are working and which ones are less successful, allowing us to streamline the therapeutic approach to meet your needs.
I will often use mindfulness therapy and meditation practice as a complement to our work together. In particular, I parter with you to learn to cope with distressing and acutely uncomfortable anxiety (and related emotions and thoughts) as they arise. This is done by learning to radically accept whatever is arising in the mind or body—neither holding on to thoughts or feelings, nor pushing them away. This may be a simple concept, but it can be difficult to implement! Practice, practice, and more practice is needed on an ongoing basis. For those who want to establish a regular meditation practice, we can look at how to implement this too. I feel so strongly about mindfulness and meditation that I employ it on a daily basis in my own life.
More recently, I have come to realize that when anxiety is related to neurodivergence a different approach is usually needed as therapies like CBT have been historically harmful to many neurodivergent people and they often just don’t work!
I look forward to meeting you and partnering with you on your journey of recovery. Call or email me if you have questions or would like to set up an appointment. I look forward to hearing from you!
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You Can’t Cheat The System
When cutting corners leads to nervous system consequences.
Choosing Counselling: What Does This Say About Me?
Self-stigmatization can be a big barrier when seeking counselling. We can move through these feelings and surprise ourselves along the way!
Confessions of a Recovering Sorry-aholic
Recognizing over-apologizing and what to do about it.
Coping with Anxiety: One Size Does Not Fit All!
Once we have sifted through known coping strategies, there is also the need to be specific.
There’s a Bug in My Water! (And Other Unexpected Things)
Coping with the unexpected in our day-to-day.
Dr. Google: Friend or Foe?
An article about health anxiety and its relationship to the Internet.
The Therapist Floats
Guest writer and counsellor Susie Merz reflects on her experience in a therapeutic flotation tank.
When Crisis Hits
A sudden crisis and how I worked through it.
When Worry Takes Hold – Part 2
Talking about ways of working with worry so that it doesn’t overwhelm. A follow up article to When Worry Takes Hold, Part 1.
When Worry Takes Hold – Part 1
Some observations about worry and some options for change.
Facing the Fear of Judgement in Counselling
You may feel tremendous fear that your counsellor will judge you, but will they?
Cognitive Behavioural Therapy (CBT)
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Recommended Books
Books are now linked to independent booksellers; Willow Tree Counselling receives no financial remuneration for purchases made through these links. Please consider supporting local indie bookstores - many of which are fighting to stay open.
Why We Sleep: Unlocking the Power of Sleep and Dreams
by Matthew Walker (2017)
Written by a neuroscientist, this is the book that changed my 30+ year mediocre sleep habits. While annoyingly hyperbolic in tone at times, I credit the author’s passion for shocking me into making the changes I should have made years ago (and which polite manuals on sleep hygiene couldn’t do).
Empowered Boundaries: Speaking Truth, Setting Boundaries and Inspiring Social Change Top Pick
by Christien Storm (2018)
There is a lot of information available on boundaries but out of everything I’ve read, this is my top pick. The author is particularly notable for their discussion on the nuanced nature of boundaries–honouring the fact that setting boundaries is inherently difficult but that it is not necessarily a rigid, inflexible process. Practical, inclusive and trauma-informed, guiding strategies are offered.
How To Keep House While Drowning: A Gentle Approach to Cleaning and Organizing Top Pick
by KC Davis (2022)
While Marie Kondo taught me to let go of a lot, KC Davis helped me to forgive myself, no matter the state of my home. A boon to neurodivergent folks, those struggling with mental health issues, or anyone else who is overwhelmed by life, therapist KC Davis, offers practical, forgiving strategies and care tasks that we can all use. Highly recommended.
Set Boundaries, Find Peace: A Guide To Reclaiming Yourself
by Nedra Glover Tawwab (2021)
This book has emerged as a prominent and popular choice for those who wish to better understand emotional boundaries and co-dependency. Straightforward and practical.
The Anxiety and Phobia Workbook
by Edmund Bourne (2020)
A best-selling self-help workbook using the principles of cognitive behavioural therapy (CBT) to help with generalized anxiety, panic attacks, phobias, social anxiety and other anxiety-related conditions. Best for those with an interest in CBT who also have an affinity for exercises and homework.
The Assertiveness Workbook
by Randy Patterson (2022, revised)
This book was first written when there was very little on the market to help with assertiveness skills. This practical workbook for understanding and improving assertiveness is now in its 2nd edition.
Scaredy Squirrel Top Pick
by Melanie Watt (2006)
Children’s book with excellent adult appeal. The story about how a squirrel inadvertently faces his fears, with positive results.
Resources
A Soft Murmur
Creator Gabriel Brady offers a curated, remixed list of a variety of soundscapes, a project originally started to help reduce distractions in busy environments while working or studying. Great for those who focus better with background noise.
Heads Up Guys
A wealth of information and resources on men’s mental health, with a focus on depression.
Discovery College – Canadian Mental Health Association
A wealth of free online mental-health related courses, developed in conjunction with people who have lived experience.
Sleepwell
Online non-profit initiative from Queen’s University to help the public learn non-drug treatments for insomnia, primarily Cognitive-Behavioural Therapy for Insomnia (CBT-I).
Anger – A Self-Help Guide by Moodjuice
A self-help and educational guide about anger, from the counselling department at McGill University.
Vancouver Low-Cost Counselling List
List of private master’s-level counsellors, or their interns, offering subsidized counselling. Updated quarterly.
Nurses Line – Health Link BC
Call 8-1-1 to speak with a registered nurse 24/7. Other professionals available through this line include after-hours pharmacists, exercise professionals and dieticians
Kelty’s Key Online Therapy
Free, self-directed online cognitive behavioural therapy.
Dialectical Behaviour Therapy (DBT)
Web-based learning of DBT skills. Particularly useful for those without access to individualized programming, or to supplement an existing group DBT program.
Crisis Services and Hotlines in Vancouver
Resource list, updated quarterly.
Bounce Back Program
Telephone coaching for people with mild-moderate depression with or without accompanying anxiety. Coaching available in English, Cantonese, French and Punjabi. Family doctor’s referral required to access this program. Free.
Mind Shift CBT
App developed by the folks at Anxiety Canada to help manage anxiety symptoms and promote relaxation.
Reduced-Cost Counselling [PDF]
A resource list of lower-cost professional counselling options in Vancouver. Corrections and suggestions welcome.
Mood Gym
Online self-help program for depression and anxiety, using cognitive behavioural principles (CBT).
Relaxation Audio Download
From the people at Simon Fraser University’s Centre for Applied Research in Mental Health and Addiction (CARMHA). Scroll down for link.
Vancouver Access and Assessment Centre (AAC)
604-675-3700 – Joseph and Rosalie Segal Centre, Vancouver Hospital, Level 1, East Entrance
7 days a week: 7:30am-11pm. Phone, walk-in and outreach support for urgent, non life-threatening mental health and addictions issues. Response times vary. Serves residents of Vancouver.
Anxiety Canada
National organization providing information and extensive online resources for managing anxiety.
Here to Help
BC-based website offering comprehensive information on a wealth of mental health conditions and addictions concerns.
1-800-SUICIDE
24-7 crisis service for anyone that is suicidal, thinking about suicide or for concerned friends/family. BC-wide service.
SAFER, Vancouver Coastal Health
Time-limited counselling support for adults who have made a suicide attempt, or are experiencing suicidal thoughts; also offers support and education for people who are concerned about a loved one with suicidal ideation, or are grieving their loss by suicide.
Coping With Suicidal Thoughts
Self-help guide (pdf). Not intended to replace professional help.