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The Art of Play in Therapy

Some time ago I was speaking with one of my academic mentors about therapeutic approaches and he said, “You should be experimenting in therapy.” I was surprised to hear this, even a little unsettled. At the time, I was working for a governmental organization and experimentation was not encouraged. Evidence-based practice (EBP) was the advanced paradigm. Cognitive Behavioural Therapy (CBT) was the go-to technique.

Of course evidence-based practice. Of course. Though definitions of EBP abound, this one suits well: “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. What could be wrong with that? Nothing, really. But perhaps there’s more to consider.

For one thing, the therapeutic methods that are thoroughly researched are generally the ones that gain institutional respectability. CBT is the most funded and researched therapeutic model that exists, and therefore also the most promoted. And it’s great – I use it often. However, as a therapist I can confirm that CBT is good for what it’s good for, and falls short in other ways.


Before I studied counselling, I studied Chinese Medicine. Through that education, I learned that if you look at something one way, you will ask certain questions and get certain answers based on those questions. Western medicine approaches the body from the perspectives of pathology, physiology, microbiology, and pharmacology; it directly targets pathogens; and it’s evidence-based. Chinese medicine, on the other hand, considers disease to be an obstruction of qi, or an imbalance of qi or yin-yang. It’s a holistic approach, and not always as strongly evidence-based as Western medicine.

However, to say that a 5,000-year-old system of medicine is nonsense because it lacks the EBP backing of the much younger Western medicine would be an error of hubris. They are two different systems of medicine that approach the body in fundamentally different ways. If I break my leg, I’m going to my local emergency room – no question. But when I’m healing my bones afterwards, I’ll consult a TCM practitioner. They’re good at different things. Complementary rather than contradictory.

I’ve come to understand that while the evidence-based lens is useful, it has its limitations. Just like skills in therapy, if you plug the wrong skill into the wrong situation, you will think that the skill doesn’t work. Context matters. So it is with EBP: not all systems are quantifiable. Some are qualitative, and evidence-based measures may not be up to the task of determining their value.


Geez, Deirdre, I thought this article was about play in therapy. This is b-o-r-i-n-g. Fair enough! I wanted to lay that foundation first. One more time for the people in the back: the point I want to make here is that there is a time and place for evidence-based practice. It’s just not all there is.

Enter curiosity. Enter experimentation. Enter play. It took some time for me to unlearn the concept of colouring within the lines, so to speak. To step outside the conventions of a therapeutic model or an employer’s mandate felt a little….irresponsible. Like flying through the air without a net. Yet it’s like I used to tell my daughter when she didn’t want to follow the rules of grammar that she was forced to learn: you have to know the rules before you can break them. Or at least, before you can break them responsibly. But once you have the skill, you invite the potential for artistry.

Because that’s the thing as well: the whole art of therapy is holding space in a skillful way. So yes, I do believe it’s important to know the rules and undertake learning them in a comprehensive way. Many things can go sideways in therapy. Understanding this and tending well to those potentials is an ethical imperative. Once you’re able to do that skillfully, you’re ready to welcome play.


Recently, I moved into my own office – the first office of my own since I’ve been in private practice. That alone is exciting, and what’s even more exciting is that I’m getting to colour outside the lines of conventional therapy. Convention might say something like, “You’re not trained as an art therapist: you can’t do art therapy.” But I think about what my mentor said about experimentation…and it gives me license to try. I make art myself, and I’ve transformed one of my two office rooms into an art studio. Let the play begin! There are so many amazing resources out there to guide the way with art therapy ideas, too, that I’m never alone. I’m in good hands.

And then there’s the second room – my counselling space. It’s another expression of this desire for curiosity, experimentation, and play. In the last year I have been formally studying relational somatic therapy – a body-based approach to working with trauma. Remember what I said about asking certain questions and getting certain answers, and asking other questions and getting different answers? After working with cognitive approaches to therapy for several years, I came to understand that not everything can be adequately addressed with these techniques. Simply put, some things cannot be approached mentally.

Certain things must be approached through the body. Traumas that happened preverbally and cannot be resolved with words; other events get stuck in the body and can’t be unwound through reason. We need other ways to meet this, other skills.

Recently I was reading a yoga nidra meditation to the members of an eating disorder group I was running over Zoom. It’s an ancient practice that has more recently been rebranded as the modern-sounding iRest. It’s used by the US military to help soldiers with PTSD. Knowing that my group clients express – among other things – trauma through their eating disorders, I just thought I’d try it out.

The script took about 20 minutes to read. As is directed by the practice, I had them lie down, close their eyes, and cover themselves with a blanket. Every so often I would say, “True awareness has never been traumatized.” When I finished the script, I gave them a few moments to stir so that we could carry on with the rest of the hour.

…and the most interesting thing happened. Nothing at all. They didn’t stir at all. I sat on the Zoom call for the remaining 40 minutes and turned my mute on. I simply held space for them until the hour was up. Even as I signed off from the meeting, they lay still – silent in their own beings.


If it doesn’t surprise you, you’re making it up. As my mentor said, as therapists we ought to be experimenting. So my second room, the counselling space, is an ode to experimentation. To curiosity, humility, and play. I have a yoga mat and pillow, a meditation cushion and blanket. Tools and skills I’ve gathered across disciplines, whether evidence-based or not: Chinese medicine; yoga; somatic, narrative, dialectical, and cognitive behavioural therapies. Each one of these systems of thought and experience has something to offer – the art and the skill is in knowing when and how to apply them.

Occasionally, someone tells me that they dread therapy. At those times, I feel like I imagine a dentist sometimes does: like the last person someone wants to see! What I want people to know is that, yes therapy is hard work. And also, it can be a joy. When I hear laughter from a client, I know some healing work is being done.

You know, what I really imagine is that someday everything will be measurable. What is qualitative will be quantifiable, and vice versa. And I also understand that – just like yoga nidra being rebranded as iRest – regardless of what you call it, if it works…it works. So whether you’re a client or a practitioner, invite curiosity into your therapeutic experience. If something’s not working it doesn’t necessarily mean you’re doing it wrong: maybe a different skill would work better in that moment. Think outside the box. Experiment. Play.

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The Language of Sexual Assault

Warning: Sensitive Material

You would think it was the act itself, but more often it’s the other thing that tears a life apart: the aftermath of being a survivor in a rape-condoning world. Awaiting or avoiding trials that are certain to dehumanize. Ruminating, dissociating. Feeling too much and then nothing at all.
Humans can hold a lot of shame about sex, and at times it makes healing difficult. There’s a cultural element to it: some places do better than others. As a sex educator, I figure if we can invite healthy conversations, we may begin to mend the damage caused by sexual violence.
Language has the potential to polarize. When either/or logic is applied to a sexual assault case, either someone fought hard or it was consensual – it can’t be neither. Either someone’s a star athlete or they’re a rapist – they can’t be both. We struggle with the complexity of more than one true thing.
Buying groceries, I see an athlete whose untimely death is splashed across the headlines – no mention of the sexual assault case of which he was a part. Only one narrative makes it through: hero. And I think of a few young women whom I know right now, gathering the shards of their shattered souls. Post-sexual assault, they merely endure. Unseen and uncelebrated. Assaulted by narratives that casually or aggressively scorn survivors. I write this for them.
What we can’t face, we won’t acknowledge – as survivor, perpetrator, and society. Yet we must find a way to hold every true thing. Language is one place to birth those truths, and it needs to be durable enough to encompass it all – the confusion and contradiction. Belief and bewilderment. Compassion and consequence. To leave some out is to deny the whole, yet it doesn’t go away: it lives in the shadows, waiting to be healed.

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(C)Lit Review: The Top 3 Sex Books I Read in 2019

I’ve done my share of sexy reading in 2019. Most of it has been for educational purposes, so I’ll save the discussion on ancient Persian erotic poetry for another day. And what a day it’ll be. However, here’s my roundup for 2019: the best sexuality books that I read, and the coolest lessons I gleaned from them. Happy reading, my friends.

The Ethical Slut, 3rd Edition (2017) by Dossie Easton and Janet Hardy

If you’ve never read this classic of the genre, do yourself a favour. There’s a reason why it’s in its 3rd edition: with a new one published every 10 years or so, it’s as relevant today as it was in 1997. You don’t have to consider yourself a slut, or polyamorous, to get some gems from its wisdom. It’s for everyone committed to the ethical, joyful expression of their sexual selves – even when that expression is asexuality.

Dossie Easton and Janet Hardy identify as polyamorous, and the book definitely has that lens. However, you can be polyamorous and only have one sexual partner – because polyamory only means ‘many loves’, not many sexual partners. Sometimes people meet other needs of companionship, from a shared interest in crafting to a love of hiking. You can be asexual and align with this lifestyle…you may already be polyamorous and not know it!

“The Ethical Slut” celebrates all forms of consensual sexuality. I think our whole culture can learn from that level of sex-positivity. The book challenges conventional thought and invites the reader to expand beyond conditioned ideas of what’s acceptable in love and relationships. When polyamory is practiced ethically, it has lessons that are universally beneficial. Here are a few:

1. People aren’t property. Many of us are accustomed to thinking it’s romantic to possess/belong to someone, which is why so many love songs, books, and movies have this theme. But the most extreme manifestation of this expresses itself as harm. ‘Crimes of passion’ fall under this category: My lover was ignoring me ~OR~ I found my lover in bed with another, so I had to hurt/stalk/kill them.” Wait, what? Polyamory practices the tenet that people can share their bodies, minds, and souls with whomever they please. No one belongs to another.

2. Honest communication is the cornerstone of good relationships. Many people consider polyamory to be about a lot of sex, but first and foremost it’s about a lot of communication. There is a vast difference between cheating and ethical polyamory: the first involves deceit, while the latter involves a rigorous commitment to honesty. Though everyone is free to explore their love lives however they see fit, when there are agreements with others there is a commitment to communicate with truth.

3. Jealousy happens, and it won’t kill you. In fact, it might even make you stronger. In the book, Easton and Hardy teach that in moving through this painful emotion, we may find resources within us that we didn’t know we had. In a Dossie Easton interview I once saw, she used the analogy of sibling rivalry: siblings sometimes feel jealous of one another, yet in that realm we expect to get over it. Whether or not you are wired for polyamory, learning to share and to work with uncomfortable emotions are valuable qualities to cultivate.

Erotic Integrity: How to be True to Yourself Sexually (2016) by Claudia Six

Claudia Six has a PhD in Clinical Sexology, and approaches her book with that clinical lens. Having said that, however, this book is by no means boring! Perhaps it’s the subject matter. What struck me first about this book was Six’s warm writing tone and genuine sex-positivity.

What’s sex-positivity in this context? Sometimes there can be subtle signs that betray an author’s sex negativity: fear-based language regarding STIs, for example. A shaming tone regarding sex work. This author truly celebrates all forms of sexual expression, and compassionately helps people move into alignment with their erotic integrity.

Some of the language in the book could use a little updating, though to be fair language evolves pretty quickly when we’re talking about sex and gender. For example, she uses the term prostitute. Sex work is the preferred language of our day, as it reflects the fact that it is indeed work and should have the same rights and protections as other forms of employment.

Also, though she acknowledges transgender populations, many of the case studies fail to reflect much diversity, and the language could be more inclusive. One dangerous oversight in the book is talking about birth control only in the context of heterosexual sex. Many people who are not heterosexual also need birth control in order to avoid pregnancy. LGBTQIA2SNB youth are among those more likely to find themselves coping with an unplanned pregnancy – perhaps for the very reason that they thought they wouldn’t have to.

Despite these critiques, Six’s approach to cultivating erotic integrity is easy to follow. She goes by three tenets: self-examination, self-acceptance, and self-actualization. People begin by honestly examining who they are as sexual beings – what is true for them, as opposed to what they might have assumed based on cultural conditioning or social norms. I love that she normalizes monogamy, even: you don’t need to be freaky to have an open mind! You just need to honestly examine what is true for you. Next, people work on accepting themselves as they are, whether it is body image that needs some love, or a part of their sexual being that they fear will be rejected. And finally, self-actualization is about moving into one’s authentic being on every level – sexually and otherwise.

The concept of erotic integrity appeals to me, because I see a lot of people suffer when it’s lacking. Part of that is because we live in a culture that doesn’t yet talk about sexuality in an open and celebratory way. How do we approach a conversation about living our sexual lives with integrity, when we don’t quite know how to discuss it in the first place? This book is a wonderful way to invite that conversation and deepen one’s own sexual authenticity.

Come As You Are: The Surprising New Science That Will Transform Your Sex Life (2015) by Emily Nagoski

Arguably the greatest gift that Nagoski brings with this book is the normalization of differing sexual expressions and desires. The author’s clinical background is in female sexuality – again, a big assumption with language that can be amended quite simply by saying people with vulvas. So this book is for vulva owners, and those who love a vulva owner, and those who want to understand vulvas better.

There are lots of educational gems in this book: one that stands out for me is the discussion about desire. People have different levels of desire – in Nagoski’s words, some people have a sensitive accelerator and almost no brake, while others are slow to arouse, if at all. And every manifestation is perfectly ok. She’s got great techniques and suggestions for how people with differing levels of desire can meet on the same page.

I think the biggest takeaway for me from this book, however, is her assertion that sexual desire is an incentive-motivation system, rather than a drive. The reason she gives for this is important: if sexual desire were a drive, like hunger or thirst are, then it would justify people doing whatever they needed in order to satisfy that drive. If someone needed sex for survival, it would even justify assault.

An incentive-motivation system is a fancy way of saying that a person is pulled by an attractive external stimulus. Meeting our sexual desires helps us to thrive, but we don’t need it to survive. As animal behaviourist Frank Beach once said, “No one has ever suffered tissue damage for lack of sex” (Nagoski, 2015, p. 230). I appreciate how this altered my perspective on sexual desire and brought me to a place of greater accuracy with my language about it.

So that’s it – that’s my 2019 (c)literary roundup. I hope this helps people who wanted to learn more about sexuality and didn’t know where to begin. The more we can begin, develop, and maintain healthy conversations about sexuality, the better off I think our whole society will be. So happy reading, and happy new year. In health and wellness, Deirdre.

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Sexual Debut

A fitting way to start a conversation about sex is with a debut. After all, a debut marks a beginning – a premiere event – and that’s what I want to do here. Have some healthy conversations about sex and sexuality.

So what is a sexual debut? Losing your virginity doesn’t have to be a thing. Nor does deflowering or any other metaphor that denotes some sort of paradise lost. Your sexual self is not an accident: it is your amazing, mysterious, and wonderful self-expression.

With a sexual debut, you determine how you enter the sexual scene. Maybe it’s with a first kiss. Maybe it’s in claiming bodily autonomy. Maybe it’s nobody’s business.

Why bother changing the language? For one thing, the ‘losing of virginity’ is such a weird concept. Like, where did it go? I always imagine it wedged behind some couch, gathering dust along with candy bar wrappers and pocket change. Also, what precisely is it that gets lost?

I would rather contemplate sexual self-determination than loss. And I wonder if we emphasize joy how that might alter our cultural conversation about sex? Change begins with conversation, and this is a beginning of sorts, this debut.

I’ve always wanted to talk about these things; as a counsellor I came to suspect that others did too. Please join me. Send me topics that you want to discuss, and let’s create a cultural conversation about sex that is fun, juicy, respectful, interesting. Let’s see how that moves the needle towards sexual expression that is consciously joyful. Next time: Sex Positivity.

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3 Mental Health Websites with a Social Justice Lens

Down by the Riverside motel
It’s ten below and falling
By a ninety-nine cent store
She closed her eyes and started swaying
But it’s so hard to dance that way
When it’s cold and there’s no music
~ Hold On, Tom Waits

It’s hard to heal from depression when you have no home. Treating mental health while ignoring the social context of people’s lives is a little bit like this. Poverty, racism, transphobia, disconnection – to name a few – are not separate from mental health, they are factors in it. You can’t treat one without addressing the other.

The go-to resource for diagnosing mental health issues is the Diagnostic and Statistical Manual, or DSM. It’s considered by many to the authoritative reference on psychiatric illness. As I’ve mentioned before in other articles: a potential danger in one perspective reigning supreme is that we tend to accept it as ‘truth’, drowning out perspectives that challenge the status quo. Dominant narratives often come from the top down, positioning medical and government agencies as experts and discounting lived experience.

There are benefits to consulting the DSM. Sometimes diagnostic clarity guides treatment (medically and therapeutically) in a helpful way. For example, if someone has a diagnosis of bipolar, it’s unlikely that they will be prescribed a stimulant or an SSRI, as both can trigger mania. In this circumstance, the diagnostic clarity that the DSM offers creates greater accountability from the helper, and increased safety for the person receiving help.

Here are a few potential dangers inherent in the medical model of mental health:

  1. Almost everything in the DSM is classified as a disorder. Language shapes our understanding, and disorder implies a ‘wrongness’ or pathology.
  2. Though some mental health diagnoses are fairly stable and consistent, many more are subjective – they come and go as social norms change. Transgender identity was classified as a disorder until the most recent edition of the DSM in 2013; homosexuality as a mental illness wasn’t removed until 1973. The work of LGBTQ+ activists has brought change to cultural understanding broadly, and the DSM specifically.
  3. Its emphasis is on symptoms rather than context, and an individual’s mental health symptoms always occur within a broader social context. Which pill, for example, treats a person’s depression when they’re homeless?

Fortunately, there are mental health activists out there doing very good work. By and large, they have lived experience with mental health issues, ranging from bipolar and schizophrenia to anxiety and trauma. If you’re hungry for differing perspectives on how to consider mental health issues, please check out the following sites.

1. The Icarus Project

One of the best sites I know of, I refer (and defer) to it frequently. The project:
…seeks to overcome the limitations of a world determined to label, categorize, and sort human behavior. We envision a new culture that allows the space and freedom for exploring different states of being, and recognizes that breakdown can be the entrance to breakthrough. We aim to create a language that is so vast and rich that it expresses the infinite diversity of human experiences. We demand more options in understanding and navigating emotional distress and we want everyone to have access to these options, regardless of status, ability, or identity.

The site is a font of resources for navigating crises; considering psychiatric medications; alternate perspectives on hearing voices; and much more. I cannot recommend it strongly enough as both a community for “people who experience the world in ways that are often diagnosed as mental illness”, and an educational tool for those wanting to understand more.

2. Mad In America

This enterprise “is a non-profit whose mission is to create a platform for rethinking psychiatric care.” It aims to challenge the ‘disease model’ approach to mental health, and houses a vast collection of articles on the intersections of science, psychiatry, and social justice. You will find a library of books written by “psychiatric survivors”; educational resources for parents; and reviews of research on psychiatric medications.

3. The Future of Mental Health

The invitation from this movement is to “take charge of your mental health through enquiry and action.” It offers guidance on questions to ask of oneself, one’s helpers, and the current medical system of diagnosis and treatment. You can find a reading list of over 100 books that offer alternative perspectives to the dominant mental health paradigm. There’s also an interview series with innovative thinkers in the field, covering topics ranging from indigenous views on mental health, to first-person narratives on madness.

These websites are but a sampling of the array of conversations we can have on mental health, yet there’s room for even more. If you’re someone who experiences the world in ways traditionally defined as mental illness, I hope you find some connection and empowerment through these sites. And for those who have never experienced the stigmatization that can accompany a label, may these websites illuminate and educate. Let’s co-create a culture where mental health is much more than diagnosis and medication. While these may be a part of healing, we must also address the multiple factors that comprise true well-being, from dignity and respect to food and housing.

In health and well-being, Deirdre.

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A Letter to My Daughter in Birmingham, Alabama

Dearest daughter,

Guard your uterus in these darkening days. Gather your wits as you go into the belly of the beast. Your lifelong dream of travelling to the South has dovetailed with a moment in history. Find a rally. Don’t get shot.

Memes of fallopian tubes giving fascists the finger won’t cut it in this climate.These arcane anti-abortion laws are not concern for human life: like rape,they are about power and control. This is your coming-of-age story.

The uterus is a miraculous thing. Yes, it is. Pre-packed at birth with two million eggs, you will keep half a million of those. Only 300-500 are released in your lifetime – imagine the mystery and potential. The human egg is the largest cell in the human body – visible to the naked eye it’s the size of a grain of sand. All yours, all yours, all yours. The universe in a grain of sand.

The forward progress of the “Me Too” movement is not completely lost. Behind blinding eyes, Bill Cosby may recall his glory days of pudding pops, The Cosby Show, and penetrating unconscious women. But the monuments to his greatness are gone. And Weinstein is no longer a man; he’s a symbol of a man whose time has passed. The Weinstein era. Trump evades his fate like a slippery eel, but his time will come as well.

So until then, dear daughter, guard your uterus. Gather your wits in the belly of the beast. Find a rally and speak up for your constitutional rights to dignity, privacy, and bodily autonomy. And please, I beg of you, do not get shot. You are the universe in my grain of sand.

Love, Mum

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The Art of Truth-Telling

For most of us honesty is a quality that we value, though when it comes right down to it, telling the truth isn’t always easy. If it were, we would do it all the time, and we don’t. On a large scale, many environmental, political, and economic disasters would be mitigated by speaking and acting from truth. As a young adult I starved myself, but only learned how to speak from truth in recovering from anorexia. For individuals and cultures, it’s an essential skill to cultivate.

Within families and communities, truth shines light on sexual abuse, substance use, extramarital affairs, mental illness – heavy stuff, scary stuff. We go to enormous lengths to deny and conceal truths that we fear. There are many ways that people strive to contain certain truths from emerging.

As someone in a profession where sharing vulnerabilities is par for the course, I’ve given a lot of thought to why honesty can seem so hard. Though it’s not an exhaustive list, there are at least three reasons why people don’t tell the truth:

  1. We are afraid of the consequences.
  2. We don’t trust ourselves.
  3. We don’t know how.


Let’s look at the first point. Why would someone be afraid of the consequences of truth-telling? The simple answer is that you may not get congratulated for telling the truth. Perhaps you won’t be believed; maybe you’ll be punished. Some of the greatest pain in people’s lives comes from the fallout of revealing a secret. Whether it’s met with incredulity or outright rejection, the invalidation of one’s truth is an awful – and sometimes costly – thing to bear.

As unattractive as the consequences may be, however, consider the alternative: when you lie, contain, or conceal truths, it creates dissonance in the body, mind, and spirit. It disrupts connection with self and others, and deprives you of being seen as you are. Simply put, it’s exhausting to lie.

Concealing a secret gives it a great deal of power, and if there is another person – an abuser, for example – who also knows, it gives them a certain kind of power over you. Revealing a truth, on the other hand, breaks its spell. Shame researcher Brene Brown says, “If you put shame in a Petri dish, it needs three things to grow exponentially: secrecy, silence and judgment.” When it’s exposed to the light, however, shame can’t survive – it no longer governs a person in the same way. One can breathe more freely and reconnect with life.

Trusting Yourself

One of the things that can make it hard to tell the truth is not trusting yourself. I think at the root of this obstacle is a fear that if you tell the truth and it blows up in your face, you will not be okay. A lack of validation from others does not alter your inner knowing: trusting yourself means that, no matter what, you know you will be okay.

Maybe someone rejects your honesty; maybe you will lose something valuable to you – a partner, a job, your reputation. Those are real fears, with real consequences. But they must be weighed against the cost of concealment – the stress, alienation, and exhaustion of not fully standing in your truth.

There is a difference, however, between an ‘earned’ truth and an ‘owed’ one. With certain aspects of your life, you get to decide who to tell: just because something is true doesn’t mean that you have to share it with everyone. But it’s also not an excuse to conceal the truth from people who have a right to know. For example, there is a big difference between sharing a mental health diagnosis with others (an earned truth) and sharing an extramarital affair (an owed truth).

Of course, there are exceptions to this (not every marriage is built on a cornerstone of this kind of honesty, but you probably know if yours is one of them). And some people share their truths with everyone – power to you! Trusting yourself in this context means attuning to your powers of discernment: is this a truth that I want to share? Do I have an ethical or legal duty to be honest about this? And then building up the courage and self-love to know that you’ll be okay no matter what the consequence.

Telling the Truth

I used to think that honesty was an end in itself, and that it didn’t matter how it comes out. Then I learned that there is certainly an art – a difference between the soft touch and a sledgehammer. As a teacher of mine once said, “Honesty without compassion is abuse.”

So, how do you tell a difficult truth? An important first step is to – again – reassure yourself that you will be okay regardless of whether you’re believed, validated, congratulated, scorned, rejected, or punished. Know your reasons for speaking up, and honour them. Be proud of the courage that it takes. There is a certain kind of freedom that lies beyond the threshold of a binding secret.

If your secret is personal and vulnerable (for example, a mental health diagnosis or surviving sexual abuse), choose the safest and most trustworthy person that you can share with. Ideally this is someone who will hold and honour your truth, and help you find the resources you need. If by some bad luck that person does not hold your truth well, the problem isn’t with what you’ve said; it’s with who you’ve told.

Trust your inner knowing and keep seeking the support you need: it’s out there, I assure you. There is a reason why you have chosen to share, and the right people are out there to celebrate you. The internet is a great place to find supports if you live in an area with limited resources. Keep trying to find the help you need.

If the truth you need to share is of the “owed” variety (for example, abuse of a child or theft of property) it’s still important to trust your inner knowing. Though there’s a higher possibility of legal ramifications (divorce, fine, incarceration), on a fundamental level you will still be okay. Even with a certain loss of freedom, you may in fact feel liberation: there is relief in unburdening heavy secrets. I’ve often thought that when people ‘get away’ with crimes are often not actually free. Sociopathic tendencies aside, people have to live with their secrets and lies.

Your truth is one of the only things you own: no one can take it away from you. Secrets bind, and truths really do set you free. Work to trust, love, and forgive yourself if need be, so that no matter what happens you have refuge in your being. Seek support and guidance from people you can trust, and please be in touch if you need any extra help. In health and wellness, Deirdre.

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Three DBT Skills To Help a Suicidal Teen

Living in the Kootenays, we are isolated from acute care facilities that help teenagers who struggle with serious mental health issues. The closest adolescent psychiatric hospital is in Kelowna; the closest eating disorder hospital is on the coast. If a teenager struggles profoundly with a mental health issues like suicidality or anorexia, they must leave their home community in order to receive the help they need.

We need more resources closer to home for rural teenagers. Not only is it less disruptive, if we’re talking dollars and cents it is also less expensive. With better supports in local settings, communities can gather and help teens further upstream. Dialectical Behaviour Therapy, or DBT, is one such resource.

Dialectical Behaviour Therapy was originally designed to help profoundly suicidal patients within hospital settings. As the name suggests, at its outset DBT was a behaviour therapy, meaning that its approach was to change ‘problematic’ behaviours. However, the pioneering patients of the therapy felt that they were being moved too fast into changing their behaviours. As a result, DBT was modified to be based on acceptance and change. A key tenet of DBT is that one must first accept reality as it is – totally and completely – before even beginning to contemplate change.

I sometimes get calls from concerned parents, psychiatrists, and other helpers looking for DBT support specifically for teens. It’s a good fit: teens often struggle with regulating emotions, relating with parents, impulsive behaviours and so forth – all of which DBT addresses. While it is often delivered in a group setting, there is no such resource for teens in the West Kootenays. The good news is, DBT skills can also be utilized on a one-to-one basis. There’s even a great DBT book for adolescents. It’s full of skills and activities to work through alone or with another. Below are three skills that can help teens who struggle with suicidal ideation. The last one – TIPP – is specifically for when crisis feelings are high.


Many of us know how it feels when our truth is not validated from the outside. On the emotional level, it doesn’t matter very much whether other people’s intentions are kind or hurtful: a feeling of invalidation leads to isolation. If the pain is too great to bear, it can turn to suicidal thoughts and behaviours. The founder of DBT, Marsha Linehan, outlines some of experiences that lead to painful invalidation:

1. Being ignored.
2. Being repeatedly misunderstood.
3. Being misread.
4. Being misinterpreted.
5. Having important facts in your life ignored or denied.
6. Receiving unequal treatment.
7. Being disbelieved when being truthful.
8. Having private experiences trivialized or denied.

For many teenagers, being misunderstood is quite common. Feelings of injustice can arise when perspectives are ignored, or when teens differ from their caregivers on the best way to guide them. It is a difficult time of life. Power dynamics shift and they often see things differently than the adults in their lives. Whether or not teenagers find support and validation on the outside, there are skills by which they can self-validate. These include:

1. Being non-defensive and checking the facts of a situation. Are your responses valid, or have you misunderstood another’s intentions? If you have someone in your life that you trust, check your responses with them.
2. Acknowledge when your responses don’t make sense, and drop blame – it rarely helps.
3. Be kind to yourself. Remind yourself that you are doing your best (just getting through the day can be a heroic accomplishment).
4. Admit that it hurts to be invalidated by others.
5. Grieve traumatic invalidation and the harm it creates. If you have a trusted person in your life, share it with them.

Radical Acceptance
Radical acceptance is a superstar of the DBT world. In a nutshell, what it means is this:

It is what it is.
Oftentimes, the pain we experience is exacerbated by the idea that if we could only make it different somehow, things would be better. We don’t like the present moment. We hate the way things are. As unpleasant as things may be, however, if we rail against the reality of it we only increase our suffering.

The word radical has its origin in the Latin word radix, or ‘root’. What it means in this context is to go all the way to the root of acceptance – totally and completely. In radical acceptance there’s no “Yeah, but…” It’s complete acceptance, all the way, even if the situation sucks.

Sometimes people think that acceptance means saying that something is okay, even if it is intolerable. That’s not what is meant here. It means is that even if the situation is unacceptable – say, sexual abuse for example – radical acceptance simply states that it is what it is. It doesn’t cancel out problem solving or change. It just means that we have to allow that the bad/uncomfortable/painful thing happened/is happening/might happen.

TIPP Skills

When a person is in crisis, these are the skills to use. The human nervous system consists of both the sympathetic and parasympathetic nervous systems. The first stimulates arousal; the second calms us down. All of the TIPP skills work to stimulate the parasympathetic nervous system. These skills don’t replace the problem solving; they calm us down enough to begin to think of solutions.

1. Temperature
The ‘T’ stands for changing your facial temperature with cold water, while holding your breath. This activates the dive reflex, which reduces physiological and emotional arousal. For those who are unfamiliar, the dive reflex causes the heart rate to slow down to below resting heart rate in mammals when they are immersed in very cold water without oxygen. A great way to do this is to fill a sink with very cold water and ice if it’s available, and then immerse your face for as long as you can hold your breath.
Caution: please avoid if you have heart problems. There are other skills you can use in a crisis.

2. Intense Exercise
The ‘I’ stands for intense aerobic exercise for at least 20 minutes. Not only does intense exercise increase positive emotions, it also helps to shake off unpleasant ones. According to DBT, emotions help to organize the body for action. For example, anger cues the body to fight, while fear cues us to run. Sometimes emotional reactions are not useful and can even make a situation worse. Exercise can help us discharge the energy of the emotion without causing any harm.

3. Paced Breathing
The last two TIPP skills are less vigorous and better for people who, for whatever reason, should avoid extreme physical states. Paced breathing includes slowing the breath down to 5 or 6 breath cycles per minute, and breathing deeply from the abdomen. The outbreath should be longer than the inbreath. This longer outbreath stimulates the parasympathetic nervous system, which in turn calms the body down.

4. Paired Muscle Relaxation
With this skill, the strategy is to tense muscle groups while breathing in, and then to relax the muscles on the outbreath while silently saying “Relax”. This skill teaches a person to notice the sensations of tensing and relaxing, and also allows for greater muscle release by tensing first. Pairing it with a word (the word can be anything calming) also brings a different level of awareness to the calming intention.

This is a “quick and dirty” rundown of some DBT skills to help teens work through suicidal thoughts and behaviours. It is by no means exhaustive, and is meant to complement rather than replace a safety plan. If you know (or are) a teen who is suicidal, make sure that there is a trusted someone to reach out to – be it a friend, a caregiver, or a counsellor. There is a 24/7 crisis line to access, and you should know where the nearest emergency room is as well. If all other supports fail, this is the place to go, any time of the day or night.

It is sometimes said that suicide is a permanent solution to a temporary problem, and I really do believe this to be true. It can be hard to believe that things will get better – especially when you have relatively little life experience with which to compare your current situation. The beautiful thing about getting help young is that the earlier someone gets help, the better the outcome – even going into adulthood. So don’t be afraid to reach out – there is help, hope, and healing available. Feel free to be in touch if you have any questions. In health and wellness, Deirdre.

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Anorexia, Bulimia, and the Starving of Saints

There is an idiom about the canary in the coal mine, dating back to when miners brought caged canaries underground with them. If the canary died, signalling toxic levels of methane or carbon monoxide which were undetectable by smell, the miners knew to get out. I’ve heard those with eating disorders likened to canaries in coal mines – delicate, small beings heralding some imperceptible danger. Sometimes, too, they pay with their lives.

A compelling parallel can be drawn between the canary and those with eating disorders (often young, usually female): underestimated, ornamental, expendable – their deaths indicative of a problem beyond themselves.

But what might eating disorders say about our culture at large? For although narrow body image standards extend ever farther with the impact of globalization, eating disorders are a particularly Western problem.

Tracing Western thought back a ways, the influence of Judeo Christian values on our culture is undeniable. Not long ago, the Lord’s Prayer was recited in the classrooms of public schools, and – needless to say – what are you doing for the holidays? How we organize our time, many of our statutory holidays, the very year we are in, orbit around the Christian calendar.

Here’s something to ponder: a great number of Christian saints died of anorexia. The literature does not define it as anorexia nervosa mind you, but really, how can we know? To explain the difference: anorexia is simply a medical term meaning “a lack or loss of appetite for food.” Anorexia nervosa, on the other hand “is an emotional disorder characterized by an obsessive desire to lose weight by refusing to eat.” This starving of the saints has been called “holy anorexia” – the melting away of flesh to be closer to God.

Compare this, on the other hand, with the seven deadly sins, of which gluttony is one. In this context, to hunger, to desire, to eat and not stop is sin – a deep taboo. In Latin, bulimia literally means “ox-hunger” (bous=ox, limos=hunger). In modern times, we intersperse saintliness and sinfulness into how we describe food and desire. There are ‘pure’ and ‘clean’ foods; angel and devil’s food cakes; temptation and denial; ‘sinful’ indulgence; good or bad foods – the list goes on. Control over our physical nature is both implicitly and explicitly reinforced as desirable, even morally superior.

Which brings me to another point: in the 1600s, when Rene Descartes said, “I think, therefore I am” he ushered in a new mode of thought that we now call Cartesian dualism. It runs like a silent, underground river – or noxious substance, depending on your politics – through our culture to this day. Dualism separates the mind from the body, and – as his famous statement suggests – elevates the former.

Reason over emotion dominates some of our most respected institutions, from law to ‘higher’ learning. Feminist scholars have done an admirable job of tracing how this dualism prizes the masculine over the feminine, as well. After all, women are inextricably bound to their physical nature – at the very least, every month. As a quality, emotion is considered more feminine, ration more masculine. Again, the list goes on.

At the intersection of the Western body, these associations have been grave. As women have been subjugated, so have their bodies – indeed, subjugated because of their bodies.

Eating disorders are a new(er) spin on an old story: that the avenue to worthiness, goodness – ‘perfection’ – is through denial of the physical self.

There is no room for the deep wisdom of bodily hunger, or for the sensual joy that comes from loving life. There is no room for that to be form of worship, devotion.

And this worthiness we seek: of what, to whom? The old answer would be God; the new answer is open to interpretation. Certainly, media is a modern day god, and a punishing one at that. The beauty industry alone is a multi-billion dollar enterprise, keeping us spending with little regard for cost to the individual. By design, it constantly shifts the goal posts beyond reach while it sells the fantasy of perfection.

In the midst of my own eating disorder decades ago, a new thought occurred to me:

What would I be doing with my life if I weren’t so obsessed with this impossible pursuit?

And the answer was: pretty much anything. Using my voice, that’s what. Taking up space, that’s what. Asking that question was my first awakening to a life outside of the Matrix.

And there’s another message here about freedom. The canary in the coal mine was caged. Do you think she so loved the miners that she volunteered for her mission? Doubtful. Throughout history and even today, women have been caged, corseted, covered, concealed. The peculiar success of the eating disorder is that a person comes to confine themselves, and that it appears to be an individual – rather than cultural – problem.

As feminists of the 1960s said, the personal is the political. To believe that eating disorders are unique to the individual is to not question the institutions that shape our thought. If eating disorder sufferers are canaries in coal mines, it leads one to wonder a few things:

· Who has the right to confine another ideologically?

· Who benefits from that confinement?

· What if, instead of disappearing, individuals broke free and took up space?

And a word about the miners in all of this: the same system that sacrifices canaries is the very one that sends men underground to work for wages at the cost of their lives. Guaranteed, someone profits from that sacrifice. This narrow focus on body image that occupies our culture is a red herring of sorts. It keeps us from remembering to ask whatever was wrong with our body in the first place. And who got to set that standard?

Perhaps the greatest cost incurred is that eating disorders inhibit exploration; taking up space; and being of service to some cause greater than perfection. The actual answer that emerged for what I would be doing with my life if I weren’t so preoccupied with an eating disorder was this: digging waters wells in Africa. I haven’t done it – yet. But now that I’ve said it aloud, I have to. And because I’m alive, I can. It is the privilege of living in this human body.

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What’s the Difference Between Borderline and Bipolar?

That’s the question that begat this article, but it mushroomed into more than that. You see, to talk about how borderline and bipolar are different, we also need to talk about how they’re similar. And to talk about how they’re similar, we need to talk about how they’re both diagnoses in the Diagnostic and Statistical Manual, or DSM. And to talk about the DSM, we need to talk about how language shapes our understanding of a thing.

On Language and the DSM

If you’re unfamiliar with the DSM, it’s the manual that contains all the current psychiatric presentations. A new one is published roughly every 10 years or so; the fifth one has been out for about 5 years. Everything in the DSM – from anxiety to adjustment to tobacco use – is classified as a disorder.

Classifications and definitions change: for example, the DSM listed homosexuality as a mental disorder until 1987. One can see how this paralleled our cultural treatment of homosexuality as somehow ‘unnatural’. Gender dysphoria is still a classification in the DSM-V, parceled out with goal posts such as “a marked incongruence between one’s experienced…and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following symptoms”. The medicalized language, with its precise delineation of symptoms, suggests that gender – already a cultural construct – can be quantified in this way. It also implies, in what is perhaps the oddest feature of all, that the American Psychiatric Association is the premiere authority on this matter.

The point I’m trying to make here is that what we collectively decide is a disorder – and what the parameters of that ’disorder’ are – is a human construct, not necessarily fact. It would be dishonest, however, to say that certain presentations do not share recurring constellations of symptoms, because they do. What we call bipolar has existed for as long as humans have recorded symptoms. The Traditional Chinese Medical text the Spiritual Axis, which dates back to 475 BCE, describes it thusly:

When Dian [Depression] first appears, there is lack of joy, heavy and painful head, red eyes, eyes looking up. When Kuang [Mania] first appears, there is little sleep, no hunger, glorification of the self as if one were the most knowledgeable person, shouting at people, no rest in day or night.

I will say two problematic things about the DSM. First, the language we use shapes our experience. Whether we use strengths- or deficit-based language is a choice that will influence how we connect with another, and whether that person feels safe with us. When we use the word disorder it de facto becomes pathology, and sometimes by extension we pathologize the individual. I personally avoid using the word disorder when I can, and try to honour how a person defines themselves. For some, a label puts them in a box; for others, it sets them free.

The second thing I want to highlight is that the DSM carries a great deal of power: for better or worse, it shapes the dominant discourse around mental health. You know the saying, “If all you have is a hammer, everything looks like a nail?” Well, if all you have is the DSM, everything looks like a disorder. Boiled down to its simplest element, what I’m trying to say is this: think critically about all information, including this article. No one has an absolute window on the truth.

Back to the Original Question

An important distinction between borderline and bipolar is that bipolar has a strong physiological/genetic component. One of the screening questions for bipolar is whether any family members have had it. Borderline can also run in families, but that tends to be more a product of environment than genetics. Moreover, people often outgrow a borderline presentation with maturity, treatment, and time, whereas for most people, bipolar is a sidekick for life.

Impulsivity and extreme highs and lows can make the two look similar, though in borderline the behaviours can shift many times within the same day and are usually caused by external factors. With bipolar, on the other hand, the factors generally have a physiological basis and episodes last longer. There are some hallmarks of mania that you wouldn’t find with borderline, such as not sleeping yet not being tired; a rapid rate of speech; an elevated expression of righteousness. Bipolar depression is unique, as well. In the absence of mania it can look like regular depression; however, with bipolar antidepressants often trigger mania.

Also, there are some things that make borderline unique. Some people experience an inconsistent sense of themselves. Suicidal or self-harming behaviours are quite common. Intense relationships can form quickly but then fall apart, intensifying a person’s feelings of unworthiness. Sometimes because of boundary violations in the past, a person has difficulty making or honoring boundaries in the present. The good news is: sense of self, effective ways of expressing distress, and boundaries are all teachable skills. With time and effort, a person doesn’t need to feel dominated by their emotions.

Treatments for Bipolar and Borderline

For both borderline and bipolar, stress can make things worse, so skills in this area are very helpful. The ‘usual suspects’ apply here: how is the person sleeping? Eating? Moving? What substances are they putting in the body? Tending to sleep is particularly important with bipolar, as lack of sleep often precipitates an episode of mania or depression, and is itself a symptom of mania. Food is our original medicine. Having awareness of the effects sugar and caffeine, for example, can take a person a long way in regulating their own mood naturally. Ditto with exercise: move your body and chances are you’ll feel better. Even the act of getting outside and feeling the air on your skin is a powerful step in the direction of mental health.

Because borderline is influenced so much by environment, it’s helpful for individuals to gain skills that allow them respond to the events and people in their lives. Dialectical Behaviour Therapy, or DBT, is a go-to treatment for borderline. Based on acceptance and change, DBT teaches mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. As someone who has taught DBT groups for years, I can say that it teaches great life skills for anyone – you don’t have to have any sort of ‘diagnosis’ to reap the benefits. And also, people in DBT groups are always changing their hair colour, their piercings, their style. There’s never a dull moment and I love it!

On Social Justice and Mental Health

I’m including here some of the excellent work done by the Icarus Project, which is a “media and activist endeavour broadly aligned to a Recovery approach, arguing that mental illness should be understood as an issue of social justice”. For those of you who don’t know, Icarus is the figure from Greek mythology who was warned by his father but nevertheless flew too close to the sun with wings made from feathers and wax. The wax melted and he plummeted into what is now known as the Icarian Sea. The myth is often used as a metaphor for bipolar.

However, as a person whose own namesake from Irish mythology, Deirdre, suffers a similarly tragic ending, I’d like to offer a different interpretation. What if Icarus did touch the sun, and made it, and everything was okay? John Lennon asked, “Who in the world do you think you are: a superstar? Well, right you are!” What if, as he wrote, we all shine on, like the moon and the stars and the sun?

The Icarus Project goes on to state that “a person’s mental state can improve through greater social support and collective liberation.” That is my stance as a counsellor as well:

The more we attend to social justice as an aspect of mental health, and hold one another in community rather than isolation, the closer we all are to liberation.

Just because you have a mental health diagnosis doesn’t mean it defines you, but it doesn’t mean you need to ignore it either. Know yourself and the terrain of your symptoms, and create a care plan that works for you. Reach out if you have any questions and, as always, in health and wellness, Deirdre.

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