Working with teens in the counselling space can be incredibly rich and rewarding – and it also holds its own considerations. Beyond basics like whether they’ve come to therapy of their own accord or have been sent by a caregiver, there are other factors to be aware of when working with this population. Simply put, teens are their own animal. Their brains are developing in different ways than younger children or adults. This invites counsellors to view them through a broader lens, and also offers the potential for deep discovery and insight in therapy.

Dr. Daniel J. Siegel, psychiatrist and founding co-director of the Mindful Awareness Research Center at UCLA, explains the twofold task of the adolescent brain as it remodels itself. Its first task is to prune itself. Whereas in younger childhood the brain is absorbing any and all information, during adolescence the brain begins to differentiate. This is where teens begin to specialize and find their passion.

The second task of the adolescent brain is myelination. Myelin is the healthy sheath that allows connected neurons to communicate with each other in a faster, more efficient, and coordinated way. Teens can use this focused attention to become more aware of themselves, others, their environments, thoughts and activities. The potential this offers in the counselling space is vast, as so much of our work with adolescent clients involves supporting them to expand self-awareness; build interpersonal skills; and connect to their meaning and passion.

This myelination – or linkage, as Siegel calls it – can reinforce parts of the brain that a person wishes to hold onto. Between the differentiation provided by pruning, and the linkage from myelination, the brain becomes more integrated. And integration, according to Siegel, is what allows “more intricate functions to emerge – such as insight, empathy, intuition, and morality. A result of this integration is kindness, resilience, and health” (reference #1, see below).

In his work, Dr. Siegel puts forth what he calls the ESSENCE of adolescence – an acronym that stands for Emotional Spark, Social Engagement, Novelty-seeking, and Creative Exploration. Emotional spark refers to the way that “emotion generated from sub-cortical areas washes over the cortical circuits of reasoning” (reference #2, see below). When we talk about teens and emotions, we often hear stories about attitude. Viewed from a more empowering lens, however, emotional spark points toward their passion and idealism.

Social engagement refers to the importance of relationships in our lives. During adolescence, this can look like turning away from parents and more toward peers. It also highlights how central relationships are in influencing and shaping who we become. Social engagement is an important aspect of our sense of connection to the world around us.

Novelty-seeking can certainly be problematic for teens: though their bodies are strong, they can be at greater risk for injury and harm. It’s one of the reasons why getting a driver’s licence is such an arduous process, and why insurance rates are higher for new drivers. On the other hand, novelty-seeking is what allows teens to move beyond the safe and familiar and into the great unknown – an important task in becoming their own people. And finally, creative exploration is a feature of the idealism that we often see from youth – that ability to see beyond (and challenge!) the status quo, in order to imagine what could be.

Why spend so long setting the stage simply to discuss alternative therapies for teens? It’s important to appreciate who we are working with so that we can understand better ways to serve them. What follows are some of my favoured approaches to working with teens – and there are many more, as well.

Art Therapy

Art therapy is a great go-to with teens. At this age, straight-on talk therapy can feel too direct. For some, language isn’t a great resource, and talk therapy can be quite demanding in this respect. Others are in counselling because their caregivers want them to be. In those cases, buy-in is not even a guarantee. Finding common ground and ways to establish therapeutic rapport are paramount.

Many adolescents also prefer a more casual approach, finding a clinical setting to be too formal for them to relax and feel safe in. Pulling out art supplies can help teens feel at ease. It invites imagination, creativity, and play. And though play sounds like a simple concept, its effects can be profound.

One of the things we can work with in art therapy is implicit rather than explicit processes – the emotional more than the cognitive. Allan Schore (2009) discusses the dominance of the right hemisphere of the brain in “the recognition of emotions, the expression of spontaneous and intense emotions, and the nonverbal communication of emotions” (p. 114). When we sit down to play with our adolescent clients, we come alongside and communicate indirectly with their emotions.

The results are often surprising. One teenage client I worked with had been coming for weeks, quite unwillingly. As a general rule I tend to decline working with clients who do not wish to be there. I made an exception in this case because the severity and immediacy of the trauma warranted intervention. We plodded along, week after week – I, trying to build therapeutic rapport and they, steadfastly withdrawn. One week we did some drawing to explore the trauma. What they drew was nuanced and expressive, the emotional communication as clear as a bell. While they had been drawing I also drew – a unicorn wearing high heels. For the first time I saw this client laugh, marking the beginning of our therapeutic bond.

Through the lens of Daniel Siegel’s work, what came alive in this interaction was the client’s emotional spark, as they shared their passion for art with me; their social engagement as we connected relationally for the first time; and of course, their creative exploration. They wordlessly taught me what they needed from therapy: an approach that fit their passions, and a language through which they could express themselves.

Somatic Therapy

Somatic therapy is a body-based approach to working with clients (soma means body in Latin). In this therapeutic technique, the body is seen as a holder of information – if you’ve ever heard the term “your issues are in your tissues” it fits here. It’s particularly useful when working with trauma. There are certain situations when cognitive approaches fall short: simply put, one cannot think their way out of trauma. When trauma is alive in the body, it must be resolved in the body.

In situations of dissociation or disconnect, somatic therapy is a means by which counsellors can help the client re-enter their bodies in a safe way. A guiding principle is that we cannot change what happened in the past, but we can change the way it’s held in the present. And the way we do this is twofold: with present-time awareness and relational support.

Generally speaking, the present moment is safer than the traumatic memories from the past. As counsellors we can help clients anchor themselves in the present moment so that they can recognize and distinguish this from the past. It must be a ‘felt sense’: their body must take in the information of the now, and allow it to update residual fear and trauma still being held in the body.

Another other key piece of somatic therapy is the relational nature of trauma. Oftentimes there was not enough (or any) support for the individual when the trauma occurred. A phrase that lends well to the experience is “No map, no help, no exit”. Our role as counsellors is to help repair that rupture, as we support the client in the present. We do this through attunement, validation, and mirroring the client’s words and gestures.

Somatic therapy lends well to themes that can arise for teens, such as bodily awareness and boundary support. Growing up, it’s fairly standard for children to be given a lot of direction. As they enter adolescence, they begin to see the world more through their own eyes. This fits well with Dr. Siegel’s’ pruning concept: rather than taking in any and all information, teens begin to specialize and find their own passions and interests. What helps any of us know what matters to us, what rings true and what does not? Bodily awareness is essential to this – the ability to check in sense of what fits, what feels safe, and what inspires us. Some people call this gut instinct.

As teens move beyond their families and into broader social connections, understanding boundaries takes on new meaning. There are a couple of activities that I like to use with them to help them gain a greater sense of their own personal space. In the first activity, they stand still and I gradually approach them. This goes very slowly so that they can continually check in with their bodies and see how they feel: Is the person too close? Do I want them to come closer? Would I like them to be more to the left or right of me? I encourage teens to get really fussy about their needs – oftentimes a new permission for them. The goal is for them to get a felt sense in their bodies of what feels ‘just right’.

Another way to explore boundaries is with props. I offer them rope and encourage them to create a circle around themselves, however large or small they feel it needs to be. Then using other props as well (pillows, furniture), I encourage them to make the boundary as strong or as permeable as feels right to them. And then again, we explore how close or near feels okay for them to have someone approach. During adolescence, teens often begin to explore intimate relationships for the first time. Whether for this reason or to simply practice assertiveness, boundary work can be a means for learning about embodiment, autonomy, and empowerment.

A Final Word

An academic supervisor for my counselling degree once said to me, “You should be experimenting in therapy.” This surprised me: at the time I really thought we had to do things by the book. As open as teens are to novelty seeking and creative exploration, they are among the most up for experimentation in therapy. Our adolescent clients are wonderful teachers.

In the end, it comes down to safety and rapport. When clients feel safe with you, they are more likely to trust the therapeutic process. The more that we, as clinicians, can abandon our own agendas and show up for what happens in the present moment, the more our teens clients will feel seen and respected. And I might add: it’s better for us, as well. Curiosity, exploration, and play don’t stop in adolescence. These qualities help us keep the passion for our work both generative and alive.

Resources

1) Dr. Daniel Siegel’s work, including articles, videos, and books: www.drdansiegel.com

2) Art therapy content and ideas:
expressiveartworkshops.com
arttherapyblog.com
thirstyforart.com

3) Somatic resources:
Opening to Grace Somatic Studies ~ openingtograce.com
*this is where I received my certification in relational somatic therapy

Lisa Mortimore ~ lisamortimore.com/workshops-training/
*Dr. Mortimore has contributed to Insights magazine in the past, and also offers trainings in somatic attachment

Trauma Geek: Trauma and Neurodiversity Education ~ facebook.com/TraumaGeek/
*this creator generates incredibly comprehensive and educational posts on, among other things, somatic therapy tools

References Within the Article

1) https://www.drdansiegel.com/about/interpersonal_neurobiology/

2) https://www.drdansiegel.com/blog/2014/02/07/the-essence-of-adolescence/

3) Right-Brain Affect Regulation: An Essential Mechanism of Development, Trauma, Dissociation, and Psychotherapy, Allan N. Schore, The Healing Power of Emotion (pp. 112-144).

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 behavioral 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.

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.

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

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.

Consequences

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.

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.

Not infrequently, I will receive a call from someone who is looking for help with addiction. In these calls I’m thinking about, it’s not the person suffering the addiction who calls – it’s a loved one. They want to know a few things:

What can I do to help?

What am I doing that harms?

Where can I find support for myself?

It’s an apt analogy to say that loving someone in addiction is like standing on the shore and watching your beloved thrash about in the waves. It’s painful. It’s scary. You don’t know if they’ll survive.

Addiction is an interesting area of mental health. Though it’s often grouped with mental health (as in, mental health and substance use treatment centres), it’s also distinguished from it. One we treat as an affliction, the other as a choice. It’s a curious thing that they are treated as separate issues, and the outcome can mean the difference between compassion and criminality.

When someone with any other mental health issue – from bipolar to anorexia to schizophrenia – becomes ill to the extent that they are gravely harmful to themselves or others, they can be hospitalized involuntarily until the risk is no longer critical. Not so with addiction. Unless incarcerated, which brings a host of other problems, a person in addiction must voluntarily seek treatment in order to get help. This can take years, for those who are lucky enough to make it.

And where does this leave loved ones? The answer is, feeling pretty helpless much of the time. Grieving someone who is still alive. Wading in the muck of uncertainty, teetering between anger and despair. So, let’s begin to unpack some of the more common questions that loved ones ask.

What can I do to help?

When someone lives with chronic pain, the pain never really goes away. The trick is to live with it mindfully, appreciating subtle differences in sensation and noting how the pain changes from one moment to the next. When you love someone with addiction the pain is always there…but life still needs to go on. There are birthdays to celebrate; love still wants to love. Rather than letting it stop you from enjoying life, invite the pain to come with you. Allow it as a guest, whether welcome or not. To resist it is to increase its hold.

Another way to help is to tend to your own wellbeing. Find a counsellor or support group if that is helpful. Eat well, sleep well, move your body. Recognize that there are other areas of your life to attend to; other people to love; events, holidays, and hobbies to enjoy. I will include resources on extra support at the bottom of the article.

What Am I Doing That Harms?

The most important thing you can do for someone in addiction is continue to hold that person in love. It’s an affliction that is easy to vilify: often the person’s behaviour is unattractive. Sometimes it is actually abusive.

So, what does loving someone with an addiction look like? Sometimes it means making a boundary. This can be anything from telling the person you will talk with them when they are sober, to calling the police if the behaviour is abusive.

In the 12 Step Tradition there is a saying: You can have boundaries or you can have resentments, but you can’t have both.

Even though boundaries can seem harsh, when done in the spirit of love they are anything but. Enabling a person to continue on a destructive path by ‘protecting’ them, however, can be inadvertently cruel. Sometimes the most loving thing you can do is stop protecting them and get out of their way so that they can crash.

Another way you can reduce harm is with your language. You may have noticed that throughout this article I don’t use the word addict. I do this intentionally to create distance between the person and the problem. While I will say that someone struggles with addiction, I won’t call them an addict. Your perspective may differ on this: whatever your choice, I invite you to bring awareness to the power of language to both harm and heal.

Where Can I Find Support For Myself?

Certainly, loved ones are the silent sufferers of addiction. There are treatment centres, support groups, and counselling for those in addiction, but far less for those on the periphery. Below are links to a few supports for loved ones:

1) To date, no one in the recovery community has mobilized or organized quite as successfully as the 12 Step Tradition. Al-anon (and Alateen) “are people, just like you, who are worried about someone with a drinking problem.”

https://al-anon.org

2) SMART Recovery Family and Friends is “a science-based, secular alternative to Al-Anon”. They have lots of great resources on their website for loved ones of people struggling with any addiction, not just alcohol.

https://www.smartrecovery.org/family/

3) Emotion Focused Family Therapy (EFFT) “support[s] caregivers to increase their role in their loved one’s recovery from mental health issues”. This support is mainly geared towards parents of children in their care, though it is useful for parents to children of all ages.

http://www.emotionfocusedfamilytherapy.org

4) For people supporting those with addiction in Nelson and surrounding areas, the Addictions Day Treatment Program (ADTP) out of Castlegar holds family and friend support groups on occasion. To find out when the next one is being offered, call 250-304-1215.

It is my heart wish that this article makes you feel more empowered and less alone. If you find yourself standing on the shore of a loved one’s addiction, you can still appreciate the beauty of the landscape. Send love and assistance to your loved one when you can, and also tend to the other areas of your life with care. If you would like more support or have any further questions, please feel free to get in touch with me.

In health and wellness, Deirdre.

When I began my master’s degree in counselling, the first thing that struck me was how genuinely warm and kind my classmates were. In a roomful of people that supportive, I thought to myself, “I’m home!” It’s pretty true that, by and large, counsellors are a caring bunch of people.

That said, when you’re looking for a counsellor of your own, it can be hard to choose the right one. How do you know who will be a good fit – what should you look for? Choosing the right counsellor is an important decision, and there are a few guidelines that will help you make the right decision for yourself.

Talk with them first

The first thing you want to do is find one that offers a free consultation. You can do this either by phone or in person, and an ideal amount of time is 20-30 minutes. The idea is that you get to ask them some questions and get a sense of their style. Just like any other important relationship, there are some people you will naturally feel more comfortable with, and that’s the sort of feel you want to go for.

I find that when someone is new to therapy, they are often unsure of how this initial conversation should go. I encourage you to have a few questions prepared – after all, you’re interviewing them for an important position in your life. A counsellor should be approachable, professional, and prepared. A few examples of questions to ask include:

1. What is your style of therapy?

2. What is the structure of your sessions?

3. What do you love about your profession?

Choose a registered counsellor

There are some exceptions to this and the designation doesn’t matter to everybody. Generally speaking, however, a counsellor having some kind designation is a good idea. Here’s why:

First, it shows that they have put in the time, dedication, and commitment to educating themselves well for this most trusted profession. For me personally, my ongoing dedication to education is an ethical stance that says I can hold the space for someone and I know what I’m doing. It also says that if something is beyond my scope of practice and I don’t know what I’m doing, I have the ethics and education to know that, and to guide a person elsewhere.

Another reason why choosing a registered counsellor (or social worker, psychologist, etc.) is important is for the purpose of benefit plans. If you have a benefit plan through work and it covers counselling of some sort, your plan will require you to engage in services with a registered provider. An important caveat: check with your plan to see what it covers. Some plans cover services with a registered counsellor, and others cover services with a registered social worker or psychologist. This will guide you in your choosing.

Go with what feels right to you

After attending to some of these checklist items, there really is no substitute for just knowing what and who feels right to you. Many factors may influence that decision:

1. Do you have a style of therapy that you either prefer or feel curious about? Maybe you’ve heard of Dialectical Behaviour Therapy and want to try it out, or you’ve done Narrative Therapy before and really like that approach. When a third party is paying for the sessions (for example, a graduated return to work after injury), they may require you to engage in the evidence-based Cognitive Behavioural Therapy. In that case, you might want to ask a counsellor about that. I will add here that research shows that the therapeutic relationship, more than any other factor, determines the success of therapy. In other words, if you have a good bond with your counsellor and you trust them, you’re more likely to reap the benefits of counselling.

2. Are you looking for someone with particular training in a certain area? For example, above and beyond offering anxiety and depression therapy, I have specialized experience with body image, self-esteem, and eating disorders. I also have training in issues pertaining to gender and sexuality: my ethical stance is to be an advocate and ally for gender-affirming health care. Other people have special designations in art therapy or somatic therapy – the list is broad and varied. Think about what is important or interesting to you, and try to find a counsellor who fits that description.

3. Money may be a factor and if so, don’t be afraid to ask a counsellor if they have a sliding scale. Even if they don’t explicitly say it on their website, many counsellors offer sliding scales based on financial need. In fact, if you have any questions that aren’t answered on their website, be sure to ask. You may be pleasantly surprised if you do.

I hope this article helps you in your pursuit to find a counsellor who is right for you. Please feel free to reach out if there’s anything I can help you with. In health and wellness, Deirdre.

“There’s no such thing as a stupid question.”

Or, as one of my teachers said, “Yes there are, but those are outliers and they don’t count.” The simple truth is that we often don’t know where an encounter will take us, and that’s the good news: this is where magic can happen. Professionally and in life, the courage to be curiously questioning opens us up to worlds of possibilities.

It requires vulnerability to ask a question for which you have no answer. You risk exposing yourself as a non-expert, or looking ignorant. Yet, as Brent Atkinson states:

“The way our brains our wired, the most effective way to solicit cooperation is by exposing vulnerability.”

Many of us can identify with the feeling of relief when someone else asks a question we are too afraid to pose. “Thank goodness,” we think. People trust sincerity, and it puts others at ease when we reveal vulnerability. It’s honest; it’s human.

When you wonder in the spirit of open-ended enquiry, seeking to learn rather than to prove, you expand your horizons and minimize the chance for bias in your thinking. On the other hand, asking leading or close-ended questions can promote a false sense of certainty and garner premature conclusions.

Assuming we already know the answer before we ask a question puts us in the same quandary as bad science: we risk making the facts fit our theories rather than the other way around.

It’s okay to begin with an idea – we often do. But from that point, try to see where the enquiry takes you. Your destination may come as a surprise and perhaps (hopefully) you will learn something along the way. Asking, rather than knowing, is really at the heart of intelligent enquiry. Einstein himself stated, “Imagination is more important than knowledge.” The poet e.e. cummings put it this way: “even if it’s sunday may i be wrong/for whenever men are right they are not young.” Not knowing can be a great thing!

The journey to embracing wonder and curiosity is fundamentally one of humility.

The very act of asking invites feedback, allowing for connection and attunement with others. In essence, we are saying, “Are we on the same page – have I understood you?” or, posed in the language of richer enquiry: “How may I understand you better, and what would you like me to know?”

What adventures await when we follow the path of openhearted questioning?

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6 Steps to Asking Curious Questions:

1. Don’t be afraid to ask questions! Welcome the quality of wonder.

2. Recognize that enquiry is a form of intelligence. From the ignorance of ‘not knowing that you don’t know,’ move to ‘knowing that you don’t know’ and from there, take steps toward discovery.

3. Be aware and self-reflective. Search for hidden biases and assumptions you may have.

4. See asking as a form of humility. It is gracious to share your vulnerability with others, and fosters understanding and connection.

5. Ask open-ended questions that cannot be answered with ‘yes’ or ‘no.’

6. Be prepared to be surprised! Be prepared to be wrong! Celebrate this.