What is different about Gottman Therapy.

Treatment for Depression: Vancouver | Burnaby

DEPRESSION AND ANXIETY COUNSELLING & THERAPY IN VANCOUVER, COQUITLAM, BURNABY and NEW WESTMINSTER, BC

The rates of Depression and Anxiety are increasing all the time. This includes the rates of these disorders for children, adolescents and adults. Depression and Anxiety lead to difficulties at school, work, with friends and in our personal relationships, including couples and marriages. Both of these disorders are treated initially by the medical field with medication. This is often useful, and sometimes necessary, however comprehensive treatment of Depression and Anxiety also calls for psychotherapy. For over 30 years Cognitive Behavioural Therapy has been found to be highly effective with both Depression and Anxiety. Most research finds that therapy using both medication and psychotherapy (Cognitive Behavioural Therapy) is the most effective means of treating Depression and Anxiety. Throughout Vancouver, West Vancouver, North Vancouver, Burnaby, Coquitlam, New Westminster and Maple Ridge we have counsellors, therapists, psychologists and social workers trained in providing CBT treatment to individuals with depression and anxiety. They are available through both public agencies and private practices. Call the British Columbia Psychological Association to find a psychologist. Other groups have similar services.

WHAT IS DEPRESSION?

Sadness, low levels of energy and worry are common to all of us. We all have times of appropriate depressed mood. Depression becomes a problem when these symptoms of Depression become too frequent, start to interfere with our ability to get things done, and begin to take over our thinking patterns. These symptoms can include losing our appetite for life, or even for food that we use to enjoy, intrusive negative thoughts, low engery, weigh changes and changes in our daily habits and activities. We become isolated, lose our ability to tolerate common problems, and start to think in black and white terms about life, or ability to cope, and become consumed with feelings of hopelessness. These are some of the common signs and symptoms of Depression. Some of these symptoms may be caused by other problems, and one should never “self diagnose.” Many of these symptoms of Depression could be a simple problem with low iron, but they can be caused by many other physical issues that you need to have assessed before a diagnosis of depression is made. Start by talking to your family doctor or a psychologist. A medical evaluation is always best practice.  

HOW DOES ANXIETY RELATE TO DEPRESSION?

Anxiety, like depression, has been increasing in frequency for several years. We are not sure why, but the world of work, school and family responsibilities has become more complex as time has gone on. Symptoms of an Anxiety Disorder include an inability to get to sleep, or to stay asleep. Sometimes individuals have extreme reactions of fear or panic to situations that don’t cause these reactions to others. Both Depression and Anxiety can cause difficulty focusing on work, at school or on relationships. Symptoms can range from feelings of worry to increases in heart rate, blood pressure, dizziness, sweating and flushing of the face or hands.  Sometimes these are general symptoms that seem to imbue someone’s entire day, other times they become more specific and targeted and constitute a phobia. Regretfully Anxiety and Depression often occur together, causing an individual to nearly stop in their shoes, afraid to take any action. As with Depression, Anxiety is not something you should self diagnose. You should write out a list of symptoms, and specific situations they may have occurred in, the time of day and so on. Take this list and see your medical doctor. He or she can either help you with a diagnosis of Anxiety or Depression, or they may ask that you see a Registered Psychologist fpor a comprehensive examination and diagnosis. Again, like Depression Anxiety if often treated with medication, however Cognitive Behavioural Therapy has also been found to be highly effective. Best practice is a combination of both medical intervention (or at least observation and monitoring) and therapy.

WHAT CAN I DO?

If you think you suffer from a Depressive Disorder of Anxiety Disorder the first step is always: See your medical doctor and talk it over. If you don’t have a family physician most walk in clinics in Vancouver, Burnaby, Coquitlam and the surrounding areas have general practitioners who are trained to help you. They can walk you through the steps of diagnosis, and make a referral to either a psychologist or psychiatrist if they feel unsure about the diagnosis. If medication is a concern, talk over your concerns directly with your doctor. Write down your questions, copy any articles or other information you may have come across that you find worrying. You doctor can explain the pros and cons of different treatments. Don’t get information about treatment - especially medical treatment - from the internet. Often internet pages provide overblown and negative information about medical treatments in order to sell you something else, which is neither effective nor proven. Be careful. Trust your doctor!

A Registered Psychologist can offer you therapy that specifically addresses both Anxiety and Depression. Cognitive Behavioural Therapy (CBT) has been found to be effective with both Depression and Anxiety. CBT teaches you skills to address immediate symptoms, such as relaxation, thought stopping and “Mindfulness.” CBT also focuses on teaching you new healthier ways to approach problems and conflicts, and helps you change negative, depressive and anxious thoughts to more realistic and helpful ones. Here in BC you will find information on Cognitive Behavioural Therapy (CBT) for anxiety at www.anxietybc.ca  You can also go to another government sponsored website: www.heretohelp.ca for information on CBT for Depression. I provide therapy and counselling for Depression and Anxiety in both my Vancouver and Burnaby offices, which serve Burnaby, Vancouver, Coquitlam, New Westminster, Port Moody and Maple Ridge. This includes treatment for children and adolescents with Depression and Anxiety.

DO I HAVE DEPRESSION OR ANXIETY?

Start by talking to your doctor. He or she can help you in determining if you have an Anxiety Disorder or Depression.  If you don’t feel comfortable talking to your medical doctor you can also talk to a Registered Psychologist. You can find a list of Registered Psychologists in Vancouver, Burnaby, Coquitlam and the surrounding area by contacting the British Columbia Psychological Association. Their website can help you find a psychologist who treats Depression and Anxiety near you. You can, of course, also check my web page and contact me if you’d like. The information is below.

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My own services, as a Registered Psychologist are located at the addresses below. You can find out more information from my web page at http://www.relatedminds.com

Other information about my practice can be found here (counsellingbc) , here (Psychology Today) or here (BC Psych Association)

Vancouver Counselling: Suite 303-338 8th Ave West, Vancouver, BC V5Y3X2

Burnaby and Coquitlam Counselling: 9304A Salish Court, Burnaby, BC V3J7C5

Phone for counselling services in Burnaby, Coquitlam, New Westminster, Port Moody and Coquitlam: 778.998-7975

Copyright 2011/2012 RelatedMinds Psychological and Educational Services - All Rights Reserved

RelatedMinds Psychological Services in Vancouver, Coquitlam and Burnaby

British Columbia. Specializing in the assessment, diagnosis and treatment of depression, anxiety, relationship issues, anger management, learning disabilities, Autism and other related conditions.

KEY WORDS: Depression, Anxiety, Burnaby, Vancouver, Coquitlam, New Westminster, North Vancouver, West Vancouver, Psychologist, therapist, counsellor, therapy, Cognitive Behavioural Therapy, CBT

ADHD Coaching | ADD Coaching

ADHD | ADD Assessment, Diagnosis and Treatment, including ADHD Coaching by a Registered Psychologist with over 20 years experience in the filed of ADD | ADHD treatment and intervention in schools, home and work. ADHD affects individuals, families and relationship. I provide interventions based upon the lasted science and evidenced based treatments.

For more information visit:
http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/
http://www.relatedminds.com
http://www.relatedminds.com/testing/
http://www.relatedminds.com/wp-content/uploads/2011/11/Psychoeducational-Assessment-Burnaby.pdf
http://www.counsellingbc.com/listings/JRoche.htm

Infidelity and Couples Therapy (Gottman's Thoughts)

John Gottman points out that it a myth that infidelity, cheating, is the cause of divorce. He reports that 20-25% of people in divorce mediation do say that an affair was a reason for the marriage ending, but THE reason given by nearly 80% of these couples is a "deterioration of intimacy." In fact, researchers (Fisher et al 2009) have found that relationship problems- usually noted as a :deterioration of intimacy" is reported in over 80 percent of cases by men. Other researches have supported this finding. IT starts with a breakdown in the love component of your relationship. The affair is often just the last straw.

There are several other myths about relationships that Gottman addresses in his work and practice as a couples therapist. One big one is that "communications problems" cause marriage problems and conflicts. This sounds good, and sounds simple. The truth is, distressed people communicate quite clearly what they feel and mean.

What Gottman suggests is that couples are never going to learn to "not communicate" the often hurtful and damaging things they say. Rather, what is important is to learn how to properly argue, disagree and differ in wants, needs, ideas and feelings. It's not what they are doing, we all disagree and get upset, instead it's about HOW they do it. Gottman offers clear, understandable tools for fixing this problem, which doesn't include the typical, " Say everything ...."  Instead it's "say what's appropriate, in a way that shows your still committed to the relationship."  In other words, make each other feel safe, especially when angry.

When you think about this, this is a skill any good parent has. They learn how to set limits, correct and when necessary even punish their children without driving a nail through their self esteem. We need to learn to do that with each other.

In happy couples Gottman's research shows that number of positive interaction to negative interactions is 20-1.  Yes, 20-1. In conflicted couples it 5-1. Maybe you thought 5-1 was good enough? Research says that 5-1 is a dangerous place to be. In soon to be divorced couples it's 8-1.  Unhappy couples tend to have a filter that screens out positive events and makes even neutral events look negative.  You need to learn to increase the number of daily positive interactions between you.  And, going back to the beginning of this submission, you need to figure out how to renew the intimacy between you. To do that Gottman uses what are called "Love Maps."

If your interested in learning more about Dr. Gottman and his techniques, yuou can visit his website or just Google him on YouTube. He has his own YouTube channel! You'll find a good number of videos on his practice.  If your interested in seeing me for marriage therapy, couples counselling or family therapy, feel free to call me. More information is available on my website at http://www.relatedminds.com or on my marriage counselling | family therapy page at: http://www.relatedminds.com/couples-therapy

I see couples for therapy in both my Vancouver office (serving Vancouver, West Vancouver, North Vancouver and Richmond) and Burnaby (serving Burnaby, Coquitlam, Port Coquitlam, Port Moody, Maple Ridge, New Westminster, Langley and Surrey). In addition to being a Registered Psychologist in BC I am also a Registered Marriage and Family Therapist (RMFT) with the British Columbia Association of Marriage and Family Therapists, and a Clinical Member of the American Association for Marriage and Family Therapy.

Jim Roche
http://www.psychologists.bc.ca/users/jimroche
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Keywords: Marriage therapy, marriage counselling, couple therapy, couple counselling, marriage and family therapist, psychologist, infidelity, cheating, Gottman, Vancouver, Burnaby, Coquitlam, New Westminster

Counselling | Therapy | Vancouver | Burnaby

About Individual Counselling | Therapy and CBT (Cognitive Behavioural Therapy)
As a registered psychologist I provide therapy and counselling services to individuals in the Burnaby and Vancouver areas using the clinically proven and evidence based techniques of Cognitive Behaviour Therapy (CBT) and Rational Emotive Behaviour Therapy (REBT). Individuals are seen for a variety of issues including chronic pain, depression, anxiety, stress, panic, anger management, ADHD and work or relationship issues. I hold an advanced certificate in Cognitive Therapy from the Albert Ellis Institute in New York. If you are looking for a cognitive therapist you should ask what training they have in CBT, as many individuals claim they practice CBT after completing only a workshop or reading a book. The Advanced Certificate Program at the Albert Ellis Institute included extensive CBT readings, group and individual training and supervised practice of Cognitive Behaviour Therapy/Rationale Emotive Behaviour Therapy under the supervision of a licensed mental health practitioner. In addition to my practicum at the Ellis Institute I also focused on CBT during my graduate studies and post doctoral internship.

About Cognitive Behaviour Therapy (CBT)My primary mode of practice is rational-emotive/cognitive therapy. Cognitive Behaviour Therapy or CBT (including Rational Emotive Therapy) is a highly effective, research driven approach that helps people to combat and overcome such difficulties as high anxiety/stress, panic attacks, depression, anger, relationship problems, phobias, worry, obsessions, compulsions, addictions (food or drugs), social anxiety, sexual problems, ADHD and low self-esteem. The course of treatment is typically short-term (approximately 8-12 sessions), and people often enjoy rapid and enduring relief from their symptoms.

Where are your offices?

Offices are located in Burnaby (providing therapy and counselling services to Burnaby, Coquitlam, New Westminster, Port Moody, Port Coquitlam, Maple Ridge and, some individuals come from Surrey and Langley) and Vancouver (providing counselling and therapy services to Vancouver, North Vancouver, West Vancouver and some clients from Richmond).

How long does it take to get an appointment?

Counselling and therapy appointments are usually available within a week. Please feel free to call to set up and appointment.

Dr. Jim Roche

778.998-7975

www.relatedminds.com

www.relatedminds.com/individual-therapy/

Counselling for Depression and Anxiety in Burnaby, Coquitlam, Vancouver and New Westminster

DEPRESSION AND ANXIETY COUNSELLING & THERAPY IN VANCOUVER, COQUITLAM, BURNABY and NEW WESTMINSTER, BC

The rates of Depression and Anxiety are increasing all the time. This includes the rates of these disorders for children, adolescents and adults. Depression and Anxiety lead to difficulties at school, work, with friends and in our personal relationships, including couples and marriages. Both of these disorders are treated initially by the medical field with medication. This is often useful, and sometimes necessary, however comprehensive treatment of Depression and Anxiety also calls for psychotherapy. For over 30 years Cognitive Behavioural Therapy has been found to be highly effective with both Depression and Anxiety. Most research finds that therapy using both medication and psychotherapy (Cognitive Behavioural Therapy) is the most effective means of treating Depression and Anxiety.

WHAT IS DEPRESSION?

Sadness, low levels of energy and worry are common to all of us. We all have times of appropriate depressed mood. Depression becomes a problem when these symptoms of Depression become too frequent, start to interfere with our ability to get things done, and begin to take over our thinking patterns. These symptoms can include losing our appetite for life, or even for food that we use to enjoy, intrusive negative thoughts, low engery, weigh changes and changes in our daily habits and activities. We become isolated, lose our ability to tolerate common problems, and start to think in black and white terms about life, or ability to cope, and become consumed with feelings of hopelessness. These are some of the common signs and symptoms of Depression. Some of these symptoms may be caused by other problems, and one should never “self diagnose.” Many of these symptoms of Depression could be a simple problem with low iron, but they can be caused by many other physical issues that you need to have assessed before a diagnosis of depression is made. Start by talking to your family doctor or a psychologist. A medical evaluation is always best practice.  

HOW DOES ANXIETY RELATE TO DEPRESSION?

Anxiety, like depression, has been increasing in frequency for several years. We are not sure why, but the world of work, school and family responsibilities has become more complex as time has gone on. Symptoms of an Anxiety Disorder include an inability to get to sleep, or to stay asleep. Sometimes individuals have extreme reactions of fear or panic to situations that don’t cause these reactions to others. Both Depression and Anxiety can cause difficulty focusing on work, at school or on relationships. Symptoms can range from feelings of worry to increases in heart rate, blood pressure, dizziness, sweating and flushing of the face or hands.  Sometimes these are general symptoms that seem to imbue someone’s entire day, other times they become more specific and targeted and constitute a phobia. Regretfully Anxiety and Depression often occur together, causing an individual to nearly stop in their shoes, afraid to take any action. As with Depression, Anxiety is not something you should self diagnose. You should write out a list of symptoms, and specific situations they may have occurred in, the time of day and so on. Take this list and see your medical doctor. He or she can either help you with a diagnosis of Anxiety or Depression, or they may ask that you see a Registered Psychologist fpor a comprehensive examination and diagnosis. Again, like Depression Anxiety if often treated with medication, however Cognitive Behavioural Therapy has also been found to be highly effective. Best practice is a combination of both medical intervention (or at least observation and monitoring) and therapy.

WHAT CAN I DO?

If you think you suffer from a Depressive Disorder of Anxiety Disorder the first step is always: See your medical doctor and talk it over. If you don’t have a family physician most walk in clinics in Vancouver, Burnaby, Coquitlam and the surrounding areas have general practitioners who are trained to help you. They can walk you through the steps of diagnosis, and make a referral to either a psychologist or psychiatrist if they feel unsure about the diagnosis. If medication is a concern, talk over your concerns directly with your doctor. Write down your questions, copy any articles or other information you may have come across that you find worrying. You doctor can explain the pros and cons of different treatments. Don’t get information about treatment - especially medical treatment - from the internet. Often internet pages provide overblown and negative information about medical treatments in order to sell you something else, which is neither effective nor proven. Be careful. Trust your doctor!

A Registered Psychologist can offer you therapy that specifically addresses both Anxiety and Depression. Cognitive Behavioural Therapy (CBT) has been found to be effective with both Depression and Anxiety. CBT teaches you skills to address immediate symptoms, such as relaxation, thought stopping and “Mindfulness.” CBT also focuses on teaching you new healthier ways to approach problems and conflicts, and helps you change negative, depressive and anxious thoughts to more realistic and helpful ones. Here in BC you will find information on Cognitive Behavioural Therapy (CBT) for anxiety at www.anxietybc.ca  You can also go to another government sponsored website: www.heretohelp.ca for information on CBT for Depression. I provide therapy and counselling for Depression and Anxiety in both my Vancouver and Burnaby offices, which serve Burnaby, Vancouver, Coquitlam, New Westminster, Port Moody and Maple Ridge. This includes treatment for children and adolescents with Depression and Anxiety.

DO I HAVE DEPRESSION OR ANXIETY?

Start by talking to your doctor. He or she can help you in determining if you have an Anxiety Disorder or Depression.  If you don’t feel comfortable talking to your medical doctor you can also talk to a Registered Psychologist. You can find a list of Registered Psychologists in Vancouver, Burnaby, Coquitlam and the surrounding area by contacting the British Columbia Psychological Association. Their website can help you find a psychologist who treats Depression and Anxiety near you. You can, of course, also check my web page and contact me if you’d like. The information is below.

.........................................................................

Vancouver Counselling: Suite 303-338 8th Ave West, Vancouver, BC V5Y3X2

Burnaby and Coquitlam Counselling: 9304A Salish Court, Burnaby, BC V3J7C5

Phone for counselling services in Burnaby, Coquitlam, New Westminster, Port Moody and Coquitlam: 778.998-7975

Copyright 2011/2012 RelatedMinds Psychological and Educational Services - All Rights Reserved

RelatedMinds Psychological Services in Vancouver, Coquitlam and Burnaby

British Columbia. Specializing in the assessment, diagnosis and treatment of depression, anxiety, relationship issues, anger management, learning disabilities, Autism and other related conditions.

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For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975

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As usual, let me warn you that this blog, any of my other blogs, or my web pages are not designed to provide you with an assessment, diagnosis or treatment. If you are concerned you have a health issue such as ADHD, anxiety, depression or Asperger's | autism please see your health service provider, either a medical doctor or Registered Psychologist. What may appear to be symptoms of one disorder can often be caused by another unexpected disorder. Other disorders, such as ADHD, are very likely to exist at the same time as another disorder (called co-morbid disorder) such as anxiety, depressing or OCD. You need to see a professional to find this out. On-line symptom checklists will not provide this, and are often misleading.

Services provided in my offices include: (covered by most extended health care insurance)

ADHD (click here:http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)

Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/)

Autism and Asperger's Disorder (Click here: http://www.relatedminds.com/autism/)

Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)

Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)

Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)

Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)

The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)

Anger Management (Click here:http://www.relatedminds.com/anger-management/)

Pain Management and PTSD (Click here:http://www.relatedminds.com/pain )

Forensic Services (Independent Medical Examinations or IME)

About Dr. Roche

My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. In addition to being a registered psychologist, I am a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). I also hold a doctoral degree in law with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.

Key words

ADHD | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment

http://www.relatedminds.com

http://Therapists.PsychologyToday.com/rms/70682

http://www.therapistlocator.net/member?183420

http://www.bcpsychologist.org/users/jimroche

http://www.actcommunity.net/jim-roche.html

Medical News: Behavior Therapy Plus Drugs Best for Pediatric OCD - in Psychiatry, General Psychiatry from MedPage Today

Cognitive Behavioural Therapy and Behavioural Therapy are again found to be effecting in dealing with children and adolescents with OCD.

Medical News: Behavior Therapy Plus Drugs Best for Pediatric OCD - in Psychiatry, General Psychiatry from MedPage Today

Adding cognitive behavioral therapy (CBT) to pharmacologic treatment for obsessive-compulsive disorder (OCD) in young patients enhanced response, researchers found.
Click here for the full story: http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/28628
This study showed that in a randomized controlled trial, significantly more patients on the combination were considered responders than those who had drug therapy alone, or drug therapy plus “brief” CBT.
Children with OCD are currently treated with serotonin reuptake inhibitors, the researchers said. Yet the majority have only a partial response, so some argue that augmenting drug therapy with short-term, OCD-specific CBT may add benefits.
Franklin and colleagues found that the combination therapy of medication plus CBT was superior to the other two strategies on all outcome measures.
They estimated the number of weeks needed to treat with the drug and CBT combination therapy versus medication alone to be three, which was the same when comparing the full combination with drug-plus-brief-CBT.
When comparing the drug-plus-brief-CBT with medical management alone, the estimated number needed to treat rose to 25, Franklin and colleagues reported.
Though the study may be limited in generalizability because it didn’t include many minority participants, the researchers still concluded that the findings “highlight the importance of disseminating CBT for pediatric OCD into community settings so that affected children have options beyond medication management alone.”

Skills for Dealing with Depression

Depression is one of the main focuses of research into the effectiveness of Cognitive Behavioural Therapy (CBT). CBT has been found to be very effective, and in some cases as effective or more effective than medication. The gold standard for the treatment of depression (especially moderate to severe depression) remains a combination of medication and Cognitive Behaviour Therapy.

Over the past few weeks I've gone into some details about Cognitive Behavioural Therapy self-help programs that are available for individuals with Anxiety or Depression to use, either on their own or with the support of their therapist or counsellor. One of the programs I've recommended is the Desling with Depression books available from the Minsitry of children and Family Services, or from www.heretohelp.ca.

These are excellent, short, easy to use, step-by-step books that guide you through the therapeutic process. Several people have asked me about the major three skills and how I teach them. It would be inappropriate to go into any detail here, you either should be using these books on your own or with the help of a therapist, and internet questions and answers are no replacement for a proper medical/psychological diagnosis and treatment. (Remember: ALWAYS start by seeing your medical doctor! Sometimes what we think is depression, and what looks like depression, is really something physical. Go to your family doctor, or a walk-in clinic and get a good check up.) However, I will go over the three "antidepressant Skills" that most of these programs discuss. You should make sure your plan for dealing with depression includes these.

1) Realistic Thinking.  Much of what Cognitive behavioural Therapy is about is "Realisitic Thinking." This is a process you will review and PRACTICE again and again in many settings and situations. You will learn to spot depressive thoughts that lead to depressed moods; challenge those depressive thoughts; come up with realistic thoughts; and then practice this realistic thinking. These are not happy thoughts, it's not about "positive thinking," or some other simplistic distraction from reality. It's about learning to think "realistically" even when your brain, your mood and the situation want to keep you from doing that.

2) Problem Solving. Problem solving is the next skill you will learn in Cognitive Behavioural Therapy (CBT).  Through exercises, worksheets and face-to-face practice you will learn to: Better understand the problems your dealing with- because they are real and have real effects; come up with several different solutions to those problems; and then select the best solution and start the problem solving process. Sounds easy, but often this is difficult in a time of crisis, depressed mood or anxiety.

3) Goal Setting. Goal setting is about moving from a position of knowing what your going to go to planning how your going to do it. Once you know what you want, unless you have a good plan, your just going to be waiting for it to come to you unless you have a plan. In goal setting sessions you will: Learn to set goals that are important to you; make goals that are likely to succeed; and move on to new goals. 

Some of the other things we do in face-to-face sessions for depression are: dealing with sleep issues, dealing with anxiety, learning to cope with intrusive negative thoughts (thought stopping), learn how to relax by using external cues, examine our diets and....sorry...making sure you are exercising enough. Studies show that moderate exercise (under the supervision of your doctor) is one of THE most effective tools you have to deal with depression.

As I look over this list it seems simple, easy, and you wonder why anyone needs a therapist ..or even a book? Well, these things are not so easy to do when you are suffering from depression and anxiety. Thinking clearly, which is something we all need to do to do this right, is difficult at these times. Support and advice help to keep you on track and monitor your progress. And much of what we have discussed here is really about learning to think differently than you do now. In the early days of Cognitive Behavioural Therapy (CBT), when it was called Rational Emotive Behaviour Therapy (REBT) this learning how to think differently was called "the disputation," because, in effect your therapist disputes your irrational thoughts and makes you defend them...or pick new thoughts that can be defended. This is a critical part of the process.

So, to sum up, CBT for Depression focuses on three areas: Realistic Thinking; Problem Solving; and Goal Setting. In addition to that several very specific skills are taught to address intrusive thoughts, sleep problems and other specific symptoms giving you difficulty. I hope this addresses the questions people emailed.

For more information about the services I provide my web page can be found at www.relatedminds.com, http://www.relatedminds.com/depression. Other information on my practice can be found at: http://Therapists.Psychologytoday.com/70682, http://www.bcpsychologist.org/users/jimroche, and http://psyris.com/drjimroche

Help in Preventing Relapse of Depression

On my web site I've just added a useful link for those with a history of depression interested in relapse prevention. I often recommend "Mindfulness Training" for relapse prevention, however  this is a short workbook, easy to follow and evidence based workbooks for those with depression. Visit my site's Depression page to find links to these effective and free materials that are primarily designed to use on your own.

For the link, click here: www.relatedminds.com/depression

Self-Help Books for Depression?

In my practice I almost always provide some sort of self-help materials for depression. This might include a book, audio tape or CD and on occasion a video. One of the problems is that the best books I can recommend (Mind Over Mood and The Feeling Good Handbook - you can read more about these on my Resource page) are often too long for individuals with significant depression. There is, however, a great alternative to these lengthy books, and these alternative are free. They include downloadable workbooks, on-line workbook pages for practice, and some excellent video recordings that go along with these materials that specifically address Depression. They are also made right here in BC in Vancouver and Burnaby at Simon Frasier University.

The First is the Antidepressant Skills Workbook.
The Antidepressant Skills Workbook starts by giving you an overview of depression, explains how it can be effectively managed using Cognitive Behavioural Therapy (CBT) and Behavioural techniques and is based on the best available research. This workbook gives a step-by-step guide to changing patterns that trigger depression, it shows how to use cognitive and CBT and behavioural methods to make important changes in thinking and actions that can help you emerge from depression and make it less likely to recur. These methods can be used in combination with depression treatments, increasing their effectiveness. As the authors of these workbooks note, "for most people with serious depression, use of this self-help guide alone will not be sufficient to resolve the depression". People with serious depression should get treatment with antidepressant medication or Cognitive Behavioural Therapy (CBT) from a specially trained therapist (I hold an Advanced Certificate in Cognitive Behavioural Therapy or CBT from the Albert Ellis Institute in New York, and have been practicing CBT for over 20 years).

Here is the website to download this workbook for depression:
http://www.comh.ca/antidepressant-skills/adult/

You will find another excellent workbook to help with depression in the workplace. These together, especially with the help of a therapist who has expertise in treating depression with CBT or Cognitive Behavioural Therapy is a great place to start.

I am often asked: "How do I know if I have depression?" Well one place to start is by asking a professional. While a psychologist (like myself) offer diagnostic services, they are not covered by MSP. The are often covered by extended health care plans, but each plan is different and you need to check with your plan before making a decision. Psychologists have the expertise to make a diagnosis of depression. For locating psychologists in Burnaby, New Westminster, Coquitlam, Vancouver or anywhere in BC just contact the British Columbia Psychological Association (BCPS). They can direct you to a psychologist who has expertise in this field, and is located near you. Fees for psychologists range from $60 -$175.00 per session.

Another simple and cost effective choice, if cost is an issue, is simply talking to your family doctor. While a family doctor may not have time to see you repeatedly, and usually doesn't provide therapy, they are able to make a diagnosis and a referral. They can also refer you to a psychiatrist if need be, who is covered by MSP.

There are other mental health practitioners in BC, including MFTs and "Registered Counsellors." These individuals are not usually trained to make a diagnosis, and have less training and fewer hours of supervision than a psychologist or medical doctor. Additionally, while they call themselves "Registered Counsellors" they are not really regulated by a registration board (Called a "College" in BC). Some of these individuals are excellent therapists, but you need to check their credentials. Finally, Registered Social Workers are often highly trained in providing therapy/counselling and often work with government agencies and in private practice here in BC. They too can be an excellent choice.

If you feel depressed, and wonder if you need help working out your depression, start by talking to your family doctor (or any doctor in a walk in clinic). They are a great place to start.

For more information about the services I provide my web page can be found at www.relatedminds.com, http://www.relatedminds.com/depression. Other information on my practice can be found at: http://Therapists.Psychologytoday.com/70682, http://www.bcpsychologist.org/users/jimroche, and http://psyris.com/drjimroche

Self-Help Book for Relationships and Couples

I thought it might be a good idea to repost this blog about self-help books for couples:


If your looking for a good self help book instead of marriage counselling, here is one I can recommend: Why Marriages Succeed and Fail: And How You Can Make Yours Last by John Gottman. Many couples need the help of a registered marriage and family therapist, but this book is useful for anyone, including those who decide to see  therapist of counsellor. Here is the book at Amazon.ca:

<a href="http://www.amazon.ca/Why-Marriages-Succeed-Fail-Yours/dp/0684802414/ref=pd_sim_b_1/701-7522828-1360365?ie=UTF8&qid=1189021726&s">http://www.amazon.ca/Why-Marriages-Succeed-Fail-Yours/dp/0684802414/ref=pd_sim_b_1/701-7522828-1360365?ie=UTF8&qid=1189021726&s</a>

The book is by marriage researcherDr. John Gottman. It's described as "upbeat, easy-to-follow manual based on research into the dynamics of married couples. Gottman describes his studies as being akin to a CAT scan of a living relationship and asserts that he's been able to predict the future of marriages with an accuracy rate of over 90 percent. In 1983 and 1986, his research team monitored more than a hundred married couples in Indiana and Illinois with electrodes, video cameras, and microphones as they attempted to work out real conflicts. Using the information derived from these sessions, Gottman concludes here that a lasting relationship results from a couple's ability to resolve conflicts through any of the three styles of problem-solving that are found in healthy marriages- -validating, conflict-avoiding, and volatile. Numerous self-quizzes help couples determine the style that best suits them. Gottman points out, however, that couples whose interactions are marked by four characteristics--criticism, contempt, defensiveness, and withdrawal--are in trouble, and he includes self-tests for diagnosing these destructive tactics, as well as steps for countering them. Interestingly, Gottman asserts that the basis of a stable marriage can be expressed mathematically: the ratio of positive to negative moments must be at least 5:1--and he offers a four-step program for breaking through negativity and allowing one's natural communication and problem-solving abilities to flourish. Mathematics and science aside, there's plenty of old- fashioned, helpful, and worthwhile advice here about gender differences, realistic expectations, love, and respect--advice that may appeal especially to those who enjoy taking quizzes and analyzing relationships."

If you love your mate, and your relationship just seems to be going off track, and becoming less and less important to you, this is THE book for you. As the author above describes, Gottman's book is one of the very few relationship books that is actually based on science. There are many theories, but most are ...it may seem hard to imagine...just made up! Yes, people look at a situation and develop a theory, and then a practice, on what they think is right, with no research to back up their ideas, or the treatment you are exposed to. Gottman bases his suggestions on scientific observations and years of research. The ideas on how to strengthen your relationship are easy to follow, clearly laid out and presented in a step by step manner. Those of us who practice marriage and family therapy often use both his books and his many packets of clinical material to help guide couples through this learning process in a supportive and direct manner.  In the book you will learn: That more sex doesn't necessarily improve a marriage, Frequent arguing will not lead to divorce, Financial problems do not always spell trouble in a relationship, Wives who make sour facial expressions when their husbands talk are likely to be separated within four years, There is a reason husbands withdraw from arguments -- and there's a way around it

Dr. Gottman tells you how to recognize attitudes that doom a relationship, which he calls "The Four Horsemen" - contempt, criticism, defensiveness, and stonewalling, and provides you with readings, exercises, role plays, tips and easy to use techniques that will help you understand and make the most of your relationship. Through reading and practicing his suggestions you can avoid patterns that lead to divorce.

About Dr. Roche:
Dr. Jim Roche is a Registered Psychologist and a Registered Marriage and Family Therapist with offices in Vancouver and Burnaby, BC. He has been in practice for over 25 years and uses Dr. John Gottman's programs and techniques, as well as Cognitive Behavioural Therapy, when working with couples and families. For more information about his marriage therapy practice check out his web page at: http://www.relatedminds.com/couples-therapy/

Other information about Dr. Roche can be found at:  <a href="http://relatedmnds.com">www.relatedminds.com</a> or <a href="http://www.relatedminds.com/adhd">www.relatedminds.com/adhd</a>. Other information on my practice can be found at: <a href="http://Therapists.Psychologytoday.com/70682">http://Therapists.Psychologytoday.com/70682</a>, http://www.bcpsychologist.org/users/jimroche or <a href="http://psyris.com/drjimroche">http://psyris.com/drjimroche</a>.

What is CBT (Cognitive Behavioural Therapy)?

I've just finished a new blog post on the RelatedMinds website on CBT - Cognitive Behavioural Therapy, explaining what CBT is and listing some good resources. Please visit that page for more information on CBT:

http://www.relatedminds.com/2011/08/23/764/

Self-Help Ideas for couples

I've just put a new post on my RelatedMinds website blog. Click here to find the post: CLICK HERE

This post reviews a couple of the more useful, and scientifically based, self-help programs for couples who are considering a self-help approach rather than couples counselling / therapy or marriage counselling / therapy. The suggestions are based on the work of Dr. John Gottman, one of the few scientifically - research based marriage and relationship counselling programs available.

Dr. Jim Roche
Registered Psychologist
Registered Marriage and Family Therapist
778.998-7975

Dr. Edward Hallowell on adult Attention Deficit Disorder

I often suggest Dr. Hallowell's book(s) on ADHD (Attention Deficit Hyperactivity Disorder). I don't agree with everything he says, and differ somewhat in how I approach treatment, but still find Dr. Hallowell's writings to be useful, informative and more likely than not to set you down the right path.

This is a 25 min video. It will leave you with a lot of good information, and you'll have a good idea about where treatment of ADHD should be focused. Take a look, and enjoy.

For information on my services for children, adolescents and adults (families!) with ADHD check out my web page at http://www.relatedminds.com or contact me at jimroche@gmail.com or by phone at 778.998-7975

Information on my practice can also be found at: http://www.bcpsychologist.org/users/jimroche

or at http://therapists.psychologytoday.com/rms/name/Jim_Roche_JD,PhD,CAGS,RPsych,RMFT_Burnaby_British+Columbia_70682

What Is Cognitive Behavioral Therapy?

I often try to explain Cognitive Behaviour Therapy (CBT) to individuals, and how "Exposure and Response Prevention." This is an old therapy technique, really from behaviour therapy in the 1970-80's. It is as effective as many medications for things like OCD (Obsessive Compulsive Disorder). This page provides a great place to start getting to know what Cognitive Behaviour Therapy - CBT is and how it can be effective in the treatment of OCD, anxiety, depression and is an integral part of many other treatments such as couple's therapy, ADHD therapy and even the treatment of symptoms of ASD / Asperger's Disorder. Take a look. Some grew resources.

Dr. Jim Roche

Fundamentals of Anger Management

For more information about my services, both individual and training programs for schools, please visit my web page at http://www.relatedminds.com/the-angry-child  General information can be found at http://www.relatedminds.com  My offices are located in both Burnaby and Vancouver, BC

Many families come to me because of issues relating to anger and aggression.  They hope to receive anger management training of some sort, and are often surprised by the exact nature of anger management programs which often include a component on assertiveness training.  For the next few blogs I'd like to walk you through some information about anger management and what is out there that is helpful. There are a lot of anger management books available, some make much more sense than others. Some are evidence based, that is, developed through a process of program assessment, and others are not.  I'm going to start with a review of a program we often use in the schools- Aggression Replacement Training. This program comes with staff training videos, workbooks, social skills programming as well as specific training in anger replacement and cognitive therapy. That will be today's post. In the next post I'll be reviewing a workbook I often use: The Anger Control Workbook by Matthew McKay and Peter Rogers.  This workbook is a cognitive therapy based program about anger management and when used with some materials on assertiveness training can form the basis of a good program on anger management.

Aggression Replacement Training: ART

Aggression Replacement Training (ART) is manual-based program focused on teens. It is designed to  help them to with aggressive emotions. It is a complex, multichannel, program that uses three coordinated components to reach the youth; Social skills, Anger management and moral reasoning.  These three components cover most of the materials necessary to make significant changes in children with problems with aggression. (For younger children there are specific social skills books, and an alternative suggestion is The Explosive Child by Green.)

Anger Replacement Training is used in schools and correctional settings in North America as well as Europe. It was designed by Arnold P. Goldstein, Barry Glick and John C. Gibbs in the 1980s. They took concepts from a number of other theories for working with youth and incorporated them into one comprehensive system. The main methods for the youth to learn from the various components is though repetition. Practice, role play, and practice again. The model also focuses on Jean Piaget’s concept of peer learning. 

Social Skills
Social Skills training is the behavioral component of ART. Many youths who are involved with criminal behavior and/or have difficulties with controlling their anger lack social skills. Many of the concepts of the social skills component are taken from Albert Bandura’s. There are many different social skills that these youth are thought to lack, such as;

Making a complaint

Apologizing

Understanding the feelings of others

Dealing with someone else's anger

Keeping out of fights

Dealing with an accusation

The program begins with an assessment of the youth’s social skill levels. Then these social skills are broken down into various steps (both thinking and action steps). The facilitator discusses the day's skill, bringing out relevant examples. Then the facilitator demonstrates a practice situation to give the youth a picture of using the skill. The youth are asked to point out each of the steps using behavioural techniques such as sub-vocalizing while engaging in the behaviour. This component also provides a great deal of psycho-education for each student. Each of the youth is asked to use a practice situation that they have recently had using the skill. Again the other youth go though and discuss each of the steps each time. Modelling and practice are key components, with homework for generalizing these skills.

Anger Control Training
Anger control training is the emotional component of ART. This moves from the teaching of social skills, to losing anti-social skills and replacing them with pro-social skills. The anger control training uses what is called the “anger control chain.” This is a process taught to the youth to deal with situations that cause them to get angry. Once again, one segment of the anger control chain is taught each week and the both the facilitators and the youth practice the new skills with relevant life activities.

The anger control chain is as follows:

Triggers (internal &amp; external) -- The situation that starts the slide into anger and the self talk that perpetuates it

Cues -- physical signs of becoming angry

Anger reducers -- activities that are done to reduce or take our mind off of the situation

Reminders -- short positive statements

Thinking ahead -- If then thinking

Social Skill -- Implementing a pro-social skill into the situation

Evaluation -- Looking back over the use of the anger control chain and evaluating how was implemented

Again, youth practice these skills, use subvocalization, model the skills, role play and use homework assignments to generalize the behavioural skills.

Moral Reasoning Training

Moral reasoning training is the “values component” of the program. This component takes various scenarios and asks whether various activities would be right or wrong to do in those situations. Thinking errors are also taught during this day of training. The thinking errors that are taught are:

Self-centered thinking -- "it's all about me"

Assuming the worst -- "it would happen anyway" or "they would do it to me"

Blaming others -- "it's their fault"

Mislabeling / minimizing -- "it's not stealing, I'm only borrowing it..." or "everybody else does it"

This, and all other componets, of the program are all well planned out. Lessons are specific with a good deal of teacher specific suggestions incorporated into the written materials. The program comes with an excellent training video to help facilitators learns these specific skills, although having some supervision for new trainers would be best. 

The books: Berj Harrootunian, Arnold P. Goldstein, Jane Close Conoley (1994), Student Aggression: Prevention, Management and Replacement Training, Guilford Press, 

All of the necessary materials are available from Research Press. 

If your a teacher or behaviour specialist, take a look at these materials. They are all you really need to start an excellent program addressing aggression and anger within the school. A great way to start!

Next blog post will be addressing Anger Control for adults. This will specifically look at readings and skills programs for individuals with anger management problems from a cognitive behaviour   therapy perspective. After that, which may take two or three posts, we will discuss assertiveness training and how it is a critical component of any successful program.

Antidepressants and effectiveness

Recently there have been many articles explaining why antidepressants don't really work. On several occasions I've tried to explain how these articles were a misunderstanding of the research. This New York Times article (see below) a pretty good job at explaining this, so I'm presenting it here. I think this is an important article because the same rationale applies to all of the research that has been in the press about ADHD medications, anxiety medications and so on.  The big drug companies are not to be fully trusted, however, neither are the writers of all the anti-medication nonsense you read on the web. Almost all of that is supported not by "big pharma" but instead by "big natural health food blah blah."  Here's the link to this excellent article:

http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html

The article points out that in the depression studies often subjects are included who don't really have depression. Well sooner or later, when filling out a form about their symptoms they report that they don't have depression. That's good, they never did, so at least these individuals didn't develop depression from simply taking part in the study. There are also problems with people participating who are after free care, or in some cases payments offered for participation in the trials. You often see ads for these studies on college campuses and elsewhere. After the study is over these people return to their original level of depression, whatever that might have been. The effect isn't a result of the medication or placebo as much as an artefact of the recruitment process to find people to participate. And who, today, would even volunteer to take a new, untried medication when so many cheap and generic medications are available?

In the most recent study of the effects of antidepressants by Dr. DeRubeis (this is the one every newspaper and health food/herbal medicine web page tells us that antidepressants are only as effective or less effective than placebos, we see some odd statistics that just don't support that claim. The overall result, that for healthier patients the medications are less effective - fell shy of statistical significance. The study looked at weak treatment, and intentionally maximized placebo effect. Still this paper ended up the talk of the town.

Another excellent article on how publications don't give us a really good view of things comes from the web page Science-Based Medicine. You can find that article here: Do Antidepressants Work? The Effect of Publication Bias

This article (which you really need to print out and read with an underliner!) should make you cautious about what you read. Statistics can be used to prove almost anything....to those who don't understand statistics. It's very difficult for the lay person to know what is right and what is wrong or misleading. As usual, I suggest that you ask your medical doctor...not your neighbour, brother, sister or something you've read on the internet that trashes medications or some other treatment and ....just by chance....is on a page covered with ads for "alternative treatments."

The Science Based Medicine article on AntiDepressants ends with this:
"At this time it is premature to conclude that modern antidepressant medications do not work. There is sufficient evidence for efficacy to continue to use medication as part of the overall treatment approach to depression. The current consensus is that therapy is also a critical component of the long term treatment of depression, and therefore looking at the use of medications in isolation may not reflect their actual clinical use. Multiple studies have now shown that combination treatment (medications and therapy) are better than either alone. There is also evidence that medication treatment is more successful when multiple agents are tried in order to find the optimal treatment. These so-called “real world” treatments are not well reflected in the pre-approval trials considered in this analysis."


My advice, print out articles that bring up concerns, put them in your pocket, and take them with you to doctor.  This goes for any medicine, medication, treatment or intervention your considering. 

About Dr. John Gottman and Gottman Couples Therapy

ABOUT GOTTMAN METHOD COUPLES THERAPY
I am often asked: "What is Gottman Method Couples Therapy?" I guess the best way to explain it is to refer directly to Dr. Gottman's webpage:

Gottman Method Couples Therapy:  Through research-based interventions and exercises, it helps couples break through barriers to achieve greater understanding, connection and intimacy in their relationships. Gottman Method Couples Therapy is a structured, goal-oriented, scientifically-based therapy. Intervention strategies are based upon empirical data from Dr. Gottman’s three decades of research with more than 3,000 couples. This research shows us what actually works to help couples achieve a long-term healthy relationship. Gottman Method Couples Therapy was developed out of this research to help couples:
-Increase respect, affection, and closeness
-Break through and resolve conflict when they feel stuck
-Generate greater understanding between partners
-Keep conflict discussions calm

Research shows that to make a relationship last, couples must become better friends, learn to manage conflict, and create ways to support each other's hopes for the future. Drs. John and Julie Gottman have shown how couples can accomplish this by paying attention to what they call the "Sound Relationship House," or the seven components of healthy coupleships.

The Gottman Theory For Making Relationships Work:

What does Dr. Gottman say about getting your marriage or relationship back on track?

1. Build Love Maps: How well do you know your partner’s inner psychological world, his or her history, worries, stresses, joys, and hopes? Find out!

2. Share Fondness and Admiration: The antidote for contempt, this level focuses on the amount of affection and respect within a relationship. (To strengthen fondness and admiration, express appreciation and respect.)

3."Turn Towards:" State your needs, be aware of bids for connection and turn towards them. The small moments of everyday life are actually the building blocks of relationship.

4. The Positive Perspective: The presence of a positive approach to problem-solving and the success of repair attempts.

5. Manage Conflict: We say “manage” conflict rather than “resolve” conflict, because relationship conflict is natural and has functional, positive aspects. Understand that there is a critical difference in handling perpetual problems and solvable problems.

6. Make Life Dreams Come True: Create an atmosphere that encourages each person to talk honestly about his or her hopes, values, convictions and aspirations.

7. Create Shared Meaning: Understand important visions, narratives, myths, and metaphors about your relationship.

For more information about Dr. Gottman's approach to therapy you can visit his website at Http://www.gottman.com or visit my website at http://www.relatedminds.com or http://www.relatedmindsbc.com/couples-therapy

(For a direct link to the Gottman web page, click here.) You can also find information on The Gottman Institute at the Gottman YouTube webpage, found here: http://www.youtube.com/user/TheGottmanInstitute

Books, DVD programs and CDs are available from the Gottman website, many on Amazon.ca and you can obtain several in my office. Visit the Gottman site, watch Dr. Gottman on YouTube to get an idea about what he is saying and if your interested in seeing me individually, as a couple or just as a consultant while you work your way through a video based Gottman program, give me a call.