Yoga Show 2013 in Toronto!

Sean, Nicole, and Tim. The Zen Social Worker Team for the 2013 Yoga Show in Toronto!

        Wow! We're home from the yoga show and I have to start by giving thanks. Thank you to Sean and Nicole for being amazing people and helping give voice to my work. Without your dedication, friendship, and belief in me, I would not have been able to do this.

The yoga show was a success, which was a pretty amazing experience for me. I arrived at the show/exhibition not knowing what to expect and over the course of three days I shared my story of how I came to research yoga as a mental health intervention: as a social worker, two years ago I introduced yoga into my practice with clients. I talked about my research and found I was met with enthusiasm. Person after person wanted to talk to Tim, "the Zen Social Worker" and learn all about how yoga could be used as a mental health intervention. Many of the yoga teachers were hungry for more information, other social workers, educators, nurses, and even a few doctors found their way to me and wanted to talk about how they could use yoga in their practices or how they could start programs that yoga teachers could be involved in at their agencies. I was surprised to see friends, even some friends who were exhibitors and presenters at the yoga show who I had no idea would be there! Most of all, I am struck by how open to learning the yoga community is. I had a number of people come to our booth just to congratulate or encourage me with the research.

Thank you to all those who came by the booth and shared in my passion. Welcome to those who found their way to this website despite not being able to get time with me, while I was engaged with someone else chatting.

Timothy Gordon
Hamilton, Ontario

A Review of Training Psychological Flexibility with ACT in Montreal

"If you sort of flinch, like: Oh no, yet another person who is gonna try to convince you to get the tattoo and learn the chicken ritual and pay the fees to the central office, that's just not going to happen." Steven C. Hayes in an ACT Workshop.

        I travelled up to Montreal, Quebec for a few days to attend Benjamin Schoendorff's two day Acceptance & Commitment Therapy (ACT) Level 1 clinical training. As a researcher using Relational Frame Theory (RFT), the theory which underlies the thinking behind ACT as the theoretical underpinning of my own masters thesis, and having taken in a lot of ACT material from workshops, books, podcasts,  DVD's, really anything I could get my hands on — I felt like I had a good understanding of ACT. Also, I should mention I have practiced ACT for almost a year at the point of attending this training. I was genuinely excited for the experience but wondered if it would largely be a repeat of many things I had already learnt. I was in for a surprise. Benji (the name our beloved facilitator wished to be called by), brought a plethora of new material and approaches to using ACT with clients. Approaches I had never heard of before. Very little of what Benji spoke about in the training was a repetition of what I had already learned.

The training started with a mindfulness exercise, introductions where Benji surprisingly remembered  our names after only a quick introduction, and a note made by Benji about what each person wished to get out of the training. One attendee spoke, saying they wished to have "ACT demystified," another said "understanding how to use it with my clients," and I said "I want to know how to help clients get unstuck with things they do to avoid and control their lives." Close to the end of the workshop, Benji had cleverly returned to each point and asked each person if they "got what they came for." Everyone, including myself agreed.

        So, what was good!? Apart from how excellent of a presenter Benji was, we were offered a deeper understanding of fusion and defusion than what I had seen before. Benji spoke about the advantages of fusion, spoke from his clinical experience of how difficult it can be to work with clients to defuse from their thoughts, and even spoke about how the silliness does not work sometimes. This was an important concept for me to work on and understand, I have personally used the ACT self-help book, Get Out of Your Mind and Into Your Life and found extremely useful. In fact, I recommend it to clients frequently who wish to deepen their therapeutic work outside of our individual or group sessions. However, I must admit, the cognitive defusion has always been the most difficult for me. I now see that fusion is a result of relationally framing, thanks Benji!

Mindfulness was also presented differently than what you would typically find in cognitive therapies using mindfulness practices. Specifically, we looked at self as context and grounding through mindfulness where we weren't asked to slowly eat a raisin (a common mindfulness activity) but instead, we were invited to conjure things in our own minds and to experiment with how our mind works.

Finally, the matrix. I already learned about the hexaflex from the Learning ACT book, which I highly recommend to fellow therapists wishing to introduce ACT into their direct practice (I also make reference to this book frequently in our peer supervision group), but I felt a little intimidated about returning to the hexaflex, an already complicated concept, and adding to it gave me chills. The matrix however, posed a new and easy way to understand the link between all of the ACT concepts and offers a new way to work with clients in creating committed actions that will improve clients lives through more choices and psychological flexibility. I was impressed.

        At the end of the first day of our training, I was exhausted. I had the same experience the next day and returned home with a workbook FULL of notes. Even now, over a month later, I am still exploring my workbook, talking with colleagues, sharing ideas at our peer supervision group, and still finding that I am making gains from the training. I was convinced before the training that ACT is great but now I'm left thinking it's incredible.

Timothy Gordon
Hamilton, Ontario.

How Controversial is Yoga?

        The short is answer is: very. The fall semester is over and I have been hard at work on both my thesis and my manual for using yoga in a group setting with the Acceptance & Commitment Therapy (ACT) model and processes. When people ask what my research is about or what I'm currently writing, I expect them to raise their eyebrows when I tell them yoga. People don't tend to take yoga seriously in the part of the world I live in (Ontario, Canada). When I first tried yoga in 2005, I approached the class with skepticism; I was told it was good for me, that it would help with physical issues I experienced as a result from too much exercise, I was also told it would help my balance, and that it's a great "inner experience." I used to scoff  at that last one — I was not interested in having a meditative, contemplative, whatever experience. I tend to not like it when people try to sell me things and the words that were used to describe yoga sounded a lot like selling spirituality to me.

This position of skepticism did not instantly change after my first yoga class. Although I became hooked on yoga and genuinely enjoyed it from the first class, my skepticism was well intact. I don't think it is gone completely after years of practice and I wonder if it ever will go. I am researching yoga for this very reason: I want to understand what it is about the experience that helps people, how does yoga actually work? Is there a legitimate science to yoga?

The conversations I have about yoga tend to revolve around how helpful people find it. There are numerous ways in which yoga helps people mentally, physically and spiritually. There are numerous disciplines of yoga performed in varying styles for a diverse range of purposes. So, what is the discourse about yoga — the spiritual part. This becomes an especially hot topic when yoga is introduced to children or through public/state/provincial/municipal programs.

Photo by T. Lynne from the Dec. 15, 2012 issue of The New York Times.

New York Times writer Will Carless wrote a recent article, Yoga Class Draws Religious Protest in which parents of children aged six to seven years old are protesting the elementary school in which their children attend, as well as advocating with the district school board in Encinitas, California to remove a 30-minute yoga practice from the schools curriculum. Carless' article and academic research on yoga demonstrate the belief that yoga is a religious practice. There are numerous blogs, websites, magazine articles, and books which strongly contest this fact; they adamantly state that yoga is not religious however, this is not entirely true and people whom attempt to present it as such are misrepresenting yoga. Although yoga is not religious, it is spiritual and involves the use of sanskrit, an ancient language originating from India which is largely only used liturgically, in spiritual/religious practices today. Yoga is also utilized by the religions of Hinduism and Buddhism. This of course does not mean all yoga practices are religious or spiritually based. However, as a yoga teacher, researcher, and social worker, I can not claim that yoga is completely non-religious. The way I present yoga to clients is non-religious but I can not speak about the ways in which others may teach it — I have been privy to a number of highly spiritual or religious yoga classes. I therefore agree that inquiry into what exactly the children of Encinitas, California are being taught as yoga is useful to their parents.

Carless' article explains that amongst the controversy over yoga is an issue with meditation. The act of meditation is a part of the yoga practice and again can be presented in a way which is free from religious connotations. In fact, meditation can be presented for any religious or spiritual orientation, lest we forget: Jesus meditated.

Want to know more? Check out my article on what yoga is.

Timothy Gordon
Hamilton, ON

Creating a model of behavioral change for yourself!

The new year is almost here, a time where people want to make big changes: do more of what they value and less of other things. Some people even make plans to cut some things out of their lives completely. The reality for a lot of people is that these changes are not easy - we depend on ourselves for changing habits and committing ourselves to our valued directions in life.

In Cognitive Behavioral Therapy (CBT ) and the larger behavioral sciences community, making changes in your life is serious business. Most behavioral therapies and models focus on simple, easy, and measurable goals that lead to change. Information like this is important to pay attention to because making those first steps in pursuing your values are important. Moving beyond those first steps are basic principles that might shed some light on how the changes can be made in a long lasting and potentially more personally rewarding way:

First, behaviors are learned and may be influenced by biological factors. 

Behaviors take time to change, generally requiring twenty-one days of repetition to become a habit. 

Committing to behavior change is necessary for permanent or long-lasting changes. 

Having a substitute behavior is highly valuable. If you want to stop something, replacing it with something else to do instead does not promote reverting to the behavior you want to stop. 

Behaviors are purported to be best learned when there is a good example, role model, etc. to model the behaviors and be a source of emulation. 

Practice, practice, practice. Learning a behavior on your own is not easy, the above five points are about learning and doing them so the take home message is learning to do the behavior on your own. 

Encouragement and recovering from setbacks. Having some encouragement in response to even having the willingness to try this behavior change is a part of making this genuine change. Along with this encouragement is celebrating the successes along the way and being encouraged about recovering from the setbacks that occur.

The bottom line is this, CBT and other therapies using behavioral sciences to influence their interventions may use similar principles to the ones listed above in creating model for behavioral change. Whether you're a client wanting to make changes or a therapist working with clients who have change goals, doing this work involves commitment, willingness, and creativity.

My review of the CBT Foundational skills training at the Hincks-Dellcrest Centre

        The training at the Hincks-Dellcrest Center in Toronto is renowned amongst therapists in this area. They offer treatment and a variety of certifications as well as full-out intensive trainings for social workers and other mental health counselling professionals. I was excited to attend my first course and although it was on a subject I felt I already knew a lot about: Cognitive Behavioral Therapy - I suspected that I would learn something new and at least leave the training with a more solid understanding of using CBT in direct practice. I attended the training with two clinicians from a clinic I'm currently working at who are both more senior than I and have been practicing CBT for longer as well. I was careful to seat myself amongst other CBT newbies so that I wouldn't depend on my colleagues knowledge or answers during group work and discussions at the training - I wanted the full experience of learning CBT.

During our first break at the Hincks-Dellcrest Center

        The room was packed despite the weather. The presenter, Hester Dunlap appeared engaged and really knew the material. I believe that this is where the strength of professional training can be found, a curious and interested audience meets a practicing professional doing the actual work. For me, learning about the processes and techniques of CBT was enlightening, although somewhat repetitive as I have read a number of books and attended other behavior therapy trainings but the audience, again composed of social workers and other mental health counselling professionals brought their examples, questions they had about clients whom they have or currently were working with. This really stimulated the conversation and brought the learning that we were doing into our own realm and applying it with our clients. The cases that were presented as examples for the course were not pathologizing but presented a mature male and mature female, each were experiencing unique difficulties related to family life as well as transitions in their life. Although the scenarios were tastefully written, the participants at the training still focused on the strengths and protective factors from both of the case examples. This was refreshing and after day one left me excited for the second full-day of training.

        Day two lived up to my excitement. Again, despite the weather, the room was packed for day two and the audience was really engaged. There were many questions from audience members about clients they were seeing and the training became more practical with every example. Day two moved away from the manualized portion of the Cognitive Behavioral Treatment and focused on exposure as well as getting creative in session with exposure techniques. As I listened to the presenter I started having this feeling that what I was hearing was familiar but not entirely related to CBT. Sure enough, at the end of the presentation, our presenter, Hester Dunlap spoke about the "third wave" of behavioural therapies: Acceptance & Commitment Therapy (ACT). I was so excited to hear reference made to ACT that I almost cheered!

It was great to see ACT concepts used and spoken about during a CBT presentation. This winter I will be attending intensive ACT training in Montreal, I will be sure to post about that!

Thanks for continuing to check out the site. Now that the fall semester is winding down, I will be able to write more!

Timothy Gordon

Hamilton, ON

Dispelling the CBT Cartoon

        Recently, I have been spending a lot of time thinking about clients who come to therapy and what they might be looking for and expecting in the work that they will do with a therapist. I focused on finding the right therapist, exploring what an eclectic approach to therapy would look like and looked specifically at behavioural therapies in my last post. Although I feel that post gives a useful snapshot view of three popular approaches to therapy in the behavioural wave of therapies; I recognize that there is a "CBT cartoon" that exists; This is something I especially understand as a social worker who recognizes, uses and appreciates cognitive behavioral therapy techniques in my own direct practice - my colleagues love to give me a hard time about using CBT. In this post, I am going to do what I can to make sure that the common misconception of CBT that I hear gets dispelled.


Misperceptions of CBT


        A Cognitive Behavioural Therapist will only use CBT, no matter what my issue is. This simply is not true, CBT is not an appropriate intervention for all types of issues that people attend therapy for but it has implications for the every day life of clients. An example of this may include someone who has experienced the loss of a loved one, CBT would not be my preferred way of working through the conversations with this person, showing sensitivity and supporting them in the context of therapy. However, CBT can be an effective intervention for this person. Therapists can demonstrate how effective a CBT intervention may work here to deal with issues related to normalizing feelings, exploring what is missed, and talking about looking toward the future including coping with future losses. Yea, CBT does that (did I just come up with a new CBT catchphrase!?) The point is that CBT is useful here, in this situation.

        Cognitive Behavioural Therapy is a restricted methodology, the therapist has very little autonomy and ability to work creatively in treatment. This is completely based on the clinician doing the therapy; a therapist like any other professional is human and ultimately will have different styles, training and approaches to therapy. The need for training after graduate school is very high for therapists, new and old to therapy, being a Cognitive Behavioral Therapist does not necessarily say anything about how the therapist integrates their knowledge or simply how creative they are. CBT is simply the theory and tools behind the way the therapist will approach treatment.

        The treatment will be brief and I won't have an opportunity to talk about my past in Cognitive Behavioural Therapy. Yes and no. CBT is rather standardized in public healthcare systems in Canada, it is meant to be a short-term intervention (less than twelve sessions, often time six to eight sessions). For this reason, insurance companies approve CBT at a high rate for Employee Assistance Programs (EAP), etc. This is not unusual in psychotherapy, Solution Focused Therapy is also a rather brief intervention however, there are opportunities to talk about your past, to consolidate your history and to collect memories. This also does not preclude a client from returning to CBT after their sessions are up. A final point that is nice about CBT is that there are numerous resources out there from workbooks and even apps that clients can continue to work on themselves or at least keep track of their thoughts, feelings and emotions - empowering clients outside of the therapy room.

        Thoughts can't change. This is false, thoughts can change through theories of language and cognition. For example language acquisition and constructing a new repertoire; there are empirical studies that show this increasing of your repertoire is possible. It may be difficult but it is possible! Note here that I make mention of increasing repertoire, not getting rid of things that don't work. I will talk about this more in the next section.


What does and does not work in CBT?


        In dispelling the CBT cartoon, I also do not want to give the impression that I fully buy-in to CBT. It is an intervention that can be fun to use, clients like the activities and at times it has made conversations in therapy a little easier. I would like to spend some time looking at CBT critically and understanding what does work and does not work about this way of thinking about human behaviour.

CBT works on information and talking about it in different ways. The conversations that are held in CBT are about what is happening in your life now and dealing with present issues. CBT usually looks at what is rational or irrational, this is a big part of the traditional model but is hard to make work. Here is what I mean by "work." The literature/data does not support this right/wrong (rational/irrational) way of thinking. From the data, you could argue that traditional CBT invites people to struggle within. For example, bad cognitions leads to bad emotions and bad outcomes, this is or should be according to the theory, manipulable. There is a way to change bad cognitions (thoughts) so that people don't have bad emotions which result in bad outcomes. The work that a CBT therapist does here is around challenging cognitions. This may be in the form of asking clients to think about things differently and to look at the functionally important correlations here. This is cognitive restructuring or changing peoples' thinking. Now, this isn't a CBT therapist somehow worming their way into a clients brain and literally changing the way they think. No, that sounds rather sinister. Instead, it is the CBT therapists position to ask questions and some therapists may make comments. For a lot of clients, they see this as substantial work and call it helpful. It also creates situations like what I described earlier where a client may struggle within, changing the way you think is difficult work, CBT is not easy work.


        Approaching this therapy with respect and understanding it as a science, a CBT therapist can move forward in new and interesting ways; Instead of doing the above failed component analysis of cognitive restructuring, there is some new things in CBT such as cognitive reappraisal that are evidenced to work. Sometimes this concept of cognitive reappraisal is called "flexibility." Psychological flexibility is thinking about things in different ways and being selective about what behaviour works. Discussions around psychological flexibility and not cognitive restructuring are known as a contextual CBT method. For example rather than using "but" statements, try using "and." This is asking people to try things in a different way which at first glance seems like more cognitive restructuring but contextual CBT is more about variation, selective reinforcement, allowing the client to evolve rather than narrowing the repertoire. I would like to try and be more clear that this is not traditional or classical CBT but is still a part of CBT. Often, contextual CBT is referred to as the third wave of behaviourism. What I am describing here, contextual CBT is more about the relationship to cognitions and avoiding thinking about the "proper" or "correct" ways of thinking. This also makes therapy a more comfortable experience for therapists because it continues to tear down the expert role and places the therapist without judgement or "knowing" about what is right and wrong and allows the client to say "this does or does not work for me."


Yea, CBT does that,
Timothy Gordon.
Hamilton, Ontario

Comparing and Understanding Behaviour Therapies

        In my last post, I discussed finding the right therapist. That process takes a little bit of work and research on the part of a client seeking out someone to treat them. The matter gets more complicated when you're investigating specific therapies and if they are relevant or not to you and if they fit with how you want to do the type of therapeutic work you're involved with. During my searches, I found that Cognitive Behavioural Therapy (CBT) is extremely popular amongst clients, they simply have heard of it. Now, I am not going to make an over-generalized sweeping like "CBT is crap." Although it has become quite posh for therapists to talk trash about CBT and other Behavioural interventions; I respect CBT for what is, a sometimes useful intervention that many people have found helpful. 

So, what is my opinion!? Well, it's complicated so just give me a few minutes to explain - then you can be the judge.

I think any therapist who has an interest in helping people will use some behavioural skills some of the time as the skills are easily accessible for clients, fun to teach and highly effective. There are numerous types of behaviour therapies and I have not covered all of them here but these are the ones I know best because I have been trained and supervised on all three of them.

Dr. Linehan's Cognitive Behavioural Treatment of Borderline Personality Disorder (aka, Dialectical Behaviour Therapy) Skills Manual is pictured above.

        My career as a therapist began in forensics at St. Joseph's Healthcare in Hamilton, ON. At this site Dialectical Behaviour Therapy (DBT) is the predominant system of therapy. Before arriving at the hospital, I had heard many of my Master of Social Work colleagues speak out against Behavioral Therapy - specifically CBT, calling it oppressive, judgemental, manipulative and superficial. They asked pointed questions and were generally unfriendly to a guest speaker who came from Toronto to speak with us about the use of CBT in their direct practice. One of my patients mistakenly referred to DBT as "Diabolical Behaviour Therapy" and I thought to myself "Man, people really do have a bad impression of this stuff."

I read the book, a handful of journal articles and did the online training and quickly came to realize that DBT is not manipulative at all. In fact, I found it extremely ethical. DBT is heavily based around skills and skill training, it puts the proverbial ball in the court of clients, telling them that if they want to see changes in the way people respond to them and what is happening in their life, they need to make changes themselves with how they interact with those people. At times in DBT, the therapist closes space and confronts clients about their decisions and actions, the therapist then asks how the skills clients learned could have helped and clients have the opportunity to constructively work through situations and problems using the skills. What is rather nice about this is that therapists can be validating here, telling clients "Yes, I agree that guy was being a jerk to you. How do you feel about how you reacted though?" This also places the therapist as an ally rather than an adversary. However, the therapists role as the expert still exists here in this position.

DBT requests clients to have a level of acceptance which is referred to in this model as "radical acceptance." This is a concept that can be empowering for some and infuriating for others. The core principal here is that clients accept the narrative of their lives, their history for what it is - accepting the situation just as it is. This is best illustrated during the online DBT training where a client remarks that they were abused as a child, that the abuse never should have happened. The therapist agrees with the client and tells them that acceptance is not the client conceding to the abuse and saying it's okay the abuse happened. No. Instead the client accepts that history as a part of their life "I am a person who experienced abuse." This is an essential concept to the next behavioural intervention I will discuss, Acceptance & Commitment Therapy (ACT) however, note that ACT goes deeper into this concept of acceptance and in my experience, puts acceptance in a more appropriate perspective.

This self-help book encourages introspection and treats therapy as a journey.

        Acceptance & Commitment Therapy (ACT) has the word acceptance right in the title, so you know some sort of submission to the way your life is, is just going to be a part of the program. Well, that is true but I would argue that this position in more comforting than what clients would experience in Dialectical Behaviour Therapy. ACT recognizes the pain and utter despair that living can be and really puts the acceptance of what your life is, into perspective. ACT's acceptance is similar to the radical acceptance of DBT by stating that accepting what is happening in your life and your past does not make it okay or say that you are in favour of it. ACT goes farther and states that it's

ACT really looks for what is important and meaningful for the client. This important distinction sets ACT apart from other behavioural interventions. There is a thorough assessment in ACT for therapists to work on with clients to discover clients values and make a commitment to taking action, being true to oneself to be the person you want to be.

Let's take a moment here and acknowledge how scary this can be for some. Just discovering your values alone and committing to taking action to fulfill them in your life and make them a part of living your life is a task, an obligation. Some might see this as a burden. ACT attempts to make this experience empowering and offering some freedom for clients to acknowledge the way they want to live their life.

CBT is popular, it's like the Michael Jackson of therapy, you may not like him, you might even think he's unethical but you've definitely heard some of his tunes and he has a number of gold records because of them.

        I don't know about you, but I think that is a catchy line "Change how you feel by changing the way you think." It's simple and sounds incredibly accessible. It's like an epiphany or lightbulb moment: "DUH! The problem with how I feel is the way I think!!!!" Well, as it turns out it's not necessarily that easy all the time and sometimes your thoughts are completely accurate. The intervention offered here, Cognitive Behavioural Therapy (CBT) is about getting the right story in your head about who you are. This is a good way of challenging and disputing thoughts. However, how easy is it to really identify distortions in thinking. It isn't. Anyone who argues any differently is once again playing that role we social workers love to hate, the expert.

The work that is done in Cognitive Behaviour Therapy is rigid, what I mean by this is that the therapy is a process which is manualized or structured. This results in specifications over how the therapy sessions are conducted, what skills are taught when, how they are taught and what they address. A critique here is that the CBT process is "cookie cutter" or simply not unique to each client. Some argue that this is not a bad thing, insurance companies in Canada and mental health hospitals seem to have it at the top of their lists or some times even the only treatment on their list approved. This does not come as a surprise to me, the research shows that CBT is effective and it is short-term, you don't need many sessions or hours with a therapist to work through the material.

I have as of yet to see a sophisticated clinician who is a Cognitive Behavioural Therapist in Hamilton or even in the greater academic community but that does not mean they are not out there.

At the end of the day, it's about what works best for clients. I ask myself, how can I use what I know to be useful with the person sitting across from me in the therapy session?

        After having been trained in all of the above therapies, practicing and being supervised on each individually I have come to find that Acceptance & Commitment Therapy (ACT) fits best with my practice. I do not wish to devalue any of the other therapies, I still use DBT skills and found the training extremely helpful. Likewise, with CBT, I was able to put the intervention into practice which has been foundational to my understanding of behavioural interventions in general and has been greatly beneficial to the work that I do in ACT because at the end of the day, ACT is still a behaviour therapy!

Just working towards being a better clinician,
Tim Gordon.
Hamilton, ON