Thoughts on Record: Podcast of the Ottawa Institute of Cognitive Behavioural Therapy

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Psychotherapy can be a powerful & transformative experience for the clinician and client alike.  In this episode psychotherapist and author Nicole Arzt, M.S., L.M.F.T.  discusses her new book Sometimes Therapy is Awkward: A Collection of Life Changing Insights for the Modern Clinician.  In this wide-ranging conversation a number of topics central to the process of therapy are addressed including: 

• identifying and managing impostor syndrome/insecurity as a therapist
• reflections on how the provision of psychotherapy can change the therapist
• cultivating an identity as a growth-orientated therapist
• navigating termination and aiming for the "good-enough" good-bye
• managing compassion fatigue and burnout
• the unique challenges faced by new therapists with thoughts on how to best cope
• a brief consideration of how to manage the distress associated with navigating suicide 
• leveraging process related factors and the clinician's own emotional reaction in session to improve their interventions 

Nicole Arzt is a licensed marriage and family therapist specializing in providing psychotherapy to individuals, families, and groups struggling with substance use disorders and psychiatric illnesses. She received her master’s of science degree from California State University, Long Beach in 2014. She has extensive experience working in a variety of dual-diagnosis treatment centers, providing services for all levels of care from detoxification to long-term outpatient therapy. Nicole currently works full-time as a therapist, using psychodynamic and humanistic work. A passionate writer, she has authored several scholarly articles, blog posts, and professional research centered on addiction and mental health.

https://www.souloftherapy.com/
https://psychotherapymemes.com/

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Maligned and misunderstood, addiction can present among the greatest clinical challenge to mental health professionals.  In addition, the stigma and shame associated with addiction is a frequent and strong barrier to clients seeking services.  Teaching professor, Chair of the Department of Neuroscience of Carleton University and host of the podcast Minding the Brain Dr. Kim Hellemans joins host Dr. Pete Kelly, C.Psych to discuss:  

• how Dr. Hellemans became interested in the study of addiction
• current thinking around the definition of addiction
• the neurobiological basis of addiction, considering both subcortical and cortical processes
• psychological factors that influence addiction including trauma, state dependent learning, environmental conditions & social connectivity
• is there such a thing as an "addictive personality"?
• fact and fiction around addiction related to behaviour such as gambling, sex, gaming, eating & work
• harm reduction through a neurobiological lens
• some thoughts on how to leverage knowledge of the neuroscience of addiction to reduce stigma and increase access to care

Dr. Kim Hellemans is a teaching professor and the current Chair of the Department of Neuroscience at Carleton University. She received her PhD from Queen's University, where her research focused on understanding the biological basis of drug addiction. She later went on to complete post-doctoral positions at Cambridge University and University of British Columbia prior to joining Carleton University in 2008. Dr. Hellemans has received several prestigious awards for her passion and dedication to university teaching. Outside of the classroom, she's the co-host of the popular podcast, Minding the Brain.

https://mindingthebrainpodcast.com/

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Forgiveness has been defined in many ways by many traditions. However, a powerful and clinically relevant way of defining forgiveness is as a suite of skills that can be learned to promote a sense of self-efficacy, emotional effectiveness, physical and emotional well-being & resolution of grieving in the aftermath of betrayal, wrongdoings and even trauma.  In this episode with author, teacher, and clinician Dr. Fred Luskin, we discuss the clinical and practical implementation of his forgiveness model as outlined in his best-selling book Forgive For Good.  In this conversation we review:

• the Forgive for Good definition of forgiveness
• the preconditions of forgiveness, including grieving
• how & when a grievance has formed and when this becomes a barrier to moving forward
• forgiveness as a strategy for resolving complicated grief
• the definition and application of the concept of "unenforceable rules"
• the definition and application of the concept of  the "personal and impersonal pain" dialectic and how this concept is critical to conceptualizing our hurts  
• caveats and considerations around forgiveness in the context of trauma
• a brief consideration of the role of forgiveness in helping address clinician burnout/compassion fatigue.

Fred Luskin, Ph.D. is Director of the Stanford Forgiveness Project, an ongoing series of workshops and research projects that investigate the effectiveness of his forgiveness methods on a variety of populations. The forgiveness project has successfully explored forgiveness therapy with people who suffered from the violence in Northern Ireland, Sierra Leone as well as the attacks on the World Trade Center on 9/11. In addition his work has been successfully applied and researched in corporate, medical, legal and religious settings. He currently serves as a Senior Consultant in Health Promotion at Stanford University and is a Professor at the Institute of Transpersonal Psychology. He presents lectures, workshops, seminars and training on the importance, health benefits and training of forgiveness, stress management and emotional competence throughout the United States. He is the author of Forgive for Good: A Proven Prescription for Health and Happiness and Stress Free for Good: Ten Proven Life Skills for Health and Happiness with co-author Kenneth Pelletier, Ph.D.

https://learningtoforgive.com/

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Despite its many benefits, psychotherapy can understandably be an intimidating and scary proposition for many.  In this special "fireside chat" edition of Thoughts on Record, host Dr. Pete Kelly, C.Psych  walks you through:   

• common reasons why people don’t, won't (or can’t) engage in therapy and some food for thought around how to think through these challenges
• some of the top reasons to consider engaging in therapy
• observations around what allows someone the best chance to benefit from therapy
• what to look for in a therapist
• what to expect when you start therapy
• what to expect during therapy
• some additional thoughts on the opportunity that therapy presents

While crafted for those listeners who have been thinking about therapy, but who are scared, on the fence or maybe just a little curious and want to learn more, we're also hopeful this podcast might give junior and established clinicians alike some new ideas for thinking about how to talk about therapy with new or prospective clients.

Dr. Pete Kelly is a Clinical Psychologist and Executive Director of Innovation at the Ottawa Institute of Cognitive Behavioural Therapy.  He provides individual and group treatment to adults for mood and anxiety disorders and is actively involved in developing innovative clinical programming to increase the accessibility and effectiveness of psychological therapies.  He is a Clinical Professor in the School of Psychology at the University of Ottawa and Adjunct Research Professor in the Department of Neuroscience at Carleton University. In addition to publishing scientific papers and delivering public lectures, Dr. Kelly is co-author of the clinician manual “Treating Psychosis: A Clinician's Guide to Mindfulness, Acceptance, and Compassion-Based Approaches within the Cognitive Behavioral Therapy Tradition”. He is also co-author of the Canadian Adaptation of the textbook “Research Methods in Psychology” for Oxford University Press.  Finally, he hosts and produces the Ottawa Institute of Cognitive Behavioural Therapy’s podcast Thoughts on Record. 

Evolutionary biologist Bret Weinstein, Ph.D. joins host Pete Kelly, Ph.D., C.Psych for a wide-ranging discussion around how the understanding of ourselves from an evolutionary lens might help us to build the awareness needed at both the level of the individual as well as the collective, to identify, manage (and even solve) our most emergent and pressing challenges.  In this discussion they explore in depth:

• some of our more challenging characteristics as a species and the selection pressures that led to the evolution of these traits.
• Drs. Weinstein & Heyings' model of the interplay between consciousness & culture.
• the propensity for humans - both at the level of the individual as well as collectively - to view themselves as immune to maladapative, but predictable historical patterns.   
• an evolutionary lens on leadership and engaging in difficult conversations in the service of truth mapping and problem-solving.  
• conceptualization of mental illness from an evolutionary perspective, with a focus on evaluation of symptoms in context as well as relative to historical selection pressures vs the unique challenges of modernity.
• the value of utilizing all emotions - including those which are unpleasant - as problem-solving tools as well as how psychotherapy can assist in this respect.   
• evolutionary perspectives on human sexuality and sexual competition.
• Dr. Weinstein's application of our understanding of biological senescence (i.e., aging) to the understanding of the arc of societies as well as the lives of individuals (and how we might avoid the downfalls of such a trajectory).      
• a brief consideration of the rise of Trump through an evolutionary lens.
• Dr. Weinstein's advice and perspective for transcending the challenges of our evolutionary legacy to address the existential threats faced by all of us at the present moment.  

Bret Weinstein has spent two decades advancing the field of evolutionary biology, earning his PhD at the University of Michigan, before teaching at The Evergreen State College for 14 years, from which he resigned his tenured position in 2017. He has developed a new Darwinian framework based on design trade-offs, and made important discoveries regarding the evolution of cancer, senescence and the adaptive significance of moral self-sacrifice. He is currently working to uncover the evolutionary meaning of large scale patterns in human history, and seeking a game theoretically stable path forward for humanity. With his wife, Heather Heying, he is co-writing A Hunter-Gatherer’s Guide to the 21st Century, and is the host of Bret Weinstein’s DarkHorse podcast.

https://www.youtube.com/BretWeinsteinDarkHorse
https://twitter.com/BretWeinstein
https://bretweinstein.net/

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Eating disorders such as anorexia nervosa can reflect among the most severe and debilitating forms of mental illness.  In fact, anorexia nervosa has the highest mortality rate of any form of mental illness and unfortunately for a subset of clients, all current "gold standard" treatments can prove ineffective.  Dr. Blake Woodside, MD, a pioneer in the revolutionary use of deep brain stimulation for treatment resistant eating disorders joins us to discuss: 

• the history and development of DBS 
• how Dr. Woodside  personally became interested in DBS for eating disorders
• a description of the clinical presentation and prognosis of severe anorexia nervosa 
• the brain areas are typically targeted in DBS and possible mechanism of action
• inclusion/exclusion criteria for a client being considered as a candidate for DBS
• informed consent in the context of DBS 
• how the DBS procedure is undertaken (client preparation, client experience during surgery, recovery etc.)
• combining DBS combined with psychotherapy and medication 
• a review of the typical response rate to DBT
• philosophical considerations around DBS with respect to free will, ethics, human performance etc.  
• future developments and technological advances in DBS and associated techniques

Dr. Blake Woodside’s specialty in psychiatry is the treatment of eating disorders in adults, and family therapy of adolescent anorexia nervosa. He is Medical Director Emeritus, Program for Eating Disorders at the Toronto General Hospital, where he led the inpatient service for 25 years, and Professor in the Department of Psychiatry at the University of Toronto.  Dr. Woodside is actively involved in research, presently focusing on novel treatments in eating disorders, including Deep Brain Stimulation, Repetitive Transcranial Magnetic Stimulation, and Family-Based Therapy. He has also served in various capacities for the Canadian Medical Association, and the Canadian Psychiatric Association.

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Unraveling the mystery of consciousness, including experiences nested within consciousness such as emotions reflects the leading edge of inquiry in a variety of fields including neuroscience, psychology and philosophy.   Preeminent neuroscientist, author & musician Joseph LeDoux, PhD., a pioneer in the field of brain mechanisms of memory and emotion joins host Dr. Pete Kelly, C.Psych to discuss: 

• Dr. LeDoux's model of emotions, including a comprehensive tracing of the perception of a stimulus through the central nervous system all the way through to the construction of the conscious experience of an emotion.  
• the importance of a sense of self to the experience of emotions.
• the universality of the need to navigate threat contrasted with the very individual or even culturally bound experience of the emotion of fear
• construction of emotional schemas 
• a brief review of the different forms and layers of consciousness
• implications of Dr. LeDoux's model for improving the effectiveness of psychotherapy, particularly exposure based-therapy.
• consideration of how subcortical, unconscious processes interact to produce conscious states from a therapeutic lens.  
• advantages and disadvantages of the evolution of consciousness with a consideration of the implications for the fate of humanity.  

Dr. Joseph LeDoux is the Henry and Lucy Moses Professor of Science at NYU in the Center for Neural Science, and he directs the Emotional Brain Institute of NYU and the Nathan Kline Institute. He is also a Professor of Psychiatry and Child and Adolescent Psychiatry at NYU Langone Medical School. His work is focused on the brain mechanisms of memory and emotion and he is the author of The Emotional Brain, Synaptic Self, Anxious and The Deep History of Ourselves. LeDoux has received a number of awards, including William James Award from the Association for Psychological Science, the Karl Spencer Lashley Award from the American Philosophical Society, the Fyssen International Prize in Cognitive Science and the American Psychological Association Distinguished Scientific Contributions Award among many, many others.  His book Anxious received the 2016 William James Book Award from the American Psychological Association. LeDoux is a Fellow of the American Academy of Arts and Sciences, the New York Academy of Sciences, and the American Association for the Advancement of Science, and a member of the National Academy of Sciences. He is also the lead singer and songwriter in the rock band, The Amygdaloids and performs with Colin Dempsey as the acoustic duo So We Are.

https://joseph-ledoux.com
https://www.amygdaloids.com/
http://www.soweare.net

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Many psychotherapists have a number of clients who are taking psychotropic medications to address symptoms of mental illness; however, focused and in-depth didactic training in psychopharmacology as well as how to conceptualize the use of pharmacological strategies in the context of psychotherapy is not a core component of many graduate psychotherapy programs.  Dr. Cary Kogan, C.Psych, a clinical psychologist with a Post-Doctoral Master's degree in clinical psychopharmacology, shares his insights around:

• the value in training in pharmacology for psychologists
• the current prescribing environment for psychologists in Canada & the United States
• current nomenclature/classification around psychotropic medications
• considerations around the use of psychotropic medication e.g., method of administration, side-effects, brand vs. generic etc. 
• current evidence & risks around medications with antidepressant effects
• brief consideration of psychedelic compounds as therapeutic agents
• informed consent around the use of psychotropic medication
• considerations around combining psychotherapy & pharmacological strategies
• the complex relationship between diagnostic systems, prescription practices and conceptualization of mental illness

Episode Disclaimer:  Any discussion of medical treatment is intended as information only and should not be used as a basis for making treatment decisions without consulting with a licensed professional.

Cary Kogan earned his Ph.D. in clinical psychology from McGill University and Post-Doctoral Master’s degree in clinical psychopharmacology from Fairleigh Dickinson University in the USA. He is currently Professor of Clinical Psychology in the School of Psychology at the University of Ottawa where he also serves as Director of the Centre for Psychological Services and Research, a community-based mental health training centre. Dr. Kogan teaches at the undergraduate and graduate levels including courses on psychopathology and psychopharmacology. His research interests include classification of psychopathology and translational neuroscience with a special focus on neurodevelopmental disorders. Dr. Kogan is a consultant to the World Health Organization, Department of Mental Health and Substance Abuse, for the revision of the Mental, Behavioural and Neurodevelopmental Disorders chapter of the International Classification of Diseases (ICD). He has contributed to the development, testing, and international implementation of the clinical descriptions and diagnostic guidelines for mental health professionals.

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Although emotions comprise among the most profound and meaningful of human experiences, they can likewise evoke intense discomfort, avoidance or even phobic reactions.  Effectively matching one's emotional reaction to  the demands of the environment is a central task of every individual - a task which is increasingly difficult in an emotionally avoidant society with an increasing number of "virtual" interactions and cues.  In our discussion today, OICBT clinician Stacey Kosmerly, Ph.D., sits down with host Dr. Pete Kelly, C.Psych to discuss:

• the definition of emotion from a psychotherapeutic/neurobiological lens
• myths around "good vs. bad" emotions
• the  evolutionary purpose of a number of specific emotions (e.g., sadness, fear, jealousy etc.)
• how humans develop challenges around emotion dysregulation & emotional inhibition
• tips for parents/loved ones for understanding and managing the difficult emotional reactions of children, partners etc. 
• the central role of vulnerability in gaining confidence managing strong emotions
• shame as a particularly difficult emotion to address clinically/interpersonally
• managing emotional reactions to our emotional reactions 
• how clinicians can leverage their emotional reactions to improve their effectiveness as clinicians 
• the role social media may be playing in emotional difficulties

Stacey Kosmerly, Ph.D. is clinician at the Ottawa Institute of Cognitive Behavioural Therapy.  She has a PhD. in Clinical Psychology from the University of Ottawa and an Masters in Applied Psychology from Laurentian University.  Ms. Kosmerly is highly involved in the Dialectic Behavioural Therapy (DBT) Program and the Adult Attention Deficit/Hyperactivity Disorder (ADHD) Programs at the OICBT. She uses primarily DBT and CBT approaches to therapy, integrating her past training in emotion focused therapy (EFT) and  acceptance and commitment therapy (ACT) when appropriate. During her Master’s degree, Ms.Kosmerly worked closely with Dr. Adele Lafrance, one of the developers of Emotion Focused Family Therapy, and was involved in community outreach related to this. Since 2013, she has been involved in delivering workshops on Emotion Coaching, that is, skills for parents and caregivers to respond effectively to their children’s/loved one’s emotions, in community settings. 

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Many mental health clinicians and consumers operate under the assumption that mental illness results from chemical imbalances in the brain. However, a close examination of the evidence strongly suggests that this is not the case. In fact, there is some suggestion that psychotropic medications such as antipsychotics and antidepressants used to treat mental illness may themselves perturb normal neurochemical functioning.  Importantly, pharmacologically inducted alterations in the functioning of core neurochemical systems may have important implications for the maintenance of symptoms and long-term outcomes.  Author & journalist, Mr. Robert Whitaker joins us to discuss the core themes of his 2010 (updated in 2014) book Anatomy of an Epidemic which seeks to not only put the development and use of psychotropic medications in historical context, but also critically examines the long-term impact of these compounds from a data-driven lens.  In this discussion we cover the evidence around neurochemical "imbalances" in the brain,  findings around the the long-term outcome data around the use of antipsychotics & antidepressants  including the possibility of these compounds contributing to relapse and chronicity of illness, a brief consideration of problems associated with anxiolytics like benzodiazepines and finally, a discussion of the kinds of shift in narrative required around mental illness to move our understanding and treatment strategies forward.  Host note: the information discussed in the podcast today should not be taken as medical advice around the use of psychotropic medications and is for general information only.  If you have questions around the pharmacological management of your symptoms, please consult with your medical provider.      

Robert Whitaker is an American journalist and author who has won numerous awards as a journalist covering medicine and science, including the George Polk Award for Medical Writing and a National Association for Science Writers’ Award for best magazine article. In 1998, he co-wrote a series on psychiatric research for the Boston Globe that was a finalist for the Pulitzer Prize for Public Service. His first book, Mad in America, was named by Discover magazine as one of the best science books of 2002. Anatomy of an Epidemic won the 2010 Investigative Reporters and Editors book award for best investigative journalism. He is the publisher of madinamerica.com.

https://www.madinamerica.com