How and when to deliver care in-person vs. virtually (notes) CAMH

Yesterday I attended an one hour education period with CAMH virtually. Tomorrow I have another hour with York University. I don’t want to fall behind too much and so what I have decided to do is to write my notes to you and keep a copy of that for myself, record my education hours on my resume and for my college and appropriate association and then I can carry on with the other stuff. So, as you know I have gone from in person at my home office to virtually or telephone. However, there are still times that I do see a person in my office. I went from an office that was comforting and warm to an office that is almost sterile. My books I donated to my old professor, a Jesuit. He is now in a retirement home and so I asked him to donate them to the library when he is finished. He has told me that to read all those books a person can get a fine education. I did not donate the books he wrote. I have only one shelf of books in my office right now and another in my other home office. I re-placed my comfy love seat with wooden/metal chairs which is easy to sanitize. I have cleaning supplies replacing cute ornaments on my filing cabinet. I have had one long term client in my home office and I could tell he does not like the changes. However, COVID has changed everything. Back to CAMH. The presenters were Sandra Easson-Bruno from North Simcoe Muskoka Specialized Geriatric Services and Dr Allison Crawford - CAMH, General Psychiatry and Health systems Division, Associate Chiefs. I am always honoured to be invited. There was discussion regarding how overdoses skyrocketed in April, May and June. I see people who suffer addiction as well as their partners and/or families. Sometimes one doesn’t think he or she has a problem but arrives because of an ultimatum. There are different stages which I have written about before so I won’t elaborate. However, there are times when one really wants to get help and there the work can begin. The one suffering the addictions is the one who needs to recognize that he or she needs the help. When it comes to virtual therapy the presenter stated there was an indication that some are less vocal and they might disengage from treatment. Loneliness can increase. There was concerns about the family environment virtually. There are eyes there. I have noticed that myself especially with children. They know their parents are listening and therefore children won’t open up. Others I see use the therapy virtual room as a way of letting others know what they are saying. It is easy to tell when they start whispering with something they don’t want to share. Yes there are eyes as the presenters reported and I have noticed. With my weekly discussions of self/client care this is one topic which has been shared as we all experience virtual therapy in our care for others (I have missed last week and will also miss this week due to seeing clients and more education). In person, when I see clients, they are free to speak. There is no one listening except me. No one is standing by the door. They are safe and free. Another issue raised regarding the elderly is the circumstances of virtual when there is confusion with an elderly person, or a fall. I do see elderly people in my office and not on line. Usually a family member will bring them in and I encourage the escort to return in 50 minutes. I tell them where the local bakery is. CAMH is having 7000 virtual visits a month. I have gone from seeing people 99 % in person and about 1% by telephone to 99% virtually and 1% in person or communicating via telephone. I do try to encourage virtual. However people I see can afford to see me, either because of their EAP, Insurance or ability to pay my fee. I have decided not to increase my fees this year due to COVID. The presenters talked about Virtual mental health and the client’s experience. What happens when they cannot afford a virtual device? How can they access a device? How about their ability to engage? They also talked about those having no access what so ever to technology, not being able to see or hear. They talked about social isolation being huge. However, they also talked about great virtual programs. One of the things they mentioned is how many organizations where people depended on are now closed. I have heard complaints about that especially from the families of seniors. They talked about guidelines for virtual groups. Overall, a lot was covered in an hour. So now I will post the hour in my education platforms. My own thinking has changed since using virtual. If you read one of my previous blogs where I posted a paper regarding the ethics of virtual therapy, you will notice how I examined the pros and cons of virtual vs in person. Because of COVID I have had to move quickly to continue the care of my clients. I also had to consider my own health risk. I am six feet away from my clients in person. There is a sanitizer bottle near me and one near my clients. However, I do prefer to see clients virtually. I had to find a platform to keep my clients as safe as possible and so there are more expenses incurred for that service. After COVID I will continue to see clients virtually, because it offers a platform to those who can’t visit me because of distance, travel etc….I have noticed that some clients no matter how sick they are still wanted to see me but after COVID, they can from the comfort of their homes. The session I had with CAMH also stated they would send us the slides which I will be grateful for since they have forms I would like to have my clients compile if they wish since they can compare their virtual experience to in- person. I want to know the pros and cons my clients feel about virtual vs in person. I already have knowledge of that from clients who share it immediately without asking. There are also the guidelines for group work. I already know how to do group therapy but have never done it virtually though I offered it during the pandemic to one senior’s group. There wasn’t access or know how of virtual use. There went my offering. It is the thought that counts. No? So, I understand the concerns for those dealing with seniors. If there is a big company out there or even people who no longer have use for their devices, please donate them to CAMH or other organization who can provide it to people who don’t have access to technology. That can mean so much for someone suffering in isolation. There was also a request for that from hospitals during the COVID madness when it started. Please reach out to an elderly person by phone to just say hi. I have seen so much sadness because of the pandemic, but I have also seen so much caring from our people in Toronto as well. So many have stepped up to help others. And that helping of others is also therapeutic. It has emotional health benefits. I have two more educational events this week. There is another one hour talk from York University regarding Acute Discrimination and the Asian - white mental health gap during COVID -19. I want to share that with you probably on Friday if I can. Saturday I will be attending a virtual meeting with Canadian Association of Family Therapy (I also have to start recording hours for them as well) and a session early evening/late afternoon regarding brief therapy for couples in crises. It is all good. One of the mentions in the talk from CAMH is the effect this is all having on service providers. As for myself, I took an entire month off this summer. I am also taking the time and money to beautify my outside space. I started this fall and will continue in the spring. I want to spend as much time outside as possible during our short summer. The summer disappeared so fast. Take care. Don’t forget to focus on self care. Talk soon.

Exodus continues Theology notes

Intent of God is to being everything in life. Book of Job can be presented as terrifying God. Love of adults can be very challenging. Job - example of brother in law - fight and then what is for supper? Sacrifice son - challenge to surrender. Biblical stories are meant to present as with our greatest desires and greatest fears; not meant to emulate. Child needs to face fears with good coming on top. Concentrate on two things. 1. Figure of Moses - What happens to Moses, happens to people. 2. Theme of resistance - of people, pharaohs. Pharaohs people and Moses resist. Unlike Abraham and who is already married with Sarah. Yes had a father - we enter his story as an adult with his birth which says something about birth of a people. The Sinai Covenant is the start of a people. They make a commitment; has a response as what God has done for them. They multiplied, threat/ Hebrew boys thrown into the Nile. Moses even though he grows up in Egypt, he has compassion and leadership both to protect. Moses flees to the desert which suggests Moses’ leadership is based on a call from God. Ywah is a none name. I am who I am. I will be what I will be. The Divine name is revealed. Name is not a name. Moses and Israel - out of water. Moses encounters burning bush in the desert and so to people in the desert - fire/storm. Volcanic eruption and storm and both come together in image of lightening. Let’s try to explore why Pharaohs resist. Why the phase, God hardens heart. God hardens Pharaoh’s heart. Two verbs being used 1. Strong heart and 2. heavy heart. Pharaoh’s heart is hardened not by God. What dominates is that Pharaoh’s heart is hard. While for God hardening is at the end of plaques. Interpreted that God is giving them a chance to change and greater plaques are sent. All have to do with life and death. Notice magicians - First blood in water - no remorse. Frogs - want them removed. He revealed the hardness of his heart. 3rd gnats - magicians, therefore this is from God. 5. Life stock, 6. boils - has sinned but takes it back. 7. I have sinned - I know you do not yet fear the Lord. 8 - Locusts - Adults, but not little ones. 10:17 Forgive my sin. 9th darkness - everyone but not flocks and herds. 10th - First born 12:31 rise up and go. Letting them grow. With each plague, depth of human resistance to life. Solomon later interprets the plaques as the mercy of God. Why ten plaques? Each step reveals 1. God’s powers, 2, hardness of heart. A plaque is meant to illicit conversion. It shows the hardness of heart. He revealed the hardness of heart. Temptation - better to be a slave than liberated (Exod 16:3). This address is the covenant of Abraham - rest in the promise. Sinai covenant - struggle every day. God is the one who accompanies over the river Jordon < Weight of emphasis on Israel by giving their amen. King gives grant to loyal servant. God - Abraham. God wants human to co-operate Sinai Covenant, not simple obedience. Resistant is what is what is happening in crossing of Red Sea - God is the one who did this. They had to stand still. There is still a task. Massa means testing. The events in the desert depicts their resistance. Think of how a parent shows more responsibility for making a decision. After flood - animals consumed without blood, to show respect of the animal. Genesis - prior - both animals and people ate vegetables. Blood represents blood of God. Genesis - Trinity - Let us. Write them scripture. Psalm 22. New Testament writers reaching back for contemporary society and who gave voice to what Jesus Christ experienced. Next for theology is Conquest Joshua 1-6, 24, Judges.

A Nurse and an Orderly fired in a Quebec hospital after an incident of hurling insults to a dying woman - an Aboriginal woman (cause for reflection)

I just posted a poem I read this morning from a newsletter of one of my Associations. I don’t think they will mind. The author is unknown. It is the blog just before this one. I watched the news where a woman lay dying but managed to get her phone to post a nurse telling her that she was stupid I believe it was and that she had made bad choices in her life. Before I became a therapist I thought I had heard and seen everything. I have not. I am consistently learning, discovering and concerned. As you know I have worked as an intern in a hospital as a Chaplain. I worked with HIV, Cancer and Palliative Care. Not because I am a saint, but because no one else wanted to and we were told we were needed by the ward. That is the sole reason. Someone should do it, but no one wanted to. There was no obligation to do anything we did not want (perhaps there should be. How else does one grow?). I saw a life time of suffering as people talked to me about their lives, their regrets, their pain, their ………..At times I would go home and just look out and immerse myself in nature. I would look at my beautiful flowers and greenery and just stare off. I was suffering. I was also working seven days a week for too long, cramming two units in, the other pastoral counselling - Colpa mia. During this pandemic I have moved my private practice on line from seeing clients in my office. It is rare that I do and only under certain circumstances. Whenever I have been with the dying, I have considered it a privilege. There have been times when there was no one for the person dying. God help me, if I had ever witnessed anyone demeaning a dying person. I was fortunate to see the most amazing doctors and nurses and other hospital staff care for those who could not care for themselves. Often a doctor or nurse would ask me to see someone who was suffering. I did - always. I have attended more lecture series on line which allows me to attend more than if I had to pick and choose if it was in person. I am a very social person so I will always give priority to live sessions in person. Suddenly because of the political environment there is a concern for the aboriginal, the poor and black lives. I say suddenly because I haven’t heard too much of anything before. What I do say to my clients is to take advantage of this opportunity when something is not right, when there is discrimination. In one of my last series from York University there was a talk about how the poor, aboriginal and blacks are more prone to get COVID 19. Did I learn anything? Of course not because it is the same thing over and over again. Nothing is done. I remember in undergrad studying how we polluted lakes where our native community live and depend on. Ok, so I learned that nothing has been done to rectify that. Why should be the question? At a two day lecture course I attended several years ago there were counsellors from a native community. None of them were qualified. So, perhaps last year I mentioned that to a politician and asked why? The answer was that it is hard to get qualified people to go to these isolated areas. Do I believe that? There are incentives and there are also possibilities for students working under supervision who would be more qualified. Why has this not been done? I admire this Aboriginal woman, a mother of seven who had the insight to tape what was happening. However, I also suffer that this woman was not respected by those whose job it is to do so. Being with someone who is dying is a privilege. There are certain careers where something more is required than doing your job, it is a vocation. One that should never be taken lightly. More education is to take place about caring in these institutions. There is blame and it is systemic. Now is the right time for change. Let’s abolish prejudice. Let’s recognize hate for what it is. Let’s not use bandage solutions but get down and dirty and clean up what needs to be done. Speak up when you see something is wrong. What do you think?

The Crabby Old woman (copied and pasted by one of the newsletters from one of my associations (not therapy)

THE CRABBY OLD WOMAN When an old woman died in the geriatric ward of a nursing home in Saskatchewan, it was believed that she had nothing left of any value. Later, when the nurses were going through her meager possessions, they found this poem. This little old woman, with nothing left to give to the world, is now the author of this beautiful anonymous poem. What do you see nurses? What do you see? What are you thinking when you're looking at me? A crabby old lady with faraway eyes? Who dribbles her food and makes no reply. Who seems not to notice the things that you do. And forever is losing a sock or shoe? Who, resisting or not, lets you do as you will, With bathing and feeding a long day to fill? Is that what you're thinking? Is that what you see? Then open your eyes, nurse, you're not looking at ... me I'll tell you who I am as I sit here so still, As I do at your bidding, as I eat at your will. A young girl of Sixteen with wings on her feet. And soon now a lover she'll meet. A bride soon at Twenty, my heart gives a leap. Remembering, the vows that I promised to keep At Twenty-Five, now I have young of my own. Who needs me to guide a secure happy home. At forty, my young sons have grown and are gone, But my man is beside me to see I don't mourn. At Fifty, once more, babies play 'round my knee, Again, we know children my husband and me Dark days are upon me; my husband's now dead. I look at the future and shudder with dread. For my young are all rearing young of their own. And I think of the years and the love that I've known. \ I'm now an old woman and nature is cruel. But inside this old carcass a young girl still dwells, And now and again my battered heart swells. I remember the joys I remember the pain. And I'm loving and living life over again. I think of the years, all too few gone too fast. And accept the stark fact that nothing can last. So open your eyes, people, open and see. Not a crabby old woman. Look closer... see ME!!

Sexual Abuse

I mentioned I wanted to share what I read in an article from Psychology Today Aug 20. It reveals that one in nine girls under the age of 18 experience sexual abuse at the hands of an adult. 18% of boys are sexually abused by a trusted adult. Almost all of the survivors feel shame (p 29). Shame is something I often hear . We are sexual beings and when a predator sexually abuses he often will have the child think that it is wanted. Since in cases, pleasure is felt than the child feels the shame. Shifting the shame away from the client and onto the predator is what I do. They are children and not responsible. Others also threaten the lives of their parents if they tell. If you are reading this blog and have been sexually abused do feel free to tell. Many do not report it and many more never share this until it comes out in therapy. This is just a fraction of what happens. Pg 29 continues that that there is an assumption that men aren’t or shouldn’t be victims. This often leads boys and men to minimize or conceal what happened. Their sense of masculinity, failing to prevent the assault can undermines their self esteem. U.S. Psychiatrists recognized that early sexual abuse left lasting scars mirroring those of veteran patients. I now often ask my clients if they have been sexually abused depending who the client is. I sometimes wait for the right time to ask or patiently wait for the client to inform me when she or he is ready. The article continues that most who have been abused later have problems with intimacy, trust and sexual relationships. I concur. What the writer of the article states is that he began a group of 8 men who had been traumatized as children where they would share experiences and learn about its adult consequences. At the first meeting there was a rule of no sarcasm. He explained that sarcasm is often utilized to shut down uncomfortable conversation. Learning to live with the discomfort was one of the primary reasons they were meeting. That was in 1994. In 2020 the group of men still meet every 2nd Monday evening, except for two. One of the two moved but still tries to attend by internet. This article was written by Dr Bert Pepper, M.D. a clinical psychiatrist. If there are any errors, I claim it as mine. There are therapists who will not work with those who have abused. I am going to ask that when you read this you don’t make negative comments against the abuser. Many have been abused themselves. The first time I met a child molester I was prepared for the hostility I would feel, but as the person trembled before me (not when I was a therapist) I actually felt sorry for him. I wrote a paper which I posted on my blog “pedophile priest”. It was a research proposal as part of my studies. It is not meant to bash priests but it does provide information regarding the pedophile and how common sexual abuse is. Not everyone was pleased that I chose the topic for a proposal and I was dealt with some blocks when researching. When I shared this with my Jesuit friend, he said “of course.” As you know I have been told I am risque at times. However, we need to make changes in this world and silence does not make change. If you have been abused and are reading this article and have remained silent, remember that you don’t have to be. You can report this. If you have reported this and the adult ignored it, go to a therapist or the Police and report it. You don’t need to be silent. It is your choice. Remember that this was not your fault. I attended a three day sexual assault course in Sudbury years ago in a previous career. The first speaker informed us of how as a child she was raped by her father and brothers. When she reported it to the police when she was older, her mother called her a liar and told her she had brought shame to the family. She was told they wanted nothing more to do with her. She was introduced as the first speaker to prepare us for what we were going to hear. We were provided with the tools to co-ordinate a three day seminar ourselves. This was organized by an OPP female Officer. Wonderful course. On a lighter note: I have been attending many series, meeting etc….which I may be sharing with you before going back to my notes. Much has to do with the Corona Virus. I may as well share all this before it becomes redundant. I haven’t had much time to write for fun but am now focusing on becoming more updated on how to sell my books. Right now I am on www.silvaredigonda.com but will be adding more sites. I write for fun only. With the pandemic my work has increased so I must be mindful of how much I do. Days pass quickly. I will probably sooner, rather than later place a calendar for new clients only at my site, www.redigondapsychotherapy.com However that will be very limited. So thank you for reading my blogs. Keep healthy. Maintain distances and please take this pandemic seriously. Listen to what the Doctors who are specialists in the field before listening to the politicians because not all of them are listening to the experts. Take some quiet time for yourself and think of what is positive in your life. What do you think?

A Grateful Day with Brother David Steindl-Rast - Gratefulness.org

Climate Change for Clinicians, Family Therapy Magazine May/Jun 20 pgs 43 -44 by Gioia Jacobson, MA, LMFT - (Spend time in nature from me)

I wanted to share with you a bit of what I read as per the caption. Jacobson states that today about 55% of our population live in urban (city) areas. Anxiety and disorders and depression are positively correlated with living in the city. Contact with nature and green spaces is linked with improved mental and physical health…..Climate solutions are available now, and support psychological health, such as increasing adoption of active commuting, green spaces and clean energy. Positive mental health effects can be viewing nature, sitting in nature and conservation - based activities. Exposure to nature is correlated to reduced psychological and physiological stress. Thank you Ms Jacobson. Now for my input…….One of the things I always or nearly always recommend for my clients is to spend time in nature. Being a city person myself, spending time in nature is paramount and has been since I was a teen. Growing up my parents incorporated it into our lives and I learned that my love of animals domesticated or not was part of that love for nature. Give me a cabin by the water and I would be a queen. However, being a city person I would need it to have everything like electricity, wifi and a great toilet/bath/shower. Why not have a combination of both? I normally suggest as part of self care, walking and better still walking in nature. Some find peace in walking in cemeteries and that is ok. In some cases where people are confined and there is no possibility of park land, I suggest getting a plant or two and taking care of them while enjoying its beauty. My priority at my home is the outside. If I am confined, I can enjoy the trees and flowers and greenery around me. This article stood out to me because I take too much for granted when it comes to knowledge. Somethings which may be obvious to me isn’t to everyone. So, why not spend sometime in nature today? Close your eyes in nature? Name three things you hear. Name three things you actually feel. Now pretend you are opening your eyes and what do you see? When you are ready open your eyes and savour your senses. What do you think? Next week I want to include some of what I read in Psychology today regarding treatment for sexual abuse, for men. After that I will like to return to my notes of social studies. I believe we are still working on, and alternate weeks regarding theology. Have a good week and keep safe. Maintain social distancing, wash your hands frequently, wear a mask to protect others and live life.