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The Think FLEXibly Blog

Some ideas anyone can benefit from. Our blog is intended to provide current and future clients some ideas and resources that we think are great.
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Wellness Wednesday: Back to the Well

11/19/2020

 
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We're back. The previous few months have been filled with struggle and sacrifice. Seasons have changed, and we have set our sights on new goals and pursuits. Below we have summarized some recent Wellness Wednesday posts. Click the Title link to read more!
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Checking In. It is important in everyday life to check in with yourself, assess your feelings and your overall well being. You can do this anywhere and with ease. There are three steps you can do to check in with yourself. Pause: slow down, take a deep breath. Calm yourself and put a pause on what is going on at the moment. Reflect: be mindful of your current state, emotionally, mentally, cognitively. Focus on your internal well being. Turn inwards: ask yourself if your needs are being met. If any of your needs are not being met, what can you do to meet them? It is important to check in not only with yourself, but also with the people around you. Have your friends and family check in with themselves, and if they find any of their needs not being met, what can you do to meet them? If you can help meet their needs, they may help you meet yours too. 

Making Habits Stick. Maintaining new habits can  be a bit of a difficult task for some. However, there are five tips to make any habit stick in your day to day life. Instigation habits are cues or triggers in your environment that will help you get started on your intended action. Tracking progress brings awareness to your successes and can keep you motivated. seeing consistency in your habits will motivate you to maintain them. Recognizing milestones will help you feel accomplished and motivated. Without celebrating our progress,  it can be easier to give up. Celebrate the little things. Supportive cheerleaders in your social circle can keep you motivated to stay on track. The people you surround yourself with want you to succeed and will cheer you on. Self-efficacy helps you to understand why you are engaging in this habit. Understanding why you want to  engage in this habit solidifies the meaning behind it and can further push you to maintain consistency. 
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Book club: In This Moment: In This Moment, written by Kirk Strosahl (Ph.D.) and Patricia Robinson (Ph.D.), (2015), teaches the reader how to take a mindfulness approach to handling everyday stressors. The book places an emphasis on how someone can integrate mindfulness skills and meditation into their everyday life. The writers of the book list five facets of mindfulness necessary to engage in the mindfulness approach to handling one's stress. These facets are observe, describe, detach, love yourself and act mindfully. One of the most interesting things of this book is that it breaks down the concept of mindfulness into easy to follow and tangible steps that can be practiced. As well, each chapter dedicates a section that explains the facet from a neuroscience perspective, which helps the reader understand and explore what area of the brain develops the skill. 

Self Compassion: More recently, it is easy to find oneself in a situation where we may feel as though we are facing down critical judgement, social comparison or just a general feeling as though we are not enough. During these times, it is important to take a step back and engage in practicing self compassion. Dr. Kristen Neff (University of Texas) defined self compassion as the combination of 3 elements: Self kindness vs self judgement, common humanity vs isolation, and mindfulness vs over-identification. Embracing self compassion is a lifelong journey of learning to care for yourself, and is especially important to keep in mind during more recent world events. 

Finding Meaning in the Madness: Recent world events have brought on a rather large change to everyone's way of life. It has brought on sacrifice, change, reflection and new perspectives. During times like these, it is important to look back at previous works to see how to adapt to the events that surround us. Victor Frankl, the founder of Logotherapy, teaches that it is often within our struggles that we find meaning and can form the resilience we need in order to adapt. When we begin to look for the meaning behind our struggles, and understand that we may not be able to change our situation, it is in that moment that we understand we are challenged to change ourselves, to develop the resilience we need in order to adapt to the environment. 

Passive, Assertive and Aggressive Communication Styles: Everyone has a different preferred style of communication. Some feel it easier to be more passive and easy going, while others use a more aggressive tone to garner respect in conversation. There are upsides and downsides to both. However, there is also a middle ground option: being assertive. We aim to be assertive so we can both communicate our needs while also being able to listen to the needs of others. There are times when each style of communication is necessary and appropriate, however, more often than not the middle ground of being assertive​ may end up being the most productive. 

App Review: CBT Thought Diary: CBT (Cognitive Behavioural Therapy) is a therapy style that aims to teach individuals to challenge, and eventually change negative thoughts and learn to replace them with positive thoughts. Often, CBT is used with a thought record to keep track of the individual's thoughts and feelings throughout the day. The thought record helps individuals break down their experiences into several characteristics that allows them to see the impact of their thoughts on their emotions and choices that they may react with in a given situation. CBT Thought Diary, a free app on the app store,  aims to help the user to complete all necessary sections of a traditional thought record and allows its users to track their emotions and allow for reflection on those moods. Currently, the state of the world has lead to an increased need for resources for people to turn to in order to help themselves. The CBT Thought Diary is no exception. 

​Motivation and Giving Up: Often when we feel we have too much on our plate in front of us, our passions can easily become burdens and stressors. It can lead down a path that makes you feel disappointed. It is important to keep in mind that everyone juggles many responsibilities on a daily basis. What can be helpful is to allow yourself to be imperfect. Offer yourself compassion instead of anger if you need to turn down another commitment. Many would refuse to asking for help and accepting help from others, however there is nothing to be ashamed of when we do. Asking for and receiving help doesn't make someone look weak, rather, it shows that they are responsible and self-aware of their strengths and limitations. 

Putting Yourself Out There: Experiencing doubtful and negative thoughts affect everyone. It can affect our confidence in what we know and love. When this happens, there are ways to challenge these intrusive thoughts. Putting yourself out in the open may seem like a scary experience at first, however, it can prove to be very beneficial. When putting yourself out there, it is important to have balanced expectations rather than overly negative or overly positive expectations. You can start where you are comfortable, among family and friends, then move to less comfortable situations such as around strangers. If we never take the risks we are faced with, we never know what could have been. 

To my fellow white therapists...

6/23/2020

 
By Sorcha Ní Chobhthaigh, M.Sc.
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My thoughts on being a White mental health clinician, in a White-led mental health service, during a public health crisis impacting the mental health of the Black community.

During this time of uprising, rejection of the historical and current reality of systemic and racial injustice, Black people are forced to cope with a constant barrage of triggering images, descriptions, and the weight of constant advocacy. Add to this the presently heightened burden of white fragility and defensiveness on top of the pre-existing daily lived experiences of this reality. It is essential that non-Black mental health clinicians (including myself) recognise and acknowledge the impact of these experiences as detrimental to the physical and psychological well-being of the Black community and cannot be underestimated. Even more so, it is critical that non-Black mental health clinicians and service providers recognise the importance of providing appropriate, attuned, and genuinely accessible mental health support to the Black community. It is also our duty to amplify the voices and work of our Black colleagues and Black-led mental health services as they continue to provide invaluable support.

We know already that everyday experiences of overt or covert racism (including microaggressions) can induce a biological stress response and symptoms associated with trauma which, in turn, increases the risk of experiencing stress-related chronic illnesses (Carter & Forsyth, 2010; Carter et al., 2020; CMHA, 2008; Pieterse et al., 2010). Moreover, the trauma doesnʼt start at first exposure ‒ it is also thought to be ʻpassed downʼ through generations. Intergenerational or transgenerational trauma results from the legacy of inequality, oppression, and colonization inflicted upon a community over generations (Evans-Campbell, 2008; Yehuda & Lehmer, 2018). Clearly, the impact of racism needs to be incorporated into the assessment, formulation, and intervention plan of clientsʼ presenting concerns.

We also know that therapistsʼ perceived level of cultural competence or incompetence ‒ including their knowledge, understanding, and sensitivity to their clientsʼ lived experiences - impacts the therapeutic relationship and subsequently facilitates, or impedes, intervention effectiveness (Awosan et al., 2011; Chang & Berk, 2009; Fuertes et al., 2006; Thompson et al., 2004).

On a fundamental level, for non-Black mental health clinicians to effectively support Black clients, we need to engage in advanced trainings on racial competence and provide culturally responsive and racially informed assessments and interventions with racialized groups (Helms et al., 2012). However, that in itself is not sufficient to truly honour the lived experiences of Black individuals and families, to understand the significance of racial experiences, and to overcome difficulties addressing race in session. We need to actively reflect on and examine our own privilege and racism, in addition to recognising the inherent power dynamics of, and the significance of the racial composition of, the therapeutic dyad (Carter, 2015; Gordic, 2014). Moreover, we need to actively engage in dialogue with clients about race and racism, the implications for patient well-being, and clinical practice (Murray-Garcia et al., 2014). Without utilising trauma-informed, anti-racism, anti-oppressive frameworks, we risk perpetuating the oppressive power dynamics experienced in everyday life in the therapeutic space. Simply put, if we do not have the necessary awareness, training or skillset, we risk causing more harm. As such, it is our responsibility to recognise our limitations and support the client to access clinicians better matched to meet their needs.

*Disclaimer: I am not an expert. I am just a White mental health clinician trying to educate myself and other wannabe allies to do better. Please see references and resources below for real learning.

Below are some cultural competence resources for therapeutic spaces. This list is by no means exhaustive ‒ but itʼs a start. Contributions most welcome and encouraged.

Black-led healing spaces in Toronto*
  • The Most Nurtured
  • Black Mental Health Matters
  • Women's Health In Women's Hands
  • Black Health Alliance
  • WellNest
  • Gray Matter Health
  • Across Boundaries
  • Heart of the Matter
    *This is just a few, there are many more.

Read: In therapy

  • Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care across Settings by Monnica T. Williams, Daniel C. Rosen, and Jonathan W. Kanter
  • Counseling the Culturally Diverse: Theory and Practice by Derald Wing Sue and David Sue
  • Measuring the Effects of Racism: Guidelines for the Assessment and Treatment of Race-Based Traumatic Stress Injury by Robert T. Carter and Alex L. Pieterse
  • Intersectionality and Relational Psychoanalysis: New Perspectives on Race, Gender, and Sexuality by Max Belkin and Cleonie White
  • Care Work: Dreaming Disability Justice by Leah Lakshmi Piepzna-Samarasinha
  • The Cost of Racism for People of Color: Contextualizing Experiences of
    Discrimination by Alvin N. Alvarez, Christopher Liang, Helen A. Neville
  • The Challenge of Racism in Therapeutic Practice: Engaging with Oppression in
    Practice and Supervision by Isha McKenzie-Mavinga
  • Race Talk and the Conspiracy of Silence: Understanding and Facilitating Difficult Dialogues on Race by Derald Wing Sue

Read: In everyday life
  • How to be an Anti-Racist by Ibram X. Kendi
  • Me & White Supremacy: How to Recognise your Privilege, Combat Racism and
    Change the World by Layla F. Saad
  • White Fragility: Why Itʼs So Hard For White People To Talk About Racism by Robin DiAngelo PhD
  • So You Want to Talk About Race by Ijeoma Oluo
  • Biased: Uncovering the Hidden Prejudice That Shapes What We See, Think, and Do by Jennifer L. Eberhardt PhD.
  • The Skin We're In: A Year of Black Resistance and Power by Desmond Cole
  • Pushout: The Criminalization of Black Girls in Schools by Monique W. Morris
  • Until We Are Free: Reflections on Black Lives Matter in Canada by Rodney Diverlus, Sandy Hudson, Syrus Marcus Ware

Read: Healing from Racism
  • The Racial Healing Handbook: Practical Activities to Help You Challenge Privilege, Confront Systemic Racism, and Engage in Collective Healing by Anneliese A. Singh, PhD.
  • Healing Racial Trauma: The Road to Resilience by Sheila Wise Rowe
  • The State of Black Girls: A Go-To Guide for Creating Safe Spaces for Black Girls by Marline Francois-Madden
  • The Inner Work of Racial Justice: Healing Ourselves and Transforming Our
    Communities Through Mindfulness by Rhonda V. Magee
  • Post Traumatic Slave Syndrome by Joy Degruy Leary
  • The Unapologetic Guide to Black Mental Health: Navigate an Unequal System,
    Learn Tools for Emotional Wellness, and Get the Help you Deserve by Rheeda Walker, PhD.
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Listen
  • Therapy for Black Girls by Dr. Joy Harden Bradford
  • Melanin & Mental Health by Eliza Boquin and Eboni Harris
  • Highwater Podcast ‒ Episode ʻThe Artistʼs Guide To Mental Healthʼ with Alice Berry & ʻ#NoShameDay: Telling our mental health storiesʼ with Bassey Ikpi
  • NATAL by a team of Black creatives and parents
  • Sisters in Loss by Erica M. McAfee
  • The Friend Zone by Dustin Ross, HeyFranHey & Assante

Follow
  • @ decolonizingtherapy
  • @ ogorchukwuu
  • @ ajabarber
  • @ blackmentalwellness
  • @ inclusivetherapists
  • @ liberatemeditation
  • @ blackgirlinom
  • @ flora.mind
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Other Resources
  • Black Health Alliance
  • Therapy for Black Men
  • The Loveland Foundation
  • Ethelʼs Club
  • Black Mental Wellness
  • Omnoire
  • Black Youth Helpline
  • Black Women in Motion
  • Black Men Heal

References

Awosan, C.I., Sandberg, J.G., & Hall, C.A. (2011). Understanding the experience of Black clients in marriage and family therapy. Journal of Marital and Family Therapy, 37(2), 153-168. doi: 10.1111/j.1752-0606.2009.00166.

Canadian Mental Health Association (CMHA) (2008). Recommendations for Preventing and Managing Co-Existing Chronic Physical Conditions and Mental Illnesses. https://ontario.cmha.ca/documents/the-relationship-between- mental-health-mental-illness-and-chronic-physical-conditions/#:~:text=People%20living%20with%20a%20serious%20mental%20illness%20are%20at%20higher,rate%20o f%20the%20general%20population.

Carter, R. T. (2007). Racism and Psychological and Emotional Injury: Recognizing and Assessing Race-Based

Traumatic Stress. The Counseling Psychologist, 35(1), 13‒105. doi: 10.1177/0011000006292033

Carter, R. T., & Sant-Barket, S. M. (2015). Assessment of the impact of racial discrimination and racism: How to use the Race-Based Traumatic Stress Symptom Scale in practice. Traumatology, 21(1), 32‒39. doi: 10.1037/trm0000018

Carter, R. T., Kirkinis, K., & Johnson, V. E. (2020). Relationships between trauma symptoms and race-based
Photo used under Creative Commons license. Source here.
Image: Black Lives Matter by John Lucia. See side panel for further copyright information.

Wellness Wednesday: A Trip to the Well

6/17/2020

 
We fell behind on updating readers about all the going ons at #WellnessWednesday, but we are back and have a full week worth of readings ready for you. We have a lot to share, so let us get right to it:
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Seeking Control: Managing Change. April stood out as the moment many of us became increasingly aware that we were not going to be moving on from COVID for a while. Jessica brought us a good look at managing change that still resonates today.

Navigating Sleep in Quarantine. Good sleep habits keep us healthy. Those habits are often anchored by our normal school and work week, which has been quite disrupted over the last few months. Jessica takes a look at how we can bring those old habits back to help navigate stress and stay healthy.

Five Things That Have Helped Get Me Through Quarantine. Jessica gives us a nice little list of activities and strategies that she has found helpful in navigating the stresses of quarantine.

Activity Scheduling During Quarantine. For many of us the days and weeks have been blurring together. Jessica looks at how activity scheduling can bring some order to our lives, allowing us to feel more productive and healthy.

What I Have Gained From Quarantine. It is not too hard to see some of what we have actually gained from quarantine and social distancing if we look closely enough. Jessica reveals a bit of her journey and encourages you to take a new look at yours.

The Healthy Mind Platter. With warm weather comes the spring and summer reading season. Jessica gives us some thoughts on Dr. Daniel Siegel and Dr. David Rock's Healthy Mind Platter.

The Language We Use. After taking a hiatus in support of BLM and the ongoing protests around the world, Jessica looks at the language we use and how it can affect our experience and others around us.

Escaping Screens. It can be pretty easy for us to dive into our phones or computers as soon as we wake up and then get lost in them for the day. This week Jessica looks at how we can disengage from our technology and take back control.

Image used under Creative Commons license. CLICK HERE for the source.
Image: gratitude by keico taguchi. See side panel for further copyright information.

Wellness Wednesday: Spring Cleaning

4/16/2020

 
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While we somehow ended up with snow yesterday through much of Southern Ontario, spring training is on a lot of our minds while they are stuck at home. This #WellnessWednesday, FLEX Blogger and Therapist Jessica Danilewitz discusses spring training and minimalism, and how a bit of clean up of both our personal and mental space can be a good way to give yourself room to grow. CLICK HERE to read this weeks Wellness Wednesday!

Wellness Wednesday: Compassion Fatigue

4/8/2020

 
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This weeks Wellness Wednesday post continues FLEX Therapist-Blogger Jessica Danilewitz's focus on our shared experience with COVID19. Today Jessica is discussing compassion fatigue, which we can experience not only as health practitioners, but also as caring partners, friends, or family members. It is another great post and provides some food for thought on how we can both support ourselves and others. CLICK HERE to read Wellness Wednesday.
Photo used under Creative Commons license. Source here.
 Image: fatigue by hnt6581. See side panel for further copyright information.

Providing Ethical Telepsychology: What are the rules, and is what the news is saying really true?

4/8/2020

 
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The following is a cross-post from the blog of FLEX's founder Michael Decaire. The post is the opinion of the author based on his experience in the regulatory, clinical, and telehealth sector. It is not a legal opinion, though it is based on a thorough review of relevant legislation and ethical standards. It is written to inform clinicians on how they can ethically provide care through video, but may have information regarding regulations and privacy that could set some mental health consumers of at ease.
 
FLEX Psychology has provided clinical services over telehealth systems for well over a decade. This has included support for remote communities and hospitals, transitional support for in-person clients, or simply the provision of accessible care where and when it is needed. I personally have had the opportunity to be  an educator and trainer in this area for many years, assisting therapists and organizations to implement an ethical and efficacious telehealth solution into their clinics. Over the last decade I have had the opportunity to try out virtually every video solution available. Some are good. Some are bad. None are perfect. Fortunately, nearly every solution (including every free solution) appears to meet the legal and professional requirements of use in Ontario. In other words,  you would have to put forth a concerted effort to break any rules.
 
Today I want to tackle some of the ethical and legal questions I have been hearing when conversing with peers and clients. For obvious reasons, we have seen a clear push towards the implementation of telehealth solutions. The need to rapidly transition to this medium has forced a lot of professionals who were dragging their feet to suddenly shift their practices online. That has brought with it a lot of anxiety, which several video solution providers have appeared to decide to capitalize on. This has further fostered a range of sensationalistic news articles that are difficult to decipher for the layman and, at their worst, are deliberately misleading.
 
What Laws and Standards Police Telehealth in Ontario?
 
There is no specific law targeting telehealth solutions in Ontario, but since these tools are used for the real time implementation of healthcare, they do fall under the purview of the Personal Health Information Protection Act (PHIPA). There are a number of similar information acts that have an application to non-health information that may apply on the periphery (e.g. FIPPA; MFIPPA; PIPEDA), but these acts are substantially similar to PHIPA, and PHIPA tends to supersede those acts given the nature of the information we manage within the profession.
 
So, what does PHIPA have to say about telehealth?
 
Absolutely nothing. 
 
You are welcome to say that again along to War by The Temptations.
 
Canadian laws tend to be designed in a manner that is technology (and thus time) agnostic. To be more specific, PHIPA has no reference to encryption, technology, means of service, or location of service.
 
That leads to the question of how a piece of software can be listed as "PHIPA compliant" if there are essentially no actual prescribed routes to compliance. Realistically, it appears that "PHIPA compliant" is nothing but a nonsense marketing technique. Vendors are likely borrowing the marketing term from "HIPPA compliant", which relates only to practitioners in the United States. HIPPA compliance is an actual thing, but relates primarily to a liability agreement that is signed between a vendor and the health practitioner end user. Those agreements are required by law in the US, but are not accessible to Canadian providers. In many cases, upgrading to "compliant" software provides you no additional protections at all. Zoom Cloud Meetings, for instance, provides identical encryption techniques across both their free and professional accounts. While the pro and healthcare versions do provide some additional features (e.g. unrestricted group meetings), the level of encryption is the same across all versions of the platform.
 
Given the lack of any actual prescribed compliance standards, I like to remind those I speak to that my cat is PHIPA compliant.
 
So are there any rules in PHIPA I need to be mindful of?
 
PHIPA provides a framework for how health professionals are permitted to engage with the personal and confidential information of our clients. The rules that apply to a brick and mortar clinic are essentially identical to a virtual one. If you were following the rules at your normal office, you likely remain complaint with PHIPA online.
 
There is a key wording in PHIPA that health practitioners need to be aware of: Reasonable.
 
This is a term that comes up routinely throughout PHIPA and the Information and Privacy Commissioner of Ontario's (IPC) rulings, fact sheets, and advice on the application of PHIPA.
 
Within PHIPA itself:
 
“A health information custodian shall take steps that are reasonable in the circumstances to ensure that [PHI] in the custodian’s custody or control is protected against theft, loss and unauthorized use or disclosure…”
 
Within IPC's Fact Sheets on Protection:
 
A Health Information Custodian "must take steps that are reasonable in the circumstances to [protect] personal health information in their custody or control”
 
Within IPC's Fact Sheets on Encryption:
 
“‘strong encryption’ does not refer to a particular technical or design specification, or even to a specific encryption feature that could be inserted into a … specification.”
 
“Encryption must be commensurate with, and responsive to, known threats and risks”

 
The IPC goes on to note that "reasonable" is situationally dependant. A large governmental funded organization may be expected to have a highly encrypted system that is locked down through high end security software, where a small private practice is, at the very least, expected to use passwords and flip the switch for basic encryption already built into their computers. It is readily apparent that the IPC is not expecting small clinics to be security experts, but that reasonable protections should be put in place.
 
The reality is that every video software solution is encrypted, though the nature of that encryption may vary to some degree. No one seems to be questioning the ethical use of the telephone in care. Video software is providing only a visual addition to what can be acquired by phone. In essence, a clinician would have to seemingly put in a concerted effort to break the rules here.
 
What do regulatory colleges have to say?
 
Again not much in terms of technology use. The College of Psychologists of Ontario (CPO) introduced a variety of telehealth guidelines in 2017. These focused primarily on the requirement to maintain the same standard of care over telehealth solutions that you would in person. Otherwise, most of the focus here was insuring you are practicing within your scope, in jurisdictions that you are permitted, and in a manner that is covered by liability insurance. The College of Registered Psychotherapists of Ontario (CRPO) has a fairly similar set of rules.
 
The only real area of note with both colleges is the expectation that clinicians are competent in care over this medium and that back-up solutions are in place for any technology failure (e.g. switch to the phone if you cannot get your video to connect and a client is in crisis). As is typical with most of these rules, competency is not defined. If we want to keep it simple though, I would suggest that clinicians be able to recognize how technology may preclude certain types of treatment/service and that they either modify their approach to avoid any compromises or do not offer such services over that medium. That being said, during times such as these, it may be important to remember that "best practice" and "competent practice" are not always equivalent. This medium may not be one's preferred manner of providing clinical support, but that does not mean that it precludes us from providing competent and necessary care during a time of high need.
 
What is all this news I keep hearing about Zoom Cloud Meetings being the boogeyman?
 
There is a lot of sensationalistic news going around right now regarding Zoom Cloud Meetings, which happens to be my personal telehealth solution of choice. Zoom appears to be the focus of these reports due to the surge in usage it has received during the COVID pandemic, which has resulted in a lot more attention to the platform, but has also made it a juicy target for technology reporters during a particularly notable slow time for that industry.
 
The problem is that the majority of these reports are utter nonsense, extremely overblown, silly semantic arguments, or, at times, clearly being fostered by other video platform providers who see this as an opportunity for a financial windfall. I thought I would tackle some of the most common silly worries I have been seeing. I would also like to remind people that the Zoom platform is actually what many other platforms people have earmarked as "safe" is built upon, which means these solutions are really no different than Zoom's offerings. I would also like to note that Zoom is now the platform of choice for Ontario's criminal courts during the COVID shutdown. You can be fairly confident that this group did its due diligence.
 
Is Zoom is selling my information to Facebook? No. Many software companies allow you to login using your Facebook or Google credentials. In a sense, this is actually a security feature, as the confirmation of your identity is handled by this third party and you do not have to worry about having another login and password out there that could be hacked and released. In order to allow this login format, Zoom has to communicate with Facebooks servers to allow them to confirm you are who you say you are. This process does not pass on additional information and your attendees do not actually need a Zoom account in the first place (they simply click and attend as guests).
 
Another cause of the "Facebook" is stealing your information fear is that Zoom used a Facebook "analytics plugin". Analytic plugins are used to acquire technical information about a user (e.g. what computer platform you are using; what web browser you are using). They are needed to provide smooth and personalized services and are imbedded everywhere, including this website. Facebook and Google are amongst the biggest analytics companies in the world, so I would have been surprised if Zoom did not have this relationship with Facebook. The important detail for readers to know is that this information is not of the personal and confidential type, and certainly does not pose a health information risk.
 
I heard the free and pro version of Zoom is not PHIPA compliant? PHIPA compliance is not a thing. At best, it is a misunderstanding of how PHIPA works. At worst, it is a manipulative marketing technique.
 
I was told Zoom is not end to end encrypted. Admittedly, Zoom did use the term end to end encrypted in a non-traditional manner, though they were semantically correct. In theory, end to end encryption is generally accepted to mean that all communication goes through a secure and direct communication between two end points. Think of it as a tunnel between two places that no one can see into or get into other than the two people who initiated the travel between those two places. This sounds like a good idea, but this sort of security is unnecessary, not practical, and would actually be compromising to care and safety. A end-to-end tunnel such as this would prevent group meetings (e.g. that third person would not be able to get into the tunnel), break virus scanners (e.g. computers in the cloud would not be able scan files to see if someone is trying to send you a virus), and cause a number of logistic issues.
 
In essence, Zoom acts as a relay of fully encrypted sessions. The signal is encrypted by your computer, goes to the relay station, is received by the end user, and only they can decrypt it. So, in a manner, it is fair to say that this transmission is encrypted end to end. If we required end to end AND direct communication without relay, we would not be able to use the phone to talk to patients, send documents by courier, use a fax machine, implement digital outcome and progress monitoring measures, or any electronic records software. In essence, Zoom's security is the equivalent of taking information, locking it in a safe, sending that safe by armed courier to the intended recipient, and then have them lock their response in that safe and send it back through the same means. That is more secure than most ways we currently communicate.
 
Is Zoom spying on my clients? This was a real sensational one. Zoom used to have a software feature for large group meetings and webinars that alerted the presenter if the audience was no longer attending to the screen. They have turned this off due to privacy complaints, but this is far from "spying". In case you were wondering, I can tell when you are not paying attention to me in person as well.
 
But Zoom was hacked, and people can control my computer! While this may not make anyone feel better, most software platforms have been hacked in one way or another and new bugs are found every day. This is actually one of the reasons I prefer more popular platforms, because these bugs are spotted more quickly, and the company has the resources to squash those bugs. I have used smaller platforms that I have generally loved, but ultimately ended up abandoning them because it took months to fix small issues and I began to seriously worry that they would not even know if they had been hacked.
 
So, does Zoom have any serious bugs? Absolutely, but fortunately you probably do not have to worry about them. The current issues they have been working to resolve include the ability to obtain higher access to your computer than you would wish IF a hacker was physically sitting at your computer and you logged them in (why would you do that?) or if you are sent a malicious link by a hacker you happen to be having a meeting with. The latter is a problem nearly every chat application has dealt with, including your text message app. I would simply suggest not chatting with hackers or letting them come into your house during social isolation. Problem solved!
 
The reality is that all software platforms experience these types of bugs. It is good that they are highlighted, because that is how they get fixed. The key is whether one would reasonably think these bugs pose a risk to patient privacy or safety, and they clearly do not.
 
I heard that Zoom Trolls are attacking our sessions! I wanted to leave this one for last, as it is a perfect example of sensational news and people not actually reading the article. So Zoom allows you to host large scale group meetings. People log into these meetings by following a shared link. You can make it that each attendee needs to be approved for entry, but when your meeting is hosting a 1000 people you usually turn that off. So a couple of groups have hosted these meetings AND publicly posted their invites for the meeting. Some jerks showed up and started saying offensive things. Some of those jerks were racists and the FBI, rightfully so, is investigating those individuals for hate crimes. Somehow this turned into articles about the FBI investigating Zoom, which is untrue and just silly to believe given the scenario. This would be the equivalent of a streaker running into a public park and the police coming in and arresting the sandbox. These Zoom troll stories are so laughable that they are not worth talking about any further.
 
So should I just install a platform like Zoom and not worry about it? Definitely not. You need to do some due diligence, but you need to do "reasonable" due diligence. You do not need to know about the differences between AES128 and AES256 encryption, but rather need to know that your communication is encrypted. You need to trust legitimate IT professionals or informed peers who have knowledge of technology AND health regulatory law. Ask them not if a platform has "no risk", but rather if it poses a "reasonable" risk to your patients.
 
You also need to act in a "reasonable" manner in how you use these platforms. I particularly like the different levels of security I can put in place on Zoom that are ironically rarely available on some of the more higher end telehealth solutions. Here is a list of settings and procedures you should put on right away:
 
  1. Preferably create your Zoom account using a unique email address (e.g. business address instead of your personal email) that is not used on other online mediums that are common targets of hackers.
  2. Create your Zoom account with a strong and unique password.
  3. When setting a meeting topic, attempt to make it easy to identify your client, but maintain privacy where possible (e.g. Michael S Meeting vs. Michael Smith’s Psychotherapy Session).
  4. When scheduling a meeting always select your “Meeting ID” to “Generate Automatically”. This will prevent all clients from having a common “link” or “Meeting ID” to attend sessions. It assists in avoiding other clients or individuals from accidentally (or intentionally) joining an ongoing session.
  5. When scheduling a meeting either “Require [a] meeting password” that is unique to each client (you will not have to personally enter this when initiating a meeting) or login to the Zoom.us website to adjust additional preferences and activate ”Waiting Room”. The Waiting Room feature provides you a prompt to allow an individual to connect to the session once they have logged into the meeting.
  6. Be mindful that if you select the “participants” video to be “on” when scheduling the appointment, it will activate by default when they connect to the meeting. While this has been flagged by some as a privacy concern, it appears reasonable that a client would presume their video would be activated on initiating a meeting. Activating this feature will minimize confusion on entry to the session.
  7. Recognize that it will take a few moments for you and your clients audio to activate. Attempt to problem solve any audio connection concerns, but transition smoothly to an alternative means of communicating if barriers last for more than a few minutes (e.g. staying connected by video, but supplementing with a phone call).
  8. Recognize when your client’s space is not amenable to confidential communication and try to facilitate alternative communication options if this emerges as a concern.
  9. Accept that there will be challenges at times, but that patience and flexibility will allow for efficacious care to continue.
 
In the end, it is important for us to recognize that any concerns that have been flagged about telehealth solutions like Zoom are not unique to that platform. Just as important, we need to recognize that these problems do not appear to pose any meaningful risk to care or patient privacy. We need to stay informed about the solutions we use, but spreading unsubstantiated fears and misleading information does compromise care and THAT is the real risk here.
 
Readers who would like to learn more about the provision of care over telehealth are welcome to contact FLEX to join in on our telehealth webinar series. I would also encourage professionals to visit the Telebehavioral Health Institute website and sign up for their excellent newsletter. It provides free webinars periodically and offers reasonably priced intensive training on implementing ethical and efficacious telehealth solutions. I studied with this institute early in my telehealth journey and found it to be an excellent resource.

Wellness Wednesday: Close Quarters

4/1/2020

 
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FLEX therapist and blogger, Jessica Danilewitz, has written one of her strongest posts to date, with this excellent look at managing isolation with and without loved ones. This one is a must read for sure, so jump over to Wellness Wednesday: CLICK HERE.
Photo used under Creative Commons license. Source here.

Wellness Wednesday & Self-Disclosure: Managing Seclusion

3/25/2020

 
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Today we bring you a double dose of blogs, as both Wellness Wednesday's Jessica Danilewitz and Self-Disclosure's Michael Decaire target different strategies for the management of isolation in the face of covid.

Join Jessica on Wellness Wednesday as she explores of implementing routines even when you do not have a whole lot to do. CLICK HERE to read more.

Meanwhile, over at Self-Disclosure, Michael gives a look into his home and how they are keeping his five year old sane and engaged throughout his lockdown. CLICK HERE to read more.
Photo used under Creative Commons license. Source here.
 Image: tuesday to-do list by Stacy Spensley. See side panel for further copyright information.

Wellness Wednesday: Pandemic of Fear

3/18/2020

 
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FLEX blogger and psychotherapist Jessica Danilewitz has some good thoughts on how we can control our consumption of anxiety inducing media and counter that time with healthy behaviours while we respect social distancing. This weeks #WellnessWednesday is a must read and is available by CLICKING HERE.
Photo used under Creative Commons license. Source here.
 Image: isolation  by Leonard J Matthews . See side panel for further copyright information.

Wellness Wednesday: Tough Conversations at Work

2/12/2020

 
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For this weeks #WellnessWednesday blog we take a look at strategies to manage difficult conversations in the work place. Even with a group of therapists, these sorts of conversations can be challenging. FLEX's resident blogger and psychotherapist Jessica Danilewitz prrovides some good strategies that can apply to any tough conversation.

CLICK HERE to visit Wellness Wednesday with Jessica!
Photo used under Creative Commons license. Source here.
 Image: 2017 Detroit career exploration trip and reception by Gerald R Ford School of Public Policy. See side panel for further copyright information.

Wellness Wednesday: Getting Unstuck

2/5/2020

 
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Everyone can get stuck once and a while. FLEX Therapist and Blogger Jessica Danilewitz digs into the work of Marsha Linehan and explores the "four options" one has when feeling stuck with a problem. Not ever option will apply to a situation, but there may be an option not being considered that provides a better outcome. It is a brief and easy read, CLICK HERE for this weeks #WellnessWednesday.
Photo used under Creative Commons license. Source here.
 Image: stuck in mud by robert thigpen. See side panel for further copyright information.

Wellness Wednesday: Went to Seek Help

1/29/2020

 
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For this weeks #WellnessWednesday, FLEX Psychotherapist Jessica discusses when and why someone may seek professional support for a problem they are trying to resolve or change they are trying to make. She highlights how the positive psychology movement transitions the therapy suite from an environment aimed to resolve problems to a domain where we can plant the seats of growth and wellness. It's a brief and accessible read and available by clicking here.
Photo used under Creative Commons license. Source here.
 Image: therapy by Jason Rojas. See side panel for further copyright information.

Wellness Wednesday: Hacking Memory

1/22/2020

 
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Many of FLEX's clients are about to enter into first term final exams, which means everyone is clamouring for studying strategies. Fortunately, this weeks Wellness Wednesday is taking a look at how human memory works, and uses what we know about attention, encoding, and retention to help file memories properly and make them retreivable when it counts.

Even if you are long past exams, this is a great post to help you recognize why you are losing track of those important to-do's in your daily life. CLICK HERE to read this weeks #WellnessWednesday.
Photo used under Creative Commons license. Source here.
 Image: Studying by Steven S. See side panel for further copyright information.

Wellness Wednesday: Hobbies ... What We've Learned

1/15/2020

 
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FLEX therapist and resident blogger is back with an update on what she learned from taking the challenge of picking up a new hobby. As she expected, there were some lessons along the way that can certainly add value to many other aspects of life.

CLICK HERE to read #WellnessWednesday.
Photo used under Creative Commons license. Source here.
 Image: Ready for the Kiln by Martin Cathrae. See side panel for further copyright information.

Happy New Year: Resolution Month at FLEX

1/1/2020

 
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Half of the media you will see this week will be about resolving to make real change in 2020, while the other half will be about acceptance and avoidance of the resolution trend. We resolve to help you on both of these journeys. Join us all month on FLEX's blogs and social accounts as we try to grow together and accept failure. 

Pre-Resolution: Accepting Feedback (Wellness Wednesday with Jessica)
Chapter 1: New Year, New You? (Wellness Wednesday with Jessica) 
Chapter 2: Maintaining Resolutions (Wellness Wednesday with Jessica)
Photo used under Creative Commons license. Source here.
 Image: Happy New Year!! by Carlo "Granchius" Bonini. See side panel for further copyright information.

Self-Disclosure: Challenging Perception

12/29/2019

 
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The ability to see one's situations through an alternative perspective is the core of many psychotherapeutic models. FLEX's founder, Michael Decaire, discusses how his own ability to challenge his perceptions was fostered on this weeks Self-Disclosure blog.

CLICK HERE to read Self-Disclosure with Michael.
Photo used under Creative Commons license. Source here.
 Image: Perception by Quinn Dombrowski. See side panel for further copyright information.

Wellness Wednesday: Accepting Feedback

12/25/2019

 
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We are amidst the early days of resolution season at FLEX, which is ironically placed right after the holidays to likely maximize our gluttony related guilt. Resident blogger and psychotherapist Jessica Danilewitz is back for another #WellnessWednesday, this time looking at how we considering and accepting feedback and criticism from others can help us experience more meanigful growth.

CLICK HERE to read Jessica's musings and come back next week for some more resolution guidance.
Photo used under Creative Commons license. Source here.
 Image: cricticism by Marco Verch. See side panel for further copyright information.

Wellness Wednesday: NETFLIX's The Mind Explained

12/18/2019

 
Because we can only watch so much Baby Yoda, FLEX Therapist and Blogger Jessica Danilewitz is recommending we take the time to binge NETFLIX's The Mind Explained this holiday season. Take a look at her thoughts on #WellnessWednesday to see if this is the series for you.

Wellness Wednesday:  Patience

11/27/2019

 
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To help you manage the stress of having to wait another week for another edition of #WellnessWednesday, FLEX blogger and therapist Jessica Danilewitz does a deep dive into patience. You are probably excited to read it right away, so let us say being impulsive this time around is alright.

CLICK HERE to go to Wellness Wednesday.
Photo used under Creative Commons license. Source here.
 Image: wait by brian donovan. See side panel for further copyright information.

Self-Disclosure: Fostering connection through genealogy

11/25/2019

 
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FLEX's founder, Michael Decaire, has shared another long form piece on his website Self-Disclosure. This week, Michael explores how he uses genealogical research to foster increased connections within his family. Described as, geneatherapy, Michael discusses story telling traditions and how our modern lives have moved us away from this powerful way to connect with ourselves and those we care about.

You can CLICK HERE to read about Geneatherapy and how it could become a powerful way for you to feel more connected.
Photo used under Creative Commons license. Source here.

New FLEX Blog: Self-Disclosure

11/20/2019

 
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Due to the popularity of FLEX's first external blog, Wellness Wednesday with Jessica Danilewitz, we are proud to introduce our readers to FLEX's newest blog project: Self-Disclosure with FLEX's founder Michael Decaire.

Each week (or so), Michael will discuss some health and wellness topics that have had personal meaning to him over the years. At times, Michael promises to divert to general commentary on psychological practice, community mental health advocacy, and other topics that are dear to him. The blog will be of interest to the public, our clients, and our professional peers.

Michael's first two entries are live now, with more to come in the weeks ahead:

Chapter 1: Welcome to Self-Disclosure
Chapter 2: Mindfulness - Attention and Intention

Wellness Wednesday: Building Resiliency Through Hobbies

11/20/2019

 
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Parents and educators know how valuable play is for children. It is an opportunity to explore the world with an open mind and learn how to navigate the world adaptively. Play provides lessons that cannot be learned by sitting at a desk or being stuck in one's habitual routines. Curiously, many of us seem to presume that this opportunity for growth ends when we enter adulthood. This week #WellnessWednesay blogger and FLEX therapist Jessica Danilewitz breaks from her routine and jumps into a new hobby to see what learning opportunities lay ahead.

CLICK HERE to read what Jessica learned and what's next on her wellness journey.
Photo used under Creative Commons license. Source here.
 Image: 0452_04 by Arlington County. See side panel for further copyright information

Wellness Wednesday: Managing Strong Emotions in Children

11/13/2019

 
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FLEX's resident blogger Jessica Danilewitz is back for another #WellnessWednesday. This time Jessica looks at how we can be informed by the traditional parenting styles of other cultures to find a new way to engage with our children and promote self-regulation in the face of strong emotions. It is an interesting look at how we can examine the old way (for many) to find a new way (for us).

CLICK HERE to read this weeks Wellnesses Wednesday.
Photo used under Creative Commons license. Source here.
 Image: Tantrum by Chirag Rathod. See side panel for further copyright information.

Wellness Wednesday: Mindfulness with Muse

11/6/2019

 
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Last week FLEX therapist and blogger Jessica Danilewitz explored the concept of mindfulness and how it can assist us to move through life in a more aware and deliberate manner. As mindfulness is always a hot topic, Jessica is back with an exploration of how tools like the Muse Headband can provide a bit of support and accelerate your mindfulness journey. It is a popular tool at our clinic with both staff and clients and something that has certainly led to significant gains for a lot of those we support.

CLICK HERE to read this weeks Wellness Wednesday and learn how the MUSE Headband may be right for you.

Wellness Wednesday: Understanding Mindfulness

10/30/2019

 
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FLEX Psychotherapist and Wellness Wednesday blogger Jessica Danilewitz provides a great look at we really mean when we encourage clients to be more mindful. Mindfulness is something many our our clients have put on their to-do lists, but few of them really know what it means. Jessica does a great job of introducing the core concepts of mindfulness to help people take that first step to being more present.

CLICK HERE for this weeks #WellnessWednesday entry.
Photo used under Creative Commons license. Source here.
 Image: Meditation by Sebastien Wiertz. See side panel for further copyright information.
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