Lessons learned from Dr. Thira's "The Community is the Medicine" Wellness Training

I recently attended a two-day training with Dr. Darien Thira, a clinical psychologist based out of BC, but also an expert in using community based interventions for wellness, particularly in Indigenous communities.

I wanted to share some of the main insights that I gained from the training. Some of the insights are lengthy, some are short one sentences.

Post Colonial Thinking
One of the first pieces he addressed was the importance of thinking in a non-colonial fashion. It sounds easy, but it is really difficult to do. Colonialism has impacted everyone is some shape or form.

Good Enough Parenting
It's not everyone's favourite term, good enough parenting. But if you are a "good enough" parent, your child will have the foundation to reach 90% of their potential. If you are a perfect parent, if that even exists, that will make up the remaining 10%. This is an important message that you can still be good enough to raise a successful child, you don't need to be perfect.

Successful Helping Relationships
There are three things Dr. Thira identified that helpers can bring to the table to make an effective helping relationship: who you are, being useful, and being safe.

He later presented a different interpretation of what makes a helping relationship work. In the past it was identified as 40% extra therapeutic factors, 30% the helping relationship, 15% hope, and 15% technique. Dr. Thira said 40% is the clients readiness to change, 30% is the therapeutic relationship, 15% is the counsellors readiness, and the remaining 15% is technique.

Re-framing Depression
Dr. Thira presented a different definition for depression, that it is a realistic view that lacks imagination for hope.

Trauma Braid
Our Survival Instinct to Traumatic Event Coping to Colonization Terms
Flight to Anxiety to Addiction
Freeze to Depression to Suicide
Flight to Rage to Violence

This is an interesting flow of how our natural instinct may correlate with a response to trauma, which then has a colonization impact.

Successful Circles Created for First Responders
Dr. Thira emphasized that circles should be small to contain the safety.

Circles should go through four phases or steps: past, present, future (individual), future (community).

Many circles, in my experiences and Dr. Thira's stop at the second step. We talk about the terrible thing that has happened and how it impacts us presently, but we never talk about what we are going to do about it on an individual and community level.

Counselling is Spritiual
Dr. Thira said that counselling is spiritual. It is a placebo, a non-medical effective intervention.

Don't Say "Stop It"
When it comes to addiction or problematic behaviours, there is a tendency to say "just stop it." However, as any addiction counsellor knows, the behaviour needs to be replaced with a healthier habit.

Replacement Technique
Building upon the replacing a habit with something healthier, Dr. Thira outlined the following steps:
-Identify the Problem Behaviour
-Purpose of the Behavior. The answer to this question "What would I lose if it stopped?" is the purpose of the behaviour.
-Problem Behaviour Advantages.
-Problem Behaviour Disadvantages
-Replacement Behaviour

As you begin to understand the advantages and disadvantages of a behaviour it becomes easier to identify a customized replacement behaviour. The new behaviour may not have the same advantages, but the costs of the disadvantages should be greatly reduced.

Balance Respect & Care
It is a delicate process for helpers, who want to help, to show appropriate respect and care for clients. If we do things for them, we are caring but not respecting. Balance needs to be found when supporting individuals.

No Respect Responses create Low Self-Esteem
Dr. Thira encouraged us to be careful with our words, and what we may be unintentionally telling someone when we try to give them advice.

As some examples if we try to give advice to protect them, we are in way telling them that they are vulnerable. If we give advice to solve, they have a problem. If we want to use advice to be fast, they are slow. To help, they are helpless. Because we have they answer, they are stupid. Because we are strong, they are weak. To fix, they are broken.

Low self-esteem is then expressed in two ways according to Dr. Thira. Despair or Arrogance. Despair then tends to create a victim state of being, and arrogance a bully state of being.

Dr. Thira said that the antidote for advice is a question.

Post-Traumatic Growth
Wounds have the ability to become gifts.

Importance of Creating Safety 48 hours after a traumatic event
Dr. Thira gave a timeline that if safety is created within 48 hours of a traumatic event, it lowers the chance that the emotional fallout of the event will create the symptoms of post traumatic stress.

This for me personally emphasized the importance of walk-in counselling clinics to be available to create an emotionally safe environment for individuals. However, keep in mind that 40% of counselling success is client readiness, and a client may not be ready to deal with a traumatic event 48 hours after ward.

Validation-Invitation 2-Step
First, validate the person or the situation. To validate the individual consider validating the person themselves, their social connections, culture, or principles. To validate the situation, validate emotions, thoughts, observations or needs. Personally, I tend to do more validating of the situation.

Second, invite. Seek information, and then create steps to change.

Scaffolding
I Do, We Do, You Do. Can also be considered as modelling.

Four Branches of the Wellness Wheel
The primary model driving Dr. Thira's interventions is the Four Branches of Wellness:
-Caring Connection
-Respectful Empowerment
-Contributing Purpose
-Cultural/Spiritual Wisdom

When the four branches are in unison, it creates self-worth and a worthwhile life.

For more information about Dr. Darien Thira visit Thira.ca


Picture at top: Myself with Dr. Darien Thira

Anticipated Board & Card Games of 2019

I'm a bit late to the party, but I thought I would share board and card games that I am looking forward to in 2019.

First, I want to fully acknowledge that KickStarter is my addiction.

Now that I have gotten that out of the way. Here are games that I am looking forward to, or those games with an asterisk that I was looking forward to this year and have received.

#10 Kill The Unicorns

If there is a game and it includes unicorns, my family (cough daughter cough) wants to have it.

This is a blind bidding game where you try to catch as many unicorns as possible.

#9 Volleyball High

This is a crisp newly anticipated game. There are not many volleyball themed games out there, so that's where this game piqued my interest.

#8 Kaboom Universe

Rescue the dinosaurs!!!! That's about as simply as I can put this game. Oh, and there is aliens.

It's a random cut-throat card game. Right up my families alley.

Turn on English subtitles for this video...

#7 Talisman: Kingdom Hearts

They had me at "Kingdom Hearts" and that was all that was needed.

I have never played Talisman, so this will be my gateway when it arrives.

#6 Critical Core

Colleagues over at the Geek Therapy Network brought this game to life. It's marketed towards building social skills and confidence for youth on the spectrum, but I am hopeful it can be beneficial for all youth in building confidence and social skills.

#5 Unstable Unicorns: Chaos and Control*

I mentioned unicorns earlier. We are already big fans of Unstable Unicorns, so when two exclusive decks came up, we were in.

If you have played Unstable Unicorns, it's the same basic game, just these decks either create control, or chaos.

#4 Trick Shot

My son and I enjoy playing Blue Line Hockey. It's fun skating miniatures around and scoring goals. However, Blue Line Hockey is from 1968 - it's dated.

Trick Shot looks like a fresh take on the game, with a push your luck mechanic. It definitely looks healthier than a 1968 game.

#3 Sonic the Hedgehog: Battle Racers

Sonic is all over the media, it's like it's 1992 all over again.

Besides unicorns, miniatures is another aspect of games that my family likes. The idea of racing our favourite characters from the Sonic the Hedgehog universe seemed too good to turn down.

Plus, Sonic looks like Sonic.

#2 Throw Throw Burrito

From Exploding Kittens to Bears vs Babies, my family loves their games.

A fast paced card game that includes dodgeball where the ball is a burrito? Sounds like crazy fun for family game night!

#1 Conspiracy: The Solomon Gambit

My family had the cool opportunity to play test this game. It was a neat experience for us to try a game and provide our feedback.

We loved the idea of out bidding hitmen contracts to retrieve the secret suitcase.

We are thrilled to see a game that we were involved in come to life. Which makes this game, the most anticipated, for me and my family, of 2019.

Video: The Repair of Early Trauma; A Bottom Up Approach

My Family's Most Played Board Games in 2018

Thanks to my love for stats, I track mine and my families board game plays. Here are the top 10 games that we played most in 2018.

10. Exploding Kittens

There was a time, a year ago, where it seemed like we played this game every day during the summer. Alas, our desire to defuse kittens that are accidentally blowing stuff up has slowed this year.

9. Doctor Who: Time of Daleks

There are not many Doctor Who games on the market, and this one is worth while. It's a semi-cooperative game, and the more players the easier. There is nothing quite like choosing your favourite Doctor and companions, and then saving the universe from the Daleks.

8. Dixit

Apples-to-Apples but with pictures. The game is great, and it is simple to play.

7.  Unstable Unicorns

My daughter LOVES this game. So much so that we hunted down the booth at the Comic Expo and got some extra swag. The art is fun, but this is a cut throat game. Feelings will get hurt.

6. Zombicide

My son LOVES this game. There is something anxiety inducing as your squad gets cornered by wave after wave of zombies. We love that this is cooperative and that we have to work together to survive.

5. Monza

I was surprised how much we played this game. I think it's the colour matching of the dice to the tiles as you race around the oval track that makes my kids like it so much. It's simple problem solving.

4. Fabled Fruit

The game that never ends - or at least feels that way. Each time after you use enough fruits to make a juice, another juice option replaces the completed one with a different set of rules.

3. Emojito!

The game that all kids of counsellors are/will be playing. It's a fun way to try to express and read emotions. You can play as a team against the game, or individually. I like it for it's ability to create emotional language. Check out my post on Nerdy Parenting for more.

2. Happy Salmon

This game will get really loud! Especially as your hand gets smaller as you find a matching partner to high five, switcheroo, fist pump, or happy salmon with.

1. Beasts of Balance

You need a tablet for this game to work. But it is magical to watch as you balance beasts on the plynth to watch them come alive on the tablet. Migrate, cross-breed, or power them up to unlock different beasts.

My Family's Top 10 Video Games of 2018

Welcome to 2019!

I did a quick poll with my kids (8 & 10) about what their favourite games to play this year were, despite release date. We had a little debate, and then concluded with our Top 10 list.

10. Roblox

Free to use. Can be played on many different platforms, which makes it popular in my house for modern day couch gaming.

9. Kirbey Star Allies

Up to four players for this game, as long as Kirby has that many allies.

8. Halo: Master Chief Collection

Nothing more fun than switching between previous and present graphics and then trying to get the kids guess which is modern day. Appreciate how far modern consoles have come in 18 years.

7. Mario Tennis Aces

No one plays tennis in my family. We don't watch tennis. But when you combine Mario and Tennis, it's a lot of fun.

6. Trials Fusion

The ATV is the least eventful, and the unicorn with a cat is everyone's favourite. Add bailing to make it even more entertaining.

5. Kingdom Hearts

It's amazing that this originally came out in 2002 and I only heard about it in 2017. The story and the Disney combination make this a favourite.

4. Mario Odyssey

Countless hours. Many challenges even after the "main story" is done.

3. Minecraft

The game that never ends, unless you are in survival mode. So much to see, so much to create.

2. Fortnite

You know you have a boy in the house when.... you have to play Fortnite. The cross-console play has helped this become popular in the house multiplayer play.

1. Spider-Man

Never before have I bought a console just for a game, until this year. New York Island is your area to explore and save. Plus there are many suits to choose from to make your Spider-Man game feel personable.

Thanks for reading! And here's to more gaming in 2019!

Top 5 Board Games for Grades 5-6, voted by Grade 5-6 Students!

This school year I started a board game club at a school where I am a school counsellor. It has been a great experience for me and the students.

Now that we are entering the final weeks of school, I had the students pick their top five games, and then from everyone's votes we will be playing their favourite games for the last weeks of school.

These rankings are from the students themselves, which I think will help those looking for board/card games to play with this age group.

Please do keep in mind that since it was a club during lunch break we only had 30 minutes to play, so many of the games that we played were short and easy pick up and play games.

#5 Fabled Fruit

A fun card game where you collect different fruits to make juices. With the fabled system, the game continues from where you left off. No two games will be a like (except for the start).

#4 Who Farted

The creative art work and character titles created a lot of chuckles for this age group. It is a simple who-dunnit card game where you don't want to get caught with the character that farted!

#3 Pit

This game has been around FOREVER! It's a fast paced trading game that simulates the stock market as each player trades goods to corner the market.

#2 Sushi Go

A game where you risk the odds of picking a card and then passing the hand along as you try to make the highest scoring meal.

#1 Exploding Kittens

A cut throat game. Players try to be the last one standing as they diffuse exploding kittens, while intentionally trying to blow up their peers. This game allowed for opportunities to express winning and losing in helpful ways (didn't always happen, given how cut throat the game is).

Now you know our play list for the last weeks of school!

Honorable mentions (to round out a top 10): Beasts of Balance, Formula D, King of Tokyo, Fauna, and Timeline.

What if Wade Watts (ParZival) had a good counsellor? #parzival #readyplayerone #aces #psychology #positivepsychology

Wade Watts is one of the heroes in the book and upcoming movie Ready Player One. Spoilers are ahead. The movie may change the background of the Wade, so this assessment is purely based on the book by Ernest Cline.

What Happened (Spoilers!)
Wade is the only child of his teenage parents. Both his parents were refugees to the United States of America. When Wade was a couple of months old, his dad was shot and killed while searching a grocery store during a power outage. Loretta, Wade's mom, raised him alone while working two jobs. Wade was babysat by the virtual world, OASIS; this is where Wade learned his life skills.

At age 11, Wade would find his mother dead from an overdose. He then lived with his aunt Alice who only wanted Wade for the food vouchers. She had abusive boyfriends and tenants in her double wide trailer. He slept in the laundry room, the only free space from everyone in the trailer. However he spent most of his time in his secret hideout in an abandoned vehicle.

Wade went to school in the OASIS. He excelled academically, but spent most of his time researching James Halliday, the creator of the OASIS, and the quest for the easter egg that Halliday left in the OASIS after he died.

Around the age of 18, just prior to graduating high school, Wade was the first to uncover the first clue in the hunt for Halliday's egg. This led to him forming close ties with the "high-five", five egg-hunters: Atr3mis, Aech, Shoto and Daito. Wade was known online as ParZival. Wade also became a main threat to a corporation seeking to win the hunt.

Adverse Childhood Experiences

1. Did a parent or other adult in the household often swear at you, insult you, put you down, or humiliate you? OR Act in a way that made you afraid that you might be physically hurt?
• YES - his Aunt Alice brought home less than desirable boyfriends, and she poorly cared for Wade
2. Did a parent or other adult in the household often push, grab, slap, or throw something at you? OR Ever hit you so hard that you had marks or were injured?
• NO - It's hard to think that this didn't happen given the boyfriend situation, but I can't recall any mention of it.
3. Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way? OR Try to or actually have oral, anal, or vaginal sex with you?
• NO - this was not reported.
4. Did you often feel that no one in your family loved you or thought you were important or special? OR Your family didn’t look out for each other, feel close to each other, or support each other?
• YES. His mom was working hard to provide for him. But at the same time, he learned his basic skills in the OASIS. With his Aunt, she didn't include him.
5. Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? OR Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
• YES. His dad was stealing from a grocery store. His mom died from an overdose. His aunt only wanted him for the vouchers - and at times would take Wade's stuff and pawn it.
6. Were your parents ever separated or divorced?
• NO. They were not separated by choice.
7. Was your mother or stepmother: Often pushed, grabbed, slapped, or had something thrown at her? OR Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? OR Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
• YES. Aunt Alice had abusive boyfriends.
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
• YES. His mom (and most likely his aunt)
9. Was a household member depressed or mentally ill or did a household member attempt suicide?
• YES. His mom was not stable, nor was his aunt Alice.
10. Did a household member go to prison?
• NO. This was not reported. It could be stretched to say that Wade's dad could have served jail time instead of being shot while looting.

Discussion about ACE's

Wade has an ACE's score of 6. With each additional adverse experience so does the likelyhood of health problems in adulthood. In a recent study, male's who experienced six or more ACE's were more than 46 times more likely to an injection drug user.

As we will discuss later, ACE's are not a life-sentence. There are also protective factors that we will look at.

Current Mental State

Going strictly by DSM V terminology, Wade would be diagnosed with major depressive disorder, recurring, with no psychotic features.

Wade says many times himself that he is a depressed shut-in. That may be the best description of his mental state.

He is struggling with his sleep patterns, lost interest in some of his social connections. He had a plan for suicide.  He also had to order new suits because of his weight gain. All indicators of depression

Anxiety is often concurrent with Depression. It becomes difficult to figure out which one is "driving the bus." Is anxiety present because of how depressed someone is, or is depression present because of the anxieties? He does report some anxieties, such as racing thoughts.

While it may be understandable that he is suffering traits of acute traumatic stress disorder, given threats to his life, but he doesn't report flashbacks or other symptoms.

A depressive disorder is the best fit.

Positive Psychology (PERMA)

• Positive Emotions - Despite his history and experiencing six ACE's, Wade does an excellent job of experiencing positive emotions. Not just the idea of being "happy" but experiencing and expressing silliness, fun-loving, curiousity, gratitude, trust and many other positive emotions as outlined by Barbara Fredrickson.

• Engagement - Wade often expresses slipping into the zone when playing a video game, or going on a quest - the state of flow where the challenge meets the skill level. His engagement level was low until he found the first clue - until then he escaped or transported his brain into his passion. But as he earned credits and experience with his avatar in his late teens, his engagement increased.

• Positive Relationships - It is easy to identify Art3mis, Aech, Shoto and Daito as positive relationships, which they are. An overlooked positive relationship is Mrs Gilmore, Wade's only real-world friend. He valued that relationship with her, and became one of his motivators.

• Meaning - This one is of course complicated. He comprehended and understood his meaning as he began finding the clues. Until then, meaning was a struggle. He was lacking his self-concept, understanding his past, present, and future self - until he uncovered the first clue. His self-efficacy, was low to start; he lacked the resources to even think that he could succeed; once he unlocked the first clue, boom, he had self-efficacy. Self-worth - low until the first clue, and then everyone valued what he contributed to the online and offline world.

• Achievement - Has the same theme as meaning. He had a goal of finding the egg - many people did. He lacked the sense of achievement in his life, until that first clue. A smaller achievement, that is worth acknowledging, is Wade's education. He was self-taught, and had a passion for learning.

Post Traumatic Stress vs Post Traumatic Growth

So where is ParZival at? Is he stressed or is he growing. The answer is definitely yes to both. He is currently stressed with the crisis he is in, so since the stress is present, we can't really say he is experiencing 'post' traumatic stress. This is where, despite everything that is and has happened, Wade is experiencing post traumatic growth. As outlined in meaning, self-esteem is on the rise as each component (self-concept, self-efficacy, and self-worth) came to have more meaning. He found online friendships within the high-five. As he began fighting his depression with PTG, we were able to see him increase in mental processing and planning.

Interventions

It's important to realize we are just going to stick with interventions at the individual level, not at any of the systems: family, community, societal; which all could use an intervention or two as well.

With a young Wade, he could have benefited from human baby-sitting to help him learn how to navigate in the real world. There is safety and comfort that comes from nurturing human contact that allows the brain to grow healthily.

Grief support. Losing anyone is hard, especially a parent, not to mention both. Grief is a natural reaction to an unnatural event and doesn't always need a therapeutic intervention. But due to his new living situation, being without either biological parent, extra support would be beneficial as he transitioned.

Exercise. This was something that Wade became aware of himself during the story. Exercise is an excellent combatant of depression. It doesn't need to be marathon running, but simple walks or lifting weights. An extra bonus, exercising with someone.

Healthy eating. The only food that Wade cooked was microwave brownies. Nutrition is an important component to mental health and well-being.

Trauma therapy. Being an EMDR trained clinician, I'd recommend that mode. But any trauma informed therapy would be beneficial to Wade when he is ready to deal with his ACE's and then his experiences finding the easter egg. The narrative he did of his experiences is a great start to healing.

Natural supports. What often makes a traumatic event a traumatic experience is the reaction of, or having natural supports. Having people around to provide support and care help buffer against the effects of a traumatic event. Wade was lacking natural supports in the offline world.

To finish, here is a clip that summarizes everything we have discussed about depression including interventions, called the Black Dog.

Closing Thoughts
Wade, definitely would benefit from therapy. However, timing is the important piece here. Therapy is needed when Wade is ready. When someone is in crisis, therapy for historical events is not appropriate, the crisis needs to be dealt with first.

The difficult piece with therapy with teenagers is that their past, present, and future is at stake. If the present counselling was forced and Wade perceived it was a waste, he then would not seek out therapy when he is 25, 35, or 75.