Portrait

Ruth Downie RCT-C CCC C.Hyp™

I have worked for 22 years as a registered Nurse in the Canadian health care system after graduating from Saint Francis-Xavier University with a BSc in Nursing in 1988. I have a Master of Education in Lifelong Learning from Mount Saint Vincent University, and a Master of Education in Counselling and Psychotherapy from Acadia University.

I am a certified Hypnotherapist through Daybreak Therapy and Training.

I am a member of both the Nova Scotia College of Counselling Therapists and the Canadian Counselling and Psychotherapy Association.

I provide counselling for clients who have received a life altering diagnosis such as cancer, are managing a chronic condition like Crohns or diabetes, or are experiencing a developmental transition as experienced with aging or menopause. I offer both individual and group counselling depending on client preference.

Resources

Reading and reflection often facilitate the counselling experience. Please enter the code provided to you to access some resources.

My Blog

I will be updating my blog often, so stop back anytime to read what’s new.

Cancer

Cancer Related Anxiety

Its not in your head!

As you travel through the cancer experience feelings such as anxiety, sadness, and anger can be common. Many cancer patients report that they have difficulty in forcing themselves to attend appointments and follow up visits to the cancer clinic. Patients say that the moment they enter the hospital or cancer care center they feel profoundly anxious. They may report sensations such as hyperventilation and a pounding heart. Often these are manifestations of our threat response and are almost completely involuntary. For many cancer patients the smell, lighting, color schemes, and sounds of the cancer ward, chemo lounge, or radiation suite can bring on feelings that make them feel panicked. Many patients describe these bodily sensations as “anxiety attacks” or “panic attacks”.

Using deep breathing, guided meditation with visualization, and hypnotherapy to combat these overpowering and uncomfortable sensations can help to allow the patient to get through their treatments with minimal distress. For many patients they are not remembering the events of diagnosis and treatment, they are re-experiencing those events as though they are occurring in that moment. Using Hypnotherapy and meditation to go to a safer and more pleasant place in your own mind can alleviate the anxiety provoking experiences of cancer treatment. If a patient knows that they might have panic feelings when they return for follow up visits to clinic, they can prepare themselves for those visits by practicing breathing and relaxation techniques. Using hypnotherapy or guided meditation can distance patients from the experience and lessen its negative impact on their feelings of well being.

The added benefit of these anxiety reducing strategies is that the patient’s vital signs and health assessments will reflect a more accurate picture of their wellness. The patient may also be more receptive to educative strategies if they are not in a state of hyper-vigilance. The patient will be more likely to attend follow up appointments if they can successfully manage their anxiety.

Enhanced Recovery After Surgery

ERAS

Enhanced Recovery After Surgery, also referred to by the acronym ERAS, is a series of protocols created to optimize post surgical recovery through research, education, and evidence-based practice. Protocols have been developed for almost every sort of surgical intervention. These initiatives not only focus on the intra-operative aspect of care but also on post-operative and pre-operative strategies to optimize patient outcomes. ERAS are associated with 50% reduction in overall complications and length of hospital stay (Engelman 2019).

Counselling is among those pre-operative strategies that improve patient surgical outcomes. Using counselling to encourage the patient to adopt behaviour change and provide pre-op teaching is a low risk intervention that has the potential to offer high benefits. This part of the preconditioning process incorporates psychoeducation and pre-op teaching.

The pre-op teaching aspect is about managing patient expectations, familiarizing the patient with the surgical process (information on the what, when, and how processes will happen), the post-operative phase of the surgical experience, and addressing those lifestyle factors which may have the potential to negatively impact patient recovery. Clear direction regarding post-op mobilization and pre-op food and fluid intake should be part of the pre-op teaching plan.

Counselling supports behaviour change such as smoking cessation and alcohol abstinence (ideally 4 weeks before surgery) using therapeutic interventions like CBT (cognitive behaviour therapy), ACT (acceptance commitment therapy), Hypnotherapy, motivational interviewing, and ego strengthening or an integrated approach using all of these. Anxiety reduction strategies such as guided meditation, rhythmic breathing, and intention statements can also be introduced during the pre-operative psychoeducation phase. Enhancing coping skills using emotion focussed interventions which help with emotional regulation and reactivity. Identifying patients who may have depression or anxiety and providing them with symptom reducing strategies has been shown to reduce post surgical pain in this population (Levett 2019). Counselling offers the added benefit of increasing patient engagement in care and providing the patient with processing time. Ideally counselling pre-operatively should be 4-6 sessions depending on patient need.

If you would like to see more about ERAS you can go online and see the ERAS Society guidelines.

Engelman, Daniel et al. (2019). Guidelines for peri operative care in cardiac surgery. Journal of American
Medical Association. May
Levett, D.Z.H.;Grimmett, C.(2019). Psychological factors, prehabilitation and surgical outcomes:
Evidence and future directions. Anesthesia. 74(suppl. 1) 36-42.

Developmental Transitions

Menopause: It’s Complicated

Looking for information about menopause can provide many different messages about symptoms, feelings, and aspects of the menopause experience. Generally, there is the medical picture of menopause and the advertising aspect of this stage. The medical way of describing this stage focusses on the definition of menopause at a hormonal level and possible negative physical symptoms associated with a decrease in the hormones, progesterone and estrogen. The advertising world focusses on symptoms of menopause and offers simple solutions to alleviate those symptoms.

The problem with allowing advertising to define menopause is that ultimately the goal is to sell product. All advertising tends to work in the same way, create fears, desires, and needs and then offer simple solutions to those problems. For women in the menopause phase it is important to be aware of this manipulation and to resist messages of how our bodies should feel, behave, or function. It is in the interests of advertising to frame the menopause body as “failing” or “dysfunctional”. The notion that menopause is a condition that should be treated often makes one wonder what is the end game? If menopause is treated with hormone replacement how long should one expect to be using that medication to prolong a sort of eternal youth? At what point does a woman stop medicating herself to keep menopause at bay? When hormone therapy is stopped the menopause experience will resume with all the things that entails. Although symptoms of menopause have been described as everything from hair loss, to mental decline, the only symptoms which are consistently identified as part of menopause are vasomotor symptoms (hot flashes, night sweats) and genitourinary symptoms. Other symptom suggestions may play upon fear of aging that a woman may have and may be used to promote a particular product.

The interplay of advertising and medicalization of the menopause experience can create a great deal of uncertainty for a woman as to what is reasonable to expect during this stage. This undermining of confidence in a woman’s ability to interpret her own body function can contribute to anxiety and taboo creation by silencing. Meeting other women who are in the same stage can normalize the experience for many women. Using Psychoeducational counselling to address concerns women in the menopause stage have empowers women to define their individual and collective experiences and resist social messaging about how they should be in the world.

Krajewski, Sabine. (2019). Advertising menopause: You have been framed. Journal of Media & Cultural Studies. 33(1), pp 137-148.
Nelson, Heidi D. (2008). Menopause. The Lancet. 371 (March 1), pp 760-770.
Parton, Chloe; Usher, Jane; Perz, Janette. (2017). Experiencing menopause in the context of cancer: Women’s constructions of gendered subjectivities. Psychology and Health. 32(9), pp 1109-1126.

Cancer

Cancer Is a Lonely Place

When you get a cancer diagnosis you can find yourself in a lonely place, the health care world is one which is not very familiar to most people. If you can hardly remember which cancer specialist, you are seeing and what it is that they do, you are not alone. Even the language can be confusing. A negative result is a good thing! A positive result is not a good thing! This strange world can make you feel anxious and powerless.

Feeling anxious regarding your cancer diagnosis is completely natural but adding to those feelings of uncertainty can be the very system you rely on to help you get through this experience. The number of specialist physicians and other personnel you may encounter during your cancer journey may seem overwhelming. You may see a surgeon for the physical removal of your cancer. Then you might see an Oncologist for your chemo regimen. It is not unusual to be referred to a Radiation Oncologist as well to irradiate the cancer. The one constant in all this besides you and your family or friends will be your primary care provider. Using your primary care provider to help you negotiate the health care system can make the experience seem less intimidating.

Although you may have family and friends who are doing their best to be supportive and encouraging ultimately you are alone in this fight. No one else can have a chemo treatment for you, no one else, however well meaning or willing to be supportive, can really understand what you are experiencing. For many this can be a very lonely time. It may be helpful to remember that although your friends and family cannot have this painful experience for you, they are suffering as well. They are there when you receive treatment and are frequently having many anxious feelings too. Sometimes it is difficult for you to share what is happening to you because you do not want to frighten your family, or you think they cannot understand what you are going through. Sharing your experience with a counselling therapist or peer volunteer can alleviate your feelings of aloneness at a time when feelings of isolation are common.

Things like journaling can help both you, your friends and loved ones through this challenging time. Using counselling both in group and individual formats can also create the sort of unbiased support that is often helpful. The cancer society can provide resources for counselling services to help both the person with cancer and those who are co-surviving to cope with this life altering challenge. Your emotional and mental well being is an important part of your recovery. Taking advantage of resources to improve your mood and reduce your anxiety can reduce feelings of loneliness during this cancer journey.

Carr, Kris. (2007) Crazy, sexy, cancer tips. Guilford, CT. Globe Pequot Press.
Katz, Anne. (2012). After you ring the bell…10 challenges for the cancer survivor. Pittsburgh, PA. Hygeia Media

Cancer

My Cancer Treatment is Over, Now What?

If you have had a cancer diagnosis and have completed your treatment you may have feelings that are mixed. Of course, you and those in your life are very happy you have completed your treatment. You may have a sense of relief, or you may just be too exhausted for that, and are just grateful that the whole thing is over and done. Well meaning friends and family may tell you that you are a “survivor” and for many people this does boost their mood and make them feel they have managed to endure their diagnosis and treatment successfully. For others the designation, “survivor” may make them feel uncomfortable.

At the time of your diagnosis you may have felt so shocked that you couldn’t really think about what this cancer journey was going to be like. Your health care team may have moved very quickly making appointments for you with a variety of “specialists”, and although they explained things to you, at the time you really couldn’t think too much about what they were telling you. With cancer things move both fast and slow and your mind is often distracted. It is not unusual for all sorts of feelings and thoughts to surface after all the treatment is completed and you have returned to your primary care provider whether that is your Family Doctor or your Nurse Practitioner.

The post treatment period is often one of the most difficult times for a former cancer patient to experience. It may be the first time you have really had time to think about your experience and to start to try and make sense of it, and how it has impacted your life. At this point using a cancer counsellor may seem a little too late, but this is usually when you may find a counsellor who has an understanding of the cancer experience most helpful.

The time after your treatment is one when many former patients find themselves in a transition between how their life was before their cancer diagnosis and how their life is now. It is completely understandable that a life altering diagnosis may make you want to examine your values or suddenly experience feelings you had not had before such as anxiety, sadness that leaves you exhausted, and often anger. Counselling can be both a place to express all those confusing emotions associated with a cancer experience, and to start to make sense of how you are impacted in your life by this going forward.

Katz, Anne. (2012). After you ring the bell...10 challenges for the cancer survivor. Pittsburgh, PA. Hygeia Media

Developmental transitions

Menopause

The onset of menopause often coincides with other milestone events in life

Often this is the time that older children leave the family home or gain new independence through starting career-oriented work, completing post secondary education, or finding a life partner of their own. This is often when personal career goals are attained, or work is starting to wind down into retirement. Through these many transition’s life can seem to be in a state of change that borders on chaos. Re-negotiating your role as parent, employee, boss, and life partner can be stressful and disorientating. As all these mile stone life events are occurring your body is also renegotiating its role as a sexually mature adult capable of reproduction. Unlike males, the female body has a fourth state, sexual maturity not capable of reproduction! This means that women live their life as a child, an adolescent, a reproductive adult, and finally a state where she is an adult without all the worries of reproduction, child bearing, or child rearing!

When menopause is reframed as a natural developmental state that has its own challenges and rewards it can allow women to view menopause as a gateway to more autonomy and personal freedom. This is the time to make time to reconnect with those things enjoyed in the past that can be rediscovered. Menopause is not a hormone deficiency disease, nor is it a medical anomaly which requires treatment. The best “cure” for menopause is to reduce its more unpleasant symptoms until a new state of normalcy is reached. For many women this is a new phase where they can re-engage with their former interests and pastimes form new bonds and strengthen present relationships with their partners, families, and themselves.

Therapeutic lifestyle changes

Changing the way you live your life can be challenging

The most effective way to change your present habits for healthier and more sustainable ones is to choose just one thing you think you could change and stick with that one. Perhaps committing to walking for half an hour in the day or drinking more plain water. When the new habit becomes a part of your life and is no longer a challenge, choosing another change you could make, seems more possible.

When you experience success in one area of change it increases your motivation to continue to adhere to that change as well as encouraging you to adopt another change in your lifestyle. Sometimes you can be overwhelmed by advice which seems to want all things to change at the same time. This sort of lifestyle change is difficult to sustain as it asks you to completely abandon your present way of living. Identifying barriers such as time constraints or responsibilities at work or at home can help to clarify how you can work around your existing lifestyle to implement one change. The change can be as small as eating one meal a day sitting down at a table as opposed to standing in the kitchen!

Generally, when we think of lifestyle changes we focus on diet and exercise, but more evidence suggests that interpersonal relationships, community involvement, perception of loneliness as well as sleep habits contribute to our sense of well being and overall heath. Meeting with friends in person, getting regular sleep, and participating in community events can improve mental and physical health. The role of pets can also be beneficial as it can reduce feelings of loneliness.

Learn more . . .