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.

What Is Defusion?

My thoughts are hijacking my life!!

Sometimes we all feel that thoughts are intrusive, and we cannot help but have the same thought over and over again. We have the same old thought. But sometimes our thoughts do not reflect reality. Take any thought you often have that seems to lower your mood or create anxiety for you. Try and insert the statement I am thinking that… before the thought. I am thinking that my test result is taking a long time to come back. This places the thought into a context that is simply something you are thinking and not actually something that is happening. If you can then take this strategy one step further and state; I am noticing that, I am thinking that, my test result is taking a long time to come back. Then you will be able to distance yourself from this intrusive thought by noticing it is there without investing energy into maintaining it.

Using a mindful strategy where you notice the thought (I am thinking that…) then you acknowledge the thought (I am noticing that….) you can let it go. The defusion exercise below uses a leaf on a stream metaphor, but you can use a package on a UPS truck theme, seafoam on a beach theme, or cars on a highway theme. Any theme that works for you which can allow you to visualize your acknowledged, noticed thought leaving, will work.

Often the thought returns and that’s okay just let it get on the truck and leave as often as it needs to. The goal of the exercise is not to make the test result arrive faster but to recognize and become aware that the thought is the intrusive aspect of the experience. Allowing the thought to flow away is a step toward reducing its power in your life.

Defusion (video) . . .
Defusion Exercise (video) . . .
Harris, Russ. (2009). ACT made simple. Oakland, CA: New Harbinger Publications, Inc.

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.

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 . . .