What We Do

Functional Restoration Services


When the treatment options for a mental or physical health problem have been exhausted, an individual may be left with a chronic condition for which the usual medical approaches are no longer effective.  This can lead to a downward spiral of frustration, physical deconditioning, limited daily activities and a feeling of helplessness.  We call this “secondary suffering” and there is something that we can do about it.

Physical and mental fitness both play a very important role in our lives.  Our Psychotherapists and Kinesiologists design and implement a structured individualized plan designed to assist our client to return to most, if not all, of the activities in which they previously engaged.  This would include family, recreational and social activities, and gainful employment.  Individuals identify what matters most and choose activities that will move them in the direction of a more meaningful life.


We Use Approaches that Work

There have been many approaches developed to help people struggling with physical, emotional and psychological difficulties.  How does someone find the best fit for his/her needs and concerns?  While there are no guarantees that a specific approach will work for someone, we do know that certain approaches work for many people experiencing a specific type of concern (e.g. chronic pain, depressed mood, anxiety, substance abuse, post-traumatic stress disorder, etc.).  These types of approaches are termed “evidence-based”.  An evidence-based approach is one that has been scientifically investigated and been shown to effectively address a particular concern or problem.  Evidence-based counselling can increase the chance that a problem is identified accurately and handled effectively.  This can prevent the problem from being drawn out unnecessarily and decrease the chances of it coming back (i.e. relapsing).

To give you a sense of the types of services that we provide at JMA, below are the therapies and approaches that we practice and that have been shown through research to be effective.


Physical Conditioning & Functional Activation

Individuals who suffer with chronic health problems frequently become deconditioned due to disuse and inactivity.  Kinesiologists use exercise in the management of chronic disease and injury and focus on the improvement of function and well-being for both physical and mental health conditions.

With input from the client’s health care providers regarding any medical contraindications, our Kinesiologists will develop both an individualized exercise routine as well as a gradually progressed plan for increasing family, social, recreational and vocational activities.

We encourage individuals to start all new activities well within their current baseline.  For example, if an individual is starting a walking exercise we will ask them to walk only for as long as they can comfortably, and then set a starting point at 50% of that baseline with a carefully graduated progress.  In addition to fixing the amount of activity, we also ask our clients to plan in advance the time that they are doing activity.

It is important that planned activities be realistic and not tied to the client’s level of symptomology.  It is also important to recognize that symptoms, or flare-ups of symptoms, do not represent signals of health or life-threatening warning.  The scientific literature clearly establishes that such careful planning and quota-based activities assist in improving function in spite of ongoing symptomology and also appears to contribute to the symptoms gradually receding into the background.

Our clients learn not to overdo activities when they are feeling well or feeling like they have extra energy and not to avoid planned activities when they are feeling unwell.  Ultimately, this places the individual in control of what they plan to do, when they are going to do it and how much they are going to do.  It prevents symptoms from acquiring control by determining how much or how little a person does.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy, also referred to as CBT, is an evidence-based psychological treatment proven to be effective through rigorous scientific research.  This means that CBT treatment is not based on what people think might work, but what has been proven to work.

Research has shown that CBT is an effective treatment for a wide range of problems including psychological disorders (i.e. anxiety, depressed mood, phobias, stress), physical health problems (i.e. chronic pain or fatigue) and other behavioural disorders (i.e. anger, low self-esteem, grief).  Individuals tend to function better and stay that way!!!!!

Our clients work with one of our Psychotherapists either by video conferencing, phone or in person at one of our office locations.  While the sessions offer support and space to explore an individual’s concerns, it is the work they do outside of the sessions that is likely to have the most impact.  Being committed and doing the assignments is an integral part of CBT.

It is important to the therapists at JMA to be using the most current psychological therapies.  These are now typically referred to as 3rd Generation Cognitive Behavioural Therapies.


Return to Work Coordination

The benefits or working are well known and accepted.  Working provides an individual with a way of structuring and occupying their time, social contacts and support, physical and mental activity, an opportunity to develop and use skills, social status, a sense of identity and personal achievement, money and other resources needed for material well-being.

It has been our observation that it is very common for individuals who are returning to work after a prolonged absence to experience both fear and anxiety.  We find that many of our clients experience an increase in symptoms, of all types, as we begin the planning and implementation phase of a return to work.  We understand that this is a difficult time for our clients and that the increased symptoms do not signal an increase in pathology, but rather a very understandable increase in anxiety and fear about returning to the workplace.  For some individuals, this leads them to either delay or abort the return to work process in order to avoid the discomfort.  Sustaining avoidance often requires effort and energy and limits one’s focus at the expense of fully experiencing what is going on in the present.  Avoidance may get in the way of other important, valued aspects of life.

Unfortunately, delaying or aborting the return to work is a solution that has the short term benefit of reducing the discomfort.  However, in the long term this strategy actually results in increasing the fear and anxiety resulting in unnecessary avoidance and a shrinking of the individual’s meaningful life[1].

The role of the Functional Rehabilitation Counsellor is to develop a plan for a graduated return to work in conjunction with our client, the insurer and the employer.  Typically, the graduated return to work extends over the course of 4 to 8 weeks, depending on the situation.  Our involvement does not end with the beginning of the return to work.  We continue to meet with our client until he/she is working full time in order to provide ongoing support, problem solving and reminders about how to best utilize the strategies and skills learned during their involvement with us.  We have had considerable experience at managing a successful return to employment for our clients.

 

 

[1] See: Grillon, C. (2008). Models and mechanisms of anxiety: Evidence from startle studies. Psychopharmacology, 199(3): 421-437 and Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.

 

3rd Generation Cognitive Behavioural Therapies


Physical Conditioning & Functional Activation


  • Acceptance and Commitment Therapy (ACT)
  • Behavioural Activation (BA)
  • Prolonged Exposure (PE) Therapy for Post-traumatic Stress Disorder
  • Behaviour Therapy (BT)
  • Cognitive Therapy (CT)
  • Dialectical Behaviour Therapy (DBT)
Acceptance and Commitment Therapy (ACT)

A basic assumption of ACT is that suffering is a normal and unavoidable part of human experience and that it is actually people’s attempts to control or avoid their own painful experiences that lead to much long-term suffering.  ACT helps people learn ways to let go of the struggle with pain, be more mindful, get clarity on what really matters to them, and to commit to living full, vibrant lives.

ACT uses mindfulness practices to help people become aware of and develop an attitude of acceptance and compassion toward painful thoughts and feelings. Additionally, ACT heavily emphasizes the role of values to help people create meaningful lives.  ACT is centered on such questions as “What do you really want your life to be about?” or “If you lived in a world where you could have your life be about anything, what would it be?

ACT has also been adapted to create a non-therapy version of the same processes, called Acceptance and Commitment Training.  This training process, oriented toward the development of mindfulness, acceptance, and values skills in nonclinical settings, such as businesses or schools, has also been investigated in a handful of research studies with good preliminary results.

Behavioural Activation (BA)

BA is designed to manage the consequences often seen with someone who is suffering from depressed mood.  BA focuses on the depressed person’s behaviours that keep him or her stuck in depression.  The Psychotherapist helps the client examine their triggers for depression-related behaviours, as well as the effects of depressive behaviour on mood and pursuit of important activities (e.g. attending work) and encourages the client to engage in behaviours that disrupt the cycle of depression.  Clients who participate in BA learn how to examine the interactions among their behaviours and moods, how to stop the cycle of depression, and how to prevent future depressive episodes.

Prolonged Exposure (PE) Therapy for Post-traumatic Stress Disorder

PE is specifically designed to address the symptoms of Post-traumatic Stress Disorder (PTSD).  Early in counselling, the client creates a list of situations that are safe, but typically avoided because they cause anxiety.  Together with the Psychotherapist, the client learns to approach each situation on the list, starting with the easiest ones, and stay in each situation for a specific amount of time.  By staying in previously avoided situations, the client develops new skills for handling anxiety, learns how to re-evaluate their perceptions of danger, and increases their self-confidence.  Additionally, PE includes processing the traumatic event by talking about it in a safe and supportive atmosphere.  Because approaching avoided situations and reimagining traumatic events can be very difficult, our Psychotherapists work in a compassionate and collaborative manner to help people achieve success with PE.

Behaviour Therapy (BT)

Behaviour Therapy (BT) focuses on an individual’s learned, or conditioned, behaviour and how this can be changed.  The approach assumes that if a behaviour can be learned, then it can be unlearned (or reconditioned), therefore, it is useful for dealing with issues such as phobias or addictions.

Behaviour therapy helps a person understand how changing his or her behaviour can lead to positive changes in his/her life.  Often, the focus is on helping the person engage in positive or value-consistent behaviours.  The Psychotherapist works with the client to examine the barriers to or difficulties in engaging in these types of behaviours. The Psychotherapist also teaches the client to analyze their own behaviour, as well as the effects their behaviours have on mood and other areas of life.  This approach tends to be more time-limited and focused on a specific problem that the person is encountering.

Cognitive Therapy (CT)

Cognitive Therapy (CT) deals with thoughts and perceptions, and how these can affect feelings and behaviour.  By reassessing negative thoughts, an individual can learn more flexible, positive ways of thinking, which can ultimately affect their feelings and behaviour towards those thoughts.

Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy (DBT) is a cognitive behavioural treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard of psychological treatment for this population.  In addition, research has shown that it is effective in addressing a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

  • Quota Based Physical Conditioning
  • Rebuilding Social, Recreational & Family Activities
  • Sleep Hygiene
  • Mindfulness Training
  • Education
  • Work Hardening
Quota Based Physical Conditioning

Flor and Turk in Melzack and Wall’s Textbook of Pain 5th Edition (2006) state:

“The negative reinforcement of activity levels is an important process in the development of disability.  People with chronic pain typically attempt to base their decisions about the amount of physical activity or work they perform on the level of pain they experience or anticipate.  Patients with fibromyalgia syndrome tend to overestimate the extent of their physical limitations.  This overestimation may lead to a self-fulfilling prophecy and inhibit their activities because they view themselves as more disabled than they actually are.  A specific activity (e.g. walking) is performed until pain sets in, at which point the activity is interrupted and replaced by rest.  Subsequently the pain will be reduced.

This reduction of pain negatively reinforces the cessation of activity.  The cessation of activity has to be made dependent on the amount of activity achieved, quota based, rather than on the amount of pain.  Thus the pain reinforcing quality of rest is eliminated.  This formulation supports the strategy of encouraging patients to perform activity to meet a specific quota” (that is not based upon level of pain).”

At JMA our Kinesiologists use both graduated cardiovascular training and progressive resistance training depending on a client’s presenting difficulties, current level of physical functioning and requirements of the job to assist the individual to gradually resume their pre-disability level of functioning.

Rebuilding Social, Recreational & Family Activities

The clients we see at JMA often describe avoidance and withdrawal as a primary coping strategy in order to manage their symptoms of pain.  It is therefore not surprising that the very vicious cycle of physical and emotional withdrawal results in diminished meaningful interactions or activities that an individual would typically find rewarding or vital in their life.  JMA guides clients through a graduated return to meaningful activity while assisting them to incorporate recommended strategies for pain management.  Unlike traditional pain management programs, clients are supported to achieve attainable, measurable reactivation goals that result in clients safely resuming activities of daily living while managing the experience of pain.

Sleep Hygiene

For people with chronic physical conditions, sleep disruption is a common problem.  This includes trouble falling asleep, waking up during the night and waking earlier than desired.  In addition, many such individuals describe not feeling refreshed in the morning when they awaken, a sleeping problem termed “non-restorative sleep”.  At JMA, the aggressive management of sleep disturbance is an important treatment objective.  We address two important factors: the individual’s personal habits and their sleeping environment.  The things a person does during the day and leading up to sleeping at night can impact sleep just as much as the environment that they choose to sleep in.  Learning how to optimize both their personal habits and sleep environment is paramount to successful sleep.

Mindfulness Training

Mindfulness meditation is based on ancient Eastern meditation practices that focusses on paying attention to the present moment with openness, curiosity, and acceptance.  Mindfulness helps people to accept their experiences, both physical and mental, rather than react to them with aversion and avoidance. In this way mindfulness can help our clients to transform their relationship with painful thoughts and feelings in a way that reduces their impact and influence over their lives.

Education

At JMA we believe that it is important to both provide information and clear up misconceptions in order to increase the likelihood of better outcomes.  The Kinesiologists at JMA use bibliotherapy, education related to the individual’s chronic condition and collaboration with the client’s health care providers to ensure that each client has accurate, up to date information on which to base their decisions about how to make changes in their lives.  It is important for long term success that the client is able to self-manage their chronic condition in the future.

Work Hardening

For an individual who has been off work for an extended period of time, the key to a successful outcome is the preparation for a return to work.  Our work hardening process is designed to utilize real or simulated work activities intended to restore physical, behavioural and vocational functions.  Work Hardening addresses the issues of productivity, safety, physical tolerances and worker behaviours.  At JMA we use both cognitive and physical work hardening strategies.


Acceptance & Commitment Therapy (ACT)

ACT uses mindfulness practices to help people become aware of and develop an attitude of acceptance and compassion toward painful thoughts and feelings.


Behavioural Activation (BA)

BA is designed to treat depression. BA focuses on the depressed person’s behaviours that keep him or her stuck in depression.


Cognitive & Behavioural Therapy (CT & BT)

CT deals with thoughts and perceptions, and how these can affect feelings and behaviour. BT focuses on an individual’s learnt, or conditioned, behaviour and how this can be changed.

Quota Based Physical Conditioning

This can include graduated cardiovascular training and/or progressive resistance training to assist the individual to gradually resume their pre-disability level of functioning.


Rebuilding Social, Recreational & Family Activities

JMA guides clients through a graduated return to meaningful activity while assisting them to incorporate recommended strategies for pain management.


Work Hardening

Our work hardening process uses cognitive and physical work hardening strategies designed to utilize real or simulated work activities to restore physical, behavioural and vocational functions.


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J Marlin and Associates Inc. offers Cognitive Behavioural Therapy services to help individuals increase their sense of vitality, well-being, and fulfillment.

Head Office1100 Burloak Drive, Suite 602 Burlington, ON L7L 6B2

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