counseling

Virtual reality as a therapy?

Philip Be’er (photo from Philip Be’er)

Philip Be’er, a counselor based in Sidney, B.C., 27 kilometres north of Victoria, has recently introduced virtual reality therapy consultations to anyone, anywhere, “as long as they have a good internet connection.” Sessions are held both in person, using a VR headset, and, if done remotely, a computer or smartphone.

VR therapy attempts to address a number of phobias, anxieties, addictive disorders and other mental health conditions. If someone were to have a fear of heights, for example, VR therapy, using the headset and software, could simulate a scene in which one enters a glass elevator in a skyscraper. As the elevator goes up – 10 floors, 25 floors, 100 floors – a therapist can help the client work with the various sensations and emotions that the simulation evokes in the client.

Be’er said that, when he first heard about VR therapy, he recognized its potential upon reflecting on how the human brain does not always accurately distinguish between real experience and visualized or imaginary experiences. If one goes through something that feels realistic, as it can with VR, the brain sometimes believes that the experience has happened, and this belief, Be’er claims, can be used for healing.

“The power of VR is that it inserts a person into something that feels quite realistic. We take them to a place that triggers the feeling that I am not safe without ever putting the person into danger,” he explained. “It feels unsafe but I am not unsafe, and all I have to do if I am feeling this lack of safety is take off the goggles, and I realize that I am sitting in a place where there is no actual danger.”

Advocates of VR therapy think it can provide a person the ability to remove themselves from the perception of danger and into safety. Further, that it can help address deleterious emotions as they arise.

“Using virtual reality, I can take people through situations and allow them to calm their nervous systems when they feel unsafe and yet are not really unsafe,” said Be’er. “This could be going into a subway and not feeling safe around the people there or, for a person with OCD [obsessive-compulsive disorder], feeling like they are going to die because there are germs and infections around, and they are constantly washing their hands. In these situations, virtual reality can help differentiate between what is really dangerous and what my nervous system is telling me is dangerous.”

According to Be’er, it is a matter of the nervous system recalibrating. Instead of being overwhelmed by danger signals, it eventually selects only those where there really is imminent danger.

Be’er shared an example of what he considered a successful virtual reality therapy case. It involved a client who had been struggling with severe issues around social anxiety and who coped by using alcohol to self-medicate. The person was so uncomfortable with others that they rarely left their room. Yet, there was one place they were able interact with others: virtual reality chat rooms.

“The thing that made it safer for my client was that they presented as a carrot, banana, dragon or whatever avatar they chose and nobody could really see who they were,” he said. “They could go and interact with people, and the worst thing that could happen was that avatar would be rejected if they made some kind of faux pas, if they did something that was socially unacceptable or in some way antagonized or turned the other person off. There was not that much to lose because, if something went wrong for them with this particular avatar, they would simply change their user name and avatar and then they could practise again.”

Be’er coached the client to develop some of their social skills using this visualized virtual world and that person was able to reduce their dependence on alcohol. Within a few weeks, the client was interacting in a sales position with people on an ongoing basis.

To be sure, because VR therapy is still in its early stages, there are unanswered questions about its future. In a 2018 Scientific American article, Albert “Skip” Rizzo, director of medical virtual reality at the University of Southern California’s Institute for Creative Technologies, commented, “The next biggest controversy [in] psychology is going to be: How far can we go with AI [artificial intelligence] and virtual therapists?”

And lest one think that machines will supplant real-life counselors any time soon, the BBC’s Science Focusmagazine notes, “VR therapy won’t replace human therapists, but it’s a powerful adjunct and access to it is going to grow.”

Local therapists to whom the Independent spoke also noted that VR could be a useful tool in treatment, but were cautious about its use as therapy in and of itself.

Be’er said he has been on a lifelong quest to understand the roots of family (and societal) dysfunction and to identify the most effective ways to bring about individual and collective healing. He works with individuals, families, businesses and organizations, offering regular workshops, seminars and an online course.

For more information on Be’er’s use of virtual reality therapy, visit b-loops.com/vr.

Sam Margolis has written for the Globe and Mail, the National Post, UPI and MSNBC.

Pushing for more oversight

Members of the Jewish community, as well as members of various professional organizations, are calling on the government of British Columbia to do more to regulate practising therapists and counselors in the province.

According to the Federation of Associations of Counseling Therapists in British Columbia (FACTBC), which is at the forefront of the campaign for this change, there is currently no regulatory body for counseling therapists in the province and, therefore, there are no regulatory standards for the work that counseling therapists do.

As it stands, they claim, someone can call themselves a mental health professional in British Columbia without having the checks that exist elsewhere in Canada. This, FACTBC points out, differs significantly from Ontario, Quebec and Alberta, which have all established regulatory bodies to oversee who can become a mental health professional. And, they add, the remaining provinces have done more than British Columbia when it comes to the consideration of implementing regulation.

A member of the Jewish community recently came to the Independent with her story. In her attempts to remove a social worker from her mother’s life, she encountered what she believes were numerous inadequacies within the present system regarding the protection of the public’s interest and confidence.

“When we seek the help of doctors and nurses, there is a protected title that tells us the person is qualified and safe and that there is a professional regulator to back up this promise,” she said. “Regulation protects people from harm. I cannot change the events of the past, but I can take from that experience and do what I can to ensure that all our citizens are protected, moving forward.

“I knew,” she added, “and had confirmed by other counselors and social workers that what this registrant was doing was in violation of their professional code. I saw my mother become further isolated from friends and family, while her health continued to decline both mentally and physically, while in this registrant’s care.”

The community member filed a complaint with the B.C. College of Social Workers (BCCSW). “Through this experience, I saw firsthand the lack of transparency in the complaint and discipline process that gives social workers the ability to enter negotiated complaint resolution agreements (CRAs) in exchange for keeping matters confidential. How can the public have confidence in regulators if the public is not aware of actions taken by regulators to protect them?” she wondered.

The community member then did what many who lack the financial means could not: she filed a civil claim against the social worker. She was not looking for money, she told the Independent; rather, she was looking for accountability and safety.

In the end, the woman and her family received an apology from the registrant and a promise to not repeat the following conduct: failing to differentiate between professional and personal boundaries; creating a situation of dependence with clients; and failing to limit their practice within the parameters of their competence.

“The college, in their inquiry decision, acknowledged that the time the registrant spent with my mother and the amount the registrant billed were not reasonable. I am not sure I will ever be able to fully reconcile with the events that occurred over a three-year span at the hands of a social worker, who was a friend at the time, and [that] I helped facilitate the introduction to my vulnerable, senior mother,” the woman said.

“To help with my own personal healing,” she added, “I elected to join FACTBC’s stakeholder table. I hope to lend my voice to ensure social workers, counseling therapists and emergency medical assistants who deal with our most vulnerable citizens are recognized as health professionals and regulated under the Health Professions Act.”

For Shelley Karrel of Jewish Addiction Community Services (JACS) Vancouver, the importance of regulation for counselors in British Columbia cannot be overstated. “For counselors working in the area of addiction and recovery, it is critical to know the importance of assessment, understanding the various stages of addiction, being able to identify the options available for treatment and recovery,” she said.

Karrel explained that understanding co-morbidity – i.e., the presence of one or more additional conditions – of mental health issues with addiction requires psychotherapists and counselors to have the proper training and education to know how to help clients deal with their various challenges.

“Having counseling fall under a regulated body will give clients the assurance they are dealing with qualified professionals who have to meet professional standards of practice, ongoing continuing education and clinical supervision,” she stated.

According to Glen Grigg, a Vancouver clinical counselor and the chair of FACTBC, “proper regulation will prevent consumers from harm. A consumer should not have to guess whether the therapist is equipped to deliver the services they promise. Moreover, when harm is done, it is important to know that a registrant’s college has the power to bring restoration and remediation when harm has occurred.”

FACTBC, which is comprised of 14 professional organizations that represent 6,000 mental health professionals in the province, is asking for safety and accountability. On professional title, it recommends one legislative authority and one coherent and fair process that prevents harm and has the power to act accordingly when harm has been done.

The B.C. government has said that it will first implement modernization of the health professions regulatory system – a step that FACTBC enthusiastically supports – and then give attention to the mental health system.

To Grigg, “this response comes down to saying, in effect, ‘despite the opioid crisis and mental health fallout from the pandemic, we can defer this issue.’ When pressed for what is intended after a new regulatory process is put into place, timeline unknown, the response is that government will ‘recommend’ that professions, such as counseling therapy and social work, become a ‘priority.’ A recommendation to a yet-to-be created bureaucracy falls far short of commitment and action.”

Grigg added, “FACTBC has been advocating for public protection where counseling therapy is concerned for more than 20 years and have heard, over and over, variations on the theme, ‘Yes, of course, we are going to protect the public, but later, at a time we’re not prepared to specify.’”

FACTBC does give the province credit for creating a Ministry of Mental Health and Addictions – a huge step forward, in their view, as was the $5 million the province put towards increasing mental health services. What the government needs to do to follow up on this momentum is to regulate counseling therapy, they assert.

At present there is no way of accurately ascertaining how many practising counselors there are in British Columbia. However, Grigg cites what Ontario discovered. In that province, in the time since they implemented statutory regulation on counseling therapists, they found that half the people providing services did not have any form of registration or certification.

“That’s dangerous,” said Grigg. “And we suspect that the situation in B.C. is similar but, because there is no central authority, even the scale of the problem is guesswork.”

He stressed, “It’s easy to see why this is so crucial. Suppose you were sick or injured and went to your local clinic or emergency department and discovered that it was up to you to figure out whether the people working there really were nurses and doctors, and whether they were qualified to provide care? That’s what people looking for counseling services are up against every day in B.C. There is no single title, like doctor or nurse or dentist or pharmacist, that identifies qualified and accountable counseling therapists.”

Sam Margolis has written for the Globe and Mail, the National Post, UPI and MSNBC.

Couples need to talk about sex

Doreen Seidler-Feller, PhD, is a clinical psychologist who has decided to focus her practice, in part, on the underserved population of Orthodox Jews. (photo from Doreen Seidler-Feller)

While sex is vital to our existence, it remains a topic many people are not comfortable discussing. Yet it is critical that we at least feel comfortable talking about it in private with our partners. It is even more fulfilling if we are able to enjoy the act of it with them, too.

Unfortunately, some newlywed Jewish Orthodox couples find themselves unable to consummate their marriages in an enjoyable way, due to a lack of sexual education and some misguided sexual advice from their peers. Enter sex therapist Doreen Seidler-Feller, PhD, a Los Angeles-based clinical psychologist who has decided to focus her practice, in part, on the underserved population of Orthodox Jews.

“I’m the last resort for everyone in this area,” Seidler-Feller told the Independent. “Nobody likes to come and face the situation in which they need to talk about something as intimate as their sexuality and their relations with their partners.”

Since people often only go to Seidler-Feller after they have exhausted all the options they can think of to solve the difficulties by themselves, she sees more complicated cases.

“It’s rare that I see a man alone,” she said. “It’s more likely that I’d see a man together with his wife, presenting as a couple, or that I’d see women alone. The reason for this is that, frequently, the problem is identified as theirs [the woman’s]. If it is an issue of painful intercourse or the involuntary contracture of the vaginal musculature that denies entry to the man … any sort of pain condition inside the vaginal vault or inability to tolerate intercourse … it makes sense that she would present alone.”

As treatment progresses, Seidler-Feller brings her patient’s partner into the process, as there is always some bridging required to bring the couple back into harmony and aid in their sexual choreography. Sometimes, the partner, too, may have a problem undiscovered until that point. In that case, his individual problem becomes addressable.

“The issue that causes the greatest anxiety is the inability to consummate marriage – a pain condition and an inability to tolerate insertion are conditions most likely to bring them into treatment,” she said. “These conditions not only deny the couple the opportunity for the mitzvah pru u’rvu [being fruitful and multiplying]. They deny them the opportunity for pleasure, the sensations of adulthood, and related normalcy.”

According to Seidler-Feller, the next most likely causes for seeking treatment are if the man has erection or ejaculation control difficulties, while the least likely cause is a woman being unable to achieve orgasm.

The majority of Orthodox couples and individuals Seidler-Feller sees are between the ages of 21 and 35.

“People, usually women, also sometimes want to come to me to talk about something in their past that they haven’t been able to talk to anyone about, that may be relevant to their sexual dysfunction,” said Seidler-Feller. “In that case, my being a stranger to her – not necessarily part of her community – is a plus, not a minus. That is because usually it enables the patient to maintain a certain kind of anonymity. At the same time, it enables her to raise the question of to what extent an experience of either subtle or outright sexual abuse might be relevant to her sexual difficulty.”

Since the work is so intimate, Seidler-Feller works strictly in person – not over the phone or electronically – partially to challenge the taboo around frank sexual discussion in the Orthodox world. Also, because of the inhibition that exists around both the language and activity involved in human sexuality, one-on-one discussions are most useful.

In a world where oblique language supplies the vocabulary, Seidler-Feller is not a fan of maintaining the status quo. One of her objectives is to train couples to be completely open with each other, to say what they mean and mean what they say.

“They can deal with the rest of the world in euphemism and indirection, that’s fine,” she said, “but I don’t want them, with one another, to talk in euphemistic and inhibited language, as it may lead to difficulties and misunderstandings.”

On the other hand, Seidler-Feller does not advocate the use of clinical or vulgar language. Her intention is simply to help a couple speak clearly to each other, so they can effectively express their desires.

“Once the dysfunction is behind them, they are left with a world of possibilities about how to enact their sexual relationship,” said Seidler-Feller. “Some find, at that stage, that they want to have a more ample, open and variable sexual relationship. For that to be realized, they need to be strong internally and know what they feel and want. This way, they can refer to their experience clearly and can effectively achieve their wishes.”

Seidler-Feller’s treatment is short-term behavior-oriented psychotherapy and involves focused discussion, not actual activity of any sort in a session. Her patients are given a series of exercises designed for them, specifically based on what their diagnostic assessment reveals and what are their halachic (Jewish law), cultural and value considerations. The exercises, which the couple completes in the privacy of their home, are the subject of each session. Usually, the person who has the dysfunction begins by doing self-directed exercises. Later, the couple performs partner exercises together.

“Over the course of the week, I expect my patients to do the exercises three or four times, and journal,” said Seidler-Feller. “Then, they bring back their journals or good memories, as the case may be, and we talk about what they did over the course of the week. And, I put in my two cents about how to enlarge it or differently shape it.”

In this broad way, Seidler-Feller approaches numerous issues wherein primary medical causes have been ruled out or are limited in their effects.

Seidler-Feller would like to see a standardized curriculum in Orthodox day schools.

“I’d like to see Orthodox day schools become more courageous, to face the fact that we live in a modern world where people of all kinds get their sexual information and values from all sorts of places,” she said. “It’s still true that most get information from their peers, which is variable, and, even when the information is good, is never enough.

“A sexual ethic involving a modern Jewish approach to sexual values must be developed to have a chance of captivating the imagination of both young Orthodox men and women, as well as the non-Orthodox. Otherwise, we condemn our young to the values either of the street or the Kitzur Shulchan Aruch [Code of Jewish Law].”

Seidler-Feller sees talking about problems surrounding sex, and giving young people especially a way to think about sex as something that is spiritually and emotionally enriching, is critical. She also thinks it will reduce a lot of personal anguish and marital tension.

“I’d like to see public forums in the Orthodox world, where people like me are invited into synagogues, panels or programs, offering the opportunity to talk about responsible human sexuality in the Jewish context, Orthodox context, in a straightforward, unapologetic way,” said Seidler-Feller. “This could help rabbis in the institutions that have failed us, to the extent that they consider all public discussion on sexuality as somehow immodest and prohibited. My dream is that when they come to the chuppah [marriage canopy] and to the world of marriage beyond, couples are truly prepared.”

Rebeca Kuropatwa is a Winnipeg freelance writer.