How and when to End Treatment

Congruent endings are as important and valuable in the process of seeing your naturopath/homeopath as the beginnings and middle.   It is a topic that is not spoken about very much.   I have had long term patients not know how to talk to me about this and leave abruptly with a email, or a sentence in the session and leaving me disconcerted and with questions. These articles cover important aspects of any treatment process and are as applicable to the homeopathic/naturopathic process as in counselling.

When to End Treatment, Ryan Howes PhD.

Psychology Today magazine, 2017

A few months ago, a journalist sent me some questions for an article about ending therapy (because of my series on termination, I presume). I worked hard writing responses, but the article never ran, so I thought I’d post them here to bring some closure to all this hard work.

….to bring some closure to all this hard work.

Well I’ll be. That’s the function of termination as well – to give the therapeutic process a satisfying conclusion. Does that always happen? No, it doesn’t, but in an ideal world, all therapy would provide a good ending, where loose ends are tied up, take-away points are clarified, and we share a clean goodbye. Sounds nice, doesn’t it?

So why is this positive ending relatively rare? Sometimes therapists do stupid things that cause clients to leave prematurely. Sometimes clients don’t like saying goodbye so they split without notice. Many times, clients don’t even know there is such a thing as a “termination phase,” so they either ghost their therapist or fumble through the final sessions until they find a good reason to leave.

And you know what? That’s on us therapists. We should be teaching clients how to end therapy from the very moment they enter our office. Providing a good ending is one of the best things we can do as therapists. More on that below.

And so I resurrect for you the interview that never ran for your reading pleasure:

Unnamed Interviewer:  Your thoughts on what patients should consider when weighing whether it’s time to stop therapy

Ryan Howes: Clients should consider ending their time in therapy when their goals have been met or when it becomes evident that they won’t meet them with this psychotherapist. 

Ideally, therapy ends when all therapy goals have been met. If you entered therapy to treat a fear of dogs and you no longer fear dogs, your work is complete. Or you want to communicate better with your partner and you’ve learned to navigate your disagreements constructively, the goals are met. Many people have aims that are less specific, like improving self-esteem or decreasing anxiety. They may choose to leave when they’ve learned the skills necessary to do this on an ongoing basis, and the regular sessions are no longer needed to reinforce these principles. 

There’s also the idea of “internalizing” the therapist. When a client has worked with a therapist for several months or years, they’ll find themselves encountering a problem and can imagine what their therapist would say about it. We would say this incorporation of the therapist’s voice or mindset is a positive sign for the client, that they have been able to construct a portable version of the therapist who can advise them outside therapy sessions. When a positive, helpful version of the therapist has been internalized, the flesh and blood version may not be as necessary. I know, it sounds funny, but it’s true.

On the other hand, some clients realize they won’t be able to reach their goals with their current therapist. They may have a personality conflict, experience some challenges within the therapy, or they may suffer from a problem that requires a specific set of skills their therapist doesn’t have. Some therapists are highly trained to work with chemical dependency, eating disorders, or schizophrenia  for example, while others have very little training in these areas. If it becomes clear that the therapist doesn’t have the tools necessary to help the client with their issues, the therapist should make a referral to another clinician who can help.

Beyond specialty, there are also times when interpersonal issues become a barrier to the therapy. In therapy, as in all close relationships, problems with trust, communication, and empathy could render therapy an obstacle rather than a conduit to healing. If you’re seeking help with grieving a lost loved one but you don’t trust that your therapist is keeping your sessions confidential, therapy is getting in the way of your healing. In these cases, it can be helpful to discuss the problems with the therapist first, but if they can’t be resolved, leaving therapy is a viable option. 

One point to consider is whether the obstacle is central to your issues or not. If you are seeking therapy to address a history of conflict with males, and you find yourself having conflict with your male therapist, you might want to think about staying to resolve this conflict because it becomes a laboratory for your specific problem. If you have social phobia and feel awkward with your therapist, this might be just the place to work on it. But if you have a fear of heights and your interpersonal issues with the therapist are getting in the way, leaving therapy could be a good option. 

UI: Any thoughts on whether there is an optimal amount of time or number of sessions should be in therapy? What are the different variables (such as reasons for being in therapy – what would be an example of a reason that should take 8-12 sessions, what would be an example of a reason that could take months or years)?

RH: As vague as it is, it depends. 

There are people who will benefit from a single therapy session and others who have been in great therapy for 23 years and have no intention of stopping. As long as someone feels like therapy is beneficial to them and they have the practical means, they should feel free to keep going. 

A lot of this has to do with the mindset of the person seeking therapy. I’ll draw an analogy from the world of physical health, where we have two approaches – the illness model and the wellness model. In the illness model, when someone feels sick or has an injury, they go to an MD and receive treatment. When the illness clears up, they make no more appointments with the MD, and all is well. In the wellness model, a relatively healthy person decides they want to make their healthy body healthier, so they go to the gym. They work out regularly and achieve fitness goals and feel great about it. No one says: “You’re in great shape – it’s time to stop going to the gym!” That would be absurd. 

Psychotherapy is the mental health equivalent of both the illness and wellness model. People come to therapy to treat disorders like phobias, depression, anxiety, OCD, PTSD, ADHD, bipolar disorder, etc. But they also come to therapy to make a good life great by working on their relationships, finding meaning in their life, becoming a better parent, improving their communication, finding their ideal career, increasing their capacity for intimacy, enhancing their self-esteem, and so on. 

So the question about how long someone “should” be in therapy promotes a mental health stigma. It implies that people “should” be done with therapy in a predetermined amount of time and if they’re not there’s something wrong with them or the therapy. Would someone say the same thing to someone who goes to the gym? "You’ve gone to this gym for 6 years, aren’t you done yet? You’re in great shape, so stop working out.” Hell no. Let’s try to apply the same grace to mental health that we do to physical health. 

Generally speaking, people seeking relief from phobias, anxiety or depression find some relief within the first 3-6 months of therapy. People with deeper issues like trauma, relational issues, problems with core identity, sexual and intimacy problems require months to years of treatment. And if they want a safe, structured place to work on becoming the most self-aware and best version of themselves, they may want to spend much longer in treatment. 

UI: Do therapists have any responsibility to ask the patient whether he or she should stop therapy (or find another therapist)?

RH: As I said above, if a therapist finds that they are working with a client who has needs that exceed their scope of competence, the therapist is obligated to find referrals to someone who does have that skill. All ethics codes say something about therapists only working within their scope of competence.

Therapists should also be aware of whether or not therapy is giving any value to the client. This could be a therapist who recognizes that their depressed client isn’t improving despite several months of therapy, or realizing that the ADHD tools they have taught aren’t producing the desired results, or the anger management strategies seem to make matters worse. This should be a collaborative discussion with the client, where they both assess the effectiveness of the interventions and decide whether or not to stop and find outside help. 

This collaboration is very important. I remember a time early in my training when I was working with an elderly woman and I felt like our work was going nowhere. She was telling story after story and I felt like it wasn’t helping to resolve her depression at all. After several months I told her I didn’t feel I was being effective and suggested we might transfer her to someone with more experience. She nearly burst into tears and told me our sessions were the most important hour of her week, that it had helped her connect with others, and that she was heartbroken that I felt otherwise. I learned then that my experience and my client’s can be very different, and never to assume that my opinion is true for both of us. We repaired from that session, and continued several more months as her depression lifted. 

UI:  Please provide specific consumer advice tips for patients who are wondering whether they should stop or wind down from therapy, at least one robust paragraph per tip.

RH: If it’s bad therapy:

Just go. If you feel you are being exploited, if you feel unwanted romantic advances, if you feel like your boundaries are violated in any way, if you feel like therapy is going nowhere, make your next session your last. Tell your therapist you don’t feel safe and/or competently served and let them know this is your last session. If the violations are extreme or causing harm look into telling their boss or alerting the licensing board. Like physicians, therapists are ethically bound to “do no harm” in their therapy, and if you’re suffering harm there are avenues to stop the harm and find better treatment. You may feel it’s helpful for you to have a voice and tell your therapist about your complaints, or maybe not. As I’ve said many times before, it’s your time and your dime, you can have closure or choose to split with a voicemail. Whatever works best for your mental health.

If it’s good therapy:

Start early – I try to talk with my clients about when therapy will end, from the beginning. When you’re talking about the goals for therapy, talk about how and when you’ll know therapy is ready to come to a close. Maybe you’re trying to stop an annoying behavior - perhaps when you’ve been free from the behavior for a month you’ll be ready to wrap up therapy. It can seem odd to talk about the ending of therapy at the first session, but this can free both of you up to work well together and not wonder when and how you’ll end. 

Talk about it – Beyond the first session, it can be helpful to bring the topic of ending up from time to time. Let’s say you found yourself dreading therapy this week and had to drag yourself in. This can be great material to discuss and might help you develop your exit plan together. Maybe you can set a date for a final session and plan a good farewell in the meantime.

Raise your concerns – Sometimes therapy raises concerns that are speed bumps, but not necessarily reasons to end therapy. Your therapist was late for a session. You forgot an appointment. You had a disagreement. Talk about these issues and see if they are about readiness to end therapy or another problem, like resistance to diving into deeper topics. Sometimes a desire to bail is about an unwillingness to talk about really important issues more than a signal that therapy isn’t important anymore. 

Set a date – When therapy has gone well and you’ve been able to internalize the voice of your therapist, it can be helpful to set a date in the future to say your last goodbyes - some make it a month out, some make it 10% of the total amount of time in therapy. I’ve seen that doing this sometimes raises new material in therapy, issues that can be very helpful to discuss. The idea that therapy is ending can raise memories of other endings in a person’s life and give you a chance to talk about them.

Make a positive ending – The fact is, there aren’t enough good endings in life. Many relationships end in death, divorce, breakups, or a slow fade away. A good therapy ending is a lot like a graduation – it’s bittersweet. We spend some time talking about the goals achieved, lament about the problems we couldn’t resolve and had to accept, and reminisce about the time we spent together. We make an aftercare plan about what life looks like after therapy, and we end on a positive note. Unlike many relationships where there is no closure, we try to say and feel everything we can to make this as complete as possible. 

4 Reasons Not to Ghost Your Therapist

What are you really avoiding?

Posted Jan 02, 2016.  Psychology Today, Ryan Howes PhD.

  • Money’s getting tight and it just doesn’t seem worth it anymore.
  • You’ve talked through all the superficial material and all that’s left is the hard stuff.
  • You know the end is coming soon and you don’t like endings, never have.

And so ... You ghost your therapist.

Every therapist has a story or 12 about clients who seem to be connecting and doing well, but then they suddenly disappear. Poof.Phone calls and emails lead nowhere, nothing comes back. The client has ghosted.

If you’re new to the term, “ghosting” is when someone in a close relationship suddenly disappears, like an avoidant apparition. They’re there one day, everything seems to be going fine, and then they disappear——they've ghosted. You can ghost on a micro or macro scale. Let’s say you’re at a party with friends, you want to leave, but don’t want to make the rounds of goodbye hugs and “Aw, you’re leaving? One more!” so you say you’re going to the restroom but walk out the door and Uber home. That's ghosting on a micro scale.

But let’s imagine that you’re in a new relationship, and while some parts of it are working, you’re just not that into the other person. Instead of having the challenging relationship talk when you discuss your ambivalence, feel bad, and perhaps induce tears, you just stop calling. And you stop answering calls and texts. In fact, you avoid the other person completely, telling yourself that the disappearance will send the message in a more subtle way, without tears or guilt or drama of a face-to-face interaction. This is ghosting on a macro scale, breaking hearts in absentia.

Why do we ghost? We’re human: We seek pleasure and avoid pain. Goodbyes are hard for many of us, whether the harmless goodbye of leaving a party or the more substantial goodbye of exiting a relationship. All that grief, loss, guilt, and conflicted feeling are unpleasant to experience. We seek an easier route through fading away, hoping it will mitigate our pain—and maybe even the pain of the other person. By avoiding the conflict, by avoiding the other person's feelings, and maybe even our own, maybe it won’t hurt as bad. Right?

All of these ideas and behaviors show up in therapy all the time. To avoid the conflict, the feelings, the other’s opinion, clients may ghost just when the therapist least expects it.

But unlike walking away from friendships or romantic relationships, clients have one more rationalization for ghosting in therapy: “It’s not a real relationship. I pay her. I can leave whenever I want and don’t have to explain anything.”

And you know what? That's partially correct. You can leave whenever you want—that is totally your right as a consumer and a citizen (unless you’re court ordered to attend). As I’ve said many times, it’s your time and your dime. You can leave whenever you’d like. But there are 4 reasons you may not want to ghost on your therapist, reasons that may benefit you, your therapist, and society as a whole:

1. You can say anything in therapy, and that’s for your benefit.

In other areas of your life, it may be impolite to say “This isn’t working for me anymore; I’m thinking about leaving.” But in therapy, talking about the relationship is one of the central components of the work. You can say things in therapy you might feel reluctant to in other relationships, because therapy is supposed to be a safe place where all topics are fair game. Therapists are trained to hear such statements non-defensively, but even if their response is pathetic, it’s still good for you to say it. You’re just being honest, talking about how you really feel. So why not take that approach for a spin?

2. We don’t have enough good endings in life. 

Think about most endings—divorce, death, breakups, moving, fights, firing, etc. These are neither pleasant experiences nor memories. It is possible to have good endings, though. They happen all the time—graduations, for example. A journey ends with a celebration of accomplishments. Bittersweet goodbyes ensue, then brunch at the Olive Garden. That’s a decent ending. Why not model therapy’s ending on a graduation instead of a divorce?

3. What are you avoiding? 

While not everyone who wants to leave therapy is avoiding their own issues, we know that at least some are. We’re getting too close to the childhoodabuse. We’re focusing less on others in your life and more on your own contribution to your problems. We’re asking uncomfortable questions about our therapy relationship. Each of these scenarios have sent numerous people out of therapy, so they warrant mention. If you’re avoiding something you aren’t ready to talk about yet, how about talking about that? "There’s something about my childhood that I really don’t want to discuss. Can we talk about why I don't want to talk about it?” Therapists should be able to hang with that.

4. Think of the therapist’s future clients. 

Let’s say the therapist kept horrible eye contact, and this made you want to leave therapy, so you ghost. That may be a fine resolution for you, but what about all the other people this eye-avoider sees (peripherally, I suppose)? Might it be helpful, exit-interview style, to tell the therapist why it is you’re leaving, with the hope that the information may help dozens (or hundreds) of people in the future? Again, I hear you : "It’s not my job to make my therapist a better therapist.” I agree. But we do lots of things that aren’t "our job" that benefit others.

I need to add one last piece, as a therapist: It’s hard when a client ghosts, not just for the lost business or the unanswered phone calls. Those sting, but only temporarily. It’s the unanswered questions that hurt most: "Why did you leave?” “What was going on that I didn’t know about?” And the iconic, "Was it something I said?” I come to care about my clients, even after just a session or two, and a disappearance makes an impact.

Why? We spend a lot of time in our training learning to help clients feel safe and comfortable, to help them say whatever they want. Ghosting tells us that something was wrong with our rapport. Even though it seemed like the relationship was functional, something else was going on underneath. Either there was no secure connection or the client didn’t feel safe enough to talk about their insecurities. That’s a problem we’d like to correct—but without contact we’ll never know. It’s like someone telling a surgeon: “Sorry, the heart transplant failed and we lost the patient. The body is gone now, though, so we’ll never know what happened. By the way, you have three more scheduled for this afternoon.”

What happened? What went wrong? How can I improve?

These feelings are part of the cost of choosing this profession and clients shouldn’t feel that this is the main reason not to ghost. More important for you is the loss of a clean, good ending—a missed opportunity to express yourself. You lose a chance to dive into material that may be difficult, but ultimately beneficial for you.

That’s why you chose to come to therapy in the first place, isn’t it?

An Attitude for the End Zone

When Doris Grumback was 70, she wrote Coming to the End Zone: A Memoir.  The End Zone is that time of life when you must be conscious or you will miss the rest of your life.  It could start at anytime, but by the time you are 60, you automatically begin to feel like an elder, at least older than most and more experienced than many.

Here are some random thoughts about the End Zone from Jack Rosenberg (Author of IBP: Body, Self and Soul):

That which is most important comes first.  Listen to your body voice.  When you seek approval from others, it stops your internal aliveness, sense of well-being and in the end zone, it will limit your sense of freedom.  When you make decisions, you can't check with everyone in the past on whom you have counted to tell you what to do or what to rebel against, most of your trusted advisors have died anyway.

You need an intention, not a goal, to accomplish what you wish to accomplish in the rest of your life.  Do not make a plan so ambitious that it cannot be completed.  A goal so immense that it occupies your life is a trap and keeps you from living in the end zone.  Don't make a "when....then...." out of the last years of your life.

Love and companionship outweigh what looks like right or pleases someone else.

References to why-you-are-the-way-you-are are no sufficient justification to stay the way you are.

Beauty is not external.  What the light bulb looks like is not as important as the quality of the illumination cast from within.

God doesn't care about your intentions, nor does he count good deeds from the past.  Every moment is a clean slate and there are no report cards (except those given from within).

One moment of truth is work a lifetime of half lies.

Work must have personal meaning.  To work only for money or fame is too costly to the soul.

"No one can tell me what to do" is a closed system, closed to life.  It can cripple intimacy and your sense of self, personal growth, and spiritual awakening.  A closed system is just that, a closed system.  It is not a sign of power.  It's perpetrators often find themselves emotionally shallow and spiritually empty, with the finish of life coming up fast.

The end of any human endeavour is not the end of aliveness nor can it be the beginning.  The energy for closure is used for just that, for closure, for ending.  This completion can bring peace and joy, a feeling of moving on, of passage.  The energy for beginning, however, is excitement for new life. It is a separate event.  Beginnings take just as much energy as endings do. Both are necessary.  For life in the end zone, life starts anew each moment.

Not every advance in technology is automatically good.  We may, for all our inventions, have progressed no closer to God than when we were paelolithic hunters and gatherers.  We may, with all our gadgets and short cuts, have lessened our ability to be human, to feel, to love and share with our fellow man.

Spiritually and godliness cannot be worn like a bulletproof vest against the pain of being human or as protection from intimacy.

You must actively choose your friends.  There is no time to be with people you don't particularly care about.  Don't let such people choose you and steal your time.  Want them, or let them go.

Remember, change is really the only constant in any relationship.

Any relationship that isn't reciprocal in some way won't be fulfilling.

Humor is more important than drama.  There is enough drama in just being alive and staying conscious.

Your adult children must be given respect for their capacity to solve life's problems on their own.  When you tell them the answers you are often speaking of your own answers, not theirs.  When you do this, you treat them as though they were extensions of yourself.  Their lives are not your life.  The true meaning of live is freedom and respect.

If you cherish someone so much that you never cut the cord, he or she never gets the experience of flying freely in life.

Each day have one question, prayer, a thought about God or the meaning of life.

The end zone is not the end.  It is the beginning of a way of a way of being that has no time for anything that does not move forward towards aliveness.

As we age, we are forced to seek that which brings us excitement or aliveness because it doesn't seek us.  We have to conserve our physical and emotional energy so that it will not run out before we finish the race.  This insight may come after a serious illness or tragedy that awakens us to life but it must come by the time we are 60 or we will miss the end zone.

If there is something unfinished in your life that you feel is important to your destiny, you must move toward its completing.  If it cannot be finished, and you have no control, let go or you will be stuck holding onto a permanent drain in your life force.

One of my basic assumptions of life is that life force, or energy, is very much like the Chinese concept of Qi, in which each person, at birth gets a measured amount of Qi, energy, or life force (I use the phrase 'life units').  Some of us get more of it than others.  When we are young we are mostly unconscious of any need for conservation of energy or Qi, so we can push ourselves to unbelievable heights or squander Qi on unrewarding relationships, money or fame.  We often use a great many of life units to heal our children when they are ill or troubled (as any parent knows and willingly does).  But as we approach the end zone, we must practice self-healing and not give your Qi to the people who feed off the energy of others like vampires offering a kiss.

Poor mental health is not a predictor of how one does in the end zone.  However people who spend their youths being unhappy both socially and emotionally will, when older and in the end zone, still be socially and emotionally unhappy.

Similarly, just growing older is no guarantee that life will get better.  If you haven't done your own personal work, you will end up an older, dissatisfied person. The end zone will just exaggerate your unfinished emotional struggles.

It is never too late to get a little good psychotherapy to set the foundation for the imperative tasks in the end zone.  Some of my best clients have been over 60.

You have to get used to being outdated.  That doesn't mean you are out of date; it means you are comfortable with not being in the 'in' crowd.  What works or is comfortable is more important.  Be age appropriate, yet be young in thought body and spirit.  You can't wear your baseball cap backwards and ask for a senior's discount.

Goals often discourage hope for they focus you on an end product and encourage a sort of narrow or myopic view that doesn't let you see or experience the process of life.  Even if you get the product, you won't be around long enough to enjoy it, so you need to learn to treasure the process, not the product.

Death is sort of like making love, when you go for the orgasm, that may be all you get.

You must get used to the fact that you will seem to have fewer friends.  The truth is you haven't time to waste on superficial relationships anyway.  Close friends are more important.  You may not want as many friends as you did.

Much of the source of fear of aging comes from people who are frantically less comfortable with life no matter what their age.

You must be kinder to your body.  Stress is much more difficult to take. If you don't treat your body well, it will rebel like a child that doesn't want to go to the dentist.  Your body voice will speak much louder than you wish to hear.

When Diet Isn't Working

When Diet Isn’t Working

We are a diet crazy society at the moment.  Are you Paleo? anti-inflammatory?  carb free?  fruitarian? vegetarian?

Confused?  don’t know what to eat anymore?

The first mistake you might make is thinking that any one ‘diet’ will work for you.  The diet that works for you has no name.  It is a custom diet based on the individuality that is you.  To think you are going to be able to pick up a book and follow the blueprint in the book probably won't work for the long run.   You need to find the food that works for you. In order to do this you have to troubleshoot, tweak and find what works for your body.

Welcome to a fresh mindset.

Mistake #2.  Not listening to your body.  Our bodies are always talking to us, but often we don’t take the time to listen. Until the sound gets very loud and we have no choice.  Our bodies can, and will take us down if they don’t like what we are doing.  Your body is wiser than you think.

So, what to do? Well, why not consider adjusting your mindset to begin the practice of really listening closely to your body; to see symptoms as a sign of communication.  Not something to be stopped or stomped on or subdued by medication.   If your car was making a noise, or a red light is going off on the dashboard, you know that something is wrong with the car.  You can fix it now or fix it later.  If you fix it later, it will be more expensive and damaging to your car!

How to Start

  •  troubleshoot your food
  •  troubleshoot your supplements
  • troubleshoot the underlying cause

Troubleshoot Your Food
Troubleshooting food is something you can do today. Perhaps this is why it is so very popular right now.  You can take steps immediately to make yourself feel better.  The downside of this is that in the long run, stricter diets are not realistic and you will inevitably fall off the wagon, and the underlying problem has not been fixed.  Feelings of frustration and restriction can lead you to feeling low self esteem and can trigger unpleasant emotional states.

Troubleshoot your Supplements
There needs to be a reason for you to take supplements, a reason that you understand.  Some people don’t take supplements because they think they don’t work.  They purchase the multi from London Drugs or Costco, take one a day and find it does nothing, so they decide all supplements are purposeless.  I can help you learn why you are taking your supplement, and ensure  that you are taking a supplement that has quality which you are able to absorb.  If you are taking something in the incorrect dose, or poor quality or your digestion is so poor you cannot tolerate or absorb it,  it won’t be doing what you want it to do for your body.  I can help you get what you need from excellent quality supplements and herbs which can be an integral part of a recovery and maintenance program.

Troubleshoot the Underlying Cause
A good diet is extremely important. It will alleviate alot of problems. Most people come to real food diets because they are sick: female hormonal problems, weight issues, fatigue, depression,  heart disease, autoimmune disease, cancer, chronic fatigue syndrome.  As a quick fix, diet obsessed culture we very much like diet as a solution.   Many people in our culture are not capable of considering anything beyond it.   A good diet is the foundation to good health, but it is not the only answer and will not solve the root or underlying cause. Most symptoms tend to go deeper than diet and supplements.

The Underlying Cause
The deeper underlying cause is something that takes time to explore.  Do you think you could look beyond what diet may have to offer and see what else is available for healing?  We cannot get away from exploring stressors, whether they be emotional stressors, mental or physical stressors.  Sometimes the first step is basic testing for adrenal function, which measures the impact of the stress you have been in before you have come to the clinic. Be careful not underestimate the effects of chronic stress.  Some people have been under unbelievable stress, stress which puts them into a catabolic state, tearing apart body systems.  You could be so used to feeling terrible you have forgotten how to feel any other way.  

Mental and Emotional Stress
I encourage you to think creatively outside of the box: consider the healing possibilities of homeopathy, which works in a gentle way to balance the body guiding the body towards health.  A little good psychotherapy can go a long way to resolving unhelpful patterns of behaviour which cause stress and fatigue (or 'deadening' of inside spaces), or helping to move through grief. 

Physical Stressors: Gut Infections
Do you know that 80% of your immune system is in your gut? GI infections, parasites, bacterial infections, gut dysbiosis could be the root causes of issues you have been experiencing. Some people have so much mould, yeast and infections in their gut that this creates toxicity and brings down the immune system.  Infections are found through stool testing, and just like practitioners not all stool tests are created equal.  
You may wonder how your digestive system is involved if you think you have no overt Gi symptoms. Menopausal symptoms, female hormonal complaints, weight issues, depression, fatigue and other inflammatory issues such as autoimmune conditions, skin conditions, cardiovascular issues, and cancer will have GI involvement: Sixty percent of GI infections have no GI symptoms and the symptoms will appear as something else.  Anytime we are having hormone problems, we are having gut problems.  Whether it is adrenal fatigue, thyroid problems or female/male hormonal problems.  If you are under stress, the death of a loved one, a divorce, stress with work or positive stress from a pregnancy or marriage, you may develop hormonal imbalance.

What to do about it? 
 A good diet is just the beginning to a foundation to good health.  It is certainly not the only answer and will not solve the root or underlying cause of your difficulties.   If you want to work towards going a little deeper, with more permanent results, I can help.   It will take a little time but my prediction is you will be surprised at how pleasantly better life can be.      

My e-health

Are you aware of the new online system where you can print your recent lab results at home?

Myehealth offers a fast, secure method for patients to obtain their laboratory results.  As soon as results are released from the performing lab, they are available online in my ehealth.  Excelleris uses a variety of secure technologies and procedures to help protect your information from unauthorized access, use or disclosure.

It is a free service for BC patients, and is available in 4 languages.

To register you must:

  • be age 16 or older
  • have a BC care card number
  • have had lab work within the last 30 days at: Lifelabs, Valley Medical laboratories, BC Biomedical laboratories
  • as an outpatient only at Vancouver Coastal Haalth or Providence Health Care

When you visit the lab, ask the technician to provide you with a reference number.  When you get home and visit the ehealth website, you will be asked to create a password (keep it safe) which will give you access to your results, which you can print off in the comfort of your home.

Usnea barbarata: Nature's antibiotic

Usnea barbarata (Old Man's Beard) is a type of lichen that grows on trees.  Though lichens appear to be single plants, they are really a combination of fungus and algae that grow together for their mutual benefit.  Usnea is an immune system tonic that can be used in acute situation as well as for long term immune enhancement and general prevention.  Be sure to remember this humble but powerful plant when cold and flu season comes around this year, or any other time your immune system needs an extra boost.  It has no side effects and is safe for children.
Usnea is one of the most powerful herbs we have for it's antibiotic, antiviral and antimicrobial properties.  It's use dates back to ancient China, where it was used for  cooling and overheated system and topically for surface infections.
Usnea has a preference for old growth trees and its habitat is being steadily eroded by modern logging practices.  The plant has a greyish green colour and grows as a busy mat from a few inches to two to three feet long hanging off the trunks and branches.  It feels dry and coarse.  Some species have an inner core of white material.  Please don't go climbing up an old growth tree on the island to pick this wonderful herb off the trees.  Usnea should be purchased from certified wild crafters who understand the ecological cycles and can identify the proper species for medicine making.

Actions and Constituents:
In the search for antibiotics, lichens were considered because of their strong antibiotic properties.  By 1944 it was found that as many as half the lichens studied contained lichen acids which exhibited variable antibiotic activity.  They are particularly active against gram positive bacteria such as streptococcus, staphylococcus and mycobacteria.

Constituents:  barbatolic, usnic, lobaric and tartaric acids.  The clinical application of usnea is as an anti fungal, anti parasitic, and antibacterial.  It is an immune regulator and supporter, boosting the immune system. Usnic acid and its derivatives appear to be the main active constituents in Usnea spp.  It is believed to work against gram positive bacteria by disrupting cell membrane functions.   Human cells are not permeable to usnic acid and so are not adversely affected.

Dosage: Traditional uses of Usnea include dusting the powdered herb directly onto open or infected wounds, making strong decoctions and tincturing the herb in alcohol.  As a tincture, it needs a high percentage of alcohol to dissolve the active ingredient usnic acid.

Adult dose:  5ml twice daily of a 1:4 70% tincture.
Children over 3 years:  15 drops once or twice daily.
(Tincture can be diluted some in hot water and left to sit to evaporate the alcohol if needed)
Earthmed Immune Tincture: this popular mixture contains usnea can be used to prevent a cold or flu and also in the first stages of a cold or flu:  5 ml daily
If you are acutely ill:  10 ml twice daily
If you are acutely ill with infection:  10-15 ml twice daily


There are no reported side effects of using the tincture.  Many herbalists consider it a safe herb to use in auto-immune conditions, where the immune system is over active. It is safe and effective to use with children.

What to Ask on your Yearly Physical Examination

Routine blood work and a physical exam should be done annually for both men and women.  These tests can help your doctor look for things like hypertension, anemia, infections, cholesterol levels, liver and kidney function, blood sugar levels and thyroid function. We recommend you specifically ask for cholesterol levels, TSH (thyroid), ferritin and liver enzymes if they have not previously been done.  Depending on your individual health and treatment plan, your doctor might also test your hormone levels.

During your first visit at the clinic, we recommend you bring in any screening bloodwork that you may have had done before you have arrived at the clinic.  We will review findings and recommend any additional testing that may need.

Women’s Health Screenings
There are some annual tests that are specific to women’s health.  An exam is recommended yearly and includes a breast exam and pelvic exam to check your uterus and ovaries for problems such as cysts, physical abnormalities and growths.  At this time you will also get a Pap test and often the doctor will screen for STDs.    Many national organizations recommend starting Pap exams at age 21 and repeating these tests at least every 2 years.  The Pap test looks for cellular changes on the cervix that might become cervical cancer if left untreated.  

For Pap exams I refer out to Options for Sexual Health, a Program of the BC Cancer Agency (604-731-4252) which has drop in clinics in the evenings. You can request to have your results forwarded to the clinic.  OFSH can be used for information regarding contraception and to be fitted for a contraception device.

Breast cancer is the second most common cancer among women, and mammograms are recommended every 1-2 years for women over the age of 50.  A baseline mammogram at age 50 is recommended and can be self- booked through the Screening Mammography Program of BC (part of the BC Cancer Agency).  To arrange an appointment, call 604-775-0022 or toll free 1800 663 9203.  The centre is located at BC Women’s Health Centre, Block F2 easily accessed through Parking entrance #3 at Heather and West 29th.  You may request that your results be forwarded to the clinic/Dr. Doan.

Clinical breast exams and self-breast exams are recommended routinely.  This is when you check for lumps, changes in size or shape of the breast, or any other changes in the breast or armpit.  

Potential harmful effects of screening mammography include false negative and positive results, overdiagnosis, overtreatment and radiation exposure. If you would prefer not to do mammograms, there are other types of screening, including breast thermography. Breast exams can be done at the clinic and please talk to us about more information about breast thermography.

Men’s Health Screenings
Prostate cancer is the second most common cancer in men.  There are two tests your doctor which are commonly used to screen for prostate cancer.

The prostate-specific antigen (PSA) test is a blood test for men that can be added to your routine screening bloodwork.  This test is commonly recommended starting at age 50 for average risk.  If African American or family history of prostate cancer, it may be best to start at age 40.  A high PSA level does not always mean that a man has prostate cancer.  IT may be elevated with other types of prostate problems or interfering factors with the test itself.  It is important not to test PSA directly after a digital rectal exam, or within two days of ejaculation, horseback riding or biking.  In addition, high or low blood sugar and certain medications can interfere with the test.  Commonly if the PSA is initially or slightly elevated with no other symptoms or signs of concern, we repeat the PSA in 2-3 months.

A Digital Rectal Exam (DRE) is where the doctor inserts a gloved, lubricated finger into the rectum to feel the prostate for asymmetry, lumps, enlargement or anything else unusual.

Bone Health
Healthy Bones are essential for aging well and quality of life.  The National Osteoporosis Foundation recommends testing postmenopausal women, all women over the age of 65, all men over the age of 70 and men between 50-69 with a high risk factor profile.  The first 5 years post-menopause is the time of most bone loss.  If you have higher risk factors (history of smoking, previous fractures, use of corticosteroids, amenorrhoea or anorexia) it may be a good idea to screen early.  

Colon Health
If you are 50 or older, getting a colorectal cancer screening test could save your life.  Screenings will help detect both polyps, which can turn into cancer as well as colorectal cancer at an early stage.

The frequency of routine colonoscopies is every 10 years, unless advised more frequently by your gastroenterologist.  If you have a parent that was diagnosed with colon cancer, it is recommended that you start getting screened 10 years prior to their age at diagnosis.  

Other Screening Tests
Skin: If you notice changes in moles, or other skin issues it is a good idea to have someone have a look at it.  If you have a mole that you think is suspect, taking a picture annually of it will help you track changes.  Make an appointment with a dermatologist if you are concerned.

Thyroid:  If you have thyroid disease, it is recommended you get a yearly screening thyroid ultrasound.  Thyroid cancer is one of the few cancers that has increased in incidence over recent years and occurs in all age groups from young children thru seniors.  An ultrasound can check for thyroid size, masses or nodules and follow-up screening can monitor for number, size and stability of nodules if you have them. Thyorid cancer is usually high treatable when found early.

Sexually Transmitted Diseases:  Depending on your risk factors, we also recommend screening tests for sexually transmitted diseases.  These risk factors include having unprotected sex, sexual contact with multiple partners, a history of STDs.  Many infections often do not cause symptoms.  Getting tests can put your mind at ease and get you (and your partner) treated.

Naturopathic Physicians in BC have access to Lifelabs. This means that if you have a test you want done, we now have the ability to give you a requisition that you take directly to Lifelabs and the results come to the clinic.  Currently you as the patient pay for the test and work continues to be done by our Association about this.

Your lab results are now available online.  You create a password, and then you yourself have access to any labs that you have recently had done. You can print them out and bring them to the clinic for review.

I believe in prevention.  Make sure to schedule an appointment with your physician today to talk about screening exams that can make a difference in your life.

College of Homeopaths of Ontario

Homeopathy has become a regulated health profession in Ontario, setting the standard for healthcare in Canada.  Just like the College of Traditional Chinese Medicine, which was established in British Columbia over 10 years ago, this move was followed by the Ontario government, which formed the College of TCM of Ontario shortly after.  Regulating the profession in Ontario sets a standard and means now means that other provinces can follow suit.  

There are a variety of groups to join as a Homeopath in Canada and the US.  I am a member of the BC Society of Homeopaths and the Canadian Homeopathic Society.  Each of these groups advocates homeopathy and sets a standard for practice in order to be a member.  I have been looking to join a group which I feel sets a high standard for Homeopathy in Canada.  I am the first person to be accepted from British Columbia,  and my registration will take effect April 1, 2016.

What is a College?
Every regulated health profession has a College governed by the Provincial Government and the role is to protect the public interest by ensuring that the members of the College practice safely, ethically and competently.  For example, Dr. Doan belongs to the CNPBC, the College of Naturopatic Physicians of British Columbia. She also belongs to the College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia.  Other examples of Colleges include the College of Physicians and Surgeons, The College of Midwives, The College of Physiotherapists, The College of Massage Therapists, The College of Podiatrists etc.  This means that Homeopathic medicine is recognized by the Government of Canada as part of the Healthcare system. 

If you want to read more about the  Regulated Health Professions Act, 1991 (RHPA) and the Homeopathy Act, 2007, you can visit the college website at  You can find here the objectives of the RHPA, and who the RHPA is responsible to. 

History and Politics of Homeopathy

They say that hindsight gives perspective so lets have a brief walk through history.  Hahnemann, the founder of homeopathy,  was an MD in Germany and discovered and developed a successful new system of treating patients.  It wasn't difficult at the time to outperform conventional medicine.  Docs of the 1800s were using leeches, bled their patients, poisoning them with mercury, theorized that a stronger pain elsewhere would distract and therefore cure the patient of the pain they currently had,  and had not yet realized that a surgeon who does not wash his hands will kill the patient.  Many patients of the day died of the treatment and not the illness.  

Hahnemann was one of the first physicians to advocate hygiene in medicine. His treatment was ‘less is more’, recognizing that the treatments his patients were undergoing were creating problems worse than the ailment. Hahnemann advocated for good food, sanitation, quiet and rest along with his new gentle medicines allowing for support of the innate vital force of the patient to carry towards health.  Hahnemann was a chemist and made and dispensed his own medicines.  Hahnemann  was given a difficult time in his home country being driven out of communities where he worked 17 times, as he was the competition for the local pharmaceuticals.  It was only in Paris where he spent the end of his career where he achieved notoriety and fame and homeopathy flourished in Europe and internationally. 

In the late 1800s and early 1900s, North America had large number of homeopathic medical colleges, including the Hahnemann University Hospital in Philadelphia which still exists today and maintains the founders name.  Ask Mr. Google about 'defunct medical colleges' and you will find an interestingly long list of homeopathic universities and colleges in the US and Canada at this time.  If you wanted to be a physician, you could choose to go to a conventional medical college, or a homeopathic medical college.  

It’s the 1920s and the main ways of making money at this time was to invest in new technology:  mass transit, steel, oil, electricity, and the new industry: pharmaceuticals. Science is the new hollywood, scientists are the stars. Breakthroughs include Einstein and his theory of relativity. Penicillin is discovered.  The practice of conventional medicine evolves; hygiene is now the norm.  Homeopathy isn't a way to make money.  The AMA (American Medical Association)  successfully pushes homeopathy out of medical training.  

In the 1800s, it wasn’t hard for homeopathy to outstrip conventional medicine. Modern medicine excels now In the areas of research, emergency medicine, and diagnosis. However, the area conventional medicine does not address or have any solution for is chronic disease.  

Could this be the New Model for Medicine?

A bold idea of a future medicine where a blend of the best of both worlds: conventional medicine brings emergency care, research, diagnosis and homeopathy brings a solution for chronic cases. Imagine including this holistic treatment where the goal is healing and the patient is cured, not just managed.  

India has exploded as a super-power leader in homeopathy, where ground breaking advances and some of the most influential and brilliant doctors live today.  Homeopathy is fully integrated into the medical system in India, having a Minister of Homeopathy and Alternative medicine. Homeopathy is hugely popular with the middle and upper classes; it is eye opening to experience the extent to which homeopathy is used in this country. The sale of homeopathic medicines has exploded in India and around the world. 

Current pushback in the UK with the campaign 'Homeopathy Worked For Me" is huge.  England has been a leader in homeopathy having three homeopathic hospitals and many GPs using homeopathy in their practice.  Recent attacks targeted in the UK over the past 10 years has caused public pushback for freedom of choice in healthcare against the proponents against homeopathy and those who would have a vested interest in homeopathy not succeeding. 

Let's look at some other popular practices of mind-body medicine.  Deepak Chopra and Louise Hay both have practices which follow principles of mind-body medicine. Dr. Jon Kabat-Zinn, meditation teacher, author, researcher and clinician in the field of mind-body medicine and has introduced his mindfulness programs into mainstream medicine and hospital settings. 

Homeopathy is about healing deeply. Homeopathy is a growth model which understands the need for development is inherent to the soul.  If our growth and development gets stuck someplace, the body will create disease so we can work on it and release it. Our disease is a lesson for us, something we use in order to evolve. The work is slow, layer by layer. It is not possible to work very fast, and it is not good if this happens.  This would be like the person who wins a lot of money in the lottery, and does not know how to contain or manage it.  If there is a good relationship with your practitioner, you will know when it is time to come in. You will know inherently when something is off balance and will bring to the homeopath to work on. 

Prevention of Colds and Flu

In these times of varying health reports in the media, it can be confusing.  It is the position of this clinic that continued ongoing homeopathic and naturopathic care is your best 'defence' regarding acute colds and flus.  If you are already coming in for homeopathic treatment, you are already doing your best for your health by strengthening your overall system in a holistic way.

In the context of Naturopathic and Homeopathic medicine, it is considered that getting a cold or flu once or twice a year is a good thing. It is also important to come into the clinic at this time, as your body is expressing itself in an acute way and I can get important information that I would not otherwise be able to obtain.  The acute state is important for homeopathic prescribing, and also an important way our body detoxifies.  

 If it is your time then let's make your experience as painless as possible.  In this model of healthcare, a normally functioning immune system will have you ill with a cold or flu at least once per year, if not twice for a reasonable duration of time.  If you are falling ill more than this, it is prudent to seek help from your homeopath or naturopath.  The coughing, spluttering, sneezing, fever is your body taking you through a natural detoxification process.

I will discuss two things in this blog article, firstly are some tools to stop you getting sick (if your body wants to truly be sick these will not work) and secondly how to be happily sick.  The goal of treating a cold of flu is to have the body be content, and to ensure no complications (such as bronchitis or pneumonia).  In this way the body can do what it needs to do and then move on.  Children who are unwell and limp and miserable need to come in for support and an appointment.

These are some guidelines to help you through this fall and winter season.

Stage One of a Cold or Flu
In Traditional Chinese Medicine (TCM) there are 9 stages of a cold or flu.  The early stages are often triggered by the environment, coming in from the cold or wind and noticing your ears are ringing, or your throat is sore. This is the 'oh oh' moment, where you realize you are on your way to getting sick.  Some classic signs: you feel suddenly tired or weak, you have a headache, your throat is sore, your ears are ringing.  These are often after some environmental exchange.

The homeopathic remedy Aconite 30c is very effective for this state and if taken early enough will resolve the issue and your symptoms will disappear.  If you wait too long to take the remedy (if stage 2 is reached) it will be too late.  Also if you body is intending to be ill it will not work.

Jade windscreen formula is another TCM formula designed to strengthen your protective Qi, or Wei Qi.  This formula can be used to protect yourself if you are around those who are unwell.

Later Stages
There are several things you can do to help yourself be more comfortable if you become unwell.  Here at the clinic, we recommend our Immune Tincture containing Usnea barbarata, one of the most potent anti-viral and anti-bacterial plant medicines.

Bedrest.  One of the least expensive and more potent treatments is bedrest.  This is where your immune system does it's best work.

Vitamin C.  Vitamin C is important for strengthening the adrenal and therefore the immune system. Take up to 6g (6000 mg).  Vitamin C does not have to be expensive, look for powders or buffered C products.

Cooked foods.  Avoiding cold and raw foods will strengthen your immune system.  In TCM, soups and stews made with chicken and barley are recommended.

Important Special Tip
Sugar in any form (including honey, fruits and white flour) directly lowers the immune system by lowering the white blood cells (defence cells) which destroy pathogens (viruses and bacteria).  You may notice that if you have sugar, even a small amount, you will feel worse.

Ongoing homeopathic and naturopathic treatments will resolve issues of getting ill more than once or twice per year for a longer time than normal.  

Hiding Under the Covers

Hiding under the covers is something that I prescribe to my patients and encourage on a regular basis.  It is a mental health day, a restoration day to be used when we are burned out, fighting a lot of colds, having a lot of headaches or feeling moderately depressed and don't know why.  I am writing this blog before Christmas and it is my experience that the month of December is very stressful.  Many of my patients start to twitch in December.

This excerpt is taken from the book The Woman's Comfort Book by Jennifer Louden, a self nurturing guide for restoring balance in your life.  There was a time when I read this book regularly.  When we are burned out, we can't come up with idea as how to care for ourselves, this has some great suggestions.  She has also written The Couples Comfort Book which is a great resource for couples.

What is it?
Hiding under the covers is a planned retreat, a healthy way to care for yourself.  Give yourself permission to stay in bed or on the couch for a day and do whatever you like.  That may be sleeping, eating, reading, watching old black and white movies or a combination of these.  This may sound indulgent but it isn't!

Hiding under the covers is a variation of playing sick.  Remember when you were a child and you would stay home from school, sick enough not to feel guilty, but not so sick you couldn't enjoy the food your mom prepared or watching 'Leave it to Beaver'.  This is the warm, safe feeling you need to recreate.

Allowing yourself to retreat gives you the critical time you need to reflect on your life and balance yourself.  By taking time for yourself in such a lavish way, you are saying to your mind and body 'I deserve the same amount of love and care I give to others.'

You'll need:
Your bed or couch.
Fluffy blankets and lots of pillows
Snack food, books, magazines.  Whatever fun and silly things make you feel good.

When to do it:
when you are so burned out you can barely keep going.
When you keep saying to yourself "I'll just power through this," or "if I just keep my feet moving," or " Once I'm finished with this project, I can rest."
When you have been fighting a cold or have been having a lot of headaches.
When you have been feeling moderately depressed and don't know why.
When you never allow yourself to just lie around and relax.

What to do:

Banish Guilt!
The key to getting comfortable with hiding under the covers is to give yourself permission to take time off and crawl into bed without berating yourself.  A good way to do that is to turn off your annoying inner critic.  The inner critic may say things like, "You can't do this, people are depending on you."  "Sleeping, in the middle of the day?  What will you sink to next?" "What a wimp, in my day..."

Gently tell yourself with your nurturing voice that by taking a day off and allowing yourself to be blue or tired you are performing a very important duty.  You will be better to others, more effective at your job and a more enjoyable person to live with if you take time out.

Arrange your Hiding Space
Make the space where you plan to spend the day as comfortable as possible.  That may mean blobbing out on the cough, under a heap of cuddly blankets.  Or hide your partner's dirty socks, make the bed with clean sheets and stock your bedside table with hot cinnamon tea and sourdough toast (or gluten free toast!).  Whatever appeals to you.

Screen your calls
Turn on your answering machine or unplug the phone.  Talk only to people who help you feel better.  Avoid all unnurturing people.

Scent the Room
Hide a couple of scented sachets between the blankets.
Bake cookies.
Open the windows and let in fresh air.
Put a freesia or rose in a vase on your nightstand.

Literary Fun
Immerse yourself in a good or distracting novel.  Browse in a bookstore and stock up on a few titles or tuck away for your next day off.  

Create a tray of food to have in bed.  Consider an attractive place mat and your pretty dishes.  Try a bowl of grapes, some chocolate, whoever your body craves.

Watching television on your hiding time can be good or it can be bad.  Long hours infront of daytime TV can end up making you feel more tired and stressed than before.  But if you never get to watch daytime TV, maybe this is just what you need.

Get into the habit of having old movies on hand to watch on these mental health days.  Renting a familiar film can be very comforting.  Suggestions can be...Field of Dreams, The Women, any movie with Katherine Hepburn and Spencer Tracey, Princess Bride, etc.

Again and Again
Practice makes perfect.  Take a hiding out day to see what you need to feel refreshed and renewed.  Follow your desires.  Indulge yourself.

A whole day isn't necessary, though it is nice.  An hour or two on a Saturday morning, leaving work early, skipping a dinner party you didn't want to go to...the options are endless.