We caught up with the brilliant and insightful PJ Lewis a few weeks ago and have shared our conversation below.

Alright, PJ thanks for taking the time to share your stories and insights with us today. How did you get your first job in the field that you practice in today?

I actually didn’t set out to be a therapist… I didn’t quite know what I wanted to do when I first entered university straight out of high school. I studied kinesiology, humanities, and education in my undergraduate degree largely because the gentleman from the kinesiology department gave an exciting presentation at career day in our high school. I later went back to school thinking I’d become a teacher. In completing some additional prerequisite courses for the teaching program, I selected elective courses in the counselling psychology program. I enjoyed the courses, though didn’t imagine I’d pursue a career in counselling as it would require me to complete a three-year master’s degree, rather than a one-year teaching certificate and at the time, my wife and I were raising one- and two-year-old daughters. However, one professor I studied with informed me that she saw an aptitude for counselling in my work and challenged me to consider applying. The more my wife and I reflected, the more we felt at peace with stretching my time back at school. As such, I applied and was accepted to the Counselling Psychology Master’s program. Now that I’m working in the field, I’m grateful that we took that risk as I couldn’t imagine doing anything else.

Awesome – so before we get into the rest of our questions, can you briefly introduce yourself to our readers.

I once heard it said that the debate of nature versus nurture is akin to asking what is more essential to forming a rectangle, length or width? When it comes to the origins and prevalence rates of mental health concerns, it’s a complex matter. There are not only both biological and environmental factors to consider, but also how those factors interact over time. With respect to biological factors, one might have a certain genetic starting point that might make one vulnerable to experiencing certain mental health concerns. However, research also show us that people with similar genetic predispositions (or even identical genes in the case of identical twins) can still experience different mental health outcomes. As such, we can conclude that genetics alone don’t tell the whole story.
When it comes to environmental factors, our experiences can also shape our mental health. For example, studies have shown that people who have experienced adverse childhood experiences like abuse, neglect, or dysfunction in the household they grew up in can significantly increase their chances of experiencing behavioural concerns, and physical and mental health conditions. However, we also see cases where people endure similar challenging environments and still experience different mental health outcomes. As such, we can conclude that environmental exposures alone also do not tell the whole story.
Because genetics and environmental exposures in themselves don’t sufficiently explain the prevalence and severity of the mental health concerns we see today, I’d suggest we also look at how those factors interact over time. There is a growing body of evidence showing us that having adequate, available, responsive sources of support in families, schools, and communities are highly protective, and that the earlier these supports are available, the better the outcomes. Conversely, inadequate or absent supports can lead to mental health concerns that worsen the longer they go unaddressed.
Many of the clients I work with identify as both having a family history of mental health concerns, and as being highly emotionally sensitive. They report experiencing their emotions intensely and find it difficult to regulate those emotions. Additionally, these same clients also describe having a history of experiences with people or contexts in which it is communicated to them (sometimes inadvertently) that what they are feeling, thinking, or doing doesn’t make sense, or is inaccurate, or an overreaction. When emotional sensitivity and a predisposition to mental health concerns transact with an invalidating environment over time, it can lead to multiple concerns including a chronic struggle in regulating one’s emotions. Struggling to regulate oneself can be extremely distressing and that distress is further exacerbated when the proper supports are inadequate or unavailable.
Canada’s mental health care system is under significant strain. Long waitlists for services, a shortage of qualified mental health professionals, inconsistent standards in credential requirements for professionals across jurisdictions, and mental health expenses being uncovered by many insurance plans have left many people in a position where their mental health needs are only partially met or fully unmet. Many people also express hesitancy when considering accessing mental health services due to stigma, or a belief that it’s not ok to talk about their concerns, especially if they are feeling isolated or suicidal.
Mental Health Awareness Initiatives like Suicide Prevention Month not only raise awareness about the high rates of death by suicide in our country, but also help to reduce the significant stigma that surrounds the topic of suicide that often prevents people from talking about it.
One of the most significant myths we face in the world of mental health care is the pervasive belief that talking about suicide will give a person the idea, or permission, to consider suicide as a solution to their problems. In reality, talking calmly about suicide, without showing fear or making judgments, can bring relief to someone who is feeling incredibly isolated.
Helping people who are feeling suicidal must also go beyond stopping someone from acting on a suicidal urge. If someone repeatedly told you to stop thinking about red rubber ball, it would be very difficult to not have the thought or image of a red rubber ball cross your mind. If you don’t want to think of a red rubber ball, it’s far more effective to focus our thoughts on something that is not a red rubber ball.
As observers of others’ pains, we need to recognize that the only way to know if someone is feeling suicidal is to ask. After asking the question, our willingness to listen, and not judge, communicates sincere care and concern. We need to be mindful not to rush the process of listening, and avoid the urge to interrupt, or change the focus of the conversation too quickly to “look at the positives.” If we rush the listening it can inadvertently communicate that we are not up to the task of being with them in their pain. Encouraging someone to speak about their suicidal feelings can reduce their risk of acting on an urge for suicide. We can validate how much pain and suffering they are experiencing while in no way encouraging or endorsing suicide as a solution to these problems. Then, once we’ve listened, we can also ask about their reasons for living. By the very fact that they are still alive and having a conversation with us, there is some part of them, however small it might be, that is connected to life. Perhaps those reasons for living include people, pets, or unaccomplished tasks, whatever the reasons, once we find that part, we can breathe more life into it.
Another consideration when working with people who are feeling suicidal, and have many co-occurring complex elements to what they would like to get help with in therapy, is to look at research findings for what approaches to therapy have a body of evidence to support their effectiveness. In our clinic, we offer Dialectical Behaviour Therapy (DBT) as it is an approach with a great deal of evidence for its effectiveness in helping people move past feeling suicidal, and reach their goals in therapy.
DBT was developed by Psychologist Dr. Marsha Linehan. Originally, the therapy was designed for adults experiencing para-suicidal behaviour, self-harm, and emotion dysregulation; those adults often met diagnostic criteria for borderline personality disorder. With an ever-growing body of ongoing research, DBT has since been shown as helpful for a number of other concerns and populations including eating disorders, substance abuse, anxiety and depression in adolescents and adults. There are also advanced protocols for incorporating treatment for trauma (PTSD) into DBT.
DBT is often compared to CBT, and there are some common elements. Both acknowledge the interrelationship between thoughts, emotions, and behaviours; however, there are also key differences. In CBT, the focus if often on changing dysfunctional thoughts to regulate or change emotions. In DBT the focus is on emotion, behaviour, and thoughts and assumes that some emotional states are primary and often trigger dysfunctional thoughts which then perpetuates further emotional pain; often resulting in impulsive behaviours or ineffective problem-solving attempts.
One of the advantages of DBT is that it is a therapy that has a sufficient balance of structure and flexibility to effectively help clients who are experiencing multiple complexities at the same time. These complexities often include: reduced awareness and focus, confusion about self, emotional dysregulation, impulsivity, and interpersonal problems. Some other strengths of DBT are that it has also been shown to be highly effective in reducing suicidality and self-harm, has a low client dropout rate, and is a treatment that assumes that skills are essential to building a life worth living.
In DBT, the overarching goal is not to stop people from acting on urges for suicide, rather, it’s to help our clients build a life worth living. Each person’s life worth living will likely look different, so DBT therapists spend time working together with their clients to figure out what that life looks like, and how the therapy will help our clients to reach those goals. As clients increase their ability to effectively use skills to solve their problems and reach their goals, they experience less suffering and are able to move past considering suicide as a possible solution to their problems.
At our centre, every client begins their services with a 90-minute intake assessment. In this appointment the client and therapist complete an in-depth assessment of the client’s concerns and goals, and decide together if DBT is the right fit to help them meet their goals. We also provide a full orientation to DBT as it looks a bit different that some other forms of therapy.
DBT is a comprehensive approach to therapy that includes four key elements: 1) structured, weekly, individual therapy, 2) group skills training, 3) phone coaching, and 4) a therapist consultation team.
In individual therapy the client and therapist work both to help the client reach their goals, and also to solve any problems that might get in the way of reaching those goals. As such, there is a focus on reducing life threatening behaviours, reducing obstacles to fully participating in therapy, reducing behaviours that interfere with the client’s quality of life, and increasing the use of more effective skills and strategies.
DBT skills training most commonly takes place in a group format. Our adult program has four modules (Core Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness) of skills each lasting six weeks. In adolescent skills training a parent or caregiver would attend with the adolescent and there is an extra module of skills (Walking the Middle Path).
Phone coaching allows clients to contact their therapist in between weekly sessions in order to get help using the skills effectively out in the context of their real lives.
Finally, DBT therapists work as a team. Our DBT therapists meet as a consultation team weekly to help each other be maximally effective in helping our clients, and to help each other stay healthy and avoid burnout.
With respect to timeline, it is not universal for all clients. Clients in DBT therapy can expect to start with an intake interview, then have a minimum of 4 individual sessions prior to commencing skills training. Then skills training and individual therapy will proceed concurrently, weekly for 26 weeks. Once skills training is complete, the client and therapist assess for progress toward the client’s goals and continue individual therapy to make further progress toward those goals.

Putting training and knowledge aside, what else do you think really matters in terms of succeeding in your field?

Don’t be an island. There have been times in my career so far when I’ve felt pressure, either perceived, or actually coming from others, or sometimes self-imposed, to have all the answers and get everything done all on my own. In my experience, I’ve never found this approach to yield results for anything longer than the short term, and to come with the cost of high stress and potential burnout. For me, the times when I thrive and avoid burnout are the times when I effectively surround myself with the right people – friends, family, colleagues, and mentors, so that I’m not alone, and don’t have to have all the answers. Don’t get me wrong, I’m an introvert, and terribly shy by nature. Despite having learned to comfortably navigate a crowd and speak in public, I need some alone time too. However, alone time to recharge is different than, “going it alone.” For me, keeping connected to others both personally and professionally helps me not only to draw from the wisdom of others and trust that together we can accomplish what is needed, but also hearing their feedback helps me to know my limits, when to say no, and when to take a break.
I don’t have a secret recipe for completely avoiding emotional spillover, though I do find that my training in DBT helps. One of the defining characteristics of DBT are the DBT skills. I find that if I actually use the skills myself and apply them in my own life, I have access to a rich resource to help manage the mental and emotional demands of this profession.
One specific key that I find helps me is the degree of intentionality I bring to my presence in each context I find myself in. In DBT this is part of mindfulness practice. I try my best to fully participate in the moment I’m in. So, if I’m with a client, I’m fully present with that client, and everything and everyone else will be there when we are finished. Then, when I’m at home, I’m at home, with my wife, or with one of our children, or cooking dinner, or folding socks, I try to be fully in that moment. That being said, it’s not an endeavour of perfection, there are all too many times when my brain goes for a walk into something from the past or a concern for the future, or my attention slips to that tough moment from earlier in the day – and, when I notice it, I try not to judge myself too harshly and then refocus on the current moment as effectively as I can.
For me, the occupational hazard isn’t so much falling into depression, it’s trying not to take on too much and burn out. I have a hard time saying no, especially if I perceive that what is being asked of me is a “good thing.” Then, when I find myself saying yes to too many things, the first things I sacrifice to make time are often my sleep, or my “down time”. Yet, sacrificing those elements of my self-care is not wise, it can lead to feeling overwhelmed and a risk of burning out.
To avoid burning out I need to be very mindful not only to practice saying no to good things sometimes, but also to not underestimate how crucial it is for me to attend to my own self-care. In that realm, I try to focus on three main things:
1. My basic needs:
a. Sleep: Try to get enough
b. Nutrition: don’t forget to pack a healthy lunch
c. Move: take the stairs, go for walks, get some exercise
d. See people: Yes, I’m an introvert, but I need social contact too outside my contact with my clients.

2. Do positive things, and pay attention to them as they happen: Sometimes I find myself finally taking some time to relax, or do something fun after a busy few days, or over a weekend. At times it will be a family movie night, or going for a walk in the park. Though, sometimes I catch myself, although physically present in an enjoyable activity, my mind has travelled somewhere else – perhaps to an unfinished chore, or to work tasks of the next morning, or mentally returning emails and texts. It doesn’t take long before the stress of what’s going on in my mind starts to become physically present in my body, my shoulders might tense, or I might become distracted or irritable. If this happens, then I’m not only feeling the stress from my mental activities, I’m also depriving myself of the rest, relaxation, and enjoyment of the pleasant activity I am engaged in! So, it’s not enough to do pleasant things, I have to do my best to be fully in the pleasant thing I’m doing.

3. Regularly achieve a sense of accomplishment. I try to regularly engage in activities that are at least moderately challenging, and give me a sense of, “ah ha, I did it,” when I complete them. Sometimes it’s a small, everyday thing in the short term and other times it’s progressively working toward a long-term goal to gain this sense of accomplishment.

Finally, I also try to keep the big picture in mind. Before my father passed away, I remember sitting at his bedside and hearing him tell me to, “take time sit at the feet of the masters, and learn from every wise person.” This advice has guided my growth and development personally and professionally. No matter how much I learn, or how much expertise I gain, the more I realize the vastness of what I do not know. As such, I make it a priority not only to engage actively and regularly in professional training and skill development, but also to listen to the wisdom in the lives and experiences of others as they share their stories with me.

Any advice for managing a team?

I once heard it said that (paraphrase from Karol Wojtyla) the ultimate test of your greatness is the way you treat every human being. I try to hold paramount this unconditional respect for the dignity of each and every human person in all dimensions of my life. When it comes to leadership and building a fantastic work culture, I believe that this principle applies to all interactions at every level. Whether I am interacting with a colleague, a mentor, a client, the admin staff, or the staff changing light bulbs or taking out the trash, I never want to treat anyone as a means to an end; nor do I ask anyone to do something that I would not do myself. Rather, I strive to give each person my full attention and the utmost respect. I believe if we each do likewise, at all levels of leadership, then we have the foundation for a fantastic work culture that can flourish.

Contact Info:

• Website: www.dbtfv.com
• Instagram: @dbtcentre
• Facebook: https://www.facebook.com/dbtcentre/
• Linkedin: https://www.linkedin.com/in/counsellorpj/
• Other: The DBT TODAY PODCAST is a podcast produced by the DBT Centre of the Fraser Valley. Every episode focuses on a specific skill and how we can implement it in an ever-changing world. https://www.dbtfv.com/podcast