Conditions I Treat

Below are some of the conditions for which I offer counselling with info on my philosophy and approach to each.

Grief and Loss
Concurrent Disorders Addictions
Relationship Issues


Many of us experience episodes of depression or low mood. There are situations or events where it makes sense for us to feel depressed like over a relationship break-up or a Canucks loss, but it passes. Other times it may be a Major Depression, significantly impairing our mental and daily functioning, or "Dysthymia" (now officially called "Persistent Depressive Disorder") when we have a persistent and mild form of depression lasting 2 years or longer. If you're in this state, you may feel "blah" a lot. Or you might find yourself regularly irritable, angry, or sad. You may find yourself having sleep difficulties, fatigue, negative thoughts, poor concentration or focus, loss of interest, withdrawal from others, etc. If other people see you or even criticize you as being "cranky", they probably don't realize that you're depressed, and that they are actually dismissing what could be a more serious mental health concern.

Depression also co-occur with many other conditions: chronic pain, insomnia, stroke, coronary heart disease, eating disorders, substance abuse, diabetes, and more. A recent 2020 study found that 28% of retirees experienced depression, especially when there was mandatory retirement due to illness. I've worked with many clients when they transition into retirement and/or medical leave.

Life events can change how we view ourselves and the world. Negative or distorted beliefs can change the way we think and behave. They reinforce self-critical beliefs (e.g. "I'm not worthy", "not good enough", etc), which can lead to depression. This is a very common presenting issue for clients. Unfortunately, many people who have experienced trauma, harassment/bullying, stigmatization/marginalization, or abusive upbringing have come to create or reinforce negative beliefs about themselves, which can become a pattern of beliefs or "schemas" (e.g. "I am not safe"), impacting their lives on a variety of levels.

Depression can also affect self esteem. Low esteem can create challenges to assert ourselves, ask for what we need, create healthy relationships, etc. Many struggle with distorted shame and guilt, magnified by cognitive distortions. This brings about all sorts of personal demons, including "All-or-Nothing" thinking and Catastrophizing. You may be more familiar with the tendency to "read other people's minds," to predict (and theoretically prevent) all sorts of doom-and-gloom, of course. Or perhaps you tend to "personalize" interactions with people in a way that makes their behaviour all about you, seeing their choices as being a frontal assault on you, your work, your relationships, or your life.

Depression can also alter how we cope with stress and daily life events. Some can withdraw and avoid people or situations, push through until exhausted, or self-medicate to boost mood. As such, depression can make it hard to be in a relationship, as we feel tired, low, negative, and withdrawn in that state. This makes it hard to fulfill relationship needs. Even worse, we might stop caring about what happens.

Suicidality is a risk when someone is depressed. Suicidality does not always mean we want to harm ourselves; rather, we may not know how to effectively reduce our suffering or emotional pain (this is where tools, support, and resilience comes in!). Many people who are depressed fear losing control. If you feel like you are at your wit's end and are seriously worried that you might make a rash decision from a state of helplessness, consider going to a hospital. Hospitalization is generally considered a last option, but for those in dire need should not hesitate to do it.


Anxiety is normal daily part of our lives. It really is. It's how we are wired. It's a natural response when we feel under stress, like when we have a job interview, a first date, or are trying to find parking at Costco. Anxiety manifests through our thoughts, feelings, and body. It's an emotion we feel when we're worried, tense, or afraid, particularly about things that are about to happen, or we think could happen in the future. We can become overwhelmed when we overestimate the "threat" and underestimate our ability to manage.

Generalized Anxiety Disorder (GAD). This is disorder occurs when worry gets out of control, when daily life feels like constant dread, fear, and worry. Someone with GAD may be waiting for disaster to strike your health, money, family, work, etc, or it could be related to everyday issues with no obvious reason. You may feel on edge nervous, worried, restless, or find that you can't concentrate or relax. You may also feel tired and experience a number of possible physical complaints like tension, stomach upset, headaches, nauseous, etc. There is a b association between major depression and generalized anxiety disorder.

Social Anxiety Disorder (SAD). This disorder is not just shyness! It is a persistent intense fear of being judged and watched by others, even in everyday situations in work or school, like talking to classmates or work colleagues. Many people with SAD "white knuckle" their way through social situations, but feel overwhelmed and tired afterwards. Or they may avoid social situations at all costs. I have had a number of clients who struggle with SAD and cope by using cannabis, but it does not change the roots of the problem. It can provide be temporary relief... until it happens again... and again.

Panic Disorder. This is when fear overwhelms unexpectedly and suddenly. Panic attacks are characterized by a sudden wave of fear or discomfort or a sense of losing control even when there is no clear danger or trigger. Racing heart rate, chest pain, difficulty breathing, dizziness, tingling, weakness are common panic symptoms. The anticipation of a panic attack is often a trigger to have a panic attack. Panic attacks will not kill you. Though they feel longer, panic attacks rarely last longer than 5 minutes, give or take, like waiting in a lineup at Starbucks... and then you are done.

Phobia. This is an overwhelming and debilitating fear of an object, place, situation, feeling or animal. Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object. If a phobia becomes severe, a person may organize their life around avoiding the thing that's causing them anxiety. As well as restricting their day-to-day life, it can also cause a lot of distress. A common phobia is Agoraphobia, feeling anxious about being in a place or situation where escaping may be difficult if they have a panic attack. Agoraphobia usually results when avoiding situations such as being alone, being in crowded places such as a mall, or taking a bus. Many veterans I work with often experience agoraphobia, especially when they have to go to a public place with limited exits ("egress").

Obsessive Compulsive Disorder (OCD). This is when a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviours (compulsions) that they may feel the urge to repeat over and over. I've worked with clients who only had obsessive thinking about a particular aspect of themselves or a compulsive behaviour (e.g. checking doors, keys, stove). Exposure and response prevention is your friend here. Perfectionism and procrastination are the evil twins of anxiety. Many clients I see experience both. Perfectionism is the need to achieve high standards to avoid internal criticism and/or avoid mistakes. Sadly, perfectionism results in self-defeating thoughts and increased anxiety to perform. So the other twin, procrastination, often follows. Procrastination is a way to manage the stress and anxiety of perfectionism by avoiding or delaying a task or situation.

Imposter Syndrome. This appears in many clients who are actually quite competent and capable. If this is you, realize that while you may have struggled to get to where they are, but you are unable to be "good enough." Many people with imposter syndrome have negative critical self-beliefs such as "I don't belong to this...", "I'm not good enough", "if people find out the real me, they'll be disappointed".

ADHD ("Attention Deficit and Hyperactivity Disorder") Unfortunately, for quite a few clients I have seen, it can be difficult to get a professional to diagnose ADHD. Many who have ADHD have an inkling that they have it, but often end up attributing their struggles to other causes like being under stress, or their own perceived failings related to their personality, ability, etc. Sadly, they struggle with ADHD and a diminished sense of self, which can result in depression and/or anxiety. Substance use is often used to cope with ADHD.

I've helped clients consult with their physician and self-screen for ADHD symptoms. This allows them to do trials of ADHD medications, which often leads to a noticeable difference almost immediately.

Counselling is helpful for people with ADHD as part of living with it is dealing with emotional dysregulation (difficulty managing emotions), as well as sensitivity to rejection. Constant negative and distorted thinking are common. A person with ADHD can develop a poor sense of self when faced with people who think you're incapable or unreliable. If this is you, this is not due to personal flaws, rather it is due to your neurobiology, and counselling can help fix the distorted view that leads to your lack of self-worth.

Grief and Loss

Unfortunately, some clients I've seen have suffered significant loss, like that of an intimate partner, family member, friend, etc. Grief becomes "complicated" when the loss is such that grief becomes pervasive and persistent. When it gets to this place, it affects the way we function, causing us to disrupt our identity and withdraw from others while yearning intensely for the person lost, and experiencing the resulting emotions intensely.

In other cases, grief becomes a "long goodbye" resulting from the slow cognitive decline from a degenerative mental disease dementia or Alzheimer's, or a chronic addiction in which you no longer have the same relationship with your loved one anymore.

Like trauma, grief changes us, but we can still move forward and live a life worth living.

Trauma / PTSD

Trauma is defined as an emotional response to an intensely disturbing and/or threatening event. Not every disturbing or threatening event causes trauma. And not every trauma produces Post-Traumatic Stress Disorder (PTSD). More info about PTSD.

I work with a number clients who have complex PTSD (c-PTSD) resulting from repeated traumatic events such as the repeated abuse from someone trusted or primary during a vulnerable period like childhood. This form of PTSD produces intense emotions (e.g. pronounced guilt or shame, risky behaviours (e.g. self harm, substance abuse), and reactivity (e.g. physical symptoms, dissociation or disconnection from one's thoughts, feelings, and physical reality).

There are a number of evidence-based therapies for PTSD. They include a process of exposure to the traumatic event so the memory can be reconsolidated and re-narrated. Trauma therapy has progressed since even a decade ago as we understand more about the impact of trauma on the brain. It's important to remember, it's not about "what's wrong with you" but rather "what happened to you".

PTSD can present as hyperarousal ("flight or flight") or hypoarousal ("freeze"). For military veterans and first responders, PTSD can be useful in the "field," making them more vigilant, focused, aroused), but destructive at home (withdrawn, angry, reactive, unable to concentrate). PTSD can become more complex as the person can also experience persistent sleep deficit resulting from nightmares, substance use, avoidance (i.e. refusal to seek help), and stigma (fear of being labeled as "broken" or "crazy").

Concurrent Disorders

This area is my jam. Concurrent disorders are when a person has both a mental health condition and substance use issue (does not necessarily have to be "addiction" or dependence). The research on concurrent disorders is clear that it is important to treat both conditions as primary. They should not be treated as "sequential" (i.e. "Let's treat the addiction first and then deal with the mental health issue later") or "parallel" (i.e. "I'll treat you for the mental health part but you have to see someone else for the alcohol abuse"). My position on this is that it's a causal relationship between the two disorders, as they are interconnected. It a lot to ask of the person to seek treatment in two separate systems (i.e mental health system and substance use system), which requires a significant amount of energy, focus, and motivation. Fortunately, this is changing.


Many of my clients struggle with substance misuse to dependency whether it is alcohol, marijuana, nicotine, illicit street drugs, prescription medications. It is common that some have "polysubstance dependency," using more than one substance (e.g. alcohol and stimulants).

There is more than one way to do recovery and/or achieve sobriety if that is the goal. Research confirms that most people with substance use dependency also have a mental health condition and vice versa. There may also be behavioural addictions on top of that (e.g. sex, gambling, shopping, risk-taking). This is why I believe in treated all concurrent disorders as primary, without having to go through separate systems to get back their mental health.

Treating PTSD and addictions are complex especially when the person stops using substances for counselling. Their primary coping is taken away when they stop using, which can increase PTSD symptoms during therapy. Safety, grounding skills, and social support are vital.

Now about that thing people say about "just needing better willpower" rather than getting help to quit? Think of willpower as being like a tank of gas. It looks full at the beginning but runs out faster than you think.

I work with clients to develop a relapse prevention plan, for both mental health and substance, to identify and address the underlying cause of the "addiction," what keeps the person wanting to use, and help them develop support networks with emphasis on the family system (client and significant others) to support recovery.

For more information about how I work with each of these conditions, please don't hesitate to contact me.

I would like to acknowledge that we are gathered on the traditional, ancestral and unceded territory of the Coast Salish peoples–Sḵwx̱wú7mesh (Squamish), Stó:lō and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) and xʷməθkʷəy̓əm (Musqueam) Nations.

2012 Otto Lim