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Happiness At Home: What Depression Is And What To Do About It (part 2)

Andrea Ramsay Speers - Tuesday, December 01, 2015

This is the second of a two-part series on depression. In this issue, I will describe how depression is treated and prevented. If you or someone close to you suffers from depression, it is important to educate yourself about it and seek treatment from qualified mental health professionals.

There are three basic ways to treat depression: psychotherapy, self-help, and medication. Many people respond best to a combination of two or more methods.

  1. Psychotherapy: Exploring one’s beliefs and ways of thinking, and learning new ways of thinking and behaving, with the guidance of a professional.
  2. Self-help: Exploring one’s beliefs and ways of thinking on one’s own.
  3. Medication: Altering one’s brain chemistry by taking antidepressant medication.

A physician may recommend medication when four conditions exist:

  1.      The patient’s depression is severe.
  2.      The patient has suffered at least two previous depressive episodes.
  3.      There is a family history of depression.
  4.      The patient asks for medication only and refuses psychotherapy.

There are four types of antidepressant medication available today:

•           Tricyclic antidepressants (TCAs)

•           Monoamine oxidase inhibitors (MAOIs)

•           Selective serotonin reuptake inhibitors (SSRIs)

•           Structurally unrelated compounds

The TCAs and MAOIs have been used for decades. The SSRIs (such as Prozac) and structurally unrelated compounds are newer and are being prescribed more and more frequently. They have fewer and less pronounced side effects than the TCAs and MAOIs.


Treatment without Medicine

One of the leading methods for treating depression is cognitive therapy. Cognitive therapy help depressed clients feel better by identifying how faulty ways of thinking are making him or her feel bad. The client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing.

Many mental health professionals believe that the ideal treatment of clinical depression is medication in conjunction with psychotherapy.


Prevention of Depression

Depression can often be prevented. It is especially important to take preventive action if you are aware that you have predisposing factors such as those mentioned in the last newsletter.

  1. Identify your risk factors and be aware of where you are vulnerable. Each of us has unique risk factors, such as things we were taught in our families of origin, values we have learned, and the presence or absence of a family history of depression. Anything that has been learned can be unlearned and replaced with something healthier.
  2. Learn to manage stress. You can learn proven techniques for calming and relaxing yourself. Consider taking a stress management class or buying a set of relaxation tapes.
  3. Learn problem-solving skills. Many people who develop depression never learned problem-solving skills. They need to develop the ability to see problems from many viewpoints and to look for a variety of solutions.
  4. Build your life around things you can control. Learn to recognize what you can control and what you can’t. Avoid spending much effort on situations that won’t pay off for you.
  5. Learn self-acceptance. Instead of rejecting the parts of yourself you don’t like, learn to manage them more productively.
  6. Become aware of selective perception. Observe how you generate ideas and opinions about people and events. Remember that these are just your views, not necessarily objective facts.
  7. Focus on the future, not the past. Depressed people tend to be focused on the past. People who set goals and focus on the future tend to be more positive about life.
  8. Develop a sense of purpose. Many depressed people lack a sense of purpose or meaning. This means they have no goals and nothing in the future drawing them forward. To prevent depression, develop your sense of purpose and meaning.
  9. Strengthen your emotional boundaries and set limits. Boundaries define your role in a social situation. They determine how you will or won’t behave in a given situation. Having clear, strong boundaries is empowering, while boundary violations make you feel victimized and helpless. Setting limits means having and enforcing rules for the behaviors you expect in a relationship.
  10. Build positive and healthy relationships. Think about what you need from others in relationships. Learn to read people and trust your instincts about which people are good for you. Avoid isolation. Talk to others about what’s going on with you. If you keep your thoughts to yourself, you may be unaware that your thoughts are distorted. If you share them with another person, you can become more objective.
  11. Avoid isolation.  Talk to others about what's going on with you.  If you keep your thoughts to yourself, you may be unaware that your thoughts are distorted.  If you share them with another person, you can become more objective.


Signs That Professional Therapy Is Needed

  1. Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately.
  2. When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.
  3. Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.
  4. You have become so isolated that you have no one with whom to test reality. Seek someone out to share your thoughts and feelings with.
  5. Depressive symptoms have become severe.


Suggested Reading

David D. Burns, M.D., Feeling Good: The New Mood Therapy. New York, Avon Books, 1999.

Michael Yapko, Ph.D., Breaking the Patterns of Depression. New York, Doubleday, 1997.

Most Of Us Hear, Not All Of Us Listen

Andrea Ramsay Speers - Tuesday, November 24, 2015

I use a lot of skills in my work as a psychotherapist in Oakville.  Some of these skills are ones that I teach my clients, too, and active listening is probably one of the most common – and most important – skills that I use and teach.  Whether you’re looking for help with parenting or with couple counselling, this skill comes up over and over again since active listening is crucial for improving any relationship.

Generally communication requires a “sender” and a “receiver”, so the receiver uses active listening skills.  What exactly is active listening?  It generally boils down to three main parts. 

First of all, we start by reflecting back what we have heard to the sender.  Paraphrasing is ok, and certainly that’s better than sounding like we’re simply parroting what we’ve just heard!  But be careful that you don’t sneak in a reflection of your own feelings.  This part is challenging, because if we need active listening skills, then almost by definition the conversation is a difficult or emotionally-loaded one.  If the sender says, “I just don’t feel that you really trust me,” it would not be active listening for the receiver to reply, “So what you’re saying is that you feel guilty and you believe I don’t trust you,” or “So what you’re saying is that your paranoia keeps you from feeling as though I trust you.”  In both of those cases, the sender didn’t say anything like that.  What was reflected back was a statement that actually reflected the receiver’s interpretation of the message or a judgment about the sender’s statement.  A more accurate example of active listening might be, “So what you’re saying is that sometimes you’re not sure if I trust you.”  That’s all.  Keep it simple.

Next, we need to clarify if we have any questions.  Don’t plow forward if there’s something you’re not following; that just increases the likelihood that you’ll stray further and further apart in your understanding of each other’s position.  It’s ok to pause the conversation and say, “Wait, I have a question,” or “Just a minute, I’m not sure I’m clear on that part.”  Make no assumptions.  Stay on a particular point until you really feel that you’ve got it, and the sender feels confident that you do too.  Sometimes we struggle to articulate what’s going on with us; this might be happening with the sender in this moment, so give him or her the courtesy and space to figure it out with you.

And finally, the whole purpose of active listening is to make sure that both the sender and the receiver are on the same page.  Keep in mind that understanding and agreeing are not the same things.  You can understand someone’s point of view without necessarily agreeing with it.  Active listening isn’t about agreeing with everything the sender says, it’s about making sure that you understand all of it.  Active listening alone might not be enough to resolve big problems, but without it, it’s almost impossible to resolve any. 

So remember these key points to active listening, whether you’re talking to your kids and you want to improve your parenting skills, or talking to your partner about couple relationship issues, or even talking to your colleagues at work:

  • focus on understanding the sender’s message.  Keep your thoughts and responses to yourself; you’ll have the chance to talk later, and if the sender feels really heard and understood, there’s a much greater chance that s/he will be more interested in hearing and understanding you when your turn comes.
  • ask questions.  Don’t make assumptions, and clarify anything that seems a little murky to you. 
  • go forward with the goal of confirming that you both understand the sender’s message.  Stay with a particular idea until you get confirmation from the sender that you really get it.

Active listening may not be the most natural skill, that’s true.  But in my counselling work I’ve found that many people never really learned solid communication skills, and that catches up with them in their relationships.  Whether your want to improve your marriage or improve your parenting, practice active listening.  Let me know how it goes!

Money, Money, Money

Andrea Ramsay Speers - Wednesday, November 18, 2015

“Mom, can I have an ice cream?”

That’s how it starts. With a seemingly innocent request for a treat – that requires money. This is your first opportunity to share with your children that these treats aren’t free and to give them a basic understanding of how our currency system works. We want them to learn that money is something they earn and save for bigger goals, not that it magically appears when a parent sticks a small piece of plastic into the money machine.

As soon as kids are old enough to start asking for a treat at the grocery store, they’re old enough to understand the concepts of money and an allowance. Whether your start with a quarter or a dollar, pay your child during each week your family meeting (you are holding those, aren’t you??). As they develop confidence and maturity, you can increase the allowance while you increase the number of purchases they are now responsible for.

Harassed for treats during shopping trips? No longer a problem. Now you can politely ask your child if she brought her allowance (or her wallet) when she makes a request, and if the answer is no, suggest that she might want to save her money and bring it with her next time for a treat. There may be a bit of a shock when she realizes that you’re not going to float her a loan, but she’ll begin to be more conscientious about bringing her wallet and judiciously spending her money if you hold your ground.

You can start providing an allowance when kids are old enough to understand and be aware of the need for money, and as they age, the amount can be renegotiated based on need. What if the “need” is bigger than the allowance? There are a few options. Encourage your children to save the whole amount all on their own, match what they contribute, or tell them that you’ll pay the balance once they reach a certain dollar amount in savings. If their needs are greater than what your family can afford, they can find alternative ways of making more money through babysitting, mowing lawns, or other entrepreneurial ventures. (My cousin baked and sold carrot cakes to friends and family members to raise money for her first trip to Disney World when she was about 10 years old.)

Parenting experts are divided on this, but I feel that it’s a bad idea to tie allowance to chores. While it makes sense from a motivational perspective when your children are young, by the time they’re teenagers, you’ll have a hard time convincing them to continue to do the chores at a fraction of what they can make at their minimum wage jobs. While there is an argument to be made that when a person “works”, they get paid, I don’t really see chores around the house as “work”. Because even the adults who work for a paycheque outside the home still end up cleaning their house without pay (or paying someone else to do it). My feeling is that a better approach is that with privileges (i.e. allowance) comes responsibility (i.e. chores). Everyone gets an allowance because they are a member of the family, and everyone does chores because they are a member of the family

While it is tempting to step in and rescue (after an appropriately long lecture, of course!) if your child overspends and runs out of money, this is a bad habit to get into. It gives the impression that adults will always be there to bail the kids out, rather than providing an opportunity to learn from their own mistakes and develop confidence and responsibility when it comes to money. As the current state of the American economy shows, this is a lesson many adults have not fully come to terms with – let’s hope we can provide a better example and an opportunity for our kids to not repeat these mistakes.

Alone…Together

Andrea Ramsay Speers - Tuesday, November 10, 2015

What your kids want more than anything is to spend more time with you.  Even your teenagers.

Seriously.

I can’t point you to any specific studies that prove this (although I’m sure they’re out there) but I can tell you what number of the teens I’ve worked with over the years have said that they wish they cold spend time with their families and their parents.  That number would be: all of them.  I think it’s safe to assume that this number would hold true for younger kids as well (but I don’t work with kids under the age of 13, so I can’t ask them myself!).

Before you start feeling guilty that you’re not spending enough time with your kids, don’t.  It’s ok.  Lots of studies (like the ones referenced here, here, and here) have shown that it’s the quality of time we spend with our kids, not the quantity, that really has an impact on our relationship and their future success. 

So what this means is that while we might be putting in a lot of “face time” with our children as we drive them to activities and friends’ houses, this quantity time is not really helping them out – especially if as parents we’re anxious and under stress about trying to fit everything in. 

Instead, it’s the quality of time that matters, even if that time is short.  Fun activities like reading a book together, doing a craft or some baking, or even running errands with a stop for a hot chocolate at the end, are all more meaningful to our children than the racing all over town to get them to extra-curriculars.  This little time together creates a bond and an opportunity to connect that isn’t there if we’re trying to do homework in the car between practice and the drive through.

So look for small, easy-to-do ways to spend some one-on-one time with each of your kids.  Make it a regular date if that helps, or get into the habit of doing something together each week, like buying groceries, taking Grandma out for lunch, or watching a favourite TV show or sporting event.  This is a time to let the conversation flow naturally and see where it takes you.  It allows you to learn more about each other and share some of what’s happening in your days.  It allows each of you to see the other as a unique person, not just “my mom” or “my child”.  And it allows each child to have some time that’s all about him or her.  What we all want is to feel important and special to those who matter to us.  Creating time to do that with our children is a great investment in our relationships and in our parenting.

Discipline Vs. Punishment

Andrea Ramsay Speers - Tuesday, November 03, 2015

I found a great explanation of the distinction, taken from Kathy Lynn's book Who's In Charge Anyway?:

Discipline is not about pain or punishment, nor about revenge or retribution.  Discipline is about teaching, guiding and training.  When we discipline children, we are teaching them the difference between right and wrong.  We're helping them to learn the consequences of their actions.  They learn why rules exist and how breaking the rules impacts others as well as themselves.  They slowly internalize the information so they can behave appropriately in the future.

Punishment is about causing pain or discomfort in an effort to change behaviour.  We typically think of punishment as being physical -- smacking or spanking.  However, threatening, insulting, frightening or humiliating children is also punishment.  And it works only as long as a child is afraid of his parents.  All the motivation is external.  Children learn that parents will hurt them if they don't follow the rules, but they don't learn why those rules exist.  And the do not learn how to take responsibility for the real consequences of the misbehaviour.  Instead, they learn to be sneaky, so they won't get caught, and that they can misbehave when nobody's watching.  They learn to avoid or disregard pain.  And they learn that hurting someone smaller is an appropriate response to anger or frustration.

Teaching, guiding and training…these are the ways that we learn best.  Punishment might seem to be effective in the short term, but it damages everything from relationships to self-esteem to personal responsibility in the long run.  Discipline might not always be comfortable – this isn’t at all about letting kids get away with everything and suffering no consequences – but it should always be focused on teaching, not pain.

Cyber-Snooping On Our Kids

Andrea Ramsay Speers - Tuesday, October 27, 2015

Since we entered the digital age in earnest, there has been an explosion of high-tech gadgets parents can get to keep an eye on their kids.  From debit cards that allow parents to control their teens’ spending and limit where the card can be used, to GPS locators that can be attached to kids or sewn into their clothing, to boxes that are installed in cars to monitor how fast teens are driving and whether or not they’re using their cell phones behind the wheel, parents have many, many options for snooping.

But is any of this a good idea? 

Perhaps this makes us pine for the days of our own childhood when we needed a quarter to make a call and there was no such thing as texting.  Or perhaps we see it as a necessary evil in order to make sure that we're keeping one step ahead of the predators who would do our kids harm, whether they're in chat rooms or in the seat next to our child in the classroom.  Parents argue for both sides of the privacy issue.  Some parents feel "my house, my right" and others felt that invading their child's privacy this way just results in kids feeling as though their parents assume they are untrustworthy and encourages kids to be sneaky .

One problem with this kind of surveillance is that while it creates a sense of security for the parents, it keeps kids from being in a position to make their own decisions, which can catch up with them later in life.  I'm not advocating a complete "do what you want, it's your life" attitude toward our children, just that we have to balance their safety needs with their need to develop critical thinking and problem solving skills.  

This balancing act has always been an ongoing challenge for parents; now, we’re just doing it digitally too.  Privacy is a big issue for kids, and once you've crossed that line into being considered a "snoop", it can be difficult to be seen as someone your kids can talk to about anything. 

This is a big issue, and one that evolves over time, not just as our children age, but also as technology advances.  Keeping the door open to honest communication is the only way to meet safety and developmental needs, but how do we do that?

Dr. Jodi Gold’s book Screen-Smart Parenting offers Family Digital Technology Agreements, tailored to the age of the children.  For teens, for example, her agreement includes the following:

  • when and where teens can use technology
  • what teens can do online
  • a description of who teens want to be online (such as being kind and not a bully, and telling parents if anything makes them feel uncomfortable online)
  • what parents agree to, and
  • provisions, agreed upon upfront, as to what will happen if they agreement is not honoured.

These agreements give parents a great starting point to talk about what’s acceptable, what’s not, and what each party, parents and kids, need to be help accountable to.

Sue Scheff, who is an internet safety expert, has a great article on Snooping Versus Monitoring Your Teen’s Online Behavior.  She gives a list of warning signs that parents should be concerned about, and points out, “Remember writing can be very healthy for teens (and adults for that matter), so if your teen isn’t giving you any valid reasons to “invade their privacy” – respect it. When safety trumps privacy – it may be time to pry – but every day you should be monitoring your child’s online activity – it’s called parenting.”

We’re writing the rule book as we go here, and there are no easy answers to complicated questions.  Remember that the net result we’re looking for is to empower our kids to make good choices for themselves and to feel ready to do that.  They’re going to need a little hand-holding during that process, so as Sue points out, don’t hesitate to value safety over privacy, and see all of this as a teachable moment.  Start by having a conversation about what your family rules are, and stay connected.

Look for the balance between monitoring everything they do and letting them do whatever they want, and they’ll be better able to make some of those good decisions for themselves as time passes, with or without a tracker sewn into their coats.

Being More Patient

Andrea Ramsay Speers - Tuesday, October 20, 2015

Most parents I’ve met would say that parenting has taught them to dig into reserves of patience they didn’t even know they had.  But they’d also probably admit that they could use a bit more patience, too.  We often feel as though we go from calm to banshee in no time flat.  But in fact, we all pass through a number of different stages between those two states.  It might happen lightening-quick, yes, but that doesn’t mean those stages aren’t there; our challenge is to learn how to recognize the stages between being patient and not, and use them to take action to help us increase our patience reserves.  Give yourself a time out if you need it, use the classic “breathe deeply and count to ten”, ask yourself, “How important will this be in one day?  In one month?  In one year?”.  Find what works for you to get grounded again in that moment.

One of the best tips for increasing our patience is knowing what our triggers are.  If we can anticipate what might set us off, then it becomes easier to plan for it and make some different choices.  So if we always end up getting frustrated at the grocery store, or at homework time, just saying to ourselves, “This time will be different” isn’t enough.  Before the time even comes, think about what typically happens, how you respond, how the kids then respond, and how you might all take a new path.  Ask your kids what they think might help to make the experience better for everyone – you might be surprised at the insight, or you might be surprised to hear what the real problem is, in their minds.  Often, a simple fix makes all the difference.

I really believe that one of the biggest reasons we as parents lose our patience, is that we get overly attached to our expectations about how we think something should happen.  We have a plan or a vision in our heads about how our day will unfold…but unfortunately, our kids don’t share that vision.  And when we get too hung up on the plan or the expectation of how things should be going, we’re going to be a lot more vulnerable to losing our cool.  As much as you can, slow down.  Schedule less.  Build in time to catch your breath.  Your patience will thank you for it.

Remember to step back and think big picture.  You’re not just raising children, you’re raising little people to be adults.  Our goal is to teach them skills and habits that will serve them well as they become more and more responsible for themselves, not to make sure they learn how to conform to our schedules.  Savour little moments with them, really remind yourself of the wonder and joy that kids approach each day with, and see if you can’t bring some of that back into your own life through them.  Remember that good relationships are built one interaction at a time, so as trying as your kids may be right now, keep in mind that one day they’ll be older and you’ll want that great relationship with them more than ever.  (You may also want that deep well of patience when they’re older, too!)


And let me also point out that these tips serve us well when thinking about our marriages as well, even though I've focused more on our children in this article.  Not over-scheduling, planning for triggers, stepping back to see the big picture...these techniques work just as well with our partners as they do with our children.  Not just for kids - it's a little shot of couple relationship counselling right here!

Foiling a Manipulation Tactic

Andrea Ramsay Speers - Tuesday, October 13, 2015

Kids develop a finely tuned awareness of which parent to go to in specific circumstances.  Whether they're looking for money, a ride to the mall, or permission to sleep over at a friend's, if one parent is more likely to say yes than the other, the children will know exactly who that is.  But that can turn into a big problem when kids use this knowledge to their advantage and begin playing one parent against the other.  Here are some suggestions for avoiding these sneak attacks.

When parents create rules, it's not uncommon for one parent to struggle more than the other to enforce them.  The thought of a temper tantrum is enough to send parents rushing to the cookie jar to hand one over.  Even though it can be tough to hold your ground when you know that what's on the other side of the "no" is particularly unpleasant behaviour from your children, it's important to stay the course.  Otherwise, this type of behaviour is reinforced, and becomes a go-to behaviour whenever they're looking for something they're not getting.  And if you have one parent who consistently gives in, even on rules that have been agreed upon by both parents, it seriously undermines the authority and respect toward the other parent.  Ideally, there shouldn't be a "good cop, bad cop" situation in the house -- aim for a consistent reinforcement of rules by both parents.

Another problem is when a child asks one parent for something, gets turned down, then promptly goes to ask the other parent the exact same request.  Asking a straight, "Have you talked to your mother/father about this already?" heads this problem off at the pass.  Because it gets tedious to check in this way every time your little darling comes to you with a question, you may decide to go this route only if the dual questioning of both parents is beginning to get out of hand, if it's something that has been discussed before and keeps popping up as a problem, or if the question is a biggie that you want to make sure you know where your partner stands.  If it comes to your attention after the fact that your partner gave a contradictory answer before you were ever asked the question, it's important to not let that behaviour slide.  Approach your child, preferably together, and let him or her know that this kind of behaviour is unacceptable, and that the original answer is the one that stands.  Even if you don't agree with what your partner said, it's important to demonstrate a united front.  Have your discussions behind the scenes, and make sure that you support each other publicly in these situations. 

Saying What We Mean and Meaning What We Say

Andrea Ramsay Speers - Tuesday, October 06, 2015

Here's an interesting statistic:

Today's Parent magazine took an online poll, in which 58% of parents responded that they sometimes say yes when they wish they'd stuck to no.  So if you're struggling with being consistent and not turning into a marshmallow, take heart that you are not alone.  It's tough to stick to our guns when the going gets tough, but it's most definitely worth it in the long run.  Just think: the more consistent you are now, the sooner the behaviour will change, and the less you'll have to face the temptation of giving in!

Parenting is tough, but there is help in Oakville.  If you feel that a psychotherapist could help you with counselling services, couples counselling, or couple relationship counselling, call me.  I can help.

When Should You Worry About Your Child’s Behaviour?

Andrea Ramsay Speers - Tuesday, September 29, 2015

How do you know when you should be worried about your child’s mental health?

There are lots of variations of “normal”, so it can be hard to know.  And when you’ve been coping with a certain situation or behaviour for a while, it can start to feel normal over time, even if it’s not something that other people are experiencing.  So how do we know when we should be worried about our child’s mental health, and what do we do next?

First of all, just how prevalent are mental health disorders in childhood?  Well, the Centre For Addiction and Mental Health reports that 70% of mental health problems have their onset during childhood or adolescence.  And mental health disorders affect 15-20% of Canadian kids.  So that’s a lot of children who may be slipping through the cracks.

Here are some common symptoms to be alert for:

  • changes in habits: eating, sleeping, socializing, studying, drop in marks at school
  • excessive anxiety or fears, that keep the child from engaging in activities that most other kids his age do or that otherwise impact his daily functioning
  • withdrawing from activities or other people
  • irritability, anger outbursts, temper tantrums that seem “bigger” than a parent would expect for that age
  • mood swings
  • physical complaints such as stomach aches, headaches or generally not feeling well
  • a change in what we might consider personality: not being as interested in previously enjoyed activities, a disregard for the feelings or property of others, disobedience or defiance, increased aggression
  • increased drinking or drug use
  • talking about suicide or hurting himself, or noticeable cuts or burns on arms, legs or torso

Look for how intense these symptoms are and how long they go on for.  Consider family history and make sure you share those details with your family doctor. 

Ask your child.  See if he thinks that his behaviour has been a problem, or if he can share with you some of what he has been feeling or noticing.  Depending on your child’s age, that might not be something he can do, but then again, kids often surprise us with their insight, so it’s worth at least starting a conversation.  If nothing else comes of it, at least you’ve begun a dialogue that lets your child know that you see what’s happening, you’re concerned and you want to help.

And trust your instincts.  No one wants their children to be unwell, but if you suspect that something other than simple growing pangs may be behind your child’s behaviour, don’t wait to get it checked out.  It’s better to be sure; get a second (or third) opinion if the answers you’re getting just don’t seem to fit. 


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