Q: What is a Parenting Plan, custody and access, and who helps us put this together?
A: When couples who have children separate, two main areas need to be addressed: Financial issues (equalization of assets, child support, spousal support) and Parenting issues (children’s scheduled and holiday time with each parent and major decision-making). Traditionally, each person’s lawyer assists their client to address all of these issues as part of the Separation Agreement. However, another viable and in many cases more cost-effective, efficient, and less potentially litigious manner of addressing the Parenting issues is to consult Dr. Sands, who is a health professional, and can assist the couple to work out these matters. The Mediator and the couple devise a document called a “Memorandum of Understanding” which is a draft of what was discussed by the couple. This document is then taken to each person’s lawyer in order to obtain independent legal advice. Once this occurs, the document can be signed by both people, thereby making it a legal, binding Agreement and can become part of the Separation Agreement.
Some mediators conduct comprehensive mediation (both financial and parenting) and others conduct either one or the other. Mental health professionals normally address parenting issues. Dr. Sands can assist couples to devise Parenting Plans which keep the children’s best interests in mind, supports healthy relations given each parent’s life demands.
Q: How do we tell the kids that we are separating? I am dreading it as I know it will break their heart.
A: No doubt it is very difficult to tell the children that the family that they have known will drastically change, even if they have already sensed that there are problems between their parents. It is advisable that you tell the children only when you have finalized all the issues with the other parent (i.e., where each of you is going to live; where the kids will go to school; when they will be living with one parent and with the other parent). It is important that both parents tell the children together without laying blame. Remaining as general as possible without providing specific details is preferred. Ensure that you tell your kids that they were in no way responsible for the separation. Unless there are serious mental health issues (violence, addiction, severe mental disorder of parent), reassure them that they will continue to have a relationship with the other parent and live with each parent on an agreed upon schedule with each parent in their new respective homes. Tell them how their life will remain the same and how it will change. Be prepared and allow your children to express their feelings. Individual therapy can help you cope with all the normal feelings which you and your children will have during this transition. Remaining as general as possible regarding the reasons for the separation is vital to your children’s emotional adjustment (e.g., mom and dad love you but cannot live together anymore).
Q: How does mediation work?
A: You and your former partner should call and interview two or three mediators until you find the one who is right for you. The mediator will likely send you each some forms with questions to answer first. An intake session will be scheduled with each of you separately to explain the mediation process, identify each of your goals for mediation, and determine whether mediation is right for you. If it is suitable, then joint mediation sessions will begin thereafter. They usually last one and a half to two hours at a time. Session fees are usually charged on an hourly basis and are shared by both of you (in whatever way you agree). Most Parenting Plans can be completed in about four to five sessions, although some take fewer hours and more complex ones may take longer. After the draft document, the Memorandum of Understanding, is completed, each of you takes it to your respective lawyers so that you can obtain independent legal advice. Once you are both satisfied with the final version, you sign and execute the document with your lawyers, thereby making it a binding, legal Agreement.
If your children are very young when you separate, you can agree to modify it as they grow older and their needs change. You can do this yourselves or by returning to mediation if you require a facilitator for this process again.
Q: I’m trying to do the best I can to care for my elderly mother but we continually get into power struggles over what I think will help, which she seems to resist or undermine. Can therapy help?
A: Parent-child relationships continually evolve even well into adulthood. It is difficult both for the aging parent and the adult child to adjust to what often feels like a role-reversal where the parent who always took care of the child is now depending on the adult child. That can create feelings of vulnerability, resentment, fear, and anxiety, all of which can lead to increased conflict. Joint or individual therapy can help in these circumstances.
Q: My dad who used to be such a gentleman has become verbally aggressive and uses profanity now which is really embarrassing. Why is this happening? It is really disturbing to me and I don’t know how to handle it.
A: Dementia and other brain disorders alter the brain’s functioning. Depending on the particular areas of the brain which have been affected, personality and behaviours can change rather dramatically. A brief course of therapy can assist you to obtain valuable, specific information about the effects of brain deterioration on behaviour and personality and can help you understand and learn to manage these difficult behaviours with your loved one.
Q: My mother is elderly and does not have a Will. She has a large estate. I took her to a lawyer but the lawyer wants an opinion on whether my mom is capable of making a Will due to the fact that we are a blended family and one step-child has been estranged from the family for many years. Can such an evaluation help?
A: I have the expertise to provide an impartial opinion on whether she does or does not have capacity to make/change her Will. Lawyers sometimes request this, particularly in the case of seniors with larger estates or health issues which could impact capacity.
Q: When do I need a capacity assessment to activate an existing Power of Attorney?
A: Show the Power of Attorney document to a lawyer so that he/she can tell you if the Power of Attorney document requires that the person’s capacity must be assessed in order to activate the document. Ensure that you seek out a lawyer who specializes in Wills & Estates or Capacity Law. If he/she tells you that a formal assessment is required, contact me and I will assist you by performing the assessment.
If an assessment is not required, you should be able to just provide a copy of the Power of Attorney document to the bank so that they are aware that you are now the legal attorney managing the individual’s financial affairs from that point on.
Q: Who conducts capacity assessments?
A: Since 1996, the Ontario government decided to train various regulated health professionals with clinical experience in this area to perform capacity assessments for Property and Personal Care under the Substitute Decisions Act, 1992. These professionals include: psychologists, medical doctors, occupational therapists, social workers, and nurses. Fees charged depend on their training and private fee schedule. The requestor is responsible for paying the assessor’s fees.
Financial assistance through the Capacity Assessment Office is available for low income eligible individuals. The Capacity Assessment Office website at the Ministry of the Attorney General’s Office guides you through that application process or you can call: (416) 458-5650 and speak with Ms. Shelley Toland.
The complete roster of assessors, by geographic region and profession can be located on the Ministry of the Attorney General’s website.
Q: What do I do if I suspect or know that someone is financially abusing (i.e., stealing from or exploiting financially) an elderly person?
A: Call the police. Most police departments have a police officer dedicated to Elder Abuse.
If there is no Power of Attorney for Property in existence for the individual who is being exploited, you can call the Urgent Investigations Unit at the Public Guardian and Trustee’s Office in Toronto and speak to their investigator.
Q. We are a long-term care facility servicing elderly clients with Dementia and other medical issues. After having a stroke, one of our residents has become aggressive during morning care and paranoid that staff are stealing from her. What can we do?
A. Dr. Sands is able to conduct an evaluation of this and many other difficult behaviours which can arise as a result of progressive brain insults. Consulting with the clinical team, particularly front-line staff, as well as a chart review, direct observation of the client (with family and staff consent), and identification of internal and external triggers of the behaviour can assist in the formulation and implementation of an effective behavioural management plan which can assist both the client to feel safe and permit staff to provide good care to the resident.
Q. We are a home care company which provides home-care services to seniors living in the community. Some clients have psychiatric and/or neurological conditions which can be challenging for some of our staff. Our staff have limited knowledge and training regarding such conditions. What can we do to support our staff and help them provide the best support to our clients and their families?
A. Dr. Sands offers training/inservices for front-line staff regarding various psychological and behavioural issues/conditions which can help them deal more effectively with their clients. Understanding depression, anxiety, personality disorders, past history of trauma, stroke, Alzheimer’s, Multiple Sclerosis, and many other conditions better can assist staff to provide appropriate and effective support and care to the client as well as ensure the health and wellbeing of the caregiver.
Q. We are a new, growing community and would like to offer public service information at the local health fair and library.
A. Dr. Sands would be pleased to offer talks and information to the public on various topics including psychological issues (e.g., depression, anxiety, personality patterns, work/life stress, sleep difficulties, self-sabotaging behaviours, interpersonal issues), senior matters, capacity issues, and coping with separation/divorce.
Q. If I’m already taking medication for depression or anxiety, when do I also need psychotherapy and how can therapy help?
A. Medication primarily targets biological symptoms of depression and anxiety (e.g., sleep and appetite changes, low energy/fatigue, agitation, loss of libido) but it will not resolve the underlying or maintaining reasons for the depression or anxiety. Psychotherapy can help you understand yourself and the reasons/causes of your depression and anxiety. Increased awareness can then help you process and resolve the issues more effectively and reduce the likelihood of recurrence in future.
Q. What is the difference between a psychiatrist and psychologist?
A. Psychiatrists are medical doctors (M.D.) who graduate from medical school with a specialization in the treatment of psychiatric disorders. Their services are covered through O.H.I.P. although an additional co-payment by clients is customary. As medical doctors, their primary mode of treatment for psychiatric conditions is pharmacological (i.e., medication). They are regulated and accountable to the College of Physicians and Surgeons of Ontario.
Psychologists are doctors who complete doctoral training through a post-graduate clinical program (Ph.D.,). As such, they are trained to both diagnose and treat mental health disorders. Training entails a minimum of ten years of university plus various clinical internships and subsequent licensing requirements. Psychologists are regulated and fully accountable to the College of Psychologists of Ontario. Psychological services are not covered under O.H.I.P. and are charged on an hourly basis. Most extended health plans through your employer provide at least some coverage for services
Psychologists’ training includes extensive knowledge and application of psychological assessment techniques and various psychotherapeutic treatments of psychological disorders. Psychologists often work together with your general practitioner or treating psychiatrist who may be prescribing medication for you to ensure that all necessary components of your treatment are working effectively for you.
Q. I’ve tried therapy before at various times in my life but things get better for a little while and then the same issues keep resurfacing. I just can’t seem to shake them and I don’t know what else I can do about it.
A. Don’t despair. We’re all “work in progress” throughout our lives. As with most things in life, we learn different things at different phases of our life. We cannot know everything all at once. As we live our life, gain experience and mature, we may be ready to see and change things that we may not have been ready or able to do in the past. Depending on the issue, exploratory (or other types of) therapy can help you gain a deeper and clearer understanding of yourself, your patterns of behaviour and reasons for them, which can help you make new lasting changes.
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