CBIST Spotlight: Arden McGregor

Arden McGregor, M.A., CPsych, CBIST, is a Canadian psychologist who has worked full time in brain injury rehabilitation since 1991, across the continuum of care and in both the public and private sectors. In 2003, Arden followed her heart and founded Brainworks, where she continues to serve to this day.  Under Arden’s leadership, Brainworks continues to grow, focusing on filling service gaps and developing new and innovative programs and services to best meet client needs. As such, Brainworks and Arden have been recognized locally, provincially, nationally, and even internationally 16 times in the past 6 years alone. In her downtime, she loves creating therapy materials and spending time by the water, in nature, with family and friends close by. Arden can be reached via email here.

Why have you chosen a career in brain injury? What are you most passionate about in the field?

I remember the moment that sparked my interest in what would ultimately become my lifetime passion for brain injury rehabilitation. When I was a teenager, I became qualified as a swim instructor and spent countless hours at the pool. One of my special memories from those years is of Anne, a ten-year-old girl with cerebral palsy who desperately wanted to learn to dive. She had so many challenges in her young life that it would have been easy to write her dream off and encourage her to work on skills that would be “beneficial” for her, but diving was her dream. Every moment I could, I helped her. It took almost a year of effort, but in the end, she did it!  I will never forget the way her whole face exploded out of the water with the joy she felt having successfully completed her first dive. The thrill I got from being part of her joyful accomplishment changed me.

Although that experience occurred years before I chose rehabilitation as my career path, I knew that very moment that I would dedicate my life to help others achieve what was most important to them. Through wonderful people, practicums, and work opportunities along the way, I discovered the field of brain injury rehabilitation, and once I got started, I never looked back. I love working in this field. It has filled me with inspiration and it has given me the opportunity to be someone who makes a difference in the lives of the people I serve.

Why is having your CBIST important to you?

I originally sought out my CBIST designation so that my training, experience and dedication to the brain injury community could be verified and certified by ACBIS. This certification has been a recognizable, shorthand way to communicate to others about what I do and about the excellence and passion with which I do it. 

ACBIS also provides me with a community of like-minded professionals who are equally invested in the brain injury community. I appreciate the wonderful teaching and learning resources as well as the collegial affiliation and communication. I am proud to have been a member of the ACBIS community since 2002.

You have written and presented on doing online therapy, what are your thoughts on the increased use of telehealth during the pandemic?

In short – I’m THRILLED!  If there is one positive that I’ve seen during the pandemic, it is the growth, ingenuity and innovation in online therapy – particularly within the brain injury rehabilitation community. I’m certain that I will always remember 2020 as the time that the rehab sector reinvented itself.  Therapists and clients have been suddenly pushed to find solutions because rehab cannot stop for the pandemic! 

I have witnessed first-hand the power of desensitization to online therapy; a treatment modality that, sometimes, has been too quickly written off for people with brain injuries. I have seen therapists and clients alike take courage and take risks, trying new things; and more often than not, advantaged by that.  I have seen a true rehabilitation mindset in action, learning something “small” and building on successes.  I have seen individuals who never thought that they could tolerate any screen time, work their way up from quick “therapy check-ins” to 30-minute online therapy sessions, learning many new skills and strategies in the process.  I have seen rehab professionals who could not envision themselves using online tools previously, quickly become skilled with this modality.

Online therapy, no matter how well done, will never meet all rehab needs in the brain injury community – not even close.  But it has proven to be a necessary (although not sufficient) means to providing rehab, especially in the midst of a worldwide pandemic.

I absolutely love rehab, and working through the pandemic has reminded me of many of the reasons why.

What do you see as the important ethical implications of utilizing virtual platforms to deliver therapy/rehab?

When I first wrote about the ethics of providing online therapy (a decade ago), service delivery via the internet was in its infancy. There were simply no guidelines (ethical or otherwise) that specifically addressed the use of technology in therapy, and clinicians were scrambling to figure out how to navigate this whole new world. Slowly but surely, guidelines caught up to technology and online service delivery became second nature – to some. 

However, in the face of the pandemic, with physical distancing restrictions forcing many rehab professionals to either go online or temporarily close down their practice, we saw an absolute explosion in virtual rehab. Unfortunately, in the haste to jump online, ethical issues once again came to the forefront. Issues related to technological competence, software security, familiarity with guidelines, informed consent, privacy, and professional boundaries ran rampant – particularly at the outset. Like the rest of the world, rehab providers were doing their very best – and scrambling – to continue to work and to continue to serve.  However, a sense of urgency seemed to thrust change forward, sometimes without adequate preparation or understanding.

We’ve all probably heard about (or experienced) an awkward moment where a client had to coach the professional on some aspect of the software that was being used… Or where a participant forgot their camera or microphone was turned on and did something particularly embarrassing like go to the bathroom… Or the internet went down at the most inopportune moment, with no backup plan in place to reach the client.  Or my personal favorite –when a therapy session is conducted from the comfort of home, and a ______ (child, parent, scantily clad partner… you fill in the blank) unexpectedly walks across the room, oblivious to the fact that a therapy session is going on. Inadvertent boundary violations are awkward at best, obviously detract from the purpose of the session, and can change the therapeutic relationship entirely. Thankfully, we learn, and the stress, boundary violations, and awkward moments that marked the early months of the pandemic seem to be settling down as our industry has learned to adapt.

Even those therapists that were used to online service provision pre-COVID often found that the time that they spent online increased markedly – with “Zoom fatigue” being reported by many clinicians and burn out being more of a risk. No matter what our level of experience with online therapy, the pandemic propelled online service delivery to a whole new level and the stress of change and heightened ethical considerations seemed to touch us all.

Now in “the second wave” we are wiser and far better prepared — not just for handling online service delivery, but for day-to-day life in the pandemic, too.