By Kimberly Eckert, R. Psych., and Kymberley Calhoun, R. Psych.

Maybe you are still doing all the things.

You get everyone where they need to go. You answer the emails. You show up for work. You remember the appointments. You figure out dinner. From the outside, your life may look completely intact.

But you know how much effort it is taking.

Maybe therapy has helped you understand yourself. You recognize your patterns. You know the strategies. You can often tell yourself exactly what you should do next.

And yet there can still be a frustrating gap between knowing what would help and being able to do it.

At the same time, your body may have changed too.

Maybe you stopped running after having a baby because you leak. You choose the workout without jumping. You think about bathrooms before long outings. Perhaps intimacy feels different. Maybe you have simply learned to work around things you once assumed would get better.

None of this necessarily means you are seriously unwell. In fact, you may be doing a remarkable job of keeping everything going.

But keeping everything going is not the same as feeling well.

At Eckert Centre, this has led us to become increasingly interested in a different question:

What if the problem isn't that you don't know what to do or aren't trying hard enough? What if something is limiting your capacity to do it?

That question is at the heart of our Brain & Body Therapies.

25 Years In, We Are Still Asking: What More Is Possible?

Kimberly reflects:

When I founded Eckert Psychology & Education Centre in 2001, I could not have imagined all of the tools psychologists would have available to us 25 years later.

What hasn't changed is what I want for our clients.

I want people to receive excellent psychological care. I want them to be understood as whole people rather than diagnoses. And I want our clinicians to have access to the best evidence-informed options we can responsibly provide when someone is struggling.

For most of our first 25 years, our tools were the ones you would expect to find in a psychology practice: careful assessment, strong therapeutic relationships, evidence-based psychological treatment, education and support.

Those things remain at the heart of who we are.

But the science has continued to move.

We understand more about the brain and body and about the biological systems that can support—or constrain—a person's ability to benefit from the psychological work they are doing. At the same time, technologies that were once found primarily in hospitals and specialized medical settings are becoming increasingly available in community-based care.

As I learned more about these technologies and began to understand what they could potentially make possible for our clients, something shifted for me.

Once I knew, I couldn't unknow it.

I couldn't be satisfied with saying, “This is what psychology has traditionally offered,” if the research was giving us additional ways to help.

That became part of the reason we created Brain & Body Therapies at Eckert Centre.

It was not about becoming a technology clinic. It was about becoming a better psychology clinic.

As we enter our next 25 years, I want our clients to continue receiving the thoughtful, relationship-based psychological care that has defined Eckert Centre from the beginning. But I also want them to have access to established and emerging treatments that may meaningfully expand what is possible for them.

That means staying current with the research.

It means being willing to learn and evolve.

It means being transparent about what is well established, what is promising, what is off-label and what we simply do not know yet.

And it means never using technology simply because we own it.

The technology has to serve the person.

From Symptoms to Capacity

Bringing these technologies into our practice has not made careful psychological assessment less important.

It has made it even more important.

As psychologists, we still want to understand the person's emotions, relationships, experiences, environment, behaviour, beliefs and history.

But now we can ask another question too:

Does this person currently have the biological capacity to do what they are trying so hard to do?

Can you concentrate when you need to? Can you get started? Can you shift when your brain gets stuck? Can you regulate an emotion well enough to choose what happens next? Can you access what you have learned in therapy when you need it most?

And when it comes to your body, can you run, laugh, exercise, travel or be intimate without pelvic-floor symptoms determining what you do?

Sometimes the barrier is not a lack of insight, motivation or effort.

Sometimes there is a capacity bottleneck.

That doesn't replace psychological formulation. It expands it.

And that is where technologies such as ExoMind™ and Emsella™ can enter the conversation.

Two Technologies. Two Very Different Jobs.

ExoMind and Emsella both use electromagnetic technology, but they do very different things.

ExoMind is an rTMS device. Repetitive transcranial magnetic stimulation uses magnetic pulses to influence activity in targeted brain networks. At Eckert Centre, our primary target is the left dorsolateral prefrontal cortex, or left DLPFC, a region involved in executive-control functions including working memory, inhibition, cognitive flexibility and aspects of emotional regulation.

Emsella uses high-intensity focused electromagnetic technology to stimulate pelvic-floor muscle contractions. For appropriately screened clients, it may be considered when pelvic-floor strengthening or activation is a relevant treatment goal.

One works directly with the brain. The other works directly with pelvic-floor musculature.

So why are we talking about them in the same article?

Because sometimes more than one thing is getting in the way of a person's ability to fully participate in their life.

They don't have to have the same cause to both matter.

ExoMind: Why We Don't Think You Should Have to Wait Until Things Get Worse

For many years, people tended to encounter rTMS relatively late in their treatment journey.

It became known primarily as a treatment for people with significant depression who had already tried other interventions without enough improvement.

That history has left many people with the impression that they need to be “sick enough” before rTMS belongs in the conversation.

Accelerated rTMS protocols are helping change that conversation.

At Eckert Centre, we believe there are times when it is appropriate to consider rTMS earlier, rather than automatically asking someone to continue struggling until symptoms become more severe.

Think about the person who is still working, parenting and getting everything done—but at considerable personal cost.

She may not describe herself as severely depressed.

She might say: “I can do everything I have to do. I just have nothing left afterward.”

Or: “Therapy has helped. I understand myself so much better. But I still can't seem to do the things I know would help.”

Or simply: “I'm functioning. I just don't feel like myself anymore.”

We don't think the only question should be: “Is this person depressed enough?”

A more useful clinical question may be: “What is getting in the way of this person's capacity to function, engage in therapy and move toward the life they want?”

Does That Mean Normal Stress Needs Brain Treatment?

No.

Sadness is part of being human. So are stressful seasons, grief, exhaustion and periods when life simply asks too much of us.

We do not want to turn normal human experiences into disorders requiring treatment.

But there is also considerable territory between “I'm fine” and “I have severe depression.”

People can experience persistent depressive symptoms, anxiety, stress-related difficulties or reduced cognitive and emotional capacity while continuing to work, parent and meet their responsibilities.

Sometimes therapy, changes in circumstances, rest, social support or time are exactly what is needed.

Sometimes, however, symptoms persist. Therapy may be helping, but progress feels disproportionately difficult. You understand what to do but can't consistently access the cognitive or emotional resources required to do it.

Accelerated rTMS gives us another option to consider.

Earlier consideration does not mean indiscriminate treatment.

It means we don't automatically require someone to become more impaired before asking whether rTMS may be clinically appropriate.

What Is ExoMind Approved to Treat?

There is an important distinction here.

ExoMind™ is a Health Canada–licensed rTMS device with indications for Major Depressive Disorder (MDD), reduction of comorbid anxiety symptoms in patients with MDD, adjunctive treatment of adult OCD, and Binge Eating Disorder (BED).

Those regulatory indications matter, and we are transparent about them.

But regulatory indications and an individual clinical formulation are not the same thing.

There is a broader scientific literature examining rTMS across different symptoms, disorders and brain networks. When we consider ExoMind outside Health Canada's licensed indications, we look at the available evidence, the person's symptoms and functioning, potential benefits and risks, and their individual clinical formulation.

When a proposed use is off-label, that distinction is discussed as part of informed consent.

This allows us to hold two things at the same time:

We can be careful about what the evidence and regulatory approvals actually say while also being willing to consider rTMS earlier when it is clinically appropriate.

ExoMind Doesn't Replace the Work You Are Already Doing

One of the reasons we became interested in ExoMind was something we had seen repeatedly in therapy.

People can have considerable insight and still feel stuck.

You may understand why you respond the way you do. You may know the boundary you need to set. You may have practised the strategy. You may genuinely want to change.

But understanding something and having enough capacity to consistently act on it are not always the same thing.

When rTMS is clinically appropriate, we think about its role as helping to expand capacity.

Therapy still provides the place for meaning, relationships, emotional processing, behavioural change and deciding what you actually want to do with that capacity.

ExoMind supports the brain. Therapy supports the person.

The goal isn't more treatment. The goal is greater capacity for change.

Now Think About the Other Thing She Stopped Mentioning

Let's go back to the woman who is getting through her days at considerable personal cost.

There may be something else she has adapted around so successfully that she barely talks about it anymore.

She hasn't run since having her baby because she leaks.

At first, she assumed it would get better. Then she assumed it was simply part of motherhood. Eventually, she stopped running.

She knows which exercises to avoid. She empties her bladder before leaving the house. She chooses clothes strategically. Maybe she laughs about it with friends because everyone seems to leak a little after having children.

Her life adjusted around the symptom.

That is another kind of lost capacity.

And it deserves to be understood too.

A Perinatal Perspective: “I Can Live With It” Isn't the Same as “I'm Well”

In perinatal mental-health work, we see how easy it can be for women to normalize their own reduced quality of life once the immediate demands of pregnancy and infancy have passed.

Everyone else may think the postpartum period is over.

You are back at work. Your child is growing. Maybe everyone is sleeping better. Life looks normal again.

But perhaps you don't quite feel like yourself.

Your mood isn't what it used to be. Everything requires more effort. Your body feels different. You haven't returned to activities that used to make you feel strong or alive. Intimacy may have changed. And because none of these things feels like a crisis, you keep adapting.

There can also be complicated feelings around acknowledging this.

You can love your child and miss parts of your old life.

You can be grateful for what your body did and still struggle with what has changed.

You can be functioning and still want to feel better.

“I can live with it” is not necessarily the same as “I'm well.”

This is one reason a whole-person perspective matters.

Where Emsella May Fit

Just as we don't assume every psychological struggle needs ExoMind, we don't assume every bladder symptom needs Emsella.

Leaking is a symptom. It does not tell us, by itself, exactly what the pelvic floor needs.

Some people have pelvic-floor weakness or reduced activation where strengthening is an appropriate treatment goal.

Others may have pelvic-floor overactivity, pain, difficulty relaxing, prolapse symptoms, scar concerns or another physical issue requiring a different approach.

That is why we screen before recommending Emsella.

For appropriately selected clients where pelvic-floor strengthening or activation is the goal, Emsella may provide a non-invasive way to stimulate repeated pelvic-floor muscle contractions.

For someone else, pelvic-floor physiotherapy or medical assessment may be the better starting point.

We don't begin with the technology. We begin with the person.

What If Both Things Are Happening?

Imagine that the same woman is experiencing persistent low mood or reduced mental capacity while also dealing with stress urinary incontinence.

The leaking has made her reluctant to exercise.

Exercise used to be one of the ways she managed stress and felt connected to herself.

She may feel less confident in her body or uncomfortable with intimacy.

Meanwhile, low mood and exhaustion make it harder to prioritize physical rehabilitation or another appointment.

Those concerns are now interacting in her life.

But we don't need to claim that one caused the other.

We don't need to call them different expressions of one “dysregulated nervous system.”

And we don't need a single treatment to explain everything.

If her psychological assessment suggests ExoMind is clinically appropriate, ExoMind may be considered.

If her pelvic-health screening suggests strengthening is an appropriate target, Emsella may also be considered.

She has one life. But she may have two different areas where capacity has been reduced.

Do ExoMind and Emsella Work Better Together?

We want to be clear about this.

We do not currently have clinical evidence showing that combining ExoMind and Emsella creates a special synergistic effect or makes either treatment work faster or better.

Their evidence bases are separate.

rTMS has a substantial scientific literature, particularly in depression, with research continuing across other clinical presentations and brain networks.

HIFEM technology has a growing evidence base for urinary incontinence and pelvic-floor applications.

A person may appropriately receive both because both areas of function matter—not because we have evidence that the two technologies potentiate one another.

They also do not necessarily need to happen at the same time.

Sometimes one concern needs attention first. Sometimes both can reasonably be addressed during the same period. Sometimes one of the technologies isn't appropriate at all.

More treatment is not automatically better treatment.

Brain & Body Doesn't Mean Treating Everything

Whole-person care can sound as though it means doing more.

More appointments. More treatments. More things to optimize.

That isn't what we mean.

A whole-person approach means looking broadly enough to identify where the actual bottleneck is.

Sometimes the primary work is psychological.

Sometimes biological capacity appears to be limiting progress.

Sometimes there is a physical function that needs rehabilitation.

Sometimes medication, pelvic-floor physiotherapy, medical care or another healthcare professional is the right next step.

Sometimes more than one system legitimately needs support.

And sometimes what a person is experiencing doesn't need treatment at all.

Our responsibility is to help distinguish among them.

What Does “More Capacity” Actually Look Like?

Flourishing can sound like a very big word when you are tired, overwhelmed, leaking or simply not feeling like yourself.

It doesn't have to mean transforming your entire life.

Sometimes it looks remarkably ordinary. Going for the run.

Laughing without thinking about your bladder.

Having enough left at the end of the day to actually enjoy your children.

Being able to use the boundary you rehearsed with your therapist.

Feeling interested in your partner again.

Starting the thing you have been thinking about starting for six months.

Making a decision instead of circling it again.

Waking up and noticing that life doesn't feel quite so effortful.

That is what we mean by more capacity.

The technology is not the destination.

What matters is what greater capacity gives back to you.

The Next 25 Years

Kimberly reflects:

Twenty-five years ago, I couldn't have imagined all of the tools we would have available to help our clients today.

I also can't tell you exactly what will become possible over the next 25 years.

What I can tell you is how we will approach it.

We will keep learning. We will follow the research.

We will distinguish excitement from evidence.

We will continue to invest in new treatments and technologies when we believe they can responsibly expand the choices available to our clients.

We will collaborate with other healthcare professionals when another form of care is what someone needs. And we will never recommend a technology simply because we have it.

The technology has to serve the person.

That is why Brain & Body Therapies matter so much to me.

After 25 years, our mission isn't to keep doing things the way we have always done them.

It is to keep asking what our clients need—and to make sure they have access to the best care we can responsibly provide as the science and available treatments continue to evolve.

And that is a commitment we share.

As psychologists, we believe new possibilities also bring responsibility. We need to stay curious without getting swept up in novelty. We need to understand the research, be transparent about its limitations, listen carefully to our clients and recommend care based on the person in front of us.

Because ultimately, ExoMind and Emsella aren't the story.

You are.

Maybe greater capacity means recovering from significant depression.

Maybe it means finally being able to use what you have spent months learning in therapy.

Maybe it means having enough left at the end of the workday to enjoy your children.

Maybe it means laughing without worrying about your bladder.

Maybe it means returning to running, intimacy, travel or something else you quietly gave up.

Maybe it is simply waking up one morning and realizing that being yourself doesn't feel quite so effortful anymore.

More access to your relationships.

More access to the things you enjoy.

More access to what you are learning in therapy.

More access to your body.

More access to your life.

More access to you.

That was the work of our first 25 years.

It is the work we are carrying into our next 25.

Wondering What Might Be Getting in the Way?

You don't need to know whether ExoMind, Emsella, counselling or another form of care is the right starting point before contacting us. That is our job to help you determine.

You can speak with Lauren Kaiser, our Brain & Body Therapies Care Coordinator, about what you are experiencing and what an appropriate next step might be.

When ExoMind is being considered, a psychologist completes the clinical assessment and develops the treatment plan.

When pelvic-floor symptoms suggest Emsella may not be the appropriate starting point, we may recommend pelvic-floor physiotherapy or medical assessment instead.

The treatment follows the person—not the other way around.

403-230-2959 | info@eckert-psychology.com | Book Online

About the Authors

Kimberly Eckert is a Registered Psychologist and the Founder and Executive Director of Eckert Psychology & Education Centre. Since founding Eckert Centre in 2001, she has focused on expanding what is possible in psychological care while preserving the thoughtful, relationship-based approach at the heart of the Centre. She leads the development of Eckert Centre's Brain & Body Therapies and the integration of ExoMind into psychologist-guided care.

Kymberley Calhoun is a Registered Psychologist with a particular interest in perinatal and family mental health, trauma-informed care and whole-person well-being. Her work considers how psychological health, physical experiences, relationships and major life transitions can intersect without reducing one to the other. Kymberley practices at Eckert Psychology & Education Centre in Calgary, Alberta.