Shame…everyone experiences it, but few talk about it. Brené Brown describes shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.” Experiencing shame can be unbearable, as it can often be felt with overwhelming intensity and power.

Shame is like a snowball, forming in childhood from our first experiences of feeling unlovable and unacceptable from unmet emotional needs from important others. The shame snowball builds throughout our lives with every experience similar enough to our earlier experiences. When toxic shame remains inside us, it can lead to depression, anxiety, low self-esteem, and many other psychological or relationship difficulties.

We have many protective psychological responses to shame that have developed along with the emotion itself. We can become critical of ourselves. We can withdraw from others, or detach from ourselves through self-harm and alcohol. We can attack others with our shame. Although these reactions serve a purpose, being that they relieve the intensity of shame at the moment, they do not help us very well in the long run. These protective reactions weaken our relationships and our sense of identity and self-esteem, which ultimately blocks us from living authentic lives and building strong relationships.

The first step in healing shame is to acknowledge shame experiences at the moment they are occurring. Once we’ve acknowledged our shame experience to ourselves, we can then speak about it with trusted others. Most importantly, we must be kind and build compassion toward ourselves in these moments of pain and struggle to heal the shame inside.

Therapists at CFIR can help you to heal the shame experiences that may be at the root of your anxiety and depression or that cause difficulty in your intimate relationships. We are here to help!

Whitney Reinhart, R.P. (Qualifying) is a qualifying registered psychotherapist, at the Centre for Interpersonal Relationships (CFIR) in Toronto. She supports adult and couple clients with a wide range of difficulties related to depression, anxiety, traumatic experiences, and interpersonal conflict.

by: Erin Leslie, Coach, EQ-i Certified

You’ve pretty much landed the job, but now you need to pass the reference check portion. Providing references to a future employer is critical to landing the job and on the right foot. 

An endorsement is a natural validation of past job(s) well done. 

How do you ensure you’re choosing the right references?

1. Request to meet with your reference so you can go over the job opportunity that you applied to and discuss your expectations of their review of you.
2. Be sure you are approaching the right people who can describe sufficient firsthand knowledge of your work patterns and achievements, to adequately speak on your behalf.
3. Make sure to validate your level of comfort and confidence with their responses on your work ethic and value. Know that they are evaluating their role in your process, their level of confidence to support you, needs to be high.

Ahead of ever needing a reference – know that all references are formed on your ability to build and maintain effective relationships. 

If you find yourself having trouble thinking of an adequate reference, it might be time to have a closer inspection of your self-awareness and interpersonal skills. 

Performing an EQ-i assessment of your emotional intelligence can help shed some light on potential blinders. Ask a coach to provide this assessment.

For more essential tips on the steps to take to support your reference check phase of the hiring process, click here to review eight mistakes to avoid when engaging your references.

Erin Leslie is an Associate of the Career Coaching and Counselling Service as well as the Career & Vocational Assessment Service at CFIR (Toronto). Erin is certified in emotional intelligence assessment (EQ-i 2.0) and is President of President, EQFootprints. She is a professional who supports clients with professional preparations in leading their careers, breaking down problems in specific projects, teaching team dynamic tools, creating effective professional branding and networking essentials. Erin currently works under the direct supervision of Dr. Dino Zuccarini, C.Psych.

by: Reesa Packard, M.A., Ph.D., R.P.

What is grief?

Grief is the emotional, bodily, cognitive, spiritual, and/or relational impacts of any important loss. The loss can be obvious, like the death of a loved one, or subtler, like a small or big shift in life circumstances. 

Lots of people find grief to be very difficult – if you feel unable to function normally in the aftermath of losing someone or something that you cherish, or are very used to, know that this is a common feeling. Some people react to the intense emotions of grief by trying to ignore them or push them away. This strategy rarely works in the long-term though, since grief is a process that we just cannot run from – like a storm, it cannot be derailed, but instead, has to run its course. 

Why is grief so hard?

Grief can be like a storm also in the sense that it rushes in – sometimes by great surprise – and ravages some or all of what we had previously known as ‘normal’. The grief storm can bring crashing waves of anger, sadness, and guilt. These emotional waves can be big, and frequent, and unpredictable. During and after the storm, it is easy to feel overwhelmed and disoriented. 

To get through the grief storm, we have to actively care for ourselves in it, which takes work. There is a decent payoff for this work, though: if we can manage to do this, then those big, crashing waves of emotion can gradually become less intense, less frequent, and more predictable. While the loss itself never goes away, the pain it brings can become easier to tolerate. Over time, we can begin to find ways to re-build a new normal. 

So, how can we weather the storm well?

Striking the right balance between connecting to difficult emotions and also taking regular breaks from them, is key. 

To connect with the difficult emotions, you can try any strategy that will help you feel and release the emotions, such as taking in a moment of silence with yourself either in stillness or while moving, journaling or drawing about the feelings, or sharing the feelings by talking to a good friend or a therapist; find ways to let it out. 

To take a break from the emotions, you can try any strategy that can re-resource you, remind you of a different perspective, or shift your experience, such as engaging in hobbies or activities that you typically enjoy. This might include social, creative, active, spiritual, or deep experiences; find ways to be a bit more okay, even just for a minute or two. 

Remember that everyone grieves differently and that your needs are likely to vary from moment to moment, and situation to situation. The process of learning to weather the grief storm well is less about doing any one specific thing, and more about exploring, and learning about yourself and what you might need. While the balancing of feeling emotions and taking breaks from them can be important, how you go about balancing these will be specific to you. Grief storms can be hard, and anything you do to get through them, that also supports your overall wellness (or doesn’t take too much away from it), can be absolutely okay. 

Take good care.

Reesa Packard is an Associate at CFIR. She has a doctoral degree from the Saint Paul school of Psychotherapy & Spirituality and works in private practice as a registered psychotherapist. She works with clients hoping to develop a more integrated sense of self as a means to well-being and meaningful, lasting transformation. Reesa is also involved in teaching and supervision of psychotherapists-in-training and advanced knowledge through research in her specialty fields.

by: Sarah G. Bickle, B.A. (Hons.)

For many women, orgasm and sex don’t necessarily go hand in hand. Only one-quarter of women “reliably” orgasm during sex and, on average, say that orgasms are their 15th motivator for sex – following motivators such as an expression of attraction or love, a desire to feel good or have fun, and a desire to please and feel closer to their partner. 

No more is orgasm an essential part of a woman’s typical sexual interaction than it is limited to it; in fact, women report having orgasms during all kinds of experiences – such as sleep, meditation, breastfeeding, assault, and medication-induced states. What’s more, not all women experience orgasms the same way. For example, 70% report feeling an orgasm throughout their entire body, 47% are multi-orgasmic, and 77.5% find that sometimes they have orgasms that are better than others. 

So, what features are important to a good orgasm? More than half of women agree that spending time to build arousal (77.2%), having a partner who knows what they like (58.6%), and emotional intimacy (55.5%), significantly contribute to a good orgasm. The possibilities of what leads to intense orgasmic experiences, however, are vast and highly detailed. For example, 39% of women find that clitoral stimulation is essential for the quality of their orgasm. The specified preferences for this source of pleasure alone can be highly variable among women with respect to: 

• location (e.g., mons pubis, hood, left side of the clitoris, direct, etc.), 
• pressure (e.g., light, firm, consistent, variable, etc.), shape/style (e.g., side to side, circular, tapping, flicking, squeezing, etc.), and 
• pattern (e.g., rhythm & repetition, alternating between motions, teasing & delaying, consistency, etc.).

The obstacles many women face regarding reaching their full orgasmic potential are undoubtedly affected by the lack of education and shame that has been produced by our cultural history. When research shows that most men and women agree that it is the responsibility of the male to stimulate the female to orgasm, and 43.9% of men cannot locate the clitoris on a diagram, many women inevitably reach an impasse. Fortunately, however, the study of female sexuality and education is growing, and research and clinical work with sexuality are helping many women become more empowered to take on an active role in closing this orgasm gap! 

The Relationship and Sex Therapy Service at CFIR offers clients comprehensive assessment, psychotherapy, and counselling to address a wide range of relationship and/or sexual issues for both individuals and couples. Through treatment, we will help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills, and address sexual issues that interfere with sexual satisfaction and fulfillment, regardless of sexual orientation. 

Read more about our Relationship & Sex Therapy Treatment Service. 

Sarah Bickle, B.A., is a counsellor at the Centre for Interpersonal Relationships, working under the supervision of Dr. Dino Zuccarini, C.Psych, and is currently completing a Masters of Clinical Psychology at the Adler Graduate Professional School in Toronto. Sarah works with adults in psychotherapy to support them to increase emotional wellness and resolve depression, trauma-related symptoms, and interpersonal difficulties.

by: Natalie Guenette, M.A.

Stigma is a negative judgment and stereotype that brings people to feel ashamed, dismissed and dehumanized. People can be stigmatized by family, friends, colleagues, in social media, and sometimes even by health professionals. It changes how people see and feel about themselves, but also how other people see them. People living with mental health and substance use issues can be profoundly affected by stigma. They can isolate themselves for fear of being judged, which can bring them to have low peer support. It can prevent people from disclosing a mental health diagnosis and increase suicide risk.

Stigma is one of the greatest barriers to help-seeking and treatment, which can delay diagnoses and treatment options for people affected by stigma, however, there are ways to change this.

1. Educate yourself and others around you by asking questions and doing research: you can visit http://www.camh.ca/or https://www.canada.ca/en/public-health/topics/improving-your-mental-health.html for informative resources;
2. Be mindful of the language you use to talk about mental health and substance use (i.e. non-judgmental, inclusive and respectful language);
3. Be aware of your attitudes and opinions: upbringing and society can influence your views on mental health and substance use; and
4. Speak up when you hear or see something that is stigmatizing: people do not always realize the impact they have on others and it is sometimes a question of not knowing all the facts about certain topics.

Clinicians at CFIR provide evidence-based treatments to individuals from an array of backgrounds based on their needs and personal differences. We continue to stay informed about leading-edge research related to the presenting issues of the clients who come to our offices.

Natalie Guenette, M.A., is a counsellor at the Centre for Interpersonal Relationships (CFIR) in Ottawa. She employs treatments that include aspects from Cognitive-Behaviour Therapy, Mindfulness-based Therapy, Motivational Interviewing, and Psychodynamic Theory, and she has an interest in working with adults experiencing a diversity of psychological and relationship issues. Natalie is currently completing a Master of Arts in Counselling Psychology at Yorkville University. At CFIR, she is under the supervision of Dr. Karine Côté, C.Psych.

References

Canadian Mental Health Association. (n.d.). Stigma and Discrimination. [online] Available at: https://ontario.cmha.ca/documents/stigma-and-discrimination/ [Accessed 29 Nov. 2019].

Centre for Addiction and Mental Health. (n.d.). Addressing Stigma. [online] Available at: https://www.camh.ca/en/driving-change/addressing-stigma [Accessed 29 Nov. 2019].

Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum, 30(2), 111–116. doi:10.1177/0840470416679413

Mental Health Commission of Canada. (2019). Stigma and Discrimination. [online] Available at: https://www.mentalhealthcommission.ca/English/what-we-do/stigma-and-discrimination [Accessed 29 Nov. 2019].

Many people struggle with being assertive or setting boundaries. The prospect of setting limits or asserting that your needs be met can provoke anxiety as this may require some form of aggression or expression of anger on your behalf. Aggression and anger – in proper measure – can help clearly signal to others what you’re willing to tolerate and is implicated in your capacity to take up space when it’s appropriate.

Some people disavow their aggressive drives – because of conditioning within the family or the broader cultural surround – as they fear that it may negatively affect how others see them or even how they see themselves. However, disclaiming anger or aggressive drives when it may be needed doesn’t mean that these parts of you vanish; instead, it accumulates within, and it may eventually be experienced as resentment and bitterness toward others and the world. Indeed, many clients I see who attempt to preserve relationships by disavowing their need to set boundaries or assert themselves, swiftly cut people out of their lives. Or they displace their anger onto “safe” relationships that are ultimately not the source of their frustration. Others may direct their anger inward, which mutates into a nasty self-critic that sometimes ends in them physically hitting themselves in frustration.

Another common outcome for people-pleasers or non-asserters is burnout. Habitually prioritizing others’ needs over one’s own is untenable and may lead to exhaustion and symptoms of depression. During burnout, their identity as someone useful and helpful is compromised, making their dominant ways of maintaining closeness and connection unavailable to them. This experience can further exacerbate distress, as people in this situation often feel unable to communicate their needs to others – the language to do so may elude them.

Therapy can help people like the ones described above to understand the context of their people-pleasing habits. Everyone is born ready to assert their needs in the world. But, in a global sense, your experiences will shape your attitudes regarding whether being assertive is perceived as negative. Understanding how you went from being an infant who only knew how to need to someone who disavowed your needs can help reorient you to a more moderate space where you can set appropriate boundaries, and where a reciprocal exchange of needs with others is possible.

Mental health professionals at CFIR can also support you in addressing problems often associated with perfectionism, including anxiety, depression, anger, eating disorders and relationship problems.  Contact us to inquire more and to begin or continue on your journey toward making yourself and your mental health a priority.

Dr. Sela Kleiman, C.Psych. (Supervised Practice) is a psychologist in supervised practice at CFIR’s Toronto office. He has provided clinical and assessment services in a variety of settings such as the Centre for Addiction and Mental Health, the McGill Psychoeducational and Counselling Clinic, and the Health and Wellness Centre within the University of Toronto. He has alsoI completed his Ph.D. in clinical and counselling psychology at the University of Toronto. In individual therapy, he help adults struggling with depression, anxiety, grief, as well as those trying to cope with the effects of past and/or current verbal, emotional, physical, and sexual abuse.

by: Stephanie Azzi, B.A., Counsellor

Humans are social beings; we all rely and depend on the support of others to help us deal with the difficulties we encounter in everyday life. Social support is a concept that encompasses the physical and emotional support we receive from our surrounding social worlds (e.g., our cities, neighborhoods), as well as from our personal relationships. We may receive social support from romantic partners, relatives, friends, coworkers, as well as from our social and community ties (Taylor, 2012). 

To better understand what effective social support looks like, it is important to look at two aspects of social support: received social support and perceived social support. Received social support refers to the emotional or physical support that is provided to a person by others, usually in a specific context or situation, and that is not always appreciated by this individual receiving it (Uchino, 2009). Perceived social support refers to a person’s beliefs about how available support is to them when they need it, and to how much they believe they are receiving it in different situations (Uchino, 2009). 

Social support can have positive effects on our physical health (e.g., reduces the risk of mortality; Holt-Lunstad, Smith & Layton, 2010) and on our mental health (e.g., reduces anxiety; Harandi et al., 2017); however, not all social support appears to be beneficial at all times. Whether or not social support is positive and beneficial appears to depend on various aspects of the support, such as who provides it and whether it is considered appropriate for the situation (Taylor, 2012). Certain forms of support may be more valued when they are provided from different individuals. For example, emotional support (i.e., providing empathy, affection and caring towards someone; Kent de Grey, Uchino, Trettevik, Cronan, & Hogan, 2018) seems to be most appreciated when received by close family members, spouses, and friends but may be perceived as unhelpful and unwanted from acquaintances (Dakof & Taylor, 1990). 

While we all need some form of social support as we deal with the vicissitudes of life, when reaching out for certain types of social support it is important that we consider who you are reaching out to and what type of support you are needing.

Stephanie Azzi, B.A., is a Ph.D. student in the Clinical Psychology program at the University of Ottawa. She is currently completing a practicum at the Centre for Interpersonal Relationships (CFIR) in Ottawa, under the supervision of Dr. Dino Zuccarini, C.Psych. Stephanie works with individual adults and couples, providing psychological assessment and treatment services for a wide range of presenting issues including depression, anxiety, and interpersonal difficulties.

What is Non-Suicidal Self Injury?

Non-suicidal self-injury (NSSI), commonly described as self-harm, involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. Typically, when we think of NSSI we think of individuals who cut, burn, punch, or pinch themselves. In the psychological literature, these behaviours are referred to as direct NSSI. In an ideal setting, individuals who engage in self-harm behaviours either independently seek out psychological support in the form of therapy, or are noticed to be engaging in self-harm by individuals close to them and are encouraged to seek help at that time.

Indirect NSSI

However, individuals can also engage in other self-harm behaviours that are not as clearly noticed by others, since the methods of self-harm do not directly lead to bodily damage. These behaviours are termed indirect NSSI. 

‘Indirect’ methods of NSSI can include:

• Involvement in abusive relationships
• Substance abuse
• Risky or reckless behaviour (e.g., reckless driving, bar fights, unsafe sexual practices)
• Intentionally putting one’s body into physical danger (e.g., ‘daredevil’ acts)
• Disordered eating behaviour

Since these activities are not often identified as self-injury, and can even be missed as warning signs by therapists, hospitals, and primary care physicians, it is crucial to notice problematic behaviours before their severity increases.

Men and Self-Harm

For a variety of reasons, individuals who identify as male are more likely to engage in indirect self-harm than those who identify as female (St. Germain & Hooley, 2012; Hooley & St. Germain, 2014). One such reason that has been proposed is that behaviors that have often been labeled as traditionally male expressions of anger and frustration sometimes contain indirect forms of NSSI (e.g., punching walls, picking fights with others, overconsumption of drugs and alcohol; Green & Jakupcak, 2016). Adherence to these traditional male gender norms is also associated with difficulties articulating thoughts and feelings, which can further increase an individual’s risk of engaging in self-harm (Levant et al., 2003). As a result, some men might not readily identify the intentionality behind some of the harmful actions described above.

Finding Help

Psychologists and therapists at CFIR are able to diagnose and guide the treatment related to direct and indirect self-harm for all individuals. We provide support to children, adolescents, adults, couples, and families who themselves struggle with self-harm, or have loved ones who do. We help clients establish solid networks of physical and emotional care and support. We also provide specific psychological treatment for individuals who self-harm, supporting them through the cascading negative emotions that may precede or accompany instances of self-harm.

Dr. Brent Mulrooney, C.Psych. is a psychologist in supervised practice at CFIR (Toronto). He has substantial interest and treatment experience in the realm of family functioning and relationships, anxiety and mood disorders, work and school success, addictions, violence (especially violence in the home), trauma, and gender identity and sexuality. Brent holds a PhD in School and Clinical Child Psychology from the University of Toronto, as well as a Masters degree in Applied Social Psychology from Memorial University of Newfoundland.

by: Brent Mulrooney, M.A.S.P., Ph.D. Candidate

What is Non-Suicidal Self Injury?

Non-suicidal self-injury (NSSI), commonly described as self-harm, involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. Typically, when we think of NSSI we think of individuals who cut, burn, punch or pinch themselves. In the psychological literature, these behaviours are referred to as direct NSSI. In an ideal setting, individuals who engage in self-harm behaviours either independently seek out psychological support in the form of therapy, or are noticed to be engaging in self-harm by individuals close to them and are encouraged to seek support at that time.

Indirect NSSI

However, individuals can also engage in other self-harm behaviours that are not as clearly noticed by others, since the methods of self-harm do not directly lead to bodily damage. These behaviours are termed indirect NSSI. 

‘Indirect’ methods of NSSI can include:

• Involvement in abusive relationships
• Substance abuse
• Risky or reckless behaviour (e.g., reckless driving, bar fights, risky sexual practices)
• Intentionally putting one’s body into physical danger (e.g., ‘daredevil’ acts)
• Disordered eating behaviour

Since these activities are not often identified as self-injury, and can even be missed as warning signs by therapists, hospitals, and primary care physicians, it is important to notice problematic behaviours before their severity increases.

Men and Self-Harm

For a variety of reasons, individuals who identify as male are more likely to engage in indirect self-harm than those who identify as female (St. Germain & Hooley, 2012; Hooley & St. Germain, 2014). One such reason that has been proposed is that behaviors that have often been labeled as traditionally male expressions of anger and frustration sometimes contain indirect forms of NSSI (e.g., punching walls, picking fights with others, overconsumption of drugs and alcohol; Green & Jakupcak, 2016) Adherence to these traditional male gender norms is also associated with difficulties articulating thoughts and feelings, which can further increase an individual’s risk of engaging in self-harm (Levant et al., 2003). As a result, some men might not readily identify the intentionality behind some of the harmful actions described above.

Finding Help

Psychologists and therapists at CFIR are able to diagnose and guide the treatment related to direct and indirect self-harm for all individuals. We provide support to children, adolescents, adults, couples, and families who themselves struggle with self-harm, or have loved ones who do. We help clients establish solid networks of physical and emotional care and support We also provide specific psychological treatment for individuals who self-harm, supporting them through the cascading negative emotions that may precede or accompany instances of self-harm.

Brent Mulrooney, M.A.S.P. is a therapist at CFIR (Toronto). He has substantial interest and treatment experience in the realm of family functioning and relationships, anxiety and mood disorders, work and school success, addictions, violence (especially violence in the home), trauma, and gender identity and sexuality. Brent is nearing the completion of his doctoral degree in School and Clinical Child Psychology at the University of Toronto.

by: Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice)

We’re used to thinking about depression in terms of its symptoms: for example, depressed mood, inability to feel pleasure, sleep disruption, and loss of appetite, weight, and/or sexual desire, among others.

But, have you ever thought about there being two types of depression? 

Some mental health professionals have begun to focus not just on symptoms, but also on the everyday life experiences associated with depression: feelings of loss and of being abandoned and unloved on the one hand, and feelings of worthlessness, failure, and guilt on the other.

Based on these two different experiences related to depression, Sidney J. Blatt, a professor emeritus of psychiatry and psychology at Yale University’s Department of psychiatry, along with his colleagues, distinguished two types of depression.

One type of depression is the “relational” type, sometimes called the “anaclitic” version, from the Greek word for “to lean on.” Typically, this depression is characterized by feelings of loneliness, helplessness, and weakness, as well as intense and chronic fears of being abandoned and left unprotected and uncared for.

The other type of depression is the “self-critical” type, sometimes called the “introjective” type. Typically, it’s characterized by feelings of unworthiness, inferiority, failure, and guilt. Introjectively depressed individuals engage in harsh in scrutinizing and evaluating themselves. They have a persistent fear of criticism and of losing the approval of others.

Not only do these two types of depression reflect two different internal experiences of depression – “I’m empty, I’m hungry, I’m lonely, I need a connection” (relational) versus “I’m not good enough, I’m flawed, I’m self-indulgent, I’m evil” (self-critical) – they also indicate different therapeutic needs.

Research shows that those who are relationally depressed are more responsive to the supportive interpersonal or relationship aspects of therapy. In contrast, those who are introjectively depressed are more responsive to the interpretive or explorative elements of the treatment process. A mental health therapist who understands different types of depressive experiences can help a range of depressed individuals understand themselves better and also overcome the difficulties that come along with depression.

Psychotherapists at CFIR can support you to deal with your negative beliefs of self and other, and the relentless characteristics that might be at the root of your depression. We integrate cognitive-behavioral, mindfulness and acceptance and commitment, and psychodynamic-based approaches to help you deal with the thinking that might be contributing to your depressed moods.

Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice) is a psychologist in supervised practice at the Centre for Interpersonal Relationships (CFIR) in Toronto. Dr. Vasilovksy works with adult and couple clients from an integrative therapeutic perspective, and helps them overcome difficulties related to depression and mood, anxiety and stress, trauma and PTSD, interpersonal conflict, major life transitions, and identify-related struggles.