This blog post is the first in a series of three posts in which I share with you some of the developmental roots of anxiety and depression. These blogs explore how anxiety and depression may be linked to how you learned to attach with others (attachment), how you developed into a distinct, separate person from your parents (separation-individuation), and how your self-esteem developed in your early years (healthy narcissism).

Blog 1 in a 3 Part Series on the Developmental Roots of Anxiety and Depression: Linking Attachment to Depression and Anxiety

We all need other people! Some of us cherish total self-sufficiency and try hard to not rely on anybody else – but we still need other people anyways. Being able to rely and depend on others can improve our mental health outcomes. In this blog, I help you understand the link between secure attachment and positive mental health.

John Bowlby, the father of attachment theory, recognized that our reliance and dependence on attachment figures exists from “the cradle to the grave.” According to attachment theory, we are hardwired to seek relationships with others to help us deal with emotional distress and stress in our lives. In the beginning, as infants, we are highly dependent on our caregivers to provide us with both physical and emotional care. When parents provide sufficient care, we go on to develop a positive sense of our self as lovable and worthwhile. We also go on to develop a sense of others as potentially trustworthy, reliable, and dependable when we are distressed and in need of physical or emotional care. As a result of their responsiveness, we become more securely attached. Secure attachment helps us develop more confidence and self-esteem because our self mattered and continues to matter to others when we are distressed. We are also more easily able to reach out for others when in need of support when facing challenging life circumstances because we remember that others can provide potential solutions to our distress. Secure attachment is a healthy antidote to stress, anxiety, and depression!

Research suggests that individuals suffering from mental health issues also tend to be insecurely attached to others. Insecurely attached individuals are less able to efficiently or effectively signal to others, or do not signal to others at all, when distressed. Developing relationships that allow for reciprocal and mutual caring is important because as humans we are not designed to be emotionally distressed and isolated. When we are alone and isolated with the stress and distress of everyday life, our mental health can deteriorate. Insecurely attached individuals cannot turn to others, or they are not effective in their efforts to seek soothing, comfort, or problem-solving responses from others. In their childhoods, their attachment figures may not have been accessible and responsive to their physical and emotional care needs. As a result of these earlier experiences involving non-responsiveness of caregivers, deep down the insecurely attached individual may feel unlovable and unworthy of care or believe that others will be unreliable, undependable, and untrustworthy when in need of support. In the present day, prolonged emotional distress and stress without a connection to others and without foreseeable solutions can contribute to anxiety and depression symptoms. Many individuals with anxiety and depression have difficulties in their attachment with others.

Clinicians at CFIR can support you to create stronger bonds in your relationships with others through an assessment of your attachment style and treatments that enhance your capacity to develop and maintain healthy relationships. Learning how to experience and express your emotions and needs to others in a safe and secure relationship is central to becoming securely attached. Being able to rely and depend on others, and develop reciprocal and mutual attachment relationships with others, is key to our mental health and wellbeing.

Dr. Dino Zuccarini, C.Psych. is CEO and co-founder of the CFIR. He has published book chapters and peer-reviewed journal articles on the subject of attachment, attachment injuries in couples, and attachment and sexuality. He has taught courses at the University of Ottawa in Interpersonal Relationships, Family Psychology, and Human Sexual Behaviour. He has a thriving clinical practice in which he treats individuals suffering from complex attachment-related trauma, difficult family of origin issues that have affected self and relationship development, depression and anxiety, personality disorders, sex and sexuality related issues, and couple relationships. At CFIR, he also supports the professional development of counsellors, psychotherapists, and supervised practice psychologists by providing clinical supervision.

When was the last time you messaged a relative on Facebook, Snapchat-ted a friend, liked a picture on Instagram, or tweeted a thought? It’s highly likely you have used one of these social media platforms to engage with people in the world around you.

The rise of social media has undeniably been observed across the world. As human beings we are apparently more connected than ever before. The advantages of social media are numerous, including increased connectedness, visibility, and availability of information. For most, social media has become an integral part of their daily routines.

Despite its advantages, studies increasingly have demonstrated a link between social media use and poorer mental health. For instance, a recent study randomly assigned 143 undergraduate students into two groups. One group was asked to maintain their regular use of Facebook, Snapchat or Instagram, and the other group was asked to limit the use of each platform to 10 minutes per day for a maximum of 30 minutes per day. As expected, the results suggest that people who limited their time spent on social media showed significantly less depression and loneliness after a three-week period. This can possibly be explained by the reduction in comparing oneself to others on social media, and thus, feeling more positive about oneself. 

Even though social media is a great way to stay connected with others, reducing the usage of social media has the paradoxical effect of helping people feel less lonely and depressed. I therefore challenge you to experiment yourself by limiting your time spent on social media and noticing the benefits it can bring you. 

Mathilde Theriault, B.A. Hons., is a clinical psychology resident at the Centre for Interpersonal Relationships (CFIR) in Toronto and a candidate in the Doctor of Psychology program (Psy.D.) at the Universite de Moncton in New Brunswick. She provides psychological treatment and assessment services to individual adults and couples in the areas of depression, anxiety and stress, trauma, personality disorders, and relationship difficulties.

Our emotions and thoughts can sometimes take over our minds in ways that are not helpful for us, and that can make us feel uncomfortable or distressed. Responding to situations and ourselves in kind and compassionate ways can allow us to feel safe and create a space to respond to our needs. Self-compassion can enable us to let go of self-criticism, and to respond to our critical thoughts in a supportive and caring manner. 

Next time you notice distressing thoughts and emotions arising in your mind, you may try the following to help yourself through in a self-compassionate way. Think of what you can say to yourself that is kind and soothing. Or, think of what you would say to a good friend when they are in distress and try applying that to yourself. Or, consider what a good friend might say to you during difficult times. For example, try these statements: “It’s okay for me to feel this way,” “I know this is difficult, but it will pass,” ; “I know it is scary, but I am here to keep you safe.” 

Don’t forget that you can comfort yourself physically, too. You might gently rub your chest or hold your hand. You may go for a nice walk, take a long bath, and change into comfortable clothes. It’s essential to stay kind and gentle towards yourself.

Dr. Khuraman Mamedova, C.Psych. is a psychologist in supervised practice at the Centre for Interpersonal Relationships (Toronto). She works with adults in psychotherapy, to support them to overcome difficulties related to mood and anxiety disorders, psychosis, trauma-related experiences, and relationships. She has completed research on the relationship between clients and therapists in psychotherapy.

These days, finding the ‘right’ therapist can be an involved process. Part of the challenge is that there are so many distinct kinds of psychotherapy. Some of the better-known forms of therapy include cognitive-behavioural therapy (CBT), psychodynamic therapy, and client-centered therapy. With so many different approaches, you may find yourself wondering, “How do I know which approach is right for me?”

Fortunately, therapists at the Centre for Interpersonal Relationships (CFIR) are trained in a wide array of major therapeutic approaches. Moreover, many therapists increasingly recognize the value that each approach brings. For instance, CBT can help people develop healthier ways of thinking and behaving, while psychodynamic therapy can help clients better understand their personality and improve their relationships. So, it’s easy to wonder, “Why not take advantage of both approaches?“

Great question! In light of the unique strengths of each form of therapy, therapists are increasingly incorporating elements of different approaches to meet the individual needs of clients; this practice is referred to as ‘integrative therapy.’ In essence, integrative therapy is an evidence-based approach that makes use of the wisdom and tools contained in a variety of other psychotherapy traditions. Importantly, there is also excellent research demonstrating the high value and effectiveness of integrative therapy.

There’s an interesting quote that I believe nicely illustrates the flexible and adaptive nature of this approach:

“If all you have is a hammer, everything looks like a nail.”

Abraham Maslow

By taking advantage of the rich diversity of tools found in the best approaches to therapy, integrative therapists can flexibly respond to the diverse challenges and concerns that clients face. As a result, clients often report feeling understood as a person, instead of as a diagnosis or problem. So, if you’re wondering which type of therapy is right for you, integrative therapy might be just what you’ve been seeking.

Adam Blake, M.Sc., is a therapist at CFIR’s Toronto location. Adam provides individual therapy with adults who struggle with anxiety, panic, OCD, depression, trauma, dissociation, attention deficits, issues related to sexuality and relationships, self-worth, assertiveness, spirituality, and vocational/work concerns. His approach to psychotherapy is integrative and draws on empirically-supported principles from well-established traditions, including humanistic, existential, cognitive-behavioural, psychodynamic, and acceptance and commitment therapy.

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.