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.

Life can seem like a circus at times. We can feel like we are goofy clowns needing to always act silly or angry lions having to growl at everything. We could feel like brave acrobats, smiling in the face of danger, but needing to engage in death-defying stunts. We could feel like cyclists trying to balance on one wheel, contortionists trying to fit into impossible spaces, jugglers keeping all the balls in the air at once, or majestic elephants dancing to others’ tunes. Most of the time, we feel like ringmasters trying to keep all our different acts running smoothly, as part of a big show.  

Life presents its challenges in a similar vein. Sometimes our needs are about doing better in some areas, like managing our time and achieving the goals we have set for ourselves. At other times, we want to reduce our distress by managing our difficult emotions or problematic behaviours, like addictions. Deeper still, we need help with understanding our unhelpful patterns or in dealing with relationship issues. We could need help with managing our social situations or our physical pain. We might wish to work on our issues as individuals, or as parents, couples or families. We might need assistance in coming to terms with traumatic issues that happened decades ago, or yesterday. Perhaps we need to find ourselves, our identities, or our own answers to life’s challenging existential and spiritual questions. Often, we can feel that we are trying to manage more than one of these challenges, again as part of some big show. 

Psychotherapy is a framework that attempts to be an answer to these varied questions and challenges that present themselves to us. Psychotherapy can be the big tent, the space where all these different roles, problems, needs, wants and desires reach awareness, exploration, discussion, insight, and resolution. People often view psychotherapy as applicable only to others and not to their own problems. We often experience ambivalence about psychotherapy, with one part our self moving towards getting help, while another part wanting to avoid it at the same time. There are too many preconceived notions and stigmatizing ideas about psychotherapy in the media and culture around us to list here. Needless to say, such notions and ideas hurt rather than help. As discussed above, psychotherapy remains an important framework for a wide range of life’s problems. The various styles and techniques of psychotherapy, such as psychodynamic therapy, CBT, Rogerian client-centered therapy, ACT, DBT, EFT, IFS, mindfulness-based therapies, and so on, address one or more of these complex problems. Experienced practitioners can integrate many different styles of psychotherapy to tailor the treatment to each individual for addressing their scope of problems. If someone has even a dim awareness that their problems would be helped by talking to someone, they should seek professional help for their own unique issues. Psychotherapy is a big tent, and in a skillful and meaningful way, it addresses the challenges of life at many levels. It helps us to live and work freely, it helps the show to go on.

Dr. Ashwin Mehra, C.Psych. is a psychologist at the Centre for Interpersonal Relationships (CFIR). He provides psychological assessment and treatment services to children, adolescents, adults, couples and families, and supports them to understand and overcome a wide range of difficulties related to anxiety and mood disorders, traumatic experiences, substance use and addictions, and interpersonal difficulties.

by: Valery Vengerov, M.Psy. R.P.(Qualifying)

One of the most common experiences that couples report having after an unresolved argument is the daunting, heavy silence that follows. The lack of resolution of an argument leaves each partner feeling misunderstood and often in a state of resignation. Each partner might think: “I give up. He/she will never understand me. Why even bother? I’ll deal with this on my own.” This lingering silence can be a protest. The longer and more frequently couples remain in this space of estrangement from one another, the more stressed and dissatisfied they become with their relationship as a whole (Liu & Roloff, 2015). Resentment builds, and distance develops as the ‘couple’ unit starts to feel unsafe. 

In therapy, couples have the opportunity to safely share the accumulated hurt and resentment that underlies and results from these silences, and that threatens their relationship. They can experience the relief that comes with being heard and listened to. They also find out more about their partner, who becomes more accessible and available to them as a result of therapy. Couples can learn how to repair conflict faster and more effectively in therapy, and reduce the amount of time they spend feeling disconnected and resentful of one another (Gordon & Chen, 2016).

Whatever challenges you and your partner want to address in couples therapy, improving communication is vital.

Evidence- and science-based couples therapy will help both of you to define your thoughts, feelings, and desires to each other with openness and empathy.

A therapist in CFIR’s Relationship and Sex Therapy team can also help you to arrive at a better understanding of each other’s point of view. You can collaboratively set your treatment goals to ensure that you or you and your partner’s concerns and needs are adequately addressed.

References

Gordon, A. M., & Chen, S. (2016). Do you get where I’m coming from?: Perceived understanding buffers against the negative impact of conflict on relationship satisfaction. Journal of Personality and Social Psychology, 110, 239-260.

Liu, E., & Roloff, M. E. (2015). Exhausting Silence: Emotional Costs of Withholding Complaints. Negotiation and Conflict Management Research, 8, 1, 25-4.

Valery Vengerov, M.Psy., R.P. (Qualifying), is a Registered Psychotherapist (Qualifying) at the Centre for Interpersonal Relationships (CFIR) in Toronto. She works with individual and couples clients, to help them resolve a wide range of difficulties related to depression, stress and anxiety, trauma and loss, and relationship conflict and betrayals.

by: Alice Lurie, M.A., R.P.

Are you struggling in your new stepfamily? It is important to ensure that all stepfamily members have reliable information about what is typical in stepfamilies and how to work toward building healthy stepfamily dynamics. Stepfamily success is built on strong one-on-one relationships before strengthening the larger stepfamily system. Specifically, the couple relationship and the parent-child relationship need to be stabilized before other step relationships are focused on. Often, solutions to step-issues are about finding a middle ground and having empathy and compassion. This is especially important as step-relationships tend to accentuate and polarize differences in families (Papernow, 2013)

In some ways, stepfamilies do not function the same as nuclear families do yet many stepfamily members enter into their new family relationships with hopes or dreams of “returning to a normal” life pathway that was disrupted by death or divorce (Papernow, 1993). The more tightly stepfamily members hold on to expectations that may not apply any longer, the harder they will experience stepfamily formation and the more likely they are to experience significant difficulties in it. Building realistic expectations based on information about how stepfamilies function most effectively is important.

Stepfamilies tend to have more conflict than first families (Martin, 2009). This is distressing for adults and children alike, and can leave the adults more likely to give up before the family has had a chance to stabilize if they are unaware of this dynamic (Hetherington 1988). At times it can be challenging to integrate a step-parent into a child’s life. The manner of integration is crucial to how this relationship will evolve. Clinicians at CFIR are skilled in providing support to develop a healthy blended family environment.

References

Hetherington, E. M. (1988). Parents, children, and siblings six years after divorce. In R. Hinde & J. Stevenson-Hinde (Eds.), Relationships within families (pp. 55–79). Cambridge, England: Cambridge University Press.

Martin, W. (2009). Stepmonster (1st ed.). New York, NY: Houghton Mifflin Harcourt.

Papernow, P. (1993). Becoming a stepfamily (1st ed.). San Francisco, CA: Jossey-Bass.

Papernow, P. (2013). Surviving and thriving in stepfamily relationships: what works and what doesn’t (1st ed.). New York, NY: Routledge.

Alice Lurie, M.A., R.P. is a registered psychotherapist at the Centre for Interpersonal Relationships (CFIR) in Ottawa. She works with adults and couples to support them to relieve distress and overcome difficulties related to anxiety and stress, depression and grief, anger management and emotional regulation, and career and workplace issues.

by: Dr. Karine Côté, D.Psy., C.Psych. 

Do you have a hard time falling asleep? Do you wake up frequently during the night? Do you tend to wake up too early? Do you feel like your sleep is never really restful? You are definitely not alone! According to the American Academy of Sleep Medicine, about 30% of adults experience occasional insomnia, and 10% of the population suffers from chronic insomnia. 

The impacts of sleep difficulties on our psychological and physical functioning are diverse. They can include mood fluctuations, increased stress and irritability, problems with concentration and motivation, low energy and fatigue, an upset stomach, and muscle tension and headaches. Fortunately, there are strategies that can help improve your sleep quality. 

1. Practice sleep hygiene

Limit coffee, tea, and sugar intake after 3 PM. Eat your dinner and exercise at least two hours before your bedtime. Your bedroom should be comfortable and quiet, and try to limit looking at electronics, screens, and alarm clocks while in bed.

2. Implement a sleep routine

Maintaining a consistent routine throughout the week is vital. Ideally, your bedtime and wake-up time should be the same every day, even on weekends! 

3. Limit time spent in bed to sleeping

Time spent in bed should be reserved for sleeping (and romantic activities) only. Activities such as watching TV or reading in bed can contribute to your sleep difficulties. It is, therefore, more beneficial to engage in these activities in a comfortable space outside of your room and go to bed only when feeling sleepy. 

4. No napping

It is often tough to resist napping when we feel tired. However, to give you the best chance of sleeping during the night, eliminating any length of napping is essential.

5. Regulate your anxiety

Our sleep difficulties are often related to anxious thoughts that are hard to control. Writing them down before bedtime can help release anxious feelings, while also being reassured that your thoughts are not forgotten in the morning!

Consistently practicing these strategies will give you the best chance to overcome your sleep difficulties. However, if these tips do not work and insomnia persists, don’t be discouraged! Cognitive-behavioral therapy (CBT) offered in psychotherapy can help you regulate your sleep and provide beneficial effects that last well beyond the end of treatment. Don’t hesitate to reach out to Centre for Interpersonal Relationships for support – it is time to prioritize your sleep and regain restful nights! 

Dr. Karine Côté, D.Psy., C.Psych. is a psychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Côté provides psychological services to individual adults and couples experiencing a wide range of psychological and relationship difficulties related to mood and anxiety disorders, trauma, eating disorders, sleep disruptions, and interpersonal betrayal. She works from a humanistic approach and integrates therapeutic techniques from gestalt and object relations psychotherapies, emotion-focused therapy (EFT), and cognitive-behavioral therapy (CBT).

 by: Dr. Meg Aston-Lebold, C.Psych

Intelligence has traditionally been defined as the ability to acquire and apply knowledge and skills. We often see it represented by an Intelligence Quotient (IQ) score. However, there is growing research indicating that emotions also play an influential role in learning. For centuries, philosophers have contemplated intelligence as more complex than cognitive capacity: 

“All learning has an emotional base.”

Plato

In response to this missing piece, the concept of Emotional Intelligence (EI) has been suggested as a complement to traditional IQ and, as such, has been affectionately dubbed EQ. While there is some controversy about how to measure EQ, it is commonly thought to describe a few key skills:

• Emotional Awareness: the ability to recognize one’s own emotions and their impact on others.
• Emotional Regulation: the ability to manage one’s own emotions, for example, by calming oneself down or cheering oneself up.
• Empathy: the ability to recognize and respond to another person’s emotions.
• Emotion Application: the ability to use one’s emotions to help guide tasks, such as thinking and problem-solving.

Well-developed emotional intelligence may lead to improved performance and satisfaction in a variety of life areas, including mood, self-confidence, and interpersonal relationships. Competence in emotional regulation allows people to remain calm and collected in stressful environments or situations and allows the brain to remain in a state conducive to effective problem-solving. 

In contrast, poorly developed emotional intelligence may lead to relationship dissatisfaction; general feelings of malaise or distress with seemingly no cause; as well as physical ailments like muscle aches, headaches and stomach/digestion discomfort that seem to have no medical basis.

While many of us may admit to the benefits of emotional intelligence in our relationships, we do not commonly value emotional intelligence in the workplace. This is a mistake. EQ competencies can help you approach an impending deadline with an organized plan, effectively respond to conflicts with co-workers or supervisors, and figure out how to get people on your side, whether that’s by motivating workers or getting buy-in from new clients. 

Without effective EQ at work, you may find yourself blaming others, lashing out, or having difficulty asserting yourself. This could potentially lead to negative consequences for yourself or others.

We are not born with EQ and, while these skills may come more naturally to some, we all must learn how to understand and respond to our own and others’ emotions. But since emotions aren’t part of the traditional school curriculum, how do we figure it out? In ideal circumstances, we learn emotional intelligence from significant adult role models in our early years. 

Unfortunately, not everyone grows up in an ideal environment where their caregivers have their own well-developed EQ. As a result, emotional intelligence often gets stunted, leaving the individual unable to articulate feelings, easily overwhelmed, unable to trust their gut, or wondering why their relationships remain shallow and unfulfilling. 

Psychotherapy can help you learn to recognize, make sense of, and respond to your emotional needs. By exploring your inner world, you can feel more competent responding to challenging interpersonal interactions, managing your stress, and obtain the healthy and satisfying relationships that you may have struggled with. These skills will help you both personally and professionally. Becoming more emotionally competent will help get you out of that rut by improving your mood and relationships, which can ultimately lead to greater productivity and success in all areas of your life.

Dr. Meg Aston-Lebold, C.Psych. is a clinical psychologist at the Centre for Interpersonal Relationships (CFIR) in Toronto. She provides psychological assessment and treatment services to adults and couples experiencing a wide range of issues related to depression, anxiety and stress, self-esteem, trauma, and relationships.

by Jonathan Samosh, B.A.

What is mental health care? Many people think that mental health care focuses on understanding our internal psychological world and relieving the distress that might exist within it. This perspective is indeed important for effective mental health care. However, a whole wide world also exists outside of our internal psychological experience. In fact, understanding how we all exist within many ecologies can have significant implications for our mental health.

‘Ecology’ refers to all of the complex social systems within which we live. For instance, our families, neighbourhoods, schools, cities, economies, laws, governments, and cultural expectations. In mental health care, ecology means that we want to understand our internal psychological world and all of the many important elements of our external worlds too.

Psychologists with an understanding of ecology can provide mental health care in many ways to promote the wellbeing of individuals, couples, groups, organizations, and communities. With awareness of the diverse ecologies that exist all around us, psychologists can see the bigger picture that enhances treatment to relieve individual psychological distress, alleviate couple relationship difficulties, empower marginalized groups, and address inequalities in social systems. This is the power of ecology in mental health care.

At CFIR, ecology informs psychological services relevant to a diversity of human experiences, such as culture, gender, relationships, and financial means. Read more about CFIR’s multicultural treatment service, gender and relationship diversity service, and accessible low fee psychological service options here.

Jonathan Samosh, B.A. is a counsellor at the Centre for Interpersonal Relationships (CFIR) under the supervision of Dr. Dino Zuccarini, C.Psych. and is currently in his third year of training in the clinical psychology doctorate program at the University of Ottawa. He provides psychological therapy and assessment services for adults and couples experiencing psychological, emotional, and relationship distress in a variety of areas, such as anxiety and stress, depression and mood, anger and emotion regulation, grief and loss, traumatic experiences, self-esteem issues, life transitions, personal growth, existential issues related to meaning and purpose, relationship difficulties, and issues related to sexual functioning.