by: Dr. Aleks Milosevic, C.Psych. 

We are hard-wired to express emotions, including anger. Anger is a complex emotion that can be either adaptive or maladaptive. Anger can be a healthy primary emotion that is expressed to protect us in moments in which we might be violated, threatened by someone, unfairly treated, criticized, or frustrated. It is a natural part of the fight or flight response when we perceive danger in our world. Anger motivates us to protect ourselves by taking some type of action to stop or confront a threat. Anger can then fuel us to express and assert ourselves. In this way, anger can be an important signal, something good for us, as it tells us it’s time to take action to take care of our selves in our environments.

Anger can also be a secondary emotion. A secondary emotion covers up some other underlying feeling or emotion you may be experiencing in a situation. Other emotions such as hurt, sadness, grief at loss, loneliness or fear can be at the root of your anger. For example, sometimes we are angry when we are tired or in pain. In these cases, our anger protects us from the more vulnerable feelings or emotions. We may express anger because we are unaware of or unable to figure out our underlying feeling or emotion. Some of us might feel emotionally unsafe expressing vulnerable feelings or emotions in the presence of others. Anger, in this case, can serve to push people away from us when we are feeling vulnerable. In close relationships, expressing vulnerable feelings allows your relationship partner to feel closer to you, whereas defensive anger can create emotional distance between partners.

Anger, when uncontrollable, chronic, or prolonged can be very unhealthy, or a bad thing, for us and other people in our life. Uncontrollable anger or rage results in displays of intense emotion that can very destructive; it is often accompanied by verbal abuse and sometimes it can be accompanied by physical abuse. It is experienced as hurtful, frightening, intimidating and humiliating, and controlling. Often, deeper psychological or physiological issues underlie such irrational and unpredictable expressions. Finally, chronic, or prolonged anger, whether toward others or a situation, can have negative health consequences when stress hormones and cortisol are released. Over time, chronic anger can put your physical health in jeopardy by creating health problems (i.e., high blood pressure, headaches, digestive problems, insomnia, etc.). Chronic, unresolved anger can also contribute to the development of psychological problems, including depression, anxiety, and substance abuse.

At CFIR we can help you become aware of your anger, distinguish whether it is adaptive and primary, and help you overcome chronic negative anger states that have a negative impact on you and your relationships with others at home or at work. Our Anger & Emotion Regulation Treatment Service offers individuals an opportunity to learn how to manage difficulties with the experience and expression of anger in their relationships.

A comprehensive psychological assessment is conducted to understand the nature of your difficulties with anger. Understanding the historical, internal, and external factors that may contribute to your anger is important in setting out an appropriate treatment plan. We employ scientifically-validated interventions in our approach to the treatment of anger problems. We integrate cognitive-behavioural, emotion-focused, and psychodynamic-interpersonal interventions to support you to manage your uncontrollable and/or chronic anger response.

Read more about our Anger & Emotion Regulation Treatment Service.

by: Dr. Dino Zuccarini, C.Psych.

Depression

Depression can bring about debilitating symptoms, both of a physical and emotional nature. Depressed individuals typically find themselves experiencing hopeless feelings, disruptions to sleep and eating patterns, a loss of pleasure in everyday life, and possibly thoughts about suicide or death. Often individuals who are depressed have physical symptoms, including aches and pains.

Finding a path toward recovery can be challenging, but the good news is depression is treatable; recent research indicates that psychotherapy is extremely important in your recovery from depression.

When depressed, we can become bombarded by an internal chorus of negative thoughts and feelings about our selves other people, and the world around us. We can be overly self-critical of our selves and others, or may find ourselves struggling to come to terms with deep feelings of loss. At these times, it can be difficult to imagine a way to restore our vitality, hope, and optimism for life. When the severity of your symptoms seriously disrupts your capacity to function at home, work, or school, consider consulting with a psychologist immediately.

Negative thoughts and feelings about ourselves and others: Healing requires us to try to make sense of and deal with the distressing negative thoughts, feelings, and emotional responses that lie at the root of our depression. Depression is often linked to negative thoughts and feelings we hold about ourselves, of other people, and of the world around us. The origins of these thoughts and feelings can extend back into our childhoods and onward to the present day. These negative thoughts can create a sense of hopelessness about our selves and the world around us. A negative, critical voice and overly rigid standards and ideals can also be at the root of your depression.

We all have standards and ideals that we internalize from childhood onward about how we should be. These standards and ideals create expectations about our own and other people’s behaviour and guide us in terms of how we ‘should,’ ‘ought to,’ or ‘must’ think, feel, and behave. Some of us will rigidly hold onto and strive to live according to unrealistic standards and ideals, and be unrelenting in our efforts to have ourselves and others live up to them. Rigidly held standards and ideals can fuel harsh self-criticism and perfectionism. Indeed, research affirms that self-criticism and perfectionism often contribute to symptoms of depression.

Unexpressed emotions and needs: For some individuals, unprocessed emotions and unattended needs can result in depression. Depression is, therefore, a signal calling for us to listen to what our feelings are telling us about our selves, other people, and the world around us. Emotions provide us with important information. Being able to identify, label, and express these feelings in words is important for us to understand what our concerns are and to identify the unmet goals or needs that are at the root of the depressed feelings we are experiencing.

Other causes:  Depression may also result from multiple other physical and psychological causes, or as a result of substance abuse. A thorough assessment by your physician and a psychologist provides the best opportunity to determine your best treatment options.

Mood

Some individuals struggle with varying moods. People diagnosed with bipolar disorder struggle with mood variation, including periods of experiencing unusually or somewhat elated moments or ‘highs’, followed by periods of ‘lows’ or depressed periods. During manic periods, individuals with bipolar disorder may engage in risky behaviours leading to financial or legal difficulties. Being aware of triggers or signs of an impending mood episode, developing strategies involving partners, addressing difficult thoughts, creating a more balanced world, and accessing support to adhere to treatment regimens, are all significant components of managing bipolar disorder.

The Depression, Mood & Grief Service at CFIR offers clients counselling and psychotherapy to support them to address depression, mood, and past and present grief and loss. We offer children, adolescents, adults, and couples psychological assessment and treatment of depression and other mood disorders. We provide a comprehensive psychological assessment of your depression and/or mood difficulties, including the use of psychological tests for the purposes of diagnosis and treatment planning. There are different causes of mood disorders, and different types of depression and bipolar conditions. Psychologists are skilled in assessing, diagnosing, and subsequently developing a tailored treatment plan to address the specific issues associated with your current depression and/or mood difficulties. We employ scientific, evidence-based treatments, including Acceptance and Commitment Therapy, Cognitive Behavioural Therapy, Emotion-Focused, Mindfulness, Psychodynamic-Mentalization-Attachment based therapies to help you overcome your symptoms and make deeper changes to your self.

Read more about our Depression, Mood & Grief Treatment Service.

1. Is your therapist trained in scientific, evidence-based treatments that are proven effective?

Over the past 40 years, numerous psychological treatments have undergone intensive scientific investigation to examine their effectiveness in helping individuals with a wide range of psychological disorders. To date, numerous empirically-supported treatments have been identified. It is important that your therapist is well-versed in what treatments are most beneficial for you based on scientific evidence. Application of these treatments alone, or in combination, provide you with optimal treatment options.

Our registered psychologists have received 3000-4000 hours of clinical training in evidence-based treatments prior to graduation, and supervise psychotherapists and social workers in the implementation of these treatments.

2. Is your therapist flexible to provide different types of treatment, or is he or she offering only one type of treatment (e.g., CBT)? Does your therapist have a preferred treatment approach or can he or she be flexible if his or her preferred approach does not fit well with you?

Not all treatments work for everyone. Not all treatments will fit your concerns and needs!

Research study after research study demonstrates that, while psychological treatments do work, not all treatments work for everyone in any study (e.g., some drop out of treatment, some do not fare as well, and some don’t achieve any significant change). It’s unclear about whether one particular brand of treatment fits better with any type of child, adolescent, adult, couple of family. From a practical viewpoint, however, some clients may want a briefer therapy option that targets their symptoms without going into a lot of depth, while others want an in-depth exploration and understanding of their difficulties. Sometimes symptoms are addressed first, and then a deeper exploration of underlying self and relational causes are explored for the purpose of acquiring deeper change.

Many psychologists and psychotherapists will combine a variety of strategies to help you achieve your treatment goals. For example, at CFIR, our psychologists, psychotherapists and counsellors may use a variety of cognitive-behavioural, dialectical-behavioral, or mindfulness-based strategies to help you diminish your emotional distress and symptoms, and then turn to various experiential or psychodynamic approaches to support you to become more aware of your self and your self in relationship with others for the purpose of creating change at a more profound and deeper level.

It is important to find a therapist that can respond to your needs and concerns by offering a variety of treatment approaches in both a short and longer-term format. CFIR mental health professionals are skilled in a variety of evidence-based treatment models and in short and long-term treatment. They are able to help you reduce your immediate distress and diminish your symptoms, as well as help you to understand and change deeper self or relational issues underlying your difficulties.

3. Does your therapist provide you with a comprehensive assessment of your condition (i.e., interview and questionnaires)?

Assessment is important to understand the nature of your difficulties and can help guide treatment and inform the direction of your recovery process. Similar to a medical doctor, who might use interviews, and ask that you complete a variety of tests (e.g., blood pressure, blood and urine tests, ultrasounds and other technologies) to understand the nature of your health issues, psychologists also conduct extensive interviews and administer questionnaires to help with their understanding of your difficulties. There are numerous factors that can contribute to your current issues. A combination of clinical interview and scientific, evidence-based measures will help your mental health practitioner understand the unique circumstances underlying your present concern.

A clinical interview and questionnaires can also save numerous dollars, hours and treatment sessions as a lot of information is ascertained all at once and used to identify contributing factors to your distress and concerns early on in treatment— as opposed to these factors being discovered over a lengthy period of time, or not discussed at all. Psychometrically-sound (i.e., reliable and valid) questionnaires can save a lot of in-session time by gathering important information about factors underlying your condition in a timely manner.

A thorough assessment can also provide important information about what to expect in terms of the duration of your treatment. At CFIR, our comprehensive assessment will help us to identify contributing factors underlying your concerns, and based on this assessment establish realistic timelines for your recovery from your condition.

4. Is your mental health practitioner well-trained? Is he or she either a provincially registered care provider or supervised by a registered clinical psychologist?

It is important that you seek treatment from a practitioner who has been well-trained and a member of a professional college in Ontario (e.g., College of Psychologists, College of Psychologists and Behaviour Analysts of Ontario, College of Social Workers). Registration with a College denotes that your practitioner has completed education and training that has met the standards of practice for the profession.

Registered psychologists have the most training in evidence-based psychological treatments. Our registered psychologists supervise psychotherapists and social workers in the application of evidence-based treatments in their practice with their clients.

5. Have you been able to speak to or meet your therapist prior to starting your therapy to ensure your therapist will be a good fit for you?

Your relationship with your therapist is the most important aspect of your treatment and recovery from your symptoms and distress! Research studies suggest that the single largest factor in whether a client changes during a course of therapy is the nature of his or her relationship with a therapist—whereas the treatment itself accounts for a less amount of your change. It’s important, therefore, to make sure you are comfortable with your therapist and how he or she will work with you to address your concerns.

Making sure that your therapist is a good fit for you is very important to us! Associates at CFIR offer you a FREE 30-minute consultation as a way for you to find out whether he or she will be a good fit for you! Meeting your therapist in person will give you a sense of whether you feel comfortable with him or her or his or her office and physical surroundings. It will also be an opportunity for you to learn more about how your therapist will work with you to address your issue. It’s an important time to ask whether he or she is flexible in providing different treatment options. There’s nothing more frustrating, and costly, for you and your loved ones than to start with one therapist, spend numerous sessions working in one treatment approach, only to find it’s not working or fitting well with you. If your therapist primarily works in one treatment modality (e.g., only CBT, or EFT, or Psychodynamic), it’s important to know whether he or she will be able to switch treatment direction if therapy is not working for you.

At the beginning, and at minimum, you’ll want to make sure that your therapist listens to your concerns, will involve you in setting your treatment goals, and has a clear sense of how he or she will work with you. It’s also important that he or she identify which treatment approach they might use to help you achieve your goals, and whether they are flexible to offer different treatment options.

It’s important to ask whether or not your therapist can provide different types of treatment. If your treatment is not working for you, it is important that your clinician can provide you with other options or refer you to someone else who might be able to meet your needs for a different type of treatment. Clinicians at CFIR are skilled in employing different treatment models and often integrate different treatment approaches to offer you the best treatment possible.

At CFIR, clinicians will provide a confidential, compassionate and caring environment to help you to explore and address the difficult thoughts, emotional reactions and behaviours that have been of greatest concern to you or your loved ones. We work collaboratively with you to identify your treatment goals and offer you many different types of treatment options to ensure that you get the help that you need. We are flexible and can change our treatment approach with you, if you find that significant progress has not been experienced using one approach.

6. Is you practitioner well-informed about the expected number of sessions required for treatment of your concern or condition? Does he or she have a clear definition of what constitutes change or ‘recovery’ of your condition? Is your practitioner promising you a quick, short-term treatment for your condition?

It’s important that you receive sufficient treatment to recover from your mental health concern! Your therapist should have some sense of the treatment dosage (i.e., number of sessions required) to reduce your symptoms or to recover from your mental health issue. Typically, 50% of clients feel better after about 7-8 sessions, and 75% report marked improvement after 20 sessions. There is, however, a significant body of research that points to the expected duration of treatment for a wide range of psychological issues (i.e., number of sessions required for symptom reduction or recovery from your condition). It’s important that your treatment provider know the research so he or she can give you some sense of what you might expect in terms of your treatment duration. This knowledge is important as both you and your therapist will be able to assess whether treatment is working for you in the expected time frame (i.e., creating significant changes in your life), and allow you to adequately plan for the cost of your therapy.

There are no quick, short-term treatments when it comes to creating meaningful and significant change. Only on rare occasions will 1 or 2 sessions suffice—usually when services are sought to acquire information or education on a condition or topic. Diminishing symptoms and recovery from your condition will, however, require more sessions and commitment to change than one or two sessions. Typically, short-term treatment requires between 8-20 sessions to ensure significant symptom reduction and recovery for most conditions. However, some conditions require upwards of 12-14 months of consistent treatment for recovery.

7. Is your therapist covered by your workplace insurance, and can you afford the number of required sessions to help you by either using your insurance coverage or paying ‘out of pocket’?

Not all mental health care practitioners are covered by workplace insurance programs. Clients who don’t review their workplace insurance prior to receiving psychological services can find themselves very disappointed, and out of a lot of money, when they find out that they are not covered for their sessions. It’s important to find out how much coverage you have, and to figure out how much ‘out of pocket’ money you’ll need to be able to attend sessions consistently and until significant change has been realized. It’s important to learn at the outset about how many sessions you’ll be able to afford with your insurance coverage and ability to pay ‘out of pocket’.

Registered psychologists tend to be covered by most workplace insurance programs. However, if you are seeing a psychotherapist or social worker, you’ll want to verify whether their services are covered under your program. At CFIR, psychotherapists and social workers are supervised by a registered clinical psychologist, and receipts are issued under the supervising psychologist. Some insurance companies will accept these circumstances, while others will not. It’s up to you to verify with your insurer whether your insurer will cover your sessions.

Since most individuals will require more sessions than their insurance covers, it’s important for you to evaluate whether you can afford to pay for sessions ‘out of pocket’ once your insurance has run out. It’s important to have these discussions with your therapist to ensure that your treatment is not disrupted by lack of financial resources. Based on your insurance, and ability to ‘pay out of pocket’, your therapist may determine given your presenting concerns, that other treatment options may be better for you (i.e., workshops or group therapy, or seeing a psychotherapist or joining our Reduced Cost Services program). In the event that you find yourself out of insurance dollars, and your ability to pay ‘out of pocket’ reduced, you may want to alter the number of sessions you attend per month, or take a break from therapy until which point your workplace insurance kicks in again.

At CFIR, we offer you different options to ensure accessibility and affordability of services. If you have run out of insurance and are having difficulties paying for services ‘out of pocket’, our counsellors, who are supervised by our psychologists, can be seen for a fraction of the cost of seeing a psychologist. Referral to our counsellors is seamless and ensures continuity of your treatment with minimal disruptions.

8. What is your therapist’s fee? Does he or she offer a wide range of fee options (i.e., sliding scales) or services in different formats (i.e., individual, couple, family, group therapy, workshops) to ensure accessibility and affordability of psychological services?

It’s important that your therapist fees be known to you and agreed to you prior to therapy commencing. Also, depending on your insurance coverage and ability to pay ‘out of pocket’, you might also want to ask about whether your therapist has variable fee options (i.e., able to offer a lower fee to ensure accessibility and affordability).

At CFIR, various mental health practitioners offer their services and at varying fee ranges depending on their education and training experience. We also offer different treatment options in different formats (i.e., individual therapy sessions, workshops or group therapy). Our psychologists’ fees range from $180-$220/session, which is below the Ontario Psychological Associations recommended fee of $225.00/session. Our psychotherapists’ fees range from $100-$155/session. Our counsellors’ fees range from $90-$110/session. We also offer weekend workshops ($33.50/hour) or group therapy sessions for $62.50/1.5 hour session.

9. Does your therapist offer short, medium and long-term treatment options?

Some issues can be addressed in fewer sessions than others. It’s important to figure out whether your concerns can be addressed in a shorter versus longer-term treatment frame. A therapist who can provide both short-term and long-term treatment options offers you flexibility to address your presenting problem or any other issues that emerge during the course of your therapy. According to research, some conditions require a lengthier treatment time.

It’s important that your therapist conduct a proper assessment and is aware of the research about treatment duration for your condition. With a proper assessment, your therapist should be able to indicate whether treatment should be short, medium or long-term. At CFIR, Associates are flexible in being able to treat a wide range of conditions in a short, medium or long-term format. We will be able to address symptoms in a short or medium-term format, but may suggest a long-term format based on your presenting concerns and our assessment. Either way, we can accommodate to your wishes as well. Even if a recommendation for long-term therapy is made, short-term therapy options can be offered if this is preferred by the client (i.e., focusing treatment on symptom reduction, problem-solving and crisis management, and skills building).

Registered Psychologists

Registered psychologists are the most extensively trained professionals in the application of psychological treatments. Psychologists will have completed a Ph.D. in psychology and have acquired specific competencies in the treatment of populations based on their extensive training experiences (e.g., competency in adult, couple, child and family, rehabilitation, health, neuropsychology, forensics, organizational). Prior to practice, they will have completed upwards of 3000-4000 hours of supervised clinical training in hospitals, community and private settings, numerous courses in assessment, diagnosis, theory and treatment, and would have completed a one-year internship. Upon graduation, psychologists complete one year of supervised practice, and during this year must pass an ethics exam, a professional psychology exam and an oral exam by the College of Psychologists and Behaviour Analysts of Ontario prior to autonomous practice.

At CFIR, all psychotherapists, social workers and counsellors are supervised by registered psychologists to ensure that treatment is optimal to address your concerns and needs.

Psychotherapists and Social Workers

Psychotherapists and social workers have received graduate training, and typically have Master’s degrees in their field. These individuals will have completed numerous courses in theory and treatment, and would have completed upward of 750 hours of training prior to graduation. These professionals are registered with either the College of Registered Psychotherapists of Ontario or Ontario College of Social Workers and Social Service Workers. Registration with the College of Registered Psychotherapists requires completion of an ethics exam for psychotherapists. Many psychotherapists and social workers continue to build their treatment credentials after graduation. Neither of these professions can provide a diagnosis.

Counsellors at CFIR

Counsellors at CFIR are completing graduate degrees (i.e., Ph.D. in clinical or counselling psychology, M.A. in clinical or counselling psychology) and are completing their final practicums and internships at our setting. They will already have had placements in a variety of community and hospital settings prior to their clients at our Centre. They are also well-versed in applying evidence-based interventions to help you with your difficulties and concerns.

Here’s what you can expect in your first meeting with a mental health professional at CFIR. In an initial session, you’ll have an opportunity to share your concerns, and talk about the thoughts, emotional reactions, behaviours or relationship issues that are of greatest concern to you. Your clinician at CFIR will ask you questions to further understand the nature of your difficulties, and working with you, will identify your treatment goals. He or she will also provide you, if needed by you, strategies to address any symptoms that are distressing for you— so you’ll have some tools to deal with any symptoms that seem unmanageable. Following an initial session, a comprehensive assessment will be conducted, including a clinical interview and administration of scientific, evidence-based questionnaires, so that we can identity the factors that have contributed to your concerns. In a following session, we’ll provide you with feedback and continue gathering more information about the origin of your problems. We will also put forward a treatment plan to address your issues and provide you with a sense of how long treatment should take, and what type of progress and change might be expected over time. Depending on your concerns, and our assessment (and any diagnosis if rendered or requested), we will make recommendations about whether a specific treatment approach, or a combination of approaches may be required to help you with your problem.

Associates at CFIR only provide scientific, evidence-based treatment interventions.

Our Centre only accepts clinicians who are experienced in many different treatment models to join. We believe that not every treatment fits with every client, and therefore, value the Associates’ abilities to flexibly address concerns using different treatment approaches (e.g., clinicians at CFIR can employ cognitive-behavioural, emotion-focused, psychodynamic and systemic approaches). 

Clinicians at CFIR are, therefore, trained and experienced to address the perceptual, cognitive, emotional, behavioural, interpersonal and socio-cultural dimensions of your concerns. Mental health practitioners at our Ottawa and Toronto locations also offer various short and long-term evidence-based treatment options.

In terms of treatment, we believe that not every treatment fits with every client. Associates are flexible in being able to provide different treatment approaches (e.g., our clinicians can employ cognitive-behavioural, emotion-focused, psychodynamic and systemic approaches). We also believe that many different interventions are required to help people change and grow, and offer our clients both short and long-term evidence-based treatment options.

We are also flexible in terms of being able to switch our treatment approach with you, if necessary (e.g., switching from CBT to other treatments as needed). We typically use some approaches to help you address distressing symptoms, and other approaches to help you to obtain a deeper, more meaningful understanding of your concerns and with the purpose of developing a more secure, resilient self and strengthening your capacity for relationships.

by: Andrea Kapeleris Ph.D.

More common than you think! About 20-50% of children and teens who have experienced trauma meet the criteria for Post-Traumatic Stress Disorder (PTSD) and nearly 75% also experience depression and substance use (Elwood, Hahn, Olatunji, & Williams, 2009). Statistics also show that about 14% of people exposed to a major stressor go on to develop PTSD (Terhakopian, Sinaii, Engel, Schnurr, & Hoge, 2008), and women are about twice as likely as men to develop PTSD after a trauma (Kessler, Berglund, & Demler, 2005). Stressors can be one-time events that cause actual or threatened death or harm to yourself or a loved one (such as, a car accident, sexual assault, mugging, natural disaster), or they can include on-going negative and damaging experiences – such as, chronic stress resulting from military service, or childhood experiences in which there was repeated damage to the attachment relationship between you and your caregiver. These chronic experiences can shatter a child’s sense that the world is benign, the world is meaningful, and the self is worthy, and often results in avoidance coping and an increase in overall level of arousal and anxiety (Roth et al., 1997).

Symptoms of PTSD are Normal Reactions to a Non-Normal Experience

• Re-experiencing the event in a number of ways including, flashbacks, nightmares, or vivid memories that come to you unexpectedly 
• Avoiding any reminders of the event (people, places, or things associated with the event), and a feeling of numbness
• Increased feelings of anxiety or emotional arousal

Treating Trauma

Overstuffed Cupboard Metaphor

The mind is like a pantry cupboard. When a traumatic event occurs, it is as if very large and oddly shaped boxes were hurriedly stuffed into the pantry. Since there was no time to properly place the boxes in the pantry in an organized fashion, each time you open the pantry to get something you need, a box suddenly and unexpectedly falls on you – startling you and possibly hurting you! The same thing happens when our mind experiences trauma. Due to the sudden and overwhelming nature of the traumatic event, the mind doesn’t have the opportunity to process all of the emotions associated with it, and as a result, unpleasant memories or emotions may come to us when we least expect them too. For example, you may become startled by an unsettling memory or emotion when you are relaxing at home, watching TV, or spending time with friends. As a result, you may begin to avoid things you previously enjoyed. 

The purpose of therapy is to help you organize this pantry. We need to take each box out of the pantry slowly and carefully, examine its contents, and then place it in its proper place. Once all of the boxes are organized accordingly, you will be able to enter the pantry without fear, and will no longer need to avoid that part of your home. Similarly, the goal is to slowly process the trauma and place events and their accompanying emotions into sequential order. In this way, your mind will be able to integrate the trauma and make sense of it. You will be able to think more freely and move forward with your life. 

Fight or Flight mode

When we encounter a traumatic event (something that threatens our physical or psychological integrity) our bodies enter a process called the “Fight or Flight” mode. This mode is evolutionarily necessary and served an important purpose – in the times of cavemen and women when our ancestors were being chased by predators (e.g., a tiger) all of the resources in their bodies left the frontal cortex (the part of our brain used to reflect on our thoughts and feelings, and make decisions) and automatically went to their muscles (to prepare them to flee or fight the predator), and also went to pump up their heart rate, breathing, and overall adrenaline (again, to make it easier for them to flee or fight predators). In modern times, when we are faced with a trauma, our bodies go into ‘Fight or Flight’ mode in order to protect us. Later, any experiences, people, places, or things that remind us of the trauma stimulate our body to again go into this fight/flight mode in case we need to be protected again. Part of our work in therapy is to help your body and mind recognize that this threat occurred in the past and that you are no longer in danger. We foster this safety on many different levels:
1) Physiologically: We must help the physical body itself feel safe and come down from overarousal. This may partly be achieved through learning relaxation strategies or overcoming avoidance-coping strategies that maintain and intensify anxiety. 

2) Emotionally: We must help the mind itself feel safe and come down from overarousal. This is achieved through:
a) processing the trauma as described above in ‘the cupboard metaphor’; 
b) learning Emotion Regulation strategies

Emotion Regulation

Emotion regulation is a process of 1) identifying and increasing awareness of your feelings (e.g., what are the names/labels for the vague and sometimes uncomfortable sensations that happen inside?), and 2) ‘sitting with’ the sensations that go on inside and experiencing the waxing and waning of your feelings – all feelings do wax/wane, come and go – the only thing we can be certain of is change from moment to moment. Physiologically, our bodies experience of any emotion follows a bell-shaped curve (i.e., it must come down from its peak) – our bodies cannot maintain the high emotional arousal indefinitely – but sometimes, our feelings about our feelings (feeling angry that we are sad, for example) may intensify our original emotion. In therapy, we help to disentangle this, and in effect, help you to regulate your emotions. Importantly, we also begin to look at your feelings as an important signal that there is something inside that needs our attention

Read more about our Trauma Psychology & PTSD Treatment Service.

By: Dr. Sela Kleiman, C.Psych

Within a few minutes of their first conversation, a White individual inquisitively asks a racialized minority a seemingly innocuous question they have likely been asked numerous times previously, “So, where are you from?” Now, imagine the above scenario but with the actors’ roles reversed (i.e., the racialized minority asks the White individual the same question). Which event is more common? Many people who live in Canada and the U.S would intuitively respond that the first scenario is more likely. The reason for this difference requires a contextual understanding of race relations; that is, knowing which social groups are dominant and as a consequence of this, who defines those that are normal from those that deviate from the norm. In our society, both historically and presently, White folks hold a disproportionate amount of power in society to institute and promulgate these definitions. Perhaps it is not surprising then, that as a result, White people receive messages daily which serve to confirm their sense of being normal. Contrarily, racial minorities often receive messages that convey the opposite sentiment. Given these realities, the question, “So, where are you from?” becomes rife with meaning. Indeed, what comes across as innocent curiosity may be read by those receiving it as reinforcement of a sense of un-belonging, especially given the frequency with which this event may occur. Inter-racial interactions between dominant and non-dominant group members are never just an isolated event; instead, they are historically and contextually grounded within the broader social systems that one lives.

The above incident highlights one of many examples of racial microaggressions which are subtle slights, jabs, and insults which convey demeaning messages to racialized minorities by dominant group members. Perpetrators of racial microaggressions are often well-meaning White folks, mostly unaware of the effect of their actions. This manifestation of racism, of course, stands in contradistinction to the overt, consciously directed racism more typical of a bygone era. And though most can agree that a dramatic decrease in “old-fashioned racism” is a good thing, one consequence has been that contemporary racism falls below the radar of most. Indeed, its subtle and insidious nature makes modern-day racism appear virtually non-existent to those who perpetuate it. Unfortunately, a consequence of this is that racism is referenced as a problem “over there” or “back then” and as such not given the warranted attention. 

Research on racial microaggressions has exploded in recent years (read Derald Wing Sue as a starting point), and various empirical studies have documented their varied manifestations. Moreover, researchers have documented its adverse psychological and physiological effects. As a starting point, it is critical for clinicians working with clients to be aware of current racial dynamics so that discussions of race and racism are not minimized or ignored in therapy. By ignoring these critical issues, therapists unwittingly disempower their clients by locating the root of mental health issues associated with racism within the individual rather than due to prevailing social forces. Clinicians who convey this message risk perpetuating the very thing that may in part be responsible for their client’s mental health issues.

by: Dr. Sela Kleiman, C.Psych.

Throughout life, especially during early life, we internalize messages sent to us by caregivers, siblings, extended family, peers, and larger social and cultural institutions. Growing up, if caregivers are attuned to our emotional needs and respond in a warm and empathic way, we are more likely to internalize, or have an unconscious felt sense, that we are a person worthy of being loved. If, on the other hand, caregivers respond to our emotional bids for affection with rebuke, derision, anger, and so forth, we instead may internalize a felt sense that we are unlovable in some way.

The messages we receive about ourselves from others profoundly impact how we feel about ourselves and how we relate to others. 

Messages sent from the cultural and social milieu in which one lives can greatly influence how we feel about our own worth. Growing up in North America where racism is prevalent, for instance, folks of colour are subject to many recurrent and demeaning messages about their racial identities. These messages often are subtle. For example, they may be revealed in television shows and movies where people of colour represented stereotypically and cast in a narrow range of roles. Additionally, these messages are found in schools. For instance, some children who have to pass through security guards checkpoints every morning before class undoubtedly receive the message that they are dangerous and not to be trusted. Unkempt school grounds and poorly supplied classrooms are a consistent reminder to some students that their education is not as important as those who live in more affluent neighborhoods. Consistently receiving these messages takes its toll on an individual; one result may be internalized racism. 

Internalized racism is a phenomenon whereby people of colour constantly exposed to demeaning messages that imply their inherent badness or lower worth may unconsciously start to feel this way about themselves. One of the most disturbing yet illuminating examples of this was the doll experiments conducted by Clark and Clark in the late 1930s/ early 1940s in which they asked children to rank Black and White dolls (everything the same except for their skin colour) on various characteristics. They showed that both Black and White children typically preferred White dolls over Black dolls in terms of appearance, niceness, and so forth. To Clark and Clark, Black children preferring White dolls for these reasons was an example of internalized racism. 

Aside from cultural and social shifts needed to combat internalized racism, a more intimate domain to work through this issue is in therapy. For this to happen, psychologists, psychotherapists, and other helping professionals must be multiculturally-competent practitioners. Indeed, they must be well-versed in psychological and emotional manifestations of discrimination and be able to engage in meaningful dialogue with clients as these issues arise. Ignoring internalized discrimination and placing the locus of responsibility solely within the client risks reinforcing oppressive patterns responsible for internalized racism. Using therapy as a space to explore themes of badness, worthiness, and so on through a culturally sensitive lens can empower clients to gain a better understanding of their pathogenic beliefs and, through deep and meaningful processing of these themes, detoxify these negative feelings about the self.

by: Ali Goldfield, M.A.

We all have stress in our daily lives. So much so that we often think nothing of running from place to place, eating on the go, and juggling work and family life. You have probably already heard that stress can wreak havoc with our immune systems, our sleep patterns and our ability to enjoy the things we used to, but did you know that stress can actually affect the size of your brain? 

Researchers know that trauma can significantly affect brain structure but one study done by researchers at Yale University now shows that everyday stressors, like a divorce, job loss, the death of a loved one or a serious illness can also affect our brain in the same way that one traumatic event can. These cumulative stressors, it seems, can lead to shrinkage in our brains, reducing the volume of grey matter and lowering our ability to further cope with adversity and may even lead to self-destructive behaviours such as addiction, overeating and depression. 

Past studies have shown that the stress response involves a brain region known as the amygdala, which sends out signals alerting us to any kind of threat. This results in the release of hormones, including cortisol, which prepare us for the flight or fight response to fend off the threat. Prolonged exposure to cortisol can cause brain neurons to shrink and it also interferes with their ability to send and receive information efficiently. This is just another piece of the puzzle in how prolonged stress can impair our ability to think and act in creative, flexible and healthy ways.

And it’s not only about stress shrinking our brains. In another study from Yale University, researchers compared the genetic makeup of donated brain tissue from deceased humans with and without major depression. Scientists found that only the depressed patients’ brain tissues showed activation of a particular genetic transcription factor, or “switch” that basically stops the genes from communicating. This lack of communication leads to a loss of brain mass in the prefrontal cortex. The scientists hypothesized that in the depressed patients’ brain, prolonged stress exposure led to disruption of brain systems. The depressed brains appeared to have more limited and fragmented information processing abilities. This finding may explain the pattern of repetitive negative thinking that depressed people exhibit. It’s as if their brains get stuck in a negative groove of self-criticism and pessimism. They are unable to envision more positive outcomes or more compassionate interpretations of their actions.

While the evidence is not conclusive, it makes a pretty good argument that stress and mental health issues that lead to stress do kill off our brain cells through the damaging effects of cortisol and through the disruption of the genes that facilitate neuronal connections. This shrinkage affects our cognitive abilities, our focus and our ability to concentrate. Since much in our lives is beyond our control, how can we prevent this type of cumulative stress from affecting our ability to deal with what life throws at us? 

The most important thing to remember is that the brain is plastic, meaning that there are ways to reverse the negative impact of stress on the brain. With the right tools and techniques, like meditation, exercise, proper diet (think Omega-3s), yoga and by maintaining strong social and emotional relationships, we can, in fact, counterbalance the damaging effects of stress and stop our brains from shrinking.

Read more about our Anxiety, Stress & Obsessive-Compulsive Treatment Service.

by: Ali Goldfield, M.A., via Therapy Stew (www.therapystew.com), on Sept. 21st, 2013   

It’s always difficult as a parent to know how much to share with your child and how much to shield them from the tragedies that happen in the world around them. While it may seem like a good idea, at times, to try and protect them from all the bad things, depending on their age, it’s not always possible. Children pick up information from other kids at school, from the television and from social media. Talking to your child about a tragedy can help her understand what’s happened and actually help them begin to process the events and feel a bit safer.

It’s a personal decision whether or not to talk to your kids or not. It also depends on their age, their level of maturity and how closely they are affected by the tragedy. Every parent knows best for their own child. If you’re struggling with how to start, here are some ways to help:

Let Your Child Be The Guide

Find out what questions or concerns your child might have. Let your child’s answers guide your discussion. Let your child know that you will always be there to listen and to answer them. Try to make your child feel comfortable asking questions and discussing what happened but don’t force your child to talk if they aren’t ready.

Tell The Truth – In Moderation

When talking to your child about a tragedy, tell the truth. You can focus on the basics but it’s not necessary to share all the unnecessary and gory details. Try no to exaggerate or speculate about what happened and avoid dwelling on the magnitude of the tragedy. Listen closely to your child for any misinformation, misconceptions or underlying fears. Take time to provide accurate information. Share your own thoughts and remind your child that you’re there for him. Your child’s age will play a major role in how he or she processes information about a tragedy.

Talk to Them at Their Level

Talk in a way that’s appropriate to their age and level of understanding. But don’t overload the child with too much information. Elementary school children need brief, simple information that should be balanced with reassurances that the daily structures of their lives will not change. Middle school children will be more vocal in asking questions about whether they truly are safe and what is being done at their school.  They may need assistance separating reality from fantasy. High school students will have strong and varying opinions about the causes of violence and threats to safety in schools, community and society.  They may share concrete suggestions about how to prevent tragedies in society. They will also be more committed to doing something to help the victims and affected communities.

Be Ready to Have More Than One Conversation

Some information can be very confusing and hard to accept so asking the same question over and over may be a way for your child to find reassurance. Try to be consistent and reassuring, but don’t make unrealistic promises that nothing bad could ever happen.

Acknowledge and support your child’s concerns

Explain that all feelings are okay when a tragedy occurs.  Let children talk about their feelings and help put them into perspective.  Even anger is okay, but children may need help and patience from adults to assist them in expressing these feelings appropriately. Let your child know that all his feelings, reactions and questions relating to the tragedy are important.

Limit Media Exposure

Don’t allow young children to repeatedly see or hear coverage of a tragedy. Even if your young child appears to be engrossed in play, he or she is likely aware of what you’re watching or listening to — and might become confused or upset. Older children might want to learn more about a particular tragedy by reading or watching TV. However, constant exposure to coverage of a tragedy can heighten anxiety.

Monitor your own stress level

Don’t ignore your own feelings of anxiety, grief, and anger. Talking to friends, family members or mental health counselors can help. It is okay to let your children know that you are sad, but that you believe things will get better. You will be better able to support your children if you can express your own emotions in a productive manner. Get appropriate sleep, nutrition, and exercise. Kids learn from watching the grown-ups in their lives and want to know how you respond to events.

We have all awoken to disasters before, whether natural, manmade, accidental and terrorist-induced and it’s inevitable that we will wake to them again in the future. What you say to your kids and how you say it will change as they get older but the one thing that shouldn’t change is your validation of your child’s feelings and the fact that you will always love them and do your best to keep them safe. 

Read more about CFIR’s Child, Adolescent & Family Psychology Service & the Trauma Psychology & PTSD Treatment Service.