by: Dr. Lila Z. Hakim, C.Psych. & Dr. Dino Zuccarini, C.Psych.

Sexuality is an essential part of who we are. At CFIR, we promote healthy sexuality. A crucial first step is to ensure that individuals and couples have access to accurate information about sex and how our bodies work, and an understanding of the physical (e.g., contraception, sexually-transmitted infections) and emotional risks involved in expressing ourselves sexually. Healthy sexuality also suggests being comfortable with ourselves (i.e., liking our bodies, finding ourselves attractive, being aware of and accepting our desires and fantasies, feeling capable sexually, knowing our sexual boundaries and asserting our limits), being able to experience sexually arousing feelings, communicating our sexual desires, and engaging in satisfying intimate-sexual relations with others. 

Sexuality, however, can also be a source of great distress. Distress can occur when we do not have accurate knowledge or information or are experiencing sexual functioning problems or sexual and pornography addictions. Some of our sexual issues flow from a lack of, or inaccurate, learning about how our bodies actually function, or distress over fears of pregnancy or sexually transmitted infections. A lack of knowledge can create anxiety about decisions and choices and sexual expressions. 

Sexual functioning problems related to desire, arousal, and orgasm are also a source of emotional distress for individuals and couples. The causes of such issues are vast. Sexual functioning is affected by a wide range of organic, biological, and medical issues, as well as social, cultural, and psychological factors. Some of us become overly consumed by negative thoughts and emotional reactions about oneself (e.g., our bodies, genitalia, sexual performance), or our sexual partner. We may also engage in relationship or sexual patterns that diminish arousal and the desire or interest in sex. Some individuals experience sexual pain or other difficulties during sexual intercourse due to a complex blend of physical or psychological factors. 

Some individuals will struggle with sexual or pornography addictions, including the use of internet porn, massage parlours, or risky sexual encounters. In these situations, individuals and their relationship partners may experience significant distress. Sexual functioning issues, regardless of their origins, can block an individual and couples from experiencing positive feelings, such as joy and pleasure, within the sexual aspect of the relationship. Sexual issues can also spill over into other aspects of the relationship, including emotional and physical intimacy. 

Psychologists and clinicians at CFIR have published research and theoretical articles in peer-reviewed journals, and written book chapters in the area of couple and sex therapy. We help you by providing a comprehensive psychological assessment to help you understand the causes of your sexual difficulties and then develop the most appropriate treatment plan to address underlying causes. We are well-informed about contraception, sexually transmitted infections, and the physical aspects of sexual functioning, and the psycho-social issues associated with these topics. We also support clients to develop sexual authenticity by helping them to clarify desires and remove blocks to the expression and assertion of their sexual needs in relationships. We also help to resolve sexual functioning issues to restore one’s sexuality as a source of joy, sensuous pleasure, and connection. 

The Sex Therapy Treatment 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. Regarding treatment, we offer individual, couple, and group therapy to help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills (e.g., communication, problem-solving and negotiation skills), and address sexual issues that interfere with sexual satisfaction and fulfillment, regardless of sexual orientation. 

Read more about our Sex Therapy Treatment Service. 

by: Dr. Aleks Milosevic, C. Psych.

Our deepest sense of our own worth or value is an important part of our self-esteem. Having a positive sense of self-esteem involves being able to hold a solid sense of being a good person, making life decisions that are respectful toward ourselves, and having a sense of worth and competency. Our early childhood experience in our family of origin has a significant impact on how our self-esteem develops. Peer relations and then relationship partners also have an impact on our self-concept. Our relationships to others will play a role in how we view ourselves, the confidence we have in our selves, and our deepest sense that we are good and competent individuals; in short, we are more likely to have a good sense of our own value and worth. This good sense of our own value and worth affects how we talk to ourselves, the choices and decisions we make for ourselves in everyday life, and how we will experience and manage our relationships with others. Healthy self-esteem adds to our sense of resilience.

Individuals with low self-esteem often struggle to come in touch, or maintain, a sense of being a good and competent person. Typically, individuals with low self-esteem experienced challenging early life environments that may have involved harsh criticalness about appearance, intelligence, or clothing by family members or peers, bullying and teasing, emotional, physical, and sexual abuse and neglect, obstacles that blocked achievement, or mistreatment based on social identity (e.g., gender, sexuality, race) or on a learning or physical disability. As a result of these experiences, one might be more self-critical, preoccupied by doubt and uncertainty, overly driven by perfectionistic standards and ideals, have less belief in one’s ability to achieve or accomplish, or experience an increased sense of anxiety, loneliness, and shame that block them from building relationships with others.

When we did not develop a positive sense of self-esteem, we are less able to tolerate challenging life moments and sudden life changes, to cope with adversity and perceived failure, or to deal with work and relationship issues. Lower self-esteem diminishes our ability to deal with these moments. Life challenges and financial, relationship, and career difficulties or failures can also have an impact on our self-esteem.

Some individuals have overly-inflated self-esteem or fluctuating self-esteem. In cases of overly-inflated self-esteem, an individual may be compensating for low self-esteem. Typically, this includes over-working, or over-achieving at the expense of mental, physical health, and relationships. They may also overestimate what they are able to achieve or accomplish, and set unrealistic goals with the intention of improving their sense of value and worth. Sometimes individuals oscillate between periods marked by anxiety and depression as they shift from experiencing low to overly high self-esteem.  

There are many dimensions to self-esteem. Psychologists and clinicians at CFIR in our Self-Growth & Self-Esteem Service are skilled in being able to understand how your self-esteem developed, and the necessary steps to foster a positive and healthy sense of self-esteem in the ‘here and now’.

Read more about our Self-Growth & Self-Esteem Treatment Service.

by: Dr. Dino Zuccarini, C.Psych. & Dr. Lila Z. Hakim, C.Psych.

“When communication breaks down, unprocessed negative emotions accumulate.” 

Emotional, physical, and sexual intimacy can be considered essential components of adult attachment bonds. Our capacity to engage in an intimate manner contributes to our ability to form and maintain mutually satisfying, long-term relationships. Emotional intimacy allows partners to feel seen, heard, and understood. Emotional closeness is core to developing satisfying couple physical and sexual intimacy.

When partners feel emotionally close, physical touch and sexual contact seem less threatening and more rewarding. A solid emotional connection allows individuals to be present and engage moment-by-moment in encounters involving intimate physical and sexual contact. Within this context, more intimate, arousing, pleasurable, and erotic encounters are then possible. On the other hand, when partners lack emotional closeness, they feel distanced or engage in circular, escalating conflicts as they strive to be understood and have their needs met by the other. Negative feelings and emotions begin to accumulate when partners are unable to intimately engage.

In some cases, a partner may fear intimacy, or lack the skills to engage in an intimate manner about their feelings, needs or desires, or lack knowledge about how to respond to the other’s feelings. When communication breaks down, unprocessed negative emotions accumulate. Unable to process their feelings and needs, partners engage in rigid, negative patterns with one another. They begin to distance from each other, experience separation fears, and engage in high-conflict exchanges in their effort to protect themselves from the growing sense of disconnection in the relationship.

Psychologists and clinicians at CFIR help individuals and couple partners learn how to identify, express, and assert their selves in their relationships to others. We also support individuals and partners on how to exit from difficult relationship patterns and become more accessible and responsive to one another. Healthy relationship and sexual functioning are important in maintaining a good sense of ourselves. Both our physical and mental well-being is improved when we have the ability to create and sustain intimate relationships with others both outside and inside the bedroom. In fact, research affirms that many individuals struggle in their efforts to maintain relationship and sexual satisfaction throughout their lives, and that dissatisfaction in these areas of life can have an impact on our mental and physical health.

Read more about our Relationship & Sex Therapy Treatment Service.

by: Dr. Lila Z. Hakim, C. Psych.

Upon birth, many couples will require some time to get used to their new home circumstances. Learning how to create and adapt to sleep and feeding schedules that suit the reality of the couple can be challenging. Numerous issues related to sleep and feeding emerge that can create distress, particularly in the context of a lack of sleep and the novelty of figuring out and managing the newborn’s needs. The relationship will transition during this period to adjust to these new circumstances. 

For some women, this period becomes complicated by depression caused by numerous physical and psychological factors, including a growing sense of isolation, emotional residues of birthing problems, sleep difficulties, and a change in sense of self and identity. Feelings of depression during this period may also be accompanied by self-criticalness and identity challenges that can then increasingly spiral into hopelessness and despair. Partners may also struggle and find themselves slipping into states of anxiety and depression. They may experience similar challenges during this transition period. 

Psychologists and clinicians at CFIR are able to diagnose and guide the treatment of postpartum depression. We provide support individuals and couples to adjust to their initial challenges upon return to home with their newborn. We help individuals and couples establish solid networks of physical and emotional care and support to ensure that isolation is reduced. We support new parents by providing them with resources to connect to the outside community. We also provide specific psychological treatment for postpartum depression, involving both individual and couple sessions to support women to emerge from the cascading negative emotions and biological turmoil that may occur during this period.

Read more about our Fertility Counselling Treatment Service.

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.