The world feels heavy right now. From the ongoing conflict and humanitarian crises in places like Iran and Gaza, to political upheaval, rising climate anxiety, and deeply personal losses, many of us are moving through our days carrying grief, fear, anger, and exhaustion all at once.

At the same time, we are trying to stay connected to the people we care about. But how do we talk about what is happening without retreating, shutting down, or unintentionally causing harm?

As a Registered Psychotherapist, I often say that it is not just what we talk about that matters, but how we approach the conversation. That is where the CAA framework I created can help, especially when emotions are high, and clarity feels hard to access.

C – Check Your Intention

Before asking someone, “Are you okay?” or opening a conversation about current events, take a moment to pause and reflect:

• Am I checking in to truly understand, or am I looking for reassurance?
• Do I want to connect, or am I trying to fix something?

Let your intention come from care and curiosity rather than control. Presence does not mean having the right answers. It means being willing to sit beside someone in their truth.

A – Awareness

Be mindful of timing, context, and your relationship to the person you are speaking with.

• Are they directly affected by what is happening?
• Is now a supportive time to talk?
• Whose discomfort is being centred in this moment?

Awareness helps us stay grounded in empathy. It gives others the space to feel fully seen, without pressure or performance.

A – Acknowledge Risk

Conversations about global pain are not neutral. For many people, these topics are deeply personal and emotionally draining. Being asked to explain, defend, or relive their pain can feel like a burden, especially when they are simply trying to survive the emotional toll.

Instead, try saying something like:
“I imagine this might be hard to talk about. No pressure at all, but I’m here to listen if you ever want to share.”

Practicing empathic presence does not mean having the perfect words. Sometimes the most meaningful act is to hold space. We can choose to be there without trying to fix or minimize the weight of what someone is feeling.

The CAA framework is not a script. It is a mindset. It reminds us that empathy is not passive. It is an active and intentional practice. This approach helps us move from avoidance to attunement, and from isolation to connection, even when the world feels uncertain and overwhelming.

Let’s show up with gentleness, with listening, and with the courage to stay present, together. If you’re looking for a place to process what you’re carrying, connect with a therapist at CFIR where compassionate, trauma-informed care meets you exactly where you are.

Laura Moore, MPsy, is an integrative Registered Psychotherapist at the Centre for Interpersonal Relationships (CFIR) in Toronto. She offers compassionate, trauma-informed support to individuals and couples navigating fertility journeys, relationship transitions, and emotional healing. Laura specializes in helping clients work through the complexities of intimacy, grief, infertility, infidelity, and reconnection. Her approach is grounded in empathy and collaboration, creating a safe space for clients to feel seen, understood, and supported as they move through life’s most vulnerable chapters.

This article is part of a series based on experiences I lived as a psychologist, client or simple observer.

When we were studying for the Ph.D. in Clinical Psychology, we had to conduct two internships of one year each. These internships, to be carried out at authorized Hospitals or Mental Health Services, were the core of our practical training. For the first one, I chose the Centre for Psychological Services at the University of Ottawa. This institution offered psychotherapy for the population at large at highly discounted rates. Most of the clients were seen by the interns. 

As we had nice offices there (the building had been recently restored) we spent most of our day in them, either seeing clients, studying or just talking amongst us. The load of work was intense given that all our sessions with clients had to be recorded (audio or video). We then had to listen to our tapes and bring the material to group supervisions. For every five hours of therapy we had, we needed to take four hours of supervision. Our days were long but the best part was still to come. 

Given that in Ottawa many people worked 9 to 5, most clients of the Centre wanted to come after that hour. The Centre was open, Monday to Friday, from 5 to 9 pm. But the atmosphere was different. There were few professors around, almost no noise and ten or fifteen interns ready to see clients, talk with each other or make an escapade to one of the small and inexpensive restaurants around the University to have dinner. 

We learnt plenty during the internship: to work long hours and see several clients; to deal with paperwork and bureaucracy; to talk and discuss cases in supervision and in individual meetings. Most of all we learnt how to be a therapist, how to understand what is affecting the client, how we can help, how to convey this to the client. 

As the months were passing, we were honing our clinical skills. Granted that we always learnt something new, indeed we still do, and therefore we had more time to read and to look at the bigger picture. 

One day I came to the realization that many clients who came to the Centre had ages finishing in nine. We discussed that in our evening conversations and most interns shared that sensation. 

Three of us went to see the Director of the Centre to tell him about this phenomenon and to ask him for permission to review the files, without looking at the name of the client, and record the age at intake. 

The Director thought about it and two days later called us in. He agreed on several conditions: it should be conducted on a Saturday when no clients were seen and it had to be anonymous. 

As we are talking about many years ago, there were no computer records of the clients, everything was paper based and the files were just the typical office style light brown folder holding the material inside. 

The three of us went on a Saturday and took several hours to retrieve files one at a time and register the age of the client when s/he attended the first interview. 

The results were clear. By far, the number that appeared the most was nine. The second one, in order of frequency, was zero. The rest of the numbers were ordered in an apparently random fashion.

Although we were expecting number nine to be the most frequent, we were surprised by the amplitude of the difference to the other numbers. We were also surprised by the appearance of number zero in second place. A logical situation in retrospect, but we admitted that we had not thought about it. 

The results were clear. The question then was “why?”. Although this was a casuistic study with no scientific rigor, I believe that the motives for some clients to demand therapy at ages ending in nine are the following:

People who are not satisfied with their work/relationships/social aspects of their life might feel embarrassment, anger, depression or many other feelings at the notion of turning 20, 30, 40, 50, etc. The previous birthday to those, namely 19, 29, 39, 49, etc., becomes a trigger to the countdown. Having a round birthday, e.g., 40, might be unwelcome but at least it might carry the hope of a better decade. Having a birthday ending in nine not only signals the advent of the round birthday but also the termination of a decade that does not satisfy them. The “nine status” might lead some people to apply the handbrake and go through life instead of developing it. There aren’t many redeeming points in being a nine. 

The issues that those clients brought to therapy show that our intuition was not off the mark. Many clients feel that they want to do something to change their life. We then see that, besides all the negative connotations that becoming something-nine might have, it has a very positive one. 

It brings the client to therapy, s/he has a clear list of issues that they want to look at and change and best of all, most clients have the motivation to do it. Therapy is never an automatic event, but some apparently negative things that happen to people might open an opportunity to face their troubles, understand them, solve them or make important decisions about their present and their future. 

David Mibashan holds a Ph.D. in Clinical Psychology from the University of Ottawa. For almost 40 years he has worked, as a Registered Psychologist, with people who felt depressed, anxious, at the verge of burn out or just not satisfied with some aspects of their life. Together with his clients, he has dealt with traumas, grief, giftedness, disabilities, immigration issues, among others. He utilizes a Humanistic / Existential approach integrating elements of Psychodrama, Gestalt and Systemic approaches. He works in English, French and Spanish.

Sleep – for something pretty straight forward, it can become quite the thorn in your side when you’re not getting enough of it. 

It likely isn’t without your best efforts. Maybe you start by hastily wrapping up your tasks for the evening and try to go to bed a bit earlier than usual. You’ve brushed your teeth and washed your face, taken a melatonin supplement, and turned all the lights out. With the added help of blackout curtains and a white noise machine, you spend the last several minutes before the anticipated end of your night scrolling through social media before a much-needed sleep.

After lights out and pillows positioned just the way you like, you close your eyes and try to go to sleep.

Then it begins…

Perhaps this sort of scenario has resonated with you. After a long and stressful day, you looked forward to getting to sleep early and let your body recuperate only to spend a good chunk of that desired sleep time awake. You’re not alone: 1 in 3 Canadians have trouble falling asleep or staying asleep, while 1 in 4 do not get the recommended 7 to 9 hours of good quality sleep (Wang et al., 2022).

It is reasonable to want to increase your chances of getting a long and restful night sleep by quickly wrapping up your evening tasks, winding down by scrolling through social media, and trying to sleep. These habits and behaviours are intended for you to reach a goal of getting to sleep earlier. Unfortunately, some of these behaviours promote wakefulness rather than sleep. For instance, rushing through last minute tasks before sleep stresses your body and thus telling it that it is not prepared for rest. The light from your smartphone as you are scrolling through social media, or any screentime for that matter, actually inhibits the release of the sleep hormone melatonin in your brain’s circadian clock, suprachiasmatic nucleus of the hypothalamus. Lastly, laying in bed awake while reviewing the stressors of your day not only stresses your body out further, but also tells your body that your bed is not a place just for sleep. Fortunately, simple changes to your routine, particularly at night, can help improve your chances of getting to sleep. 

Sleep Hygiene

You may have heard the term ‘sleep hygiene’ before – it encompasses a few behaviours and habits changes that promote sleep (Bennett, 2020; Edinger, et al., 2021). Some examples include:

• Consistent wake-up time: Set alarm and wake up at the same time every day. This helps program your circadian clock to know when to wake up every morning. 
• Go to sleep when sleepy, not tired: Only go to sleep when you feel a heaviness in your eyes and could fall asleep at any moment. If you’re able to watch a TV show, scroll through your phone, do some light cleaning, or eat – you may be tired, but not ready for sleep.
• Limit your bedroom to sleep and sex: This is pretty straight forward – other than ‘doing the deed’ or to sleep, do not use your bed for any other activity. See Part II of blog post for more information.
• A nighttime routine for relaxation: Having a routine before bed helps signal to your body (and mind) it is readying for bed. Relaxing habits like brushing skin care, stretching, or simply closing the curtains and turning off lights around your home are great ways to signal to yourself that sleep is fast approaching. Having a book with just enough warm light to read is an excellent way to prepare yourself for sleep. 

With these habits and behaviours in mind, think about how you might want to improve your sleep hygiene. Is there one that you think is pretty easy to change? Sometimes a small change is all that is necessary to ensure sleep serves its intended purpose, to recover and prepare you for the next day ahead. 

Dr. Robbie Woods (C. Psych.) is a clinical psychologist at the Centre for Interpersonal Relationships (CFIR). He provides psychological services to adults who are seeking assessments and treatments for a variety of conditions including anxiety (e.g., generalized, social, health, panic), obsessive-compulsive (e.g., body dysmorphia, skin-picking), and depressive disorders (e.g., major depressive, persistent depressive). Moreover, Dr. Woods has a keen interest in treating sleep difficulties, namely insomnia, using a combination of evidence-based cognitive and behavioural interventions as recommended by the Canadian Sleep Society and the American Academy of Sleep Medicine.

References:

Bennett, D. (2020). Cognitive-Behavioral Therapy for Insomnia (CBT-I). Sleep Medicine and    Mental Health: A Guide for Psychiatrists and Other Healthcare Professionals, 47-66.

Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., …   & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia      disorder in adults: an American Academy of Sleep Medicine systematic review,                   meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine, 17(2),       263-298.

Wang, C., Colley, R. C., Roberts, K. C., Chaput, J. P., & Thompson, W. (2022). Sleep      behaviours among Canadian adults: Findings from the 2020 Canadian Community          Health Survey healthy living rapid response module. Health reports, 33(3), 3-14.

From pregnancy to postpartum, there are many emotional and physical changes one goes through on the journey into motherhood. The body undergoes significant transformation from the moment it starts working to sustain a new and precious life until well after childbirth. Naturally, this can lead to feelings of self-doubt and body image challenges. Although these are normal feelings, this experience can become overwhelming, especially in a societal and environmental context that puts pressure on mothers to “bounce back” – to return to their pre-baby bodies and selves. If you’re struggling to accept this new version of you and needing support – you’re not alone. There is help available. When working with new moms to address body image challenges, introducing a simple yet powerful tool known as self-compassion, can be very effective.  

Research on self-compassion has overwhelmingly shown that it is associated with less anxiety, depression, and stress, and greater optimism, psychological wellbeing, and life satisfaction (Neff et al., 2018; Zessin, et al., 2015). It is also associated with greater motivation, healthy behaviours, and positive coping strategies (Allen & Leary, 2010; Braun et al., 2016; Breines & Chen, 2012; Terry & Leary, 2011). 

When aiming to feel better, we often think that the answer is to improve our self-esteem or think more positively about the self. While this can be helpful, improving self-esteem tends to be a longer process whereas self-compassion is immediately accessible in painful situations and encourages a kinder, more balanced relationship with ourselves. Self-compassion is also simple to understand as it involves treating yourself with the same care and understanding that you would offer to a loved one in a time of need. 

What is self-compassion? 

Self-compassion involves three components – (1) mindfulness, (2) a sense of common humanity, and (3) self-kindness (Neff, 2003; 2022). When we are self-compassionate, we acknowledge and stay present with our pain (mindfulness), normalize our suffering as a shared human experience (common humanity), and be with ourselves in a supportive and soothing manner (self-kindness). This definition of self-compassion was based on compassion for others as conceptualized in Buddhist philosophy (Neff, 2016; e.g., Brach 2003; Kornfield 1993; Salzberg 1997). The three elements interact with one another to create an overall self-compassionate mindset. We can use this positive mindset when external circumstances of life are simply painful or difficult to bare through such as coping the reality of a changed appearance and any negative thoughts and feelings that accompany these changes.  

Let’s look at an example of how we can use self-compassion to support ourselves when struggling with negative body image thoughts and feelings:

1. Be Present with and Acknowledge Your Feelings (Mindfulness): When we aim to employ mindfulness, we are turning towards the negative thoughts or feelings that come up about our body and stay in the present moment of our reality without judgment. We do this instead of avoiding or exaggerating these negative thoughts and feelings. We acknowledge what is happening, as it happens, without supressing it or getting carried away in it. This can sound like: “Right now I am suffering. I am experiencing a difficult moment where I am feeling down and thinking negatively about my body. It’s okay to feel this way”.
2. Recognize Your Experience is a Shared One (Common Humanity): When negative thoughts and feelings about your changed appearance or body arise, pause and recognize that this is a completely normal and human experience. You are not alone in this suffering. Remind yourself that you and your body have done nothing wrong. Your body brought a new life into the world, and that is a profound achievement. Many moms find themselves in similar circumstances after having a baby. How would you speak to a friend sharing a similar experience with you? Can you offer yourself the same gentle understanding and validation? 
3. Tune into your Needs and Offer Support (Self-Kindness):  After acknowledging your thoughts and feelings, and noting these to be part of a shared human experience, ask yourself: “What do I need right now?” “How can I support myself and be kind to myself in this difficult moment?” For example, you might need rest, comfort, connection, care, or permission to slow down. How can you honor your needs right now in a kind and gentle way?

By practicing self-compassion, new moms can foster a healthier, more loving relationship with their bodies and selves. Rather than focusing on problem-solving or fixing our changed selves or appearances, self-compassion allows for self-acceptance, helping to build confidence and body positivity during the postpartum period.

Samantha Szirmak, MPsy., R.P. is a Registered Psychotherapist at the Centre for Interpersonal Relationships (CFIR). Samantha provides psychotherapy services to individual adults and adolescents experiencing a wide range of concerns including mood, anxiety, identity/self-worth, trauma, eating/body image, grief, and relationship issues. She utilizes an integrative therapy style that blends theory and techniques from compassion-focused, experiential, psychodynamic, and cognitive therapy approaches. She has a special interest in supporting and working with pregnant and post-partum women navigating this important life transition.

References

Allen, A. B., & Leary, M. R. (2010). Self-compassion, stress, and coping. Social and Personality Psychology Compass, 4(2), 107–118.

Brach, T. (2003). Radical Acceptance: Embracing Your Life with the Heart of a Buddha. Bantam 

Books. 

Braun, T. D., Park, C. L., & Gorin, A. (2016). Self-compassion, body image, and disordered eating: A review of the literature. Body image, 17, 117–131. 

Kornfield, J. (1993). A path with heart. New York: Bantam Books.

MacBeth, A., & Gumley, A. (2012). Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552.

Neff, K. D. (2003a). Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85–102.


Neff, K. D. (2016). The Self-Compassion Scale is a valid and theoretically coherent measure of self-compassion. Mindfulness, 7(1), 264-274.

Neff, K. D., Long, P. Knox, M., Davidson, O., Kuchar, A., Costigan, A., Williamson, Z., Rohleder, N., Tóth-Király, I., & Breines, J. (2018). The forest and the trees: Examining the association of self-compassion and its positive and negative components with psychological functioning. Self and Identity, 17(6), 627-645. 

Neff, K. D. (2022). Self-compassion: Theory, method, research, and intervention. Annual Review of Psychology, 74(1). 

Salzberg, S. (1997). Lovingkindness: The revolutionary art of happiness. Boston: Shambala

Terry, M. L., & Leary, M. R. (2011). Self-compassion, self-regulation, and health. Self and Identity, 10, 352–362. 

Zessin, U., Dickhäuser, O., & Garbade, S. (2015). The relationship between self‐compassion and well‐being: A meta-analysis. Applied Psychology: Health and Well-Being, 7(3), 340–364. 

Perfectionism is a much discussed topic these days, with many books, articles, videos, and podcasts on the topic. Some of it is helpful, others not so much. One aspect of perfectionism I rarely see talked about are the different types of perfectionistic tendencies and what motivates this drive to be perfect. To start, it is important to identify what type of perfectionist you might be.  

Perfectionism is a broad term for a wide-ranging set of beliefs and actions. On one end there are perfectionists that never miss a deadline, look and act very put together, and are the ones who complete any assignments (or work tasks) as soon as they get them. On the other end are the people with perfectionistic tendencies who avoid, procrastinate until the last minute, or get lost in the planning or research phase that they do not ever finish what they start (or do so under intense pressure – often last minute). Regardless of the kind of perfectionistic tendencies a person has, there is usually at the root of perfectionism, a strong fear of failure and a tendency to be very self-critical. What differentiates the perfectionism is the motivations underlying the perfectionistic-beliefs and actions that reinforce the perfection. 

The 2-Types of Perfectionism: Motivations and Behaviours

The 2-types of perfectionism I will focus on are self-oriented and socially-prescribed. Self-Oriented Perfectionism, which is thought of as involving a set of high, unrelenting, and unrealistic standards that a person sets for themselves. People who tend to be more self-oriented in nature may be very aware of their self-critical thoughts, and judge themselves harshly, and use this as motivation (and sometimes punishment). People who are self-oriented perfectionists tend to be goal oriented, set unrealistic targets for their performance, and are strongly afraid of failing their own ambitions. 

The second type, Socially-Prescribed Perfectionism, may involve those who have high, unrealistic, and unrelenting expectations, but these expectations come from others (rightly or wrongly) and are designed to try and keep others happy. For example, people high in socially-prescribed perfectionism may work hard to take care of others, win the approval of others, and are often very concerned with how others see them (ideally in a perfect way). 

Socially-prescribed differs from self-oriented perfectionism in that beliefs and demands for perfection start with others expectations (think of a parent demanding to know what happened to that last 5% on a test), but become directed inwards towards ourselves. In other words, socially-prescribed are perfectionistic demands that are outside -> in; self-oriented are demands that are inside->out. 

It’s not always easy to figure out what type of perfectionist category we fall into. In many cases we can be concerned with both what others think or our own goals. Sometimes, our expectations depend on the environment we are in and who is around us. We all act differently at work than we do out a dinner later with friends. Here’s a way I’ve found helpful to get at the issue of what kind of perfectionist you might be: 

Ask yourself this:  

“Who would you rather disappoint: Yourself or someone else (e.g., your boss, your employees, your parents, your friends, your kids, your spouse, etc.).”

Take your time, the first option that comes to mind is often the more accurate one. Pay attention to see if one option raises your anxiety more than the other. You might be ok disappointing your friends or a manager, but become upset or tense at the idea of not meeting a goal you set yourself (in this case you’d be higher on self-oriented perfectionism).

The main message is that perfectionism comes in different forms and flavours, largely depending on where our expectations come from (inside vs. outside ourselves). This also means that the expectations around perfectionism, regardless of the source, put immense pressure on us to be perfect. Unfortunately, perfection is not something that is truly attainable, which is why perfectionism is highly self-defeating. When we push ourselves to extremes to try to achieve something that is impossible, we end up with failure. Setting our expectations more compassionately and our goals more realistically and shifting our focus to the process not the outcome helps reduce the pressures of perfection.   

Dr. Robert Hill, C.Psych. is a clinical and health psychologist at the Centre for Interpersonal Relationships. He provides psychotherapy for adults experiencing a wide range of mental health symptoms, including perfectionism. 

References:

Hewitt, P. L., & Flett, G. L. (2002). Perfectionism and stress processes in psychopathology. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 255–284). American Psychological Association. https://doi.org/10.1037/10458-011

In part 1 of this blog series, we saw the challenge of expressing emotions and the shame that can come with it – and how it can impact relationships. Shame doesn’t just silence emotions. It disconnects us from our own needs and from those we love. When we feel shame, we’re less likely to voice our emotional experience. This can make it harder for our partners to understand us or respond to what we truly need. Over time, this can create distance and misattunement in the relationship, even when both people care deeply about one another. Naming shame is the first step toward healing and reconnection.

The first step towards de-shaming emotional experiences is normalizing them. It’s okay to

• feel unsure about what you’re feeling
• need help in naming and expressing emotions
• find certain emotions, like anger or sadness, uncomfortable or even frightening

The goal is not to eliminate difficult emotions. Rather, we want to develop a new relationship with them. One that allows you to recognize, understand, and respond to them in more helpful ways, that bring growth and connection.

What does this mean for couples or individuals? It means creating space for emotions without judgment. Listening to your own/each other’s feelings with curiosity and compassion rather than defensiveness. Replacing criticism with understanding and recognizing that behind every strong emotion is a longing to be seen, heard, valued.

By shifting from shame to self-compassion, couples and individuals can break free from emotional disconnection. The more we learn to identify and express our emotions, the more we can meet our own needs as well as those of our partners. Emotional fluency is not an innate language. It is learned, practiced, and developed over time. Just like any other language! And no matter where you are in your emotional journey, it’s never too late to begin.

Mental health services can provide the tools, space, and support for this process. In therapy, individuals and couples can safely explore their emotional world with the guidance of a therapist. Therapy offers a space to practice identifying feelings, unpack the needs behind them, and work through the shame that may have built up around emotional expression. With time and support, clients can begin to rewrite the narratives they hold about emotions, learn how to respond to each other with empathy, and deepen their emotional connection in lasting ways.

Daniela Levi, MSW, MEd, is a Registered Psychotherapist at CFIR, specializing in individuals, couple and family therapy. Her work focuses on self-awareness and strengthening interpersonal relationships through an attachment-based and emotion-focused approach. With a deep passion for the role of emotions in relational dynamics, Daniela helps clients navigate their inner experiences to build deeper connections with themselves and others. She is currently pursuing her Doctorate in Psychology at the University of Toronto. 

One of the most common struggles I see in couples therapy is the difficulty one or both partners have in identifying and expressing their own emotions. Many people grow up without ever learning how to name or understand their feelings. Emotions are internal signals – our mind and body’s way of letting us know that something important is happening within or around us. They help us make sense of our experiences, guiding our attention to what matters, motivating us to act. In school, we are taught math, science, and history, but rarely are we given the tools to navigate our inner emotional experiences. As a result, emotions can feel foreign, overwhelming, or even scary and dangerous.

Every emotion has a need attached to it. Sadness might signal a need for comfort or connection. Anxiety could be pointing to a need for reassurance or safety. Anger often shows up when a boundary has been crossed, indicating a need for respect or acknowledgment. Yet, when emotions remain unrecognized, so do the needs behind them. This can leave individuals and couples stuck – feeling misunderstood, unheard, and disconnected. 

Barriers to expressing emotions and meeting relational needs

One of the greatest barriers to emotional awareness and growth is shame. Many people have been taught (either directly or indirectly) that emotions are a sign of weakness or irrationality. This is especially true for emotions like anger, which can be labeled as “bad” or “destructive,”. Vulnerability can be seen as something to suppress and hide. The fear of being judged (by oneself or others) can keep us from exploring our emotions with curiosity and compassion. Struggling with emotions is not a personal failure -it’s more common than we realize, and an aspect I often see in my work. If we were never taught how to identify, name and process our feelings, how could we be expected to do so with ease? There is no shame in finding emotions confusing or intimidating. In fact, recognizing this struggle is the first step toward change.

In part 2 of this blog series, we will explore the steps we can take to start de-shaming being in touch with our own emotions, paving the way to more vulnerability and connection with our partner.

 Daniela Levi, MSW, MEd, is a Registered Psychotherapist at CFIR, specializing in individuals, couple and family therapy. Her work focuses on self-awareness and strengthening interpersonal relationships through an attachment-based and emotion-focused approach. With a deep passion for the role of emotions in relational dynamics, Daniela helps clients navigate their inner experiences to build deeper connections with themselves and others. She is currently pursuing her Doctorate in Psychology at the University of Toronto. 

In Part 1 of this blog, we explored how complex trauma affects a person emotionally, cognitively, and physically, often leading to complex post-traumatic stress disorder (C-PTSD). In this next section, we’ll focus on the long-term effects of complex trauma and discuss ways to begin the healing process.

Complex trauma refers to prolonged, repeated exposure to traumatic events, often occurring within interpersonal relationships or early in life. Unlike single-incident trauma, complex trauma shapes a person’s sense of identity, safety, trust in themselves and the world, and general attachment to others. Understanding these impacts is the first step toward compassionate, effective care and meaningful recovery.

The Long-Term Impact of Complex Trauma

Without intervention, complex trauma can shape a person’s personality, behaviors, and overall mental health. Many individuals develop anxiety disorders, depression, or dissociative disorders as a result of their experiences. They may struggle to maintain stable jobs, relationships, and a sense of purpose in life. Self-destructive behaviors, including substance abuse, disordered eating, or reckless decision-making, can become coping mechanisms for the unresolved pain/hurt. Additionally, chronic feelings of emptiness, emotional detachment, and difficulty trusting others can make it challenging to build a fulfilling life. However, despite these challenges, healing is possible with the right support and strategies.

Healing from Complex Trauma

Recovery from complex trauma is a gradual process that requires patience, support, and intentional effort. When beginning the journey, it is important to establish a sense of safety and stability in your life. Before deep healing can occur, individuals must feel physically and emotionally secure in their environment. This includes developing healthy routines, learning self-soothing techniques, and building supportive relationships. 

Psychotherapy can also be helpful in determining the specific messaging that led to the complex trauma. After having a better understanding of the ways we were hurt, we then have the opportunity to develop new, more helpful narratives about ourselves and the world around us that makes us feel safe and secure. Additionally, psychotherapy can also be a space where you learn to recognize triggers, establish boundaries, and emotionally regulate when feeling heightened. 

Dr. Erica Tatham, Ph.D., C. Psych., is a psychologist and neuropsychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Tatham provides psychological services to individual adults and seniors experiencing a wide range of psychological and relationship difficulties. She typically works with individuals experiencing mood and anxiety disorders, complex and situational trauma, neurodevelopmental disorders (e.g., ADHD and ASD), and interpersonal conflict. She takes an integrative approach to therapy and utilizes emotion focused therapy (EFT), object relations and self-psychology, and cognitive behavioural therapy (CBT).

References:

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., & Van der Kolk, B. (2005). Complex trauma. Psychiatric annals, 35(5), 390-398.

Ford, J. D., & Courtois, C. A. (Eds.). (2020). Treating complex traumatic stress disorders in adults (2nd ed.): Scientific foundations and therapeutic models. New York: The Guilford Press.

Trauma is often thought of as a single, life-altering event, but for many people, it is an ongoing experience that shapes their entire sense of self and the world around them. Complex trauma develops from prolonged exposure to distressing events, often in relationships where there is an expectation of safety and care, such as in the home or with caregivers. Unlike single-incident trauma, which may result from a car accident or a natural disaster, complex trauma is deeply woven into a person’s development and disrupts emotional regulation, trust, and a person’s sense of self. Understanding complex trauma is essential, both for those who experience it and for those who support them on the path to healing.

The Impact of Complex Trauma

The effects of complex trauma extend beyond emotional distress, influencing cognitive functions, physical health, and interpersonal relationships. 

Emotionally, individuals may struggle with intense mood swings, difficulty regulating emotions, and persistent anxiety or depression. Many people with complex trauma experience chronic feelings of emptiness, shame, or guilt, often engaging in self-destructive behaviors such as substance abuse or self-harm as a way to cope. 

Cognitively, trauma can impair concentration, memory, and decision-making. Many individuals report experiencing intrusive thoughts or flashbacks and develop a negative self-perception, feeling inherently flawed or unworthy of love. These thought patterns often lead to overgeneralized fear responses, where a person expects harm even in safe situations. 

Physically, the body carries the weight of trauma, manifesting in symptoms such as chronic fatigue, muscle tension, gastrointestinal issues, and an overactive stress response. Sleep disturbances, including nightmares and insomnia, are also common. The nervous system remains on high alert, leading to hypervigilance and difficulty relaxing, even in non-threatening environments.

Complex PTSD (C-PTSD) vs. PTSD

When the trauma experiences cause significant psychological distress, then an individual will likely be diagnosed with post-traumatic stress disorder (PTSD). 

While both PTSD and Complex PTSD (C-PTSD) result from trauma, they differ in key ways. PTSD typically develops after a single, identifiable traumatic event and is characterized by flashbacks, nightmares, and heightened arousal. In contrast, C-PTSD emerges from repeated trauma over time and therefore makes emotional dysregulation, a distorted self-image, and chronic difficulties in relationships more likely. 

Although C-PTSD is not yet formally recognized as a separate distinct diagnosis in all diagnostic systems, it is widely acknowledged in trauma-informed care and therapeutic settings.

Dr. Erica Tatham, Ph.D., C. Psych., is a psychologist and neuropsychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Tatham provides psychological services to individual adults and seniors experiencing a wide range of psychological and relationship difficulties. She typically works with individuals experiencing mood and anxiety disorders, complex and situational trauma, neurodevelopmental disorders (e.g., ADHD and ASD), and interpersonal conflict. She takes an integrative approach to therapy and utilizes emotion focused therapy (EFT), object relations and self-psychology, and cognitive behavioural therapy (CBT).

References:

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., & Van der Kolk, B. (2005). Complex trauma. Psychiatric annals, 35(5), 390-398.

Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., … & Bohus, M. (2022). Complex post-traumatic stress disorder. The lancet, 400(10345), 60-72.

By Laura Moore MPsy.

You know that moment—when you walk away from a conversation with a lump in your throat, your chest tight, your jaw locked, and your inner voice screaming, “Why didn’t I just say it?” That’s self-silencing. And whether it shows up as a forced smile, a nod you don’t mean, or biting your tongue again—it’s not just frustrating. It’s exhausting.

Here’s the truth: we self-silence because we’re trying to stay safe. Somewhere along the way, we learned that speaking up might get us criticized, rejected, or even abandoned. So we played small. We became the easy one, the chill one, the don’t-make-it-a-big-deal one.

But let me be clear: that silence comes at a cost.

When we mute our truth, our relationships suffer. We crave closeness, but we keep hiding the very parts of us that would create it. We resent others for not meeting needs we never voiced. And at work? We play it safe, stay in the background, and wonder why we feel invisible.

Spoiler: you can’t be seen when you’re constantly shrinking.

So what do we do?

We get honest. Ask yourself: What am I afraid will happen if I speak up? And what’s already happening because I don’t? Don’t just brush past that question—sit with it.

Then try this: one act of micro-bravery a day. Say one true thing. Out loud. Even if your voice shakes. Even if your hands do too, truth builds trust—not just with others, but with yourself.

And here’s what matters most: self-validation. You’re not waiting for someone else to say it’s okay to speak—you get to say that to yourself. That voice you once silenced to stay safe? It’s time to meet it with compassion. You can be the one now who says, “I hear you.” That’s how we begin to build a home inside ourselves where truth is welcome.

You weren’t put on this planet to blend in. You were made to be seen, heard, and known.

It’s time to stop trading authenticity for approval.

Speak up.

Show up.

The real you is not too much—it’s just been waiting for permission.

And here’s the secret: you don’t need it. You are the one who gets to give it!

Laura Moore, MPsy., is an integrative therapist at the Centre for Interpersonal Relationships (CFIR) in Toronto, specializing in helping individuals and couples navigate the emotional complexities of fertility, identity, and intimate relationships. With a deep understanding of how early patterns of self-silencing, perfectionism, and people-pleasing impact adult connection, Laura creates a safe, nonjudgmental space to explore grief, loss, relational boundaries, and self-worth. She supports clients through transitions such as fertility treatments, separation, infidelity, and rebuilding after emotional trauma. Laura is passionate about helping people reclaim their voice, deepen self-trust, and cultivate relationships that honour both authenticity and connection.