In this second part of the blog on the stages of change, a few techniques are presented to help you progress from one stage to another or support a loved one going through a process of change. However, note that returning to a previous stage is not a failure. Maybe it can be seen as a reminder that more work had to be done in this previous stage before progressing to the next stage. Humans are constantly changing and adapting to external and internal situations; therefore, it is normal that our motivation also fluctuates.

1. Precontemplation: At this stage, as you may not be aware that the behaviour is problematic yet, it can be helpful to start by simply evaluating it and thinking about what you want or need. In other words, we want to develop a more conscious awareness of the behaviour.
   • How to help someone during the precontemplation stage:
     • Offer support and active listening.
     • Provide information about the impacts of the behaviour, in a non-judgmental way.
2. Contemplation: As you are starting to recognize the impacts of the behaviour, you may want to identify the pros and cons of making a change. This can help to see how your life could be different, should you modify the behaviour in any way.
   • How to help someone during the contemplation stage:
     • Make space to discuss the pros and cons of change with the person.
     • Let the person decide for themselves if they want to change the behaviour.
3. Preparation: At this stage we want to identify any obstacles that may get in the way of making a change, as well as the skills and steps needed to make it happen.
   • How to help someone during the preparation stage: 
     • Help the person identify any obstacles.
     • Encourage the person in their decision and planning.
4. Action: Here we want to use your support system and coping strategies to make the plan happen for as long as you can. Remember, it is normal to return to the preparation stage (or another previous stage), and think of more pros and cons or identify other obstacles that made it difficult to follow through with the plan. 
   • How to help someone during the action stage:
     • Reach-out and check-in with the person.
     • Remind them of the long-term benefits of their goals.
     • Play a supportive role in the life of the person.
5. Maintenance: After the action plan has been put in place and practiced, we want to identify strategies and coping tools to help maintain it for a longer period. The idea is to have tools that can be helpful to support you as you experience a whole range of emotions (e.g.: What/who will you turn to when you are happy? When you are sad? Do you feel at risk of going back to the old behaviour if you have a bad day?).
   • How to help someone during the maintenance stage: 
     • Remind the person of their strengths and what they have accomplished so far.
     • Help the person develop a plan to support them in the long-term.

If you are experiencing challenges in changing a behaviour or are finding it difficult to support a loved one in their own process of change, know that therapists at CFIR-CPRI are available to support you. Our professionals are trained to support you to better understand what prevents you from attaining the changes you are hoping for, and to develop your motivation to change. Contact us via [email protected] and a member of our team will be happy to assist you.

Natalie Guenette, M.A., R. P. is a Registered Psychotherapist who works with adults in both English and French. She works with an integrative framework and provides services to those experiencing a broad range of difficulties, including substance use, depression, anxiety, self-esteem, and trauma.  

Have you ever found yourself feeling stuck and unable to change a behaviour? Not having the motivation to make the necessary change? Feeling like ‘it’s just not the right time yet’? This might be because you are still ambivalent about changing.

The stages of change model (Prochaska et al., 1992) describes 5 stages that individuals experience when trying to change. Research shows that this model is an effective tool to help change a broad spectrum of behaviours, including addictions (Rahian, N. & Cogburn, M., 2023). It is important to note that it is common, and normal, to switch between stages and fall back to a stage we had previously ‘completed’, as the changing process is NOT linear. 

1. Precontemplation: At this stage, individuals may not see their behaviour as a problem, and therefore, may not think about changing it. There can be resistance to make any modification and/or to receive support. There is often denial about the problematic behaviour. 
2. Contemplation: In this second phase, individuals are starting to recognize and acknowledge that the behaviour may be problematic and are starting to consider changing it. Due to the ambivalence felt towards the worthiness of the changing process, individuals can often remain stuck at this stage for some time. During the contemplation stage, individuals are usually considering the pros and cons of change, although, because the behaviour is still serving them in some way, the cons associated with the change continue to outweigh the perceived pros.
3. Preparation: individuals are committed to change at this stage and have usually started taking steps toward change. An action plan is set, and the pros of changing are now outweighing the cons. 
4. Action: While in the action stage, individuals are actively involved in modifying their behaviour. This is usually the shortest stage, and when they are at the highest risk to go back to the initial behaviour, or, in other words, to relapse. 
5. Maintenance: This final stage is when individuals have maintained the changed behaviour for about six months. The risk of relapsing has reduced, and they are building their confidence in their ability to maintain the new coping strategies developed throughout the changing process.  

Therapists at CFIR-CPRI can help support you to better understand what may prevent you from attaining the changes you are hoping for, and also to develop your motivation to change. Contact us via [email protected] and a member of our team will be happy to assist you.

Natalie Guenette, M.A., R. P. is a Registered Psychotherapist who works with adults in both English and French. She works with an integrative framework and provides services to those experiencing a broad range of difficulties, including substance use, depression, anxiety, self-esteem, and trauma.  

School can be difficult for children of any age, with academic and social pressures increasing with every new grade. Children who struggle in school can be at risk for a host of negative experiences such as anxiety, depression, low self-esteem, and behavioural and social issues. As time goes on and workloads increase, struggling children may find that the strategies that have helped them in the past are no longer working effectively and it takes more time and even more effort just to maintain the level at which they are currently performing. When difficulties are left unaddressed, children can often feel lost, unsupported, and hopeless about the future. Fortunately, there are ways to identify children’s difficulties and how to better support them both in school and at home. One such way is a psychoeducational assessment, conducted by a psychologist and their relevant team.  

What is a Psychoeducational Assessment?     

A psychoeducational assessment helps children in many ways. It can help:    

• Identify areas of strength along with areas of difficulty 
• Determine the presence of learning disabilities, and/or disorders such as ADHD and ASD. 
• Determine the presence of giftedness       

The aim of this kind of assessment is to provide a better understanding of your child’s development relative to other children their age and can help get your child the supports they need at school. The report received from this assessment can be provided to your child’s school to inform them of the types of supports or accommodations your child is likely to benefit from so that they can perform to the best of their ability (e.g., extra time, one-on-one support). It can even act as a basis to monitor progress and change over time, throughout your child’s academic career (in the case of multiple assessments).  

A psychoeducational assessment can provide you and your child with a better understanding of themselves, their abilities, and can set them up to learn strategies to help them succeed both in and outside of school.  

If you believe a psychoeducational assessment may be helpful for your child, our CFIR-CPRI clinicians are ready to support you in this process. Contact us via [email protected] and a member of our team will be happy to assist you.

Massimo Di Domenico, M.A.,is a therapist working under the supervision of Dr. Nalini Iype, C.Psych. and is also working towards the completion of his PhD in Clinical Developmental Psychology. He provides both treatment and assessment services to individuals of all ages – children, adolescents, and adults. Working with an integrative framework, he treats those suffering from depression and anxiety, difficulties in social relationships, and concerns related to parenting and family dynamics. For those seeking answers on how they, or their child, learn or work best, he also provides assessment services for learning disorders and ADHD.

Trauma and chronic stress deeply affect our bodies and minds, leaving lasting imprints in our cognitive and physiological memory. Physiological memory stores the physical sensations and reactions tied to traumatic experiences, which can resurface through triggers and lead to recurring distressing symptoms. 

Body-based therapies recognize the vital role of the body in trauma healing. By integrating body and mind, these therapies provide effective tools to unlock deep healing potential. They encourage us to reconnect with our bodily sensations, movements, and postures, tapping into the wisdom of the body. This process allows for the exploration and release of tension, leading to increased body awareness. 

A key aspect of body-based therapies is learning to regulate our physical responses. Therapists can help clients gain a better understanding of their bodily impulses and sensations, guiding them in safely navigating trauma-related sensations. By gradually learning skills to regulate arousal levels, we can regain control over our bodies, promoting resilience and regulation. 

Body-based therapies also focus on integrating traumatic experiences into our overall narrative. By bridging cognitive and physiological aspects of trauma, we can form a coherent and compassionate understanding of our journey. This integration cultivates a sense of safety, healing, and wholeness. 

Recognizing the interconnectedness of our bodies and minds is crucial for healing trauma and chronic stress. Body-based therapies offer powerful pathways to overcome these challenges while honouring the wisdom of the body. By embracing these approaches, we can embark on transformative journeys toward healing, resilience, and a renewed sense of well-being. 

Grabbe, L. (2017). The Trauma Resiliency Model: A “Bottom-Up” Intervention for Trauma

Psychotherapy. Journal of the American Psychiatric Nurses Association, 24(1). https:/

doi.org/10.1177/1078390317745133 

Fisher, J. (2011). Sensorimotor Approaches to Trauma Treatment. Advances in psychiatric

treatment,17, 171–177. doi: 10.1192/apt.bp.109.007054 

Fisher, J. (2019). Sensorimotor Psychotherapy in the Treatment of Trauma. Practice Innovations,

4(3), 156-165. https://janinafisher.com/wp-content/uploads/2023/03/sensorimotor

psychotherapy-trauma.pdf 

Laura McKinney, B.A., is a therapy and assessment practicum student working under the supervision of Dr. Lila Hakim, C. Psych., currently completing her master’s in psychology. As a practicum student, Laura offers therapy at a discounted rate. She is passionate about helping clients heal from trauma and chronic stress. Please check out her profile on the Toronto team page on the CFIR website for more information.”

Cancer can completely upend your life and the lives of those who love you. It not only affects you physically, but also has profound emotional and psychological consequences for everyone involved. From the moment you receive the diagnosis to the often challenging or even excruciating medical treatments, cancer brings a whirlwind of difficulties that can lead to symptoms of posttraumatic stress. People living with cancer may have symptoms of post-traumatic stress at any point from diagnosis through treatment, after treatment is complete, or during recurrence. This can range from experiencing irritability, hypervigilance, and sleep disturbances, to loss of interest in life and feeling detached from oneself or reality.  

In simple terms, the trauma of cancer can greatly reduce your ability to handle and cope with stress and emotions, narrowing your “window of tolerance.” Within this window of tolerance, we usually feel safe, calm, and capable of effectively managing stress and emotions. However, cancer pushes us to our limits, often causing this window to shrink. It becomes much more challenging to find that sense of safety and calmness in the face of overwhelming stress. 

However, survivors of cancer also often report experiencing posttraumatic growth (PTG) after their journey. PTG refers to the positive psychological changes that can occur in people following the experience of a traumatic event or significant life crisis. PTG can include improved relationships, new possibilities for life, a greater appreciation for life, increased personal strength, and spiritual development. 

PTG coexists with personal distress and does not diminish the emotional impact of traumatic events or the amount of work that it takes to achieve it. It is not a universal or inevitable outcome for all people who experience trauma, but by working with a mental health practitioner, you can work towards achieving PTG. Embracing the potential for posttraumatic growth means embracing the opportunity to discover new paths and possibilities that may have never been considered before. It means finding a deeper appreciation for what life has to offer and a renewed sense of purpose. 

Cancer-related post-traumatic stress. National Cancer Institute. (n.d.). https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq  

Jim, H. S., & Jacobsen, P. B. (2008). Posttraumatic stress and posttraumatic growth in cancer survivorship: A Review. The Cancer Journal, 14(6), 414–419. https://doi.org/10.1097/ppo.0b013e31818d8963  

Tedeschi, R.G. & Calhoun, L. (2004). Posttraumatic Growth: A New Perspective on Psychotraumatology. 21(4). https://www.bu.edu/wheelock/files/2018/05/Article-Tedeschi-and-Lawrence-Calhoun-Posttraumatic-Growth-2014.pdf 

Laura McKinney, B.A., is a therapy and assessment practicum student working under the supervision of Dr. Lila Hakim, C. Psych., currently completing her master’s in psychology. Alongside her placement at CFIR, Laura is training as a therapist at Princess Margaret Cancer Centre, where she is working with individuals living with cancer. As a practicum student, Laura offers therapy at a discounted rate. Please check out her profile on the Toronto team page on the CFIR website for more information.

 The idea of being ‘authentic’ pops up often in popular psychology. It’s now common parlance to say, ‘just be yourself’. But if you are like me, at some point, you might have frustratingly wondered what does that mean? And what does it mean when we are not being authentic?   

Dr. Donald Winnicott’s theory of true and false self is helpful in answering these questions. In his work as a pediatrician and psychoanalyst, he saw infants as essentially a ball of needs and desires that expresses themselves spontaneously through cries, laughs, screams, and bites. Healthy development, in his view, requires a period when the child doesn’t have to be concerned with the worries and expectations of those who are taking care of them. This requires caregivers to adapt and create a holding environment that allows them to express themselves however they wish. This period of authenticity is the foundation for building a self that knows what I like what I don’t like, what my interests and passions are, and a sense that my needs are legitimate, and I can reasonably expect others to respond to them. 

We run into trouble when we are required to comply to the demands of others far too early and not having experienced much of that holding environment that allowed us to be ourselves. Perhaps a parent was depressed and overwhelmed, or a parent was often annoyed or in a rage. In these circumstances the child would have to prematurely comply, to take care of others, and to be another version of themselves—a false self. In adult life, we may become very good at taking care of others’ needs but struggle to feel satisfied in relationships. We might excel at work but find it unfulfilling. We might find ourselves having the right ‘things’ in life but lacking vitality. 

Psychotherapy is almost like a second chance for us to be in a holding environment where we can reconnect with thoughts, feelings, desires, physical felt sense that has been put away and forgotten. To be able to experience joy, anger, aggression; to scream and to laugh without being punished or shamed. From there, a more authentic sense of ourselves filled with vitality can be grown. 

Clinicians at CFIR take an integrative approach that incorporate multiple approaches such as psychodynamic, emotion-focused, and cognitive-behavioural therapies to help you reconnect with your authentic self and foster vitality in your life. 

Shaofan Bu is a Doctoral Candidate at McGill University studying Counselling Psychology. He is a Registered Psychotherapist (Qualifying) under the supervision of Dr. Dino Zuccarini. 

Shame is a powerful and overwhelming emotion that can cause people to withdraw from their relationships. Shame can also make it challenging to communicate openly and honestly with others. Feeling ashamed can affect one’s ability to express their authentic wants, needs and desires and hinder intimacy and connection.

Once you become aware of someone’s shame, sit with them in it and do not attempt to change or move past it. However, there are ways that you can overcome shame; here are 5 ways to start healing the feeling:

The 5 S’s of Healing Shame

SEE – Identify shame triggers and learn about how these affect you in your relationships.

SELF-TALK – You can change how you talk to yourself by changing what you say. For example, if your inner critic tells you that “you are not enough,” try replacing this with a statement like “I am enough” or something else in line with the truth of who and what is really important for you.

SAFETY – Recognize the urge to isolate in order to feel safe as you move through the feelings of shame. When another person creates a safe environment, you are able to be vulnerable.

SHARE – By sharing your story, the other person can regulate your emotions and respond with empathy and understanding. 

SHAKE– Set boundaries and let go of the relationships perpetuating the shame cycle where you are not seen, heard and understood.

Therapy can also be an antidote to shame as it provides a framework to learn and act on the 5 S’s of healing shame. In addition, therapy offers a safe environment to be vulnerable, share your story, understand your shame triggers, and develop distress tolerance skills.

Vulnerability and empathy are the antidotes to shame. Although sharing how you feel may seem counterintuitive, it is essential in mitigating the painful effects of shame.

Laura Moore, MPsy., is a psychodynamic therapist at the Centre For Interpersonal Relationships (CFIR) in Toronto under the supervision of Dr. Lila Z. Hakim, C. Psych. Laura provides psychological services to adults and couples experiencing a wide range of concerns. Laura has a particular interest and expertise in relationship distress, with an emphasis on interpersonal and couple relationship functioning. Laura has helped countless individuals navigate issues related to intimacy, fertility, sex, infidelity, separation and divorce. Additionally, her past research focuses on cultivating spousal attunement following traumatic experiences. 

 

Often hidden in the shadows of our unconscious awareness lives an uncomfortable feeling. So painful that the way we cope with it is to pretend it’s not there. By not talking about it, its power and potency continue to grow. As a result of secrecy and silence, we can even feel ashamed of our shame!

Shame is the emotion at the root of belongingness. Shame researcher, Brené Brown, defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging —something we’ve experienced, done, or failed to do makes us unworthy of connection.”

Shame is an important emotion to understand and acknowledge, as it can often undermine even the healthiest relationships. Shame is often used interchangeably with guilt, while guilt says, “I have done something bad. “Shame says, “I am bad.” The expression of guilt is considered psychologically healthy and allows one to acknowledge and validate their wrongdoing. While shame is a hyper-focus on the wrongdoing, the feeling of not being able to fix it compounds, it can erode our sense of self, and we are then convinced we ARE wrong.

When shame becomes an integral part of people’s image of themselves, this is how problems can occur. This persistent feeling of shame can make its way into every aspect of your life and your interpersonal relationships. Although shame can manifest in a person or relationship in various ways, here are some signs you can look out for:

Signs of Shame 

• Feelings of Inadequacy
• Lack of Authenticity
• Loss of Sense of Self
• Lack of Trust for Self
• Distrust towards your partner
• Fear of how your partner will perceive you
• Fear of Judgement
• Lack of Intimacy (Emotional and Physical)
• Poor Communication

Overcoming shame is an important part of healing and living a fulfilling life. In the second blog in our series on shame, we will provide you with tools for overcoming it.

Laura Moore, MPsy., is a psychodynamic therapist at the Centre For Interpersonal Relationships (CFIR) in Toronto under the supervision of Dr. Lila Z. Hakim, C. Psych. Laura provides psychological services to adults and couples experiencing a wide range of concerns. Laura has a particular interest and expertise in relationship distress, with an emphasis on interpersonal and couple relationship functioning. Laura has helped countless individuals navigate issues related to intimacy, fertility, sex, infidelity, separation and divorce. Additionally, her past research focuses on cultivating spousal attunement following traumatic experiences. 

People of all genders, ages, and origins are impacted by the stigma around mental health. Depression, anxiety, and other mental health issues are frequently not treated as seriously as physical illnesses due to this complicated and pervasive stigma. Mental health issues have long been stigmatized, which has mostly resulted from a lack of awareness of these diseases. For men, this stigma is prone to be more severe and convoluted.

One underlying cause of this issue is our society’s toxic masculinity tendencies. Some males may have a tendency to torture themselves on the inside in order to appear tough on the outside. This is typically done in order to avoid appearing “weak,” which is a quality our culture devalues mostly in men. 

Males often struggle to feel safe enough to reach out and get help for their depression, anxiety, and other problems because they are afraid of being judged and rejected. As a result, men in Canada are three times more likely than women to commit suicide. Men may find it more difficult to get mental health help before they commit suicide, which could be one explanation for this phenomena.

We must keep fighting these stigmas if we want to reverse this imbalance. As a society, we must change the way we think about mental health for people of all sexes. The need for mental health support must be normalized, and all people need to have access to these services. It’s important to understand that, regardless of our age, gender, backgrounds, or other characteristics, mental health issues are unquestionably genuine difficulties that can be incapacitating for anyone suffering them.

If you are a male experiencing mental health struggles, know that you do not have to do it all by yourself. Help is available, and being vulnerable and seeking it is a sign of courage. 

Sara Gharibi, MPsy, RP is a registered psychotherapist at Centre For Interpersonal Relationships. She provides trauma-informed psychotherapy with a focus on mental health of adults who experience social anxiety, generalized anxiety, burn out, depression, and other mental health difficulties as well. Sara provides psychotherapy in English, French, and Farsi.  

People tend to believe that perfectionism is an undesirable trait, but truthfully, it can be used as an asset rather than a liability. Generally, perfectionism is considered to be a tendency to believe there is a perfect solution to every problem, a schema that recognizes just two categories of performance—perfect or unsatisfactory, with nothing in between. Perfectionism is a multidimensional measure and it can be a personality characteristic. It is usually developed in childhood, primarily due to the perception of high expectations by parents (e.g., insecure children with low self-esteem seeking constant approval, acceptance, and affection from parents who are difficult to please). Given the perception of parental criticism, perfectionism may result in doubting the quality of one’s actions. Along with the preference for order and organization, it is also associated with procrastination and generally, individual tasks may take longer to accomplish because of a fear of mistakes. There is an argument that perfectionism can be healthy and unhealthy.

Research studies mention that perfectionism can be explained by understanding two main concepts (whether it is healthy or unhealthy): perfectionistic strivings and perfectionistic concerns. Perfectionistic strivings aim to achieve high-performance standards, positive emotions, and the motivation for performance by raising the bar when they reach the goal, not out of fear but out of the excitement of intellectual curiosity. This can lead to healthy perfectionism, and it can be underappreciated by individuals, their friends, and relatives. Some challenges occur with this perfectionism when it is all-consuming, overwhelming, or misdiagnosed. 

Perfectionistic concerns are associated with evaluating others: performance fear, meeting personal expectations, and fear of failure. These behaviours can be categorized as unhealthy perfectionism, as it can be a negative trait promoting self-defeating outcomes and undesirable behaviour patterns. For example, children growing up in a dysfunctional family are over-praised. When parents emphasize their accomplishments and felt the acceptance of love as conditional, they may grow up exhibiting signs of fearing failure, procrastination, avoidance of challenging activities, and generalized anxiety. 

Therapists at CFIR can offer therapeutic strategies to clients with healthy and unhealthy perfectionism. However, as these behaviours are often not recognized, the clients would manifest symptoms more like the feeling of overwhelm, exhaustion, and the inability to accomplish tasks resulting in anxiety, depression or lack of motivation, procrastination, imposter syndrome, work stress, burnout or loud inner critic leading to faulty thinking patterns. Therefore, please do not hesitate to contact us or inquire more to understand and develop strategies to cope with such behaviours or symptoms. 

“When you are a perfectionist, you don’t know when to stop because there is no end, there is no ’best work.” The standard is unreachable. —Ruth Buczynski, PhD.

Reference:

Prober, P. (2016). Your rainforest mind: A guide to the well-being of gifted adults and Youth. GHF Press. 

Roja Vivekanand, MA, MPsy, RP, is a Registered Psychotherapist at the Center for Interpersonal Relationships (CFIR) in Toronto. She is an integrative therapist who works with adults and family clients from diverse backgrounds to help them resolve a wide range of complexities related to anxiety, depression, work stress, anger, trauma, grief, health psychology, and interpersonal relationship issues.