Going to Work While Being Sick – Not Always the Best Policy (Part 1)

For many of us, work represents a significant part of our lives. Not only do we spend half of our time at work, but we also tend to invest personal resources and efforts to accomplish our professional responsibilities, develop meaningful relationships with colleagues, and construct our sense of identity on what we do.

In the past few decades, organizational and management research has focused on the impacts of absenteeism and implement measures to prevent it, such as rewarding satisfactory attendance and reinforcing policies to justify absences. Combined with a social context that values performance and being seen positively by peers, these measures can influence employees’ decisions to go to work or not. In return, another attendance behavior has been a subject of interest more recently: presenteeism

Defined as going to work while being sick, presenteeism is now known to be a widespread phenomenon among workers. It is estimated that more than 60% of employees report having worked while their health was not optimal, having different impacts for organizations and their members. 

Impacts of presenteeism for organizations

By reducing employees’ efficiency, presenteeism also generates productivity losses for organizations, which are estimated to be higher than those produced by absenteeism. It is estimated that presenteeism costs, on average, $255 annually per employee of a single organization, and its productivity losses can cost between $150 – $180 billion dollars per year (Goetzel et al., 2004; Hemp, 2004). Some authors argue that organizational culture and policies that promote presence at work can then have the impact of developing presenteeism, and therefore, is very costly.

Impacts of presenteeism for employees

Presenteeism represents a risk factor for workers’ physical and mental health. 

  • Going to work while being sick can put others at risk by contributing to the transmission of infectious diseases. 
  • This attendance behavior has been associated with different health difficulties, such as burnout, depression, anxiety, and chronic pain.
  • Presenteeism is also associated with the worsening of physical and psychological symptoms, and by delaying the recovery process, it can eventually lead to more absences.
  • Not respecting our need to stay at home and to take care of our health can also impact our productivity or sense of accomplishment at work, and therefore leading to a diminished sense of work engagement and job satisfaction.

In summary, even though absences from work can hurt an organization, going to work while being ill also can provoke real consequences for both the organization and its employees. It is, therefore, important to recognize signs of suboptimal health and to promote self-care in and outside the workplace. Psychotherapy can be a great place to start to learn how to identify our warning signs, how to assert our needs, and develop acceptance of our limits – and then optimize your health!

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

References

Goetzel, R. Z., Long, S. R., Ozminkowski, R. J., Hawkins, K., Wang, S., & Lynch, W. (2004). Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. Journal of Occupational and Environmental Medicine, 46(4), 398-412. https://doi.org/10.1097/01.jom.0000121151.40413.bd

Going to work while being sick – not always the best policy (part 1)Hemp, P. (2004). Presenteeism: At work—But out of it. Harvard Business Review, 82, 49-58. Retrieved on https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it

Passionate Love, Lust, and Attachment: The Neurochemistry of Falling in Love, Bonding, and Staying Lustful! (Pt.2)

Does love lead to lust? Can lust lead to love? And how does all of this somehow end up in our developing an attachment bond with someone else? This is Part 2 of my blog series on adult romantic passionate love, lust, and the formation of attachment bonds in couples.

Passionate Love, Lust, and Attachment: The Neurochemical Relationship Between Romantic Passionate Love, Sex, and Attachment (Blog 2 of 2)

In the early days of passionate love, sexual desire is increased due to increasing levels of dopamine and testosterone. This increased sexual activity may then also be implicated in the development of our attachment bonds. Should you worry that, despite your efforts at restraint, your repeated lustful nights with a new love interest might turn into passionate love and attachment? Can falling in love lead to lust, or can lust lead to love and bonding?

Both women and men have sexual cravings fueled by testosterone. Higher testosterone levels create greater lustful possibilities and motivate us to seek out others for sexual play. Sexual desire is recognized as different than adult passionate romantic love in different cultures and it has been shown to light up different regions of the brain in fMRI studies. In my previous related blog post titled “Passionate Love, Lust, and Attachment: The Neurochemistry of Romantic Passionate Love,” I referred to Fisher’s (2004) work linking higher levels of dopamine with romantic passionate love and how these higher dopamine levels increase the release of testosterone, the hormone of sexual desire. As a result of the romantic novelty, a new partner automatically drives up our testosterone levels because of the related increase in dopamine levels. However, Fisher notes that the reverse may also be true: sexual activity raises testosterone, which also increases dopamine and norepinephrine in our brains, which means you could end up creating a more stable attachment bond and falling in love with a casual sexual partner.

Eventually, romantic passionate love moves into the attachment phase of love. For some couples, this will mean the chemically-induced romantic passionate phase with its more energetic and exciting versions of their sex lives will begin to wane as the comfort, calm, and relaxation of attachment security sets in. With the ensuing shift in neurochemicals, the exaggeration of similarities and the obscuring of differences between partners will also wane and the realization that differences exist may become a source of conflict and diminished connectedness. For some partners, a feeling of sameness and oneness was an important driver of their passion in the first place. For others, these newfound differences will not threaten each partner and can instead become a place of intrigue, curiosity, and new learning. At this stage, secure attachment might provide couples with the best possibilities for navigating the recognition of self-related differences as partners feel enough safety and trust in the relationship to tolerate and explore the difference.

Once the attachment phase of the relationship settles in, Esther Perel (2006), author of Mating in Captivity, notes that couples can struggle to reclaim the passion of these earlier days as it is difficult to reconcile the safety and security of long-term attachment with the excitement of eroticism. For Perel, the erotic is the exotic, meaning desire requires risk-taking, novelty, and space, which can certainly oppose the safety and security focus of the attachment phase of the relationship. Some partners who are securely attached continue to keep a healthy level of desire in their sexual relationships because secure attachment allows them to take sexual risks and create sexual novelty without the fear of rejection. The securely attached are, therefore, able to continue to explore the sexual, erotic, and novel, within the context of a safe, secure, and nurturing relationship (Zuccarini, 2004; 2008; Johnson & Zuccarini, 2010; 2012).

Further neurochemical action tethers together passion, sex, and attachment. Oxytocin is the attachment-related neuropeptide that may be physiologically implicated in the process of moving us from passionate love and lust to an attachment bond with our beloved. For instance, oxytocin increases dramatically during sexual arousal and orgasm, as well as in pair-bonding (Hazan & Zeifman, 1999). What this means is that, while we are lustful, we also benefit from the attachment neuropeptide, which results in a sense of calm, safety, security, and relaxation. We are then motivated to seek out the pleasure of sex and the ensuing sense of calm and relaxation caused by oxytocin. Over time, sexuality becomes a space that can deepen our attachment to another as a result of the release of oxytocin involved in our sexual interactions. In this way, we are tethered together through passion, sex, and attachment in a neurochemical manner!

Clinicians at CFIR work to support clients to develop passionate relationships within the context of secure attachment bonds. The more securely attached you are with your loved one, the more you can take risks to share your passions, fantasies, and explore the erotic without fear of judgement, rejection, and abandonment. At CFIR we recognize that sexual desire that includes novelty and risk-taking can solidify secure attachment, while at the same time understanding that secure attachment can facilitate the risk-taking and novelty required for a relationship of romantic passionate love.

Dr. Dino Zuccarini, C.Psych. is CEO and co-founder of the CFIR. He has published book chapters and peer-reviewed journal articles on the subject of attachment, attachment injuries in couples, and attachment and sexuality. He has taught courses at the University of Ottawa in Interpersonal Relationships, Family Psychology, and Human Sexual Behaviour. He has a thriving clinical practice in which he treats individuals suffering from complex attachment-related trauma, difficult family of origin issues that have affected self and relationship development, depression and anxiety, personality disorders, sex and sexuality-related issues, and couple relationships. At CFIR, he also supports the professional development of counsellors, psychotherapists, and supervised practice psychologists by providing clinical supervision.

Passionate Love, Lust, and Attachment: The Neurochemistry of Falling in Love, Bonding, and Staying Lustful!

We are all hardwired to fall in love, share lustful moments, and bond with others. In fact, there are complex neurochemicals that are released during all of these different phases of relationship development. In this 2-part blog series, I will share important information with you about the neurochemistry of falling in love, how falling in love influences lust, how lust influences falling in love, and how all of this leads to attachment bonding in relationships!

Passionate Love, Lust, and Attachment: The Neurochemistry of Romantic Passionate Love (Blog 1 of 2)

Have you ever found yourself tightly gripping and constantly checking your cellphone awaiting contact from your new love interest? If so, you may be in the phase of the universal experience of adult romantic passionate love. Across history and cultures, we have fallen in love, lusted for others, and attached to them as a result of innate emotion-motivation systems in the brain that drive us to create relationships. In her book Why We Love: The Nature and Chemistry of Romantic Love, Helen Fisher (2004) describes the adult romantic passionate love phase as an initial phase in the formation of an adult attachment bond. Read on to find out how the neurotransmitters in our brain – dopamine, norepinephrine, and serotonin – are implicated in you falling in love.

First, Fisher described the universal experience of romantic love based on her research. When falling in love, our new partner is imbued with special meaning (i.e., unique, all-important, novel). We also develop strong focus as our beloved becomes the centre of our attention and we pay special notice of our shared events, messages, music, etc. During this period, we also aggrandize our new love. We may magnify positive aspects of our adored one while minimizing flaws and exaggerating our similarities. We experience intrusive thoughts as we just cannot stop thinking about our new loved one. Emotionally, Fisher describes us as being “on fire.” We experience intense emotions and find ourselves feeling anxious, shy, and awkward at times. We have an increase in energy as well. All of a sudden we find ourselves staying up late, having sex all night, and still making it to work … then doing it all over again the next day. This energy burst also comes with a loss of appetite and sleeplessness. Driven by a deep stirring to connect, our moods can shift rapidly from ecstasy to despair depending on whether our beloved is as responsive to us as we would like. We also become hypersensitive looking for clues about whether our beloved is into us or not! Finally, Fisher noted that when we are infatuated, we are more likely to change elements of our personal identity like clothing and music preferences, alter our mannerisms and habits, and even take on new values, all to win over our new love interest.

Once you fall in love, it is hard to turn back, as a result of the numerous neurotransmitters at play. Fisher’s research using fMRI studies found that dopamine, serotonin, and norepinephrine are the neurotransmitters at the root of passion for our new love. She found elevated levels of dopamine, which is at the root of the hyper focus, high motivation, high energy, and exhilaration, sleeplessness, and loss of appetite. She claims that this neurotransmitter, when heightened during romantic passionate love, creates something within us similar to an addiction process, intense dependency, and cravings to be with our lover. High levels of dopamine are also found in fMRI studies of individuals experiencing a drug addiction. Love becomes so addictive at this point that when you do not have access to your new loved one, more dopamine is released to energize you to focus on further pursuing the reward of being with them. Testosterone, the hormone at the root of sexual desire, is also increased in our bodies as a result of the higher levels of dopamine. In other words, increases in dopamine come with novelty and passionate love, which then increases sexual desire through a heightening of testosterone.

Finally, the neurotransmitters norepinephrine and serotonin are also implicated in romantic passionate love. Increased norepinephrine adds to the high, exhilaration, energy, and sleeplessness we experience, and fuels us to remember the smallest details about our lover. Serotonin is lowered, which results in the obsessiveness and racing thoughts we experience. With increases in dopamine and norepinephrine, and decreases in serotonin, we enter into positive states of mind about the other and obscure negative aspects of the beloved. We are neurochemically primed through these transmitters to also experience a sense of oneness based on exaggeration of similarities and minimization of difference. These effects facilitate a sense of symbiosis, which eventually wanes after about 8 to 12 months when the tidal wave of neurochemicals subsides. At this point, we begin to realize our differences with our beloved, which can then bring on more conflict for some couples. Fisher’s conclusion based on fMRI studies was that adult romantic passionate love is a primary motivation system in the brain and stems from the changes in neurotransmitters summarized in this blog post.

Fisher’s research studies explain why in the early stages of a relationship, particularly during the adult romantic passionate love phase, many partners will describe having had “tons of great sex” and then later wonder “where did it go?!” For those of you who wondered, this chemically heightened period that revs your sexual motor only lasts for about one year. After this period, sex within the context of an attachment bond becomes motivated by different goals. See my other blogs on attachment and sex, including Part 2 of this blog series, to see what happens to couple sexuality once couples move from romantic passionate love to a more stable long-term bond.

Clinicians at CFIR work to support clients to develop passionate relationships and secure attachment bonds. We recognize that novelty and a connection are important contributors to a lifetime of passion. We also support our clients to recognize that falling in love might be a different experience from the process of establishing a secure attachment bond with a partner. Once the adult romantic passionate love phase ends, usually within one year, the dust settles and our self and relationship experience can shift. Learn how to recognize the telltale signs of whether you have found Mr./Ms. Right in a future blog post titled “Is This Mr./Ms. Right or Wrong?: Consider This Dating and Relationship Screener Before You Say ‘I Do’”, so that when the adult romantic passionate love phase settles, you will be ready for a lifetime of love.

Dr. Dino Zuccarini, C.Psych. is CEO and co-founder of the CFIR. He has published book chapters and peer-reviewed journal articles on the subject of attachment, attachment injuries in couples, and attachment and sexuality. He has taught courses at the University of Ottawa in Interpersonal Relationships, Family Psychology, and Human Sexual Behaviour. He has a thriving clinical practice in which he treats individuals suffering from complex attachment-related trauma, difficult family of origin issues that have affected self and relationship development, depression and anxiety, personality disorders, sex and sexuality-related issues, and couple relationships. At CFIR, he also supports the professional development of counsellors, psychotherapists, and supervised practice psychologists by providing clinical supervision.

How Does Therapy Help?

Some people come to therapy only after having exhausted other options. For those with limited experience trying to understand themselves and the nature of their problems more deeply, therapy may seem pointless or airy-fairy. “How will talking about my problems make any difference?” is something incredulous clients ask me. I can appreciate this question because therapy is a time-consuming and expensive investment, so people want to be sure that it’s going to help. People may benefit from therapy for many reasons. This post is dedicated to clarifying these reasons.

Research has time and time again showed that the relationship between the therapist and client is one of the most potent forces for change in therapy. Many clients discount this fact. Nonetheless, having a reliable, non-judgmental, and attuned professional who can help you make sense of your experiences can lower feelings of loneliness and shame because these feelings intensify when we are alone with our distress or when we hide ourselves from others. The confidentiality afforded to clients in therapy and – often, as a result – the emotional depth and openness achieved, makes the process of treatment quite different than what is experienced by venting or seeking advice from your friends and family. Therapists are trained to notice patterns in your thinking and behaviour as well as understanding the meaning and context of your feelings so that you can understand yourself more deeply. As you come to trust your therapist over time, the depth of the conversations you have lends itself to ever deeper realizations of factors that organize and shape your behaviour so that you make choices that diverge from the well-worn path that makes you feel stuck.

Therapy is a place to process and reflect on your emotional experiences. Why does this matter? Simply put, emotions are information. People often forget or dismiss emotions – especially difficult ones – as needless encumbrances to daily living. “I’m rational” or “they’re emotional” are usually code for “emotions are for the weak” or “emotions are pointless.” The reality is that emotions are profoundly crucial to helping us understand what we do and do not like and cues us into action to make meaningful changes in our lives. If we are depressed, it might mean that we are unsatisfied with the quality of our relationships or feel hopeless about our ability to initiate actions that would enhance our career satisfaction. Paradoxically, doubling down on rationality and dismissing, minimizing, or rejecting emotions is inherently an emotionally driven process. Indeed, some people have grown up or currently exist in especially emotionally invalidating worlds that have compelled them to disconnect from their emotional experiences in order to manage pain and distress or be accepted by others. In other words, inflexible and rigid beliefs about the dominion of rationality over emotions are rooted in our attempts to limit experiencing pain and suffering. However, our ability to connect to others, to move toward things that interest us, and feel excited by the world necessitate having access to our emotions. More difficult emotions like anger, sadness, anxiety, shame, and guilt signal to us what we need more or less of and organize our behaviour to make the appropriate changes. Habits based on avoiding those complicated feelings disconnects us from our needs. Just like we need physical pain to cue us to something that needs attention, emotions cue us to essential things in our world.

Understanding our behaviours or thought processes at work, in relationships, and all parts of our life is the first step toward making important changes. We are all shaped by early life experiences that impact the assumptions we make about ourselves, others, and the world around us. As a result, people are often moving through the world as adults using assumptions and filtering information through the prism of their childhood experiences. Understanding this cycle, challenging your assumptions and biases, and deliberately making different choices to challenge outdated modes of thinking, feeling, and being can be profoundly empowering.
Notably, a focus on new behaviours is limited by those currently living in abusive environments that make change dangerous. In these cases, it would be vital to focus more on safety and problem-solving effective solutions.

Finally, therapy can help you manage your symptoms more effectively. Mental health professionals understand your symptoms, what typically helps others who have experienced similar forms of difficulty, and can provide you with information drawn from scientific research and teach you skills that will help you manage your distress.

Dr. Sela Kleiman, C.Psych. is an Associate at CFIR (Toronto). In individual therapy, he helps adults struggling with depression, anxiety, grief, as well as those trying to cope with the effects of past and/or current verbal, emotional, physical, and sexual abuse. Dr. Kleiman has published numerous academic articles on topics that include suicide prediction, racial and social attitudes, and racial and sexual discrimination, and he’s completed his Ph.D. in clinical and counselling psychology at the University of Toronto.

Can You Fall Out of Love?

My colleague and friend, Genevieve Boudreault, and I were interviewed for a university podcast. At one point, the show host asked us, “Can you fall out of love?

Gen and I are therapists who specialize in working with both couples and individuals who come to us facing loneliness, heartbreak, and uncertainty whether they can make their relationship last.

Gen remarked: “No, I don’t think that you can fall out of love…” She seemed so confident in her answer. It made me pause.

Can you fall out of love?

I pondered this question for a while, thinking about the clients who come to me for help – many who have scars based on past relationships, showing that the effects of loving another are far-reaching.

Love changes your body chemistry. It can change the way you see the world and, conversely, when love ends, the world can feel like it is falling apart. The wounds of lost love can feel devastating. Therefore, when I was asked, “Can you fall out of love?” I responded that despite whether you can or can’t ‘fall out’ of love, there are some essential ways to keep yourself together if a relationship ends:

  • Talk to someone. Often when we are hurt, it can be a tendency to keep out feelings bottled up, to slink further into ourselves. Opening up about our heartache can lessen its effects.
  • Realize that love can come from more than a romantic partner. Friends, family, and colleagues can give fulfillment and a sense of security.
  • Take time to write out a letter to yourself about why things ended. This exercise has been incredibly useful for my clients who have had recent heartbreaks. Writing a loving letter can help keep perspective when we start to miss this person and wonder why it is over.
  • Talk to a therapist. While friends can offer love and comfort, therapists are skilled at seeing patterns of relating and can help guide you to feeling worth within yourself, so when you love again, you can feel stronger.

Psychologists and clinicians at CFIR help individuals and couples discover how to identify and express their selves in their relationships with others. We also support individuals and partners on how to exit from challenging relationship patterns and become more accessible and responsive to one another. Healthy relationship functioning is essential in maintaining a good sense of ourselves.

Jess A.L. Erb, D.Psychotherapy, R.P. (Qualifying) is a Registered Psychotherapist (Qualifying) who believes that the best therapy happens when a deep trust can form between counsellor and client. She works with adults and adolescents in an array of issues such as depression/suicidal ideation, anxiety/panic disorders, grief and loneliness, as well as all forms of abuse – emotional, physical, sexual, self-harm, and eating disorders. Before working as an associate at CFIR, she trained as a doctor in psychotherapy at the University of Edinburgh, UK.

The Importance of Healthy Narcissism: The Relationship Between Self-Esteem and Symptoms of Anxiety and Depression

Blog 3 in a 3 Part Series on the Developmental Roots of Anxiety and Depression: Linking Narcissism to Depression and Anxiety

Healthy narcissism is important for us to achieve our goals and cope with the inevitable disappointments and failures we all face in our lives. The word “narcissism” usually conjures up negative images of a very entitled, attention-seeking, arrogant individual. Narcissism, however, can come in both healthy and unhealthy forms. It can even be considered synonymous with self-esteem and we know that healthy self-esteem is critical to your wellbeing and optimal functioning.

We are all born with an innate sense of the potency and vigour we possess to develop our own self through self-expression, the pursuit and fulfillment of our authentic needs, and setting and achieving our goals to thrive. We all need a healthy investment in our own self – to feel that we are significant, valuable, worthwhile, and deserving enough to take and receive what we need for our self. We must love our self enough to pursue our own self-interests and entitlements while maintaining our relationships with others. Without healthy narcissism, we may not feel potent or strong enough, or we may not have enough vigour and vitality to meet our needs and pursue our goals. We are not able to feel excited, proud, and joyful in our achievements, nor fulfilled and satisfied in the pursuit of our self and relational needs. We may not feel sufficiently entitled to assert our self with others. We may not feel worthy enough to pursue our fair share of the rewards of our work, or to request that our needs be met in our relationships.

Healthy self-esteem involves a sense of feeling competent and capable enough to achieve realistic life goals. Feelings of competency and ability come from our hard-earned efforts along with our innate sense of talents and intelligences. The more we are able to learn, achieve, and overcome life obstacles, the more confident and competent we feel as we deepen our sense that we can manage our lives effectively. Self-esteem also means developing a positive self-image that is congruent with the skills, talents, intelligences, and competencies that we possess, along with an acknowledgment of the realistic goals and achievements we have attained for ourselves. On the other hand, having an overly-inflated self-image – seeing ourselves as much greater than others see us or significantly overestimating what is possible for us – becomes problematic. Narcissism can become unhealthy when you come to believe that you deserve or are entitled to more, when in fact there is nothing real (i.e., achievements, goal-attainment, talents, skills, intelligences, contributions) to back up that entitlement.

With healthy narcissism, an increased sense of competency bolsters our capacity to face life challenges and enhance our resilience. Anxiety and depression are less likely when we have a realistic and positive self-image and we pursue realistic goals with the deep belief that “I can do it.” Healthy narcissism is important particularly in contexts in which we are facing adversity and require the stamina, resilience, and self-trust required to overcome life obstacles. We can tolerate adversity and failure much more when we have the self-esteem for it. At the same time, this healthy narcissism involves pursuing our self, but not at the expense of injuring others. Our capacity for empathy limits our narcissism within healthy ranges as our awareness of others’ feelings, needs, and rights puts a natural boundary on our ability to take excessively from others (i.e., their attention, admiration, recognition, and material items like money, property, etc.).

Some individuals go on to develop unhealthy self-esteem as a result of their early interactions with others. They will seek more than their fair share of rewards, recognition, and attention from others in their work and relationships without putting forward enough effort to justify it, or by inflating their sense of self-importance and significance. Unhealthy narcissism can develop out of different kinds of conditions. One of these conditions is when a child is overpraised and admired for something they did not initiate and something they did not put much effort into doing, such that they begin to expect or demand the same praise on an ongoing basis. Another condition is when a child is shamed, abandoned, rejected, and punished with great suffering and feelings of powerlessness that then result in fantasies and pursuit of greatness and fulfilment of self-impulses, desires, and needs at the expense of others. Unhealthy narcissists, or those with fragile self-esteem, are externally dependent on others to boost their self-esteem and good feelings about themselves. They can become anxious, aggressive, and depressed (i.e., hopeless, despairing) when the outside world does not validate them as competent or as great as they see themselves. Depression and anxiety ensue in those with poor self-esteem, as they lack the internal resilience and self-esteem to address their life problems.

Clinicians at CFIR can help individuals whose self-esteem is too externally dependent on others.  Psychodynamic and attachment-based treatments are provided to help you deal with the original suffering underlying unhealthy narcissism and to help you develop better internal self-esteem. We can help you develop more internal self-esteem while enhancing your connectedness with others. We can also help you build a greater sense of healthy confidence in your self by setting out and pursuing realistic life goals.

Dr. Dino Zuccarini, C.Psych. is CEO and co-founder of the CFIR. He has published book chapters and peer-reviewed journal articles on the subject of attachment, attachment injuries in couples, and attachment and sexuality. He has taught courses at the University of Ottawa in Interpersonal Relationships, Family Psychology, and Human Sexual Behaviour. He has a thriving clinical practice in which he treats individuals suffering from complex attachment-related trauma, difficult family of origin issues that have affected self and relationship development, depression and anxiety, personality disorders, sex and sexuality related issues, and couple relationships. At CFIR, he also supports the professional development of counsellors, psychotherapists, and supervised practice psychologists by providing clinical supervision.

The Separation-Individuation Process: Being Too Other-Directed Leads to Anxiety and Depression

Blog 2 in a 3 Part Series on the Developmental Roots of Anxiety and Depression: Linking Separation-Individuation to Depression and Anxiety

We all need to find our own “voice” and develop our own authentic identity! In this blog post, find out how anxiety and depression can arise when we are too directed by ‘others’ in our self-development.

When we are unsure of what we honestly think, feel, need, and desire, or are driven too much by what others think and feel, we can become disconnected, “unanchored,” and “decentred” from our authentic and true self. This uncertainty can lead to poor mental health outcomes, including anxiety and depression.

Margaret Mahler, the mother of separation-individuation theory, used empirical research to create a developmental model explaining how we develop a separate sense of our self and identity from our parents as we grow up. To develop a healthy sense of our self, we need to be able to become our own psychological beings – our own selves – separate from our parents. We need to develop our personal self boundary, which can grow and change over time from childhood to adulthood. Our parents, friends, and partners can facilitate and support us to develop our own “voice” and self-definition. They can do this by acknowledging, attuning to, and accepting our individual authentic self-expression (i.e., our personal reactions, thoughts, opinions, feelings, desires, and needs). Eventually, we also then need to tolerate that others will have their own self boundary and self definition and may validate who we are, but not necessarily think, feel, need, or desire the exact same things we do. We need to learn how to develop our own self boundary and respect others’ boundaries.

Sometimes parents can struggle with allowing their child to develop a separate sense of self. A lot of pressure can be exerted on the child to conform to the parent’s self and personality. Some parents leave their child with a sense of guilt, shame, or fear when the child is expressing his or her true authentic self or “voice.” Parents can also put significant pressure on children by being overly harsh and critical to ensure conformity to the parents’ wishes. We can lose confidence in our self and become self-critical to meet our parents’ expectations. Later on, we might then lack the confidence to express our true self to others or perhaps feel unsafe expressing our self-doubts and uncertainties. This high self-criticism and low self-confidence can lead to anxiety and depression.

Throughout our lives, we face many different developmental stages that require us to define and redefine our self boundary and self-identity on an ongoing basis. We need to figure out for ourselves who we are, what we like and do not like, what education and training we are going to pursue, what types of relationships or family we want to create, and what work we will do to become a productive member of society. If we let other people’s thoughts, feelings, preferences, desires, and needs define these aspects of our self for us, we can lose our selves and become “unanchored” and “decentred.”

Clinicians at CFIR support you to develop your own authentic “voice” so that your life’s choices and decisions are rooted in your genuine thoughts, feelings, desires, and needs. We can help you to find your own self boundary and self-definition. We can support you in learning how to direct your life from within. Developing a life that is more rooted in your own authentic and true self creates more certainty and confidence, allowing you to pursue a life that is purposeful, meaningful, and fulfilling.

Dr. Dino Zuccarini, C.Psych. is CEO and co-founder of the CFIR. He has published book chapters and peer-reviewed journal articles on the subject of attachment, attachment injuries in couples, and attachment and sexuality. He has taught courses at the University of Ottawa in Interpersonal Relationships, Family Psychology, and Human Sexual Behaviour. He has a thriving clinical practice in which he treats individuals suffering from complex attachment-related trauma, difficult family of origin issues that have affected self and relationship development, depression and anxiety, personality disorders, sex and sexuality related issues, and couple relationships. At CFIR, he also supports the professional development of counsellors, psychotherapists, and supervised practice psychologists by providing clinical supervision.

Secure Attachment: Relying and Depending on Others May Be an Antidote Against Depression and Anxiety

This blog post is the first in a series of three posts in which I share with you some of the developmental roots of anxiety and depression. These blogs explore how anxiety and depression may be linked to how you learned to attach with others (attachment), how you developed into a distinct, separate person from your parents (separation-individuation), and how your self-esteem developed in your early years (healthy narcissism).

Blog 1 in a 3 Part Series on the Developmental Roots of Anxiety and Depression: Linking Attachment to Depression and Anxiety

We all need other people! Some of us cherish total self-sufficiency and try hard to not rely on anybody else – but we still need other people anyways. Being able to rely and depend on others can improve our mental health outcomes. In this blog, I help you understand the link between secure attachment and positive mental health.

John Bowlby, the father of attachment theory, recognized that our reliance and dependence on attachment figures exists from “the cradle to the grave.” According to attachment theory, we are hardwired to seek relationships with others to help us deal with emotional distress and stress in our lives. In the beginning, as infants, we are highly dependent on our caregivers to provide us with both physical and emotional care. When parents provide sufficient care, we go on to develop a positive sense of our self as lovable and worthwhile. We also go on to develop a sense of others as potentially trustworthy, reliable, and dependable when we are distressed and in need of physical or emotional care. As a result of their responsiveness, we become more securely attached. Secure attachment helps us develop more confidence and self-esteem because our self mattered and continues to matter to others when we are distressed. We are also more easily able to reach out for others when in need of support when facing challenging life circumstances because we remember that others can provide potential solutions to our distress. Secure attachment is a healthy antidote to stress, anxiety, and depression!

Research suggests that individuals suffering from mental health issues also tend to be insecurely attached to others. Insecurely attached individuals are less able to efficiently or effectively signal to others, or do not signal to others at all, when distressed. Developing relationships that allow for reciprocal and mutual caring is important because as humans we are not designed to be emotionally distressed and isolated. When we are alone and isolated with the stress and distress of everyday life, our mental health can deteriorate. Insecurely attached individuals cannot turn to others, or they are not effective in their efforts to seek soothing, comfort, or problem-solving responses from others. In their childhoods, their attachment figures may not have been accessible and responsive to their physical and emotional care needs. As a result of these earlier experiences involving non-responsiveness of caregivers, deep down the insecurely attached individual may feel unlovable and unworthy of care or believe that others will be unreliable, undependable, and untrustworthy when in need of support. In the present day, prolonged emotional distress and stress without a connection to others and without foreseeable solutions can contribute to anxiety and depression symptoms. Many individuals with anxiety and depression have difficulties in their attachment with others.

Clinicians at CFIR can support you to create stronger bonds in your relationships with others through an assessment of your attachment style and treatments that enhance your capacity to develop and maintain healthy relationships. Learning how to experience and express your emotions and needs to others in a safe and secure relationship is central to becoming securely attached. Being able to rely and depend on others, and develop reciprocal and mutual attachment relationships with others, is key to our mental health and wellbeing.

Dr. Dino Zuccarini, C.Psych. is CEO and co-founder of the CFIR. He has published book chapters and peer-reviewed journal articles on the subject of attachment, attachment injuries in couples, and attachment and sexuality. He has taught courses at the University of Ottawa in Interpersonal Relationships, Family Psychology, and Human Sexual Behaviour. He has a thriving clinical practice in which he treats individuals suffering from complex attachment-related trauma, difficult family of origin issues that have affected self and relationship development, depression and anxiety, personality disorders, sex and sexuality related issues, and couple relationships. At CFIR, he also supports the professional development of counsellors, psychotherapists, and supervised practice psychologists by providing clinical supervision.

Social Media and Mental Health

When was the last time you messaged a relative on Facebook, Snapchat-ted a friend, liked a picture on Instagram, or tweeted a thought? It’s highly likely you have used one of these social media platforms to engage with people in the world around you.

The rise of social media has undeniably been observed across the world. As human beings we are apparently more connected than ever before. The advantages of social media are numerous, including increased connectedness, visibility, and availability of information. For most, social media has become an integral part of their daily routines.

Despite its advantages, studies increasingly have demonstrated a link between social media use and poorer mental health. For instance, a recent study randomly assigned 143 undergraduate students into two groups. One group was asked to maintain their regular use of Facebook, Snapchat or Instagram, and the other group was asked to limit the use of each platform to 10 minutes per day for a maximum of 30 minutes per day. As expected, the results suggest that people who limited their time spent on social media showed significantly less depression and loneliness after a three-week period. This can possibly be explained by the reduction in comparing oneself to others on social media, and thus, feeling more positive about oneself. 

Even though social media is a great way to stay connected with others, reducing the usage of social media has the paradoxical effect of helping people feel less lonely and depressed. I therefore challenge you to experiment yourself by limiting your time spent on social media and noticing the benefits it can bring you. 

Mathilde Theriault, B.A. Hons., is a clinical psychology resident at the Centre for Interpersonal Relationships (CFIR) in Toronto and a candidate in the Doctor of Psychology program (Psy.D.) at the Universite de Moncton in New Brunswick. She provides psychological treatment and assessment services to individual adults and couples in the areas of depression, anxiety and stress, trauma, personality disorders, and relationship difficulties.

Practicing Self-Compassion

Our emotions and thoughts can sometimes take over our minds in ways that are not helpful for us, and that can make us feel uncomfortable or distressed. Responding to situations and ourselves in kind and compassionate ways can allow us to feel safe and create a space to respond to our needs. Self-compassion can enable us to let go of self-criticism, and to respond to our critical thoughts in a supportive and caring manner. 

Next time you notice distressing thoughts and emotions arising in your mind, you may try the following to help yourself through in a self-compassionate way. Think of what you can say to yourself that is kind and soothing. Or, think of what you would say to a good friend when they are in distress and try applying that to yourself. Or, consider what a good friend might say to you during difficult times. For example, try these statements: “It’s okay for me to feel this way,” “I know this is difficult, but it will pass,” ; “I know it is scary, but I am here to keep you safe.” 

Don’t forget that you can comfort yourself physically, too. You might gently rub your chest or hold your hand. You may go for a nice walk, take a long bath, and change into comfortable clothes. It’s essential to stay kind and gentle towards yourself.

Dr. Khuraman Mamedova, C.Psych. is a psychologist in supervised practice at the Centre for Interpersonal Relationships (Toronto). She works with adults in psychotherapy, to support them to overcome difficulties related to mood and anxiety disorders, psychosis, trauma-related experiences, and relationships. She has completed research on the relationship between clients and therapists in psychotherapy.