Presenteeism, an attendance behavior defined as going to work while our health is not optimal, is a phenomenon more and more recognized and known to impact workers and their organizations negatively. For example, we now know presenteeism generates significant productivity and financial losses and is associated with various health difficulties, such as burnout, depression, anxiety, and chronic pain (more details on the impacts of presenteeism are presented in Part 1 of this article).

The global pandemic has changed the professional reality: most workers are now forced to work from home, organizational restructuring and layoffs are more prevalent, and maintaining a work-life balance is even more challenging. In that context, it may be even more difficult for individuals to take the day off work when they need to – putting them and their organization at higher risk of experiencing the harmful consequences of presenteeism.

The good news is that we know organizations, managers, and workers alike can prevent and intervene to limit the impacts of presenteeism and promote well-being and productivity in the workplace. Here are a few points to consider to help you and others face this reality.

Recommendations for individuals

• One of the best tools we can use to prevent health difficulties associated with presenteeism is to be aware of our signals. Our body typically tells us when we need to slow down and take a break – we just need to respect it more. If you are experiencing difficulties with concentration, motivation, low energy, higher stress levels, and physical aches, it may be time to take some time off work to recharge your battery.

Checking in with yourself to see how you are doing psychologically and physically can help you decide if it could be a good idea to take time for yourself or slow down your work pace. Even taking a half-day for yourself or respecting your work-breaks can have a significant impact.

• Asserting your limits and expressing your needs to your colleagues and managers can also help manage your workload more effectively and help you manage your energy.

• Being present for work can be a positive source of self-accomplishment and social support. Continuing to connect with colleagues and friends, and practicing self-care activities, can help meeting those needs when you are off work.

• At times, we need to adjust our self-imposed ideals and expectations. Life is full of stressors and transitions, so, understandably, we cannot always be present at work or as productive as we want to. We are not robots, and sometimes we need to accept that we have limits and needs.

Recommendations for organizations and managers

• Too often, promoting wellness and productivity clashes instead of being an integrated message within the work culture. However, from a clinical point of view, well-being and productivity go hand in hand. If we proactively respect needs and limits and take concrete actions to maintain a healthy work-life balance, we will be more productive at work and in our personal lives.

Offering sick-days to employees does not seem to be enough. Changing implicit messages that reward being present at work at all costs, training managers on the risks of presenteeism, and recommending concrete behaviors that promote well-being are all avenues that can limit presenteeism and its negative impacts.

• Managers are often in a privileged position to see members of their team struggling with workload, feeling unwell, lacking motivation, etc. Having open discussions regarding a need for taking time off work, reducing or reassigning tasks, and implementing a more reasonable work routine, can help prevent the negative impacts of presenteeism.

• Supervision and management mean many different things, and it also includes modeling. Suppose directors and managers themselves respect their own boundaries, promote well-being and healthy work-life balance, and encourage taking advantage of sick and personal days. In that case, their team members will be even more likely to practice the same behaviors.

Taking time off work is not the only solution to prevent presenteeism. Taking care of ourselves and others and promoting healthy boundaries and a work culture that does not exclusively care about productivity can positively impact employees and organizations alike.

If you recognize a more pronounced difficulty to manage psychological or physical symptoms within yourself or colleagues, starting psychotherapy can also be an option. CFIR’s professionals are here to support individuals and organizations to promote wellness in the workplace.

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).

(originally posted via National Initiative for Eating Disorders (NIED))

I started the National Initiative for Eating Disorders (NIED) back in 2012. At the time, our daughter had been suffering from anorexia and bulimia for two decades – it still feels impossible to reconcile the amount of time it’s had a grasp on her life. 

The life of a caregiver supporting someone living with a mental illness is a series of never-ending harsh realities. Here is mine: 

Twenty years ago, the word “caregiver” was not in my vocabulary. When you hear “caregiver,” most people think of seniors being looked after and cared for by their adult children – who may even be seniors themselves. I come from an entirely different caregiver population – (though I’m a senior myself!)

My caregiving journey began in 1999. Little did I know that our youngest daughter, [who was] almost 16 at the time, was struggling with self-esteem and anxiety issues. An eating disorder was about to become a devastating bomb dropped on her and the rest of our family.

When she first got sick in high school, her friend came to tell me that she was throwing away her school lunch. Around the same time, she became a vegetarian, started making and requesting ‘funny foods,’ and began exhibiting strange kitchen behaviours. Her overall attitude also started to change. 

“Where do we go from here?” I remember asking myself.

Our first thought was to speak with her pediatrician. At the time, we were so naïve and didn’t know we were about to get caught in the whirlwind of an unknown illness. We had no idea where we were heading.

I still remember my husband frantically charging through downtown Toronto to the National Eating Disorder Information Centre (NEDIC) to gather names of therapists, doctors, dieticians, nutritionists – anyone we could call or reach out to for help. There was no Google at that time, and the internet was in its infancy.

At the beginning of our daughter’s illness, I waited anxiously to attend a weekly peer support group for mothers – a life-saving program. 

I vividly remember sitting in this group and watching the facilitator ask those in the room to share how sick their daughters were and for how long. Some said three years, others said five years, and some even said ten years.

“Yeah, right, we will be done with this in a year,” I remember thinking. Unfortunately, this was not my reality, and I became one of those mothers. 

We tried everything to help her, from tough love to unconditional love, from having her living at home to refusing her living at home. From a publically televised intervention, to her residence in safe houses, renting basements, incarceration, inpatient and outpatient programs – the list goes on. Being an Eating Disorder caregiver is no easy feat.

Never in our wildest dreams (or nightmares) did we think we would be taken down these dark roads with our daughter who had everything a kid could want. We were loving parents doing everything we possibly could within reason for her and her older siblings. We even uprooted our lives and moved houses in the hopes of making our lives’ better’ and giving her privacy in our basement.

In 2016, I took her to the E.R. to be rehydrated – over 20 times. I would drop her outside and let her call me when she was done. I was getting to the end of my rope.

During that time, my only respite was that I knew she was safe in the hospital. She was too sick to run out with people watching over her. I was ‘free’ for a few hours – imagine having to think like this.

To this day, our hearts sink whenever we receive texts or telephone messages from her and have had to create an alert system so our own stress levels are lessened.

One significant lifestyle change we have made, with her agreement, is placing locks on the fridge and freezer. The only groceries in the kitchen are spices and seasonings. The rest are locked away. My grandkids are accustomed to asking “for the key to get a snack.” These adaptations are still realities in our lives.

Having an Eating Disorder is not a choice. Some people believe Eating Disorders are just a rich, vain teenage girl’s sickness. Nothing could be further from the truth.

Eating Disorders affect all genders, racial, ethnic, and religious identities, sexual orientations, and socio-economic backgrounds.

No one can condense twenty years of a living nightmare into a short blog post. But it is enough to paint a dark picture of the life my family and I have had to live with, affecting us all both emotionally and financially.

There is good news, though. After 19 years, our daughter has finally started her ascent up the mountain of recovery. She is driving again after 12 years of not being allowed to; she’s gained weight and is content. It feels like we have our daughter back.

We are finally starting to feel that all of her strength, love, and will to lead a quality life suppresses the voices stemming from her mental illness.

Although the stress and worries of being a caregiver will never leave us alone, we have remade our lives as a couple and continue living and are committed to enjoying our lives (which we do!) I count my blessings every day.

About the Guest Blogger: Wendy Preskow is the President and Founder of the National Initiative for Eating Disorders (NIED).  NIED is a not-for-profit coalition of health care professionals, counsellors and parents with children suffering from Eating Disorders. NIED’s team aims to help bring about positive change in both the availability and quality of treatment of Eating Disorders in Canada.

Existential thinking has boiled to a crescendo for many since the first pandemic began. “What is my purpose?” “What does everything mean?”; there’s no shortage of questions keeping people awake at night. In the last installment of the three-part ‘Mind-Body-Wellness Sessions’ series, Tracie Lee, M.A., R.P. (registered psychotherapist at Centre for Interpersonal Relationships – Ottawa) and Stephanie Karlovits, (founder and CEO of EPIC Fitness + Lifestyle ) share insights on supporting your physical and/ or psychological well-being by managing persistent existential thought patterns. Breathe deep, get present, and listen in now:

We’re back with another episode of ‘Mind-Body-Wellness Sessions’ part 2 of 3! In this segment, Tracie Lee, (registered psychotherapist at Centre for Interpersonal Relationships – Ottawa) and Stephanie Karlovits, (founder and CEO of EPIC Fitness + Lifestyle – Ottawa) talk about how coping with the pandemic has been affecting so many of us mentally and physically. There are ways to feel better, and in this video, this amazing duo of wellness professionals tells us what we need to know.

We love it when great insights come together! Tracie Lee, (registered psychotherapist at Centre for Interpersonal Relationships – Ottawa) and Stephanie Karlovits, (founder and CEO of EPIC Fitness + Lifestyle) recently recorded a 3-part mini-series called ‘Mind-Body-Wellness Sessions.’ The series explores ways to make psychological and physical wellbeing a priority in our day to day living, and why it matters.

In episode 1, Tracie and Stephanie discuss why it’s often essential to integrate the mind and body, especially during challenging times. Check it out!

“Playing is itself a therapy,”

Donald Winnicott (1971)

One of the reasons I love Winnicott is that he realizes just how much a child misses out on if they do not have a chance to play or truly ‘be a kid’. This is especially the case for children who have experienced abuse, parental neglect, all resulting in them having to grow up too soon. 

To play means to allow creativity and imagination to flourish. To laugh. 

Be silly. 

Get messy.

As adults, we sadly also sometimes lose this ability to play. In my practice in Toronto (www.cfir.ca), I really start to see the impact of therapy on clients when we get to play together in session through laughter, art and using our imagination. As we share in these moments of creativity, it is incredible to see the bounds of trauma start to loosen its grip. 

As much as the psychodynamic field may have once admonished its therapists to be a ‘blank screen,’ people like Winnicott showed just how essential it is to let go and be silly. It is incredible to see how clients open up and come alive as we share in a private joke or get creative together. This sense of wonder is especially the case as a trauma therapist; while much of our session may delve into darker aspects of a client’s past, being creative and playful enables a start to freedom from these bonds. 

For me, playing comes on the wheel.

In the video below, I am doing what potters call ‘throwing off the hump,’ which means I throw smaller bowls on a large mound of clay so I can cut off the bowl and then immediately make another. This process is incredibly fun because while it produces many pieces (often tinier bowls), it is a rather messy process and requires a level of creativity that makes me feel alive. 

As someone who has also faced past trauma, I find that playing on the wheel, and being messy means that I can let go of some of my guardedness and simply play. I love the way it makes me feel like a kid again.

(This post is shared content from centredself.ca)

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.

There are many different types of psychotherapy. Some of these approaches, such as CBT, IPT, and psychodynamic therapy, have amassed substantial evidence for the efficacy of these approaches in the treatment of specific disorders. Most of these studies, unfortunately, have been conducted on individuals who are mostly displaying symptoms associated with a specific psychological disorder. Participants in these studies are selected based on strict inclusion-exclusion criteria (i.e., criteria about who gets into the study).

The reality is that many clients seeking services do not present with just one discernible disorder. In fact, some will have co-occurring psychological disorders (i.e., different types of psychological issues, such as depression, social anxiety, generalized anxiety, personality traits); while others will have multiple additional issues to contend with, including different types of relational, existential and meaning issues, grief and interpersonal problems that wreak havoc and create complexity in their work and personal lives. It’s vital that your clinician has familiarity with more than one treatment approach to be able to address your specific issues; otherwise, treatment will be limited to the practitioner’s preferred modality. For example, if you go to someone who only knows CBT, you are going to run into difficulties if you are needing to explore and grow by addressing complex emotional experiences (i.e., grief, defensive and more primary emotional experiences and needs), or want to understand the origins of your issues and work through a family of origin or relational matters (e.g., complex childhood trauma and attachment-oriented issues), self-esteem deficits and issues, or wanting to deal with complex existential issues of meaning and purpose. There is a wealth of knowledge from other treatment modalities for these particular areas of inquiry.

Clinicians at CFIR can provide you with first-line treatment options in addressing your concerns. Clinicians at CFIR are able to work with you at the level of symptom reduction by using a wide range of CBT approaches to learn new skills to alleviate your distress, while also delving deeper into the origins of this distress—either through accessing and exploring deeper feelings and emotions associated with your distress, or working through earlier painful experiences related to your childhood and adolescence. Delving deeper into the origins of your symptoms involves using more experiential and psychodynamic treatment approaches. For example, psychodynamic approaches help you to gain insight into how you have become a person who is anxious or depressed in the way that you are. The approach considers your unique experience in the world by exploring how earlier experiences may have affected how you think, feel, react, act, behave, and relate to your self and others in the world. Your relationship with your therapist becomes a vehicle of change in this approach. Ultimately, this awareness and your relationship to your therapist empowers you to make significant changes by looking at your current sense of self and relationships. With support from your clinician, the learning and insights gained in integrative therapy can become the springboard of new action in the world using behavioural strategies. 

Integrative therapists at CFIR typically have you undergo an assessment to understand your issues’ earlier origins while working with you in the ‘here and now’ to reduce your distress and resolve your difficulties. Our therapists are also well-versed in multiple modalities to support you through a wide range of issues, including self-esteem, grief, existential and relational issues. We are also a one-stop setting for all of your psychological service needs with over 25 treatment services and 17 assessment services.

Dr. Dino Zuccarini, C.Psych. is a clinical psychologist, and the Co-Founder and Executive Director of the Centre for Interpersonal Relationships (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.

“I just need to get over it and not let it bother me” or “I don’t think talking about this will help” are responses I often hear in my clinical work. Such reactions are often from men who have, or are currently experiencing emotional and psychological hardships. Challenges can range from concerns such as work-related stress, relational difficulties, trauma, anxiety, and depression. Another source of mental health stress for men (often less noticeable) is trying to maintain societal expectations and stereotypes of what it means to be masculine. Such harmful stereotypes often depict men as never being vulnerable, not acting or behaving in emotional ways, and solving their problems independently. This perspective can often begin in childhood when children are told “boys don’t cry,” and the ongoing societal pressure for men to remain ‘strong’ and not admit they are struggling.

Due to such beliefs and ideas, men are much less likely to seek support or treatment. This reasoning may help explain why men have lower rates of diagnosed depression; however, suicide rates are three to four times higher in men compared to women. Knowing this, how do we help men reach out for support?

Firstly, we need to be aware of the signs of mental health difficulties. Men and women may experience the same mental health conditions at various times, although men might show different signs and symptoms. Rather than seeking treatment for a specific condition such as depression, men are more likely to engage in maladaptive coping behaviours including turning to alcohol or drug use. Depression in men can also be characterized through anger and irritability in addition to expressions of sadness. Knowing how men might show signs of mental illness and the associated risk factors is required to seek or encourage support.

Secondly, it is crucial to be aware of the harmful stereotypes associated with the idea of masculinity, which serves as a barrier for men in seeking help. As human beings of all genders, we experience emotions, which at times might be complex and challenging to organize and make sense of on our own. Expressing emotion or vulnerability does not equate to weakness. As humans, we are a social species, and we thrive collectively. Discussing our difficulties with others and having a support system help to provide a sense of relief and understanding.

Lastly, it is essential to remember that you are not alone. If you are struggling emotionally yourself or are concerned about someone, know that you are not alone in experiencing such difficulties, and you do not bear the load in silence. Whether its offering support to someone by listening, talking to a family member or friend, or reaching out to a therapist who you can build a non-judgemental and trustworthy relationship with, knowing you are not alone is a vital step in finding support.

Edgar Prudco is a therapist at the Centre for Interpersonal Relationships (Toronto) and works under the supervision of Meg Aston-Lebold. Edgar is completing his Masters degree in Clinical Psychology at the Adler Graduate Professional School. He supports individual adults and couples to deal with difficulties related to emotion (e.g., depression, anxiety, anger), the effects of trauma, loss & grief, conflict resolution, and relationship functioning.

As the possibility of business and recreation gradually reopening becomes more of an imminent reality, many of us will face the opportunity to step out into the outside world again, into closer contact with other live (not-virtual) human beings, for the first time in months. 

Despite many social media narratives that celebrate this possibility, the actual emotions we might face as such opportunities become realities might be a lot more complex than that.

When COVID-19 initially hit, we fell suddenly and unexpectedly into a full-blown crisis. As with any onset of crisis, it is common and even likely to feel emotions like anxiety, worry, panic, overwhelm, and fear.

And as long as we continue to live in this crisis, especially as food, work & income, and housing remain uncertain for so many, we can expect these emotions of anxiety, worry, panic, overwhelm and fear to stay present. 

Everything inside of us is mobilizing—body and mind—to meet these threats that we face, and to survive them. 

Now that we are a couple of months into the pandemic, I am seeing some clients in my psychotherapy practice who are beginning to enter into the next phase of emotions. Since we’ve now had some time to start absorbing a bit of the new reality, and certainly, as we anticipate returning to work, the main emotions we are feeling are expected to shift. Increasingly, I anticipate seeing more people with emotions like depression, chronic boredom & under-stimulation, frustration, hopelessness, helplessness, and despair.

As we continue to take in more of what we have been experiencing, we are going to feel more of the weight of it all, and at times that weight is likely to feel quite heavy. 

So, what can you do to support yourself through these current and upcoming emotional experiences? For me and the way that I practice psychotherapy, the answer comes back to ‘connection.’ 

Firstly, it is essential to maintain—or build—connection to yourself. Once or twice per day, for 15 or 30 or 60 seconds at a time, stop and check-in with yourself. Notice what is happening in your thoughts and feelings, and even in your body. Notice your breath, notice your bodily sensations, and check in on them at various moments and throughout the following days because they are likely to fluctuate. 

Self-monitoring, in this manner, can help you to feel grounded in yourself and your experiences. It can also help you to identify when you need help—and this leads to a second point: we also need to be maintaining connection to others. 

If you find yourself struggling or feeling unwell, try to reach out. Of course, you can always reach out to a psychotherapist, and you can also reach out to a close friend or family member who might intently listen to you, or else might help you problem solve, depending on what you need. 

You can also try going for a walk to give your thoughts some space, or write them out, or even audio record them for yourself. In any of these cases, reaching beyond yourself to outwardly express what you are thinking and feeling can help you release some emotional burden, and so can help you to feel a little better. 

Secondly, as you are reaching out to others, do not forget that you can probably assist others, too; there can be a mutual exchange of support. Sometimes all someone might want is to be heard, and even in times when we feel we have nothing left to give, just existing next to someone alongside their experiences can bring great relief. The relief is mutual, as we benefit from a dose of feel-good chemicals in the brain when we connect with and help others. 

One final thought on emotions in this next stage of the pandemic: sometimes we can forget that it is absolutely possible to feel many different things, including stress and hopelessness, and even gratitude, or any other mix of emotions, all at the same time. These feelings can co-exist together.

If we can hold on to this thought, maybe we can make even just a tiny bit more space for the feelings of connection and groundedness. 

Take good care.

Reesa Packard, M.A., Ph.D., R.P. is an Associate and registered psychotherapist at CFIR (Ottawa). She has a doctoral degree from the Saint Paul School of Psychotherapy & Spirituality and works in private practice as a registered psychotherapist. She works with clients hoping to develop a more integrated sense of self as a means to well-being and meaningful, lasting transformation. Reesa is also involved in the teaching and supervision of psychotherapists-in-training and advanced knowledge through research in her specialty fields.

It’s been a strange time. There are daily news updates regarding the current pandemic; still, it’s uncertain how long we’ll be required to stay home. Some of us have found this period at home to be calming, while others have found it to be monotonous. The change of pace has left us with time to spend with (and learn more about) our selves. Here are a few things you may wish to explore:

Do Things You Enjoy: When life gets busy, we may start to neglect aspects of ourselves to make time for things that seem even more essential. During this time, allow yourself to reconnect with the things that bring you joy (e.g., art, music, writing, etc.). Reignite those passions and take note of how they affect your wellbeing. 

Unplug: The ongoing dissemination of news can become overwhelming. It is okay to allow yourself a chance to step away and take a breath. Instead of tending to something that may exacerbate feelings of anxiety and being out of control, shift your focus to what can be controlled-you. Do the things that bring you peace of mind (e.g., yoga, reading, cooking, etc.) 

Reminisce: It’s not uncommon to want to press ‘pause’ sometimes during fast-paced times. If you have some extra time now, reconnect with who you are, and how far you’ve come, whether it’s looking at old pictures or looking at mementos; allow yourself to look back on special memories. Reconnect with the forgotten parts of yourself and reflect on how they affect your wellbeing. If distressing feelings or thoughts arise, it may be an indication for you to reach out for support.

Re-Evaluate: With the opportunity to disconnect from ‘auto-piloting’ through life, we may start to evaluate our thoughts and feelings concerning our experiences in the present. Allow yourself to acknowledge this information. Sometimes, we may need to re-evaluate what is working and what is not working in our lives and how it’s affecting our wellbeing.

Social isolation can be a confusing and anxiety-provoking state to be in, but it may also teach you a lot about yourself. Taking the time to reflect on who we are, how far we’ve come, and where we would like to head in life can be a compelling experience. Therapists at Centre for Interpersonal Relationships can help you process different aspects of your identity during this time. We are currently offering virtual sessions that you can connect to from the safety and comfort of your home. Click here to learn more. 

Nereah Felix, B.A. is a registered psychotherapist (Qualifying) at Centre for Interpersonal Relationships (CFIR) in Ottawa and is under the supervision of Dr. Dino Zuccarini, C.Psych and Dr. Natalina Salmaso, C. Psych. The clients who come to see her are provided with an authentic, non-judgmental, safe, and supportive environment to share their experiences and improve their wellbeing. Nereah is currently enrolled in the Master of Arts in Counselling Psychology at the University of Ottawa.