How long does a psychotherapy take? How many different stages will it have? The answer depends on several variables: the therapist; the client; the type of therapy.

As a psychotherapist, I think of layers. The first one is to know why the person is coming right now, that is, what motivated her or him to ask for a session. Usually, my first question is “What brings you here?” or “What ails?” I then listen. Sometimes it is specific words, like anxiety or depression. At times it is an example of the situation they are experiencing. In other cases, the client is flooded with emotion and cannot speak.

I want to know what bothers them. I try to understand what they are going through and how it feels from their perspective. I reflect what I perceived to the client, concentrating on their feelings. I convey that with simple words, the ones that do not mask things.

At this point I may want to know since when the person has been feeling the issues they have described. Sometimes the answer is forever; sometimes it’s something more specific.
We delve then into the layer of discerning whether there are repeated patterns concerning their sufferings and/or what triggers them. I ask about their history, starting as far back as they can remember.

Therapy for me is what goes on between session and session: the emotions and ideas that clients experience. Those are the main bricks of psychotherapy.

As therapy continues, the agenda will be jointly set at the beginning of every session. I’m very interested in knowing what the client experienced after the first sessions, what connections they made, what they felt. At this point I might have questions: I want to see parallelisms between the concerns that brought the clients to therapy and things that happened in the past, thus opening a new layer: Did the symptoms serve any purpose? Many times, during childhood, we utilize any mechanism that will help us tolerate or survive difficult situations and as strange as those mechanisms might sound in adult life, for a child those are life savers. However, sometimes carrying those coping mechanisms into adulthood does not lead them to achieve the things that they want (peace of mind, balanced self-esteem, knowing that they are moving forward in life).

Here starts another layer in the therapeutic work. By this time we have both rolled up our sleeves and we are working together in this. This stage might take many sessions and there is progress: clients are working on themselves; they start to make changes; they like therapy and many times there is pain involved. I believe that the pain of facing the music is less damaging and less hurtful than the pain of trying to avoid the music, something that we excel at.

So here we are and we make more connections, another layer. If we could solve one issue we can now look back at our lives and try to solve other issues or to revisit periods of our life that were not as good, understanding and coming to peace with that.

At this stage many clients will want to end therapy; we are probably anywhere from 8 to 30 sessions into the process and as I explained in other articles it generally isn’t me who decides when the end of the therapy occurs, but it is the client. Some clients want to continue until they feel certain that they can go on their own or there are no other issues to resolve. Some clients prefer to stop at that point and a few clients come back a few years later when something else flared up or just to look at specific things. Clients learn how to use the tools and they can face new situations and find the way to resolve most of the new issues.

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

Key Points:

• 1. Therapeutic alliance
• 2. Therapeutic fit
• 3. Compass for change

In the space of mental health, the importance of the therapeutic alliance is essential. It can be described as the trusting and collaborative relationship between a client and therapist that forms the cornerstone of successful therapy outcomes (Cuncic, 2023). This bond goes beyond professional interaction; it is a dynamic connection that fosters an environment where personal development and change can prosper (Ardito & Rabellino, 2011).

One key aspect of this alliance is the concept of the right therapeutic fit. Just as every individual is unique, so too are their needs and preferences in therapy. The right therapeutic fit is the interplay between a client and therapist where personalities, communication styles, and therapeutic approaches align. Like a tailor-made outfit, the right fit ensures that the therapeutic process is not only effective but also comfortable for the client.

When clients feel a genuine connection with their therapists, it creates a safe space for vulnerability, authenticity, and self-exploration – which serves as the greatest indicator of therapeutic success. A mismatch, conversely, can impede progress and leave clients feeling unheard, unresolved, or misunderstood.

Therapists who prioritize establishing a strong therapeutic alliance demonstrate empathy, trust, respect, active listening, and a genuine commitment to their clients’ well-being. The therapeutic alliance is not established overnight, however as clients navigate the often-challenging journey of self-discovery and growth, the therapeutic alliance becomes the compass guiding them toward healing and resilience. Research shas shown that the quality of therapeutic alliance acts as a dependable predictor of positive therapeutic engagement, motivation and clinical outcome – independent of the psychotherapeutic approach used (Ardito et al., 2011).

In essence, the therapeutic alliance and the right therapeutic fit are not just abstract concepts; they are the heart and soul of effective therapy. By recognizing and nurturing this alliance, clients and therapists co-create a transformative space where change and personal growth become not only possible, but probable.

Tips to make your therapy experience better include giving it a few sessions before deciding if the therapeutic alliance/fit feels right, not being afraid to ask questions about the process, making sure you feel heard, seen, understood and collaborated with, expressing your needs, providing feedback to your therapist, reflecting on your therapy journey, and keeping the lines of communication open about your changing goals and needs.

Natasha Vujovic, M.Psy, R.P (Q) is a Registered Psychotherapist (Qualifying) at CFIR. She works with individuals and couples experiencing a wide range of psychological and relational difficulties including anxiety and stress, depression, mood and grief, relational conflict, trauma, life transitions, personality, body-image, marital and pre-marital, internal conflicts, family dynamics and self-esteem. Natasha is an integrative therapist pulling from psychodynamic/analytic theories and takes a collaborative and honest approach to session.

References:

Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology, 2, 270. https://doi.org/10.3389/fpsyg.2011.00270

Cuncic, A. (2023, November 30). Why a Therapeutic Alliance Is Important in Therapy. Verywell Mind. https://www.verywellmind.com/the-therapeutic-alliance-2671571

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 admin@cfir.ca 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 admin@cfir.ca 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.  

Major life transitions can occur at any stage in life. Whether it is starting university or college and living on your own for the first time, starting a new job, becoming a parent, or experiencing a death or loss of a loved one, life transitions can evoke many complex feelings. When we experience a big life-altering change, we are often faced with many unknowns and a sense of unpredictability regarding our future. Confronting the unknown and uncertain can evoke feelings of stress, worry, fear, self-doubt, grief, and depressive experiences. While these feelings are normal when faced with a major life change, they can still feel intense and overwhelming. To support yourself or loved ones during a time of major life transition, it is important to remember to: 

1. Acknowledge and validate your feelings—Sometimes our emotions can feel so overwhelming and intense because we don’t yet know why or what we are experiencing. Acknowledging that a life transition is likely to evoke strong emotions and finding new and healthy ways to identify and validate your feelings can help you navigate change. 

2. Accept the inevitability of change— We are constantly changing, growing, and evolving in our lives and relationships. Change can be difficult and overwhelming, but it can also provide an opportunity for self-growth and development. Through experiencing change, we can discover new possibilities and parts of ourselves, which can be exciting and motivating!

3. Reach Out and Connect—Sometimes experiencing a major change in your life can feel lonely and isolating. Connecting with loved ones, members of your community, or others who may be experiencing a similar life change can help you to navigate this difficult time. Engaging in psychotherapy can be another way to address any difficulties that you are facing because of a major life change. In the process of psychotherapy, you can learn new ways to navigate difficult emotions, and develop a deeper understanding and meaning about what this major life change means to you. 

If you are experiencing a major life transition, and wanting to better understand and navigate your experience, CFIR has counsellors, psychotherapists and psychologists who are available to support you!

Jennifer Bradley, M. A. is a Registered Psychotherapist (Qualifying) at CFIR. She works with individuals experiencing a wide range of psychological and relational difficulties including life transitions, anxiety and stress, trauma, depression, mood and grief, interpersonal difficulties, and issues related to self-esteem. Jennifer is an integrative therapist with a particular interest in existential, relational, and psychodynamic approaches to psychotherapy. 

Today, I scooped myself a bowl of ice cream. This is no different from countless other times I’ve done the same thing, save for one fact: I didn’t add chocolate chips. Now, let me back up for a second. I’ve been putting chocolate chips in my ice cream since I was a small boy. (somewhere out there in internet land, there is a mention of me eating too much ice cream-it’s true!).

Vanilla ice cream? Add some chocolate chips. Chocolate? Add chocolate chips. Cookie dough brownie with fudge? You guessed it, that’s going to get some chocolate chips too. So why didn’t I add them tonight? The answer: the global pandemic.

By now, I’m sure we’re all sick of reading about and talking about and hearing about the COVID-19 pandemic. So, I won’t belabour that. However, one side effect of the situation is that it’s caused almost all of us to re-think our routines. I didn’t add chocolate chips because when I went to grab another package at the grocery store earlier this week, they were all out (we really do seem to modulate our emotions with baked goods). That made me change a tiny part of my daily routine in a way I haven’t done for probably 20 years.

I’m betting that you, dear reader, might have had something similar happen to you in your week. Maybe you made that meal that you’ve been planning on for months. Maybe you cleaned the baseboards. Maybe you finally reached out and actually called your mother, or your grandmother (or their male counterparts!). Whatever it was, I’m betting that it felt weird at first, but that you felt better after doing it.

See, massive societal changes don’t just change things on the macro (read: big picture) level; they change on the micro, too.

Brent Mulrooney, M.A.S.P. | Therapist

See, massive societal changes don’t just change things on the macro (read: big picture) level; they change it on the micro, too. For 20 years, I have consistently thought that ice cream just wasn’t right without chocolate chips, so I consistently added them to every bowl I’ve ever eaten. Today, because of a situation entirely out of my control, I changed my habit. But here’s the thing: I liked it better. I tried it and I liked it better.

That got me to thinking. How often do we recognize that there’s something happening in our lives that just doesn’t sit right with us? Maybe you don’t call your friends because you think you’re going to bother them? Maybe you want to say hello to someone in an elevator, but you get shy because you’ve never done it before and …don’t weird people do that? (I say hello quite often, so make of that what you will). Maybe you want to start going to the gym, but you haven’t found the right day, or the right time, or the right gym outfit.

Yet, when we actually try something new, those tales we tell ourselves don’t often hold water. Sometimes they’re just not true. Sometimes, the ice cream is better without the chocolate chips.

Looking to start a journey towards change and your life? Mental health professionals at CFIR can help you navigate where you’re coming from and support you in developing healthy strategies to build an emotionally healthy future.

Brent Mulrooney, Ph.D., is a therapist at the Centre for Interpersonal Relationships. He works with individuals and families to improve mood, anxiety, relationships, work, and school. He also works to alleviate problems associated with substance use, learning difficulties (including ADHD and Learning Disabilities), bullying, trauma, violence, grief and loss, transitions in life, self-esteem, gender identity, sexuality, and intimate relationships.