by: Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice)

We’re used to thinking about depression in terms of its symptoms: for example, depressed mood, inability to feel pleasure, sleep disruption, and loss of appetite, weight, and/or sexual desire, among others.

But, have you ever thought about there being two types of depression? 

Some mental health professionals have begun to focus not just on symptoms, but also on the everyday life experiences associated with depression: feelings of loss and of being abandoned and unloved on the one hand, and feelings of worthlessness, failure, and guilt on the other.

Based on these two different experiences related to depression, Sidney J. Blatt, a professor emeritus of psychiatry and psychology at Yale University’s Department of psychiatry, along with his colleagues, distinguished two types of depression.

One type of depression is the “relational” type, sometimes called the “anaclitic” version, from the Greek word for “to lean on.” Typically, this depression is characterized by feelings of loneliness, helplessness, and weakness, as well as intense and chronic fears of being abandoned and left unprotected and uncared for.

The other type of depression is the “self-critical” type, sometimes called the “introjective” type. Typically, it’s characterized by feelings of unworthiness, inferiority, failure, and guilt. Introjectively depressed individuals engage in harsh in scrutinizing and evaluating themselves. They have a persistent fear of criticism and of losing the approval of others.

Not only do these two types of depression reflect two different internal experiences of depression – “I’m empty, I’m hungry, I’m lonely, I need a connection” (relational) versus “I’m not good enough, I’m flawed, I’m self-indulgent, I’m evil” (self-critical) – they also indicate different therapeutic needs.

Research shows that those who are relationally depressed are more responsive to the supportive interpersonal or relationship aspects of therapy. In contrast, those who are introjectively depressed are more responsive to the interpretive or explorative elements of the treatment process. A mental health therapist who understands different types of depressive experiences can help a range of depressed individuals understand themselves better and also overcome the difficulties that come along with depression.

Psychotherapists at CFIR can support you to deal with your negative beliefs of self and other, and the relentless characteristics that might be at the root of your depression. We integrate cognitive-behavioral, mindfulness and acceptance and commitment, and psychodynamic-based approaches to help you deal with the thinking that might be contributing to your depressed moods.

Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice) is a psychologist in supervised practice at the Centre for Interpersonal Relationships (CFIR) in Toronto. Dr. Vasilovksy works with adult and couple clients from an integrative therapeutic perspective, and helps them overcome difficulties related to depression and mood, anxiety and stress, trauma and PTSD, interpersonal conflict, major life transitions, and identify-related struggles.

by: Roselin Leonard, Internal & External Relationships Manager

Monday, January 15, 2018 (the third Monday in January) marked what’s come to be known as Blue Monday, also known as “the most depressing day of the year”. A time when the impact of holiday spending, frigid temperatures, and long carb-loaded days laden with low motivation hits hard.

While the theory behind Blue Monday has yet to be scientifically proven, symptoms of the winter blues feel undeniable for many of us. According to CAMH British Columbia, 2-3% of Canadians will experience Seasonal Affective Disorder (S.A.D) in their lifetime. This makes up about 10% of all depression cases.

When Kai Black, Executive Producer at CBC Music in Toronto, heard about the Blue Monday phenomena, he knew it was a great starting point for a discussion about mental wellness at CBC. He envisioned an event that would raise mental health awareness and offer valuable resources to help counteract the effects of Blue Monday. Once his vision was realized, the wheels of action were set in motion.

Kai engaged CBC Toronto’s abilicrew –an amazing ‘Employee Resource Group’ for CBC employees with disabilities and their allies– to create something great. Let’s just say, they did not disappoint. The team transformed Kai’s idea into ‘Beat Blue Monday’, now an annual event.

“The event today rose out of a need to communicate to staff that this is not just the saddest day of the year, but it’s a good day to find out how you can deal with your own sadness at this time.” – Kai Black

Centre For Interpersonal Relationships (CFIR) was thrilled to be invited back to ‘Beat Blue Monday’ alongside other local exhibitors for yesterday’s festivities at the Toronto Broadcasting Centre. More exciting than the invitation itself was the opportunity to connect with employees eager to learn more about mental and physical wellness and strategies to beat the blues.

The entertainment was fun, informative and elevated the festivities to another memorable level!

CFIR Clinical Director and psychologist, Dr. Lila Z. Hakim, C. Psych. joined CBC personalities including the host of CBC Radio’s Day 6, Brent Bambury, CBC Sports host Scott Russell, and CBC Music’s Raina Douris and Angeline Tetteh-Wayoe in a game show testing their ’emotional intelligence’.

Lisa Clarkson (Executive Director, Business & Rights and Content Optimization at CBC and Executive Sponsor for the Beat Blues Monday Event) introduced the ‘Mayfield Magnetics’, the top Grade 12 vocal jazz class in Ontario and the winners of 2016’s CBC Music Class Challenge.

‘Beat Blue Monday’ 2018 was a wonderful experience. Sincere congratulations to Kai Black, Helen Kugler, Sylvie MacLean, CBC’s Engagement & Inclusion team, the CBC Toronto’s EAP, the abilicrew, DiversifyCBC and outCBC for a successful event and for their ongoing commitment to–and investment in–the mental wellness of CBC employees.

Think you might have a case of the winter blues? 

Dr. Lila Z. Hakim, C. Psych. offers a few helpful tips below to start feeling good again **:

Nourish Your Body

Many of us experience cravings for certain foods when the winter season blows in and our bodies develop a yen for carbohydrates. Carbohydrates are directly linked to the production of the neurotransmitter serotonin, an emotion regulator that helps you feel emotionally stable, less anxious, calmer, more focused and energetic.

When that 3 p.m. craving for a savoury or sweet snack hits, it’s your body’s way of self-medicating, seeking to improve your mood by boosting your serotonin levels. Listen to your body and give yourself that much-needed serotonin lift.

Instead of calorie-dense, sugary breads and sweets that offer a quick mood-boost and then a crash, consider healthier alternatives such as fruits, nuts, and yogurt.

Get Active!

Physical activity increases not only the calming neurotransmitter serotonin, but also increases dopamine, the emotion and pleasure neurotransmitter, and endorphins, your pain-relief and pleasure neurotransmitters. Incorporating movement into your day (climbing stairs, going for a walk, etc.) gives your body the activity it needs to keep your mood up throughout the day.

Make Sleep a Priority

Sleeping excessively (or hibernating) is normal in the winter and is often a reaction to the cold, but for some, ongoing insomnia or difficulties falling or staying asleep create difficulties that can lead to the blues. Provide yourself with a space at home that includes comforting objects (such as a warm blanket, beautiful objects, etc.) to calm your stress hormones. Aim to get exactly the amount of sleep you need to feel fully rested and ask a professional if you are unsure about how much rest is the ideal amount.

Do Things that Light You Up

Find activities in your life that give you a sense of pleasure and meaning, that involve curiosity, exploration, and interest­–this could be collecting or building things, researching something you love like travelling, or caring for other people. Artistic endeavours like creating and listening to remarkable music are also great options. Pleasure, curiosity, exploration, and interest all stimulate dopamine, which makes you feel exhilarated and alive!

Which strategies do you find most effective for curing winter blues? Feel free to share your comments or feedback below.

(**Note: If you or a person you know is experiencing regular symptoms of depression, it is important to seek medical attention from a physician. If you don’t have a family doctor, click here for additional information and options via Ontario.ca.)

by: Dr. Dino Zuccarini, C.Psych.

Life can be a symphony of losses. Many of us struggle to cope with unresolved losses from either the past or present day. We can experience loss as we transition through various life stages (i.e., childhood onward toward the end of life). Some individuals will experience loss as a result of unmet needs, separation, divorce, or death of loved ones, or unfulfilled goals and potentials. Some of us will experience a deep sense of loss as we inevitably experience changes in our physical and mental abilities, health status, and roles and identity. The emotional residue and grief associated with these losses, when left unaddressed and unprocessed, can evolve into anxiety and depression.

In terms of overcoming your grief, we help you to understand the meanings of your losses, and to process the unresolved or complicated emotional residue from these losses. Unprocessed grief and loss can affect our emotional well-being, our functioning in everyday life, and our interpersonal relationships. We support you throughout your grieving process so that you may move forward with your life with a renewed sense of meaning, purpose, and hope. Psychologists and clinicians at CFIR employ psychodynamic and experiential approaches to support you through the process of dealing with past and present-day losses.

Read more about our Depression, Mood & Grief Treatment Service.

by: Dr. Dino Zuccarini, C.Psych.

Depression

Depression can bring about debilitating symptoms, both of a physical and emotional nature. Depressed individuals typically find themselves experiencing hopeless feelings, disruptions to sleep and eating patterns, a loss of pleasure in everyday life, and possibly thoughts about suicide or death. Often individuals who are depressed have physical symptoms, including aches and pains.

Finding a path toward recovery can be challenging, but the good news is depression is treatable; recent research indicates that psychotherapy is extremely important in your recovery from depression.

When depressed, we can become bombarded by an internal chorus of negative thoughts and feelings about our selves other people, and the world around us. We can be overly self-critical of our selves and others, or may find ourselves struggling to come to terms with deep feelings of loss. At these times, it can be difficult to imagine a way to restore our vitality, hope, and optimism for life. When the severity of your symptoms seriously disrupts your capacity to function at home, work, or school, consider consulting with a psychologist immediately.

Negative thoughts and feelings about ourselves and others: Healing requires us to try to make sense of and deal with the distressing negative thoughts, feelings, and emotional responses that lie at the root of our depression. Depression is often linked to negative thoughts and feelings we hold about ourselves, of other people, and of the world around us. The origins of these thoughts and feelings can extend back into our childhoods and onward to the present day. These negative thoughts can create a sense of hopelessness about our selves and the world around us. A negative, critical voice and overly rigid standards and ideals can also be at the root of your depression.

We all have standards and ideals that we internalize from childhood onward about how we should be. These standards and ideals create expectations about our own and other people’s behaviour and guide us in terms of how we ‘should,’ ‘ought to,’ or ‘must’ think, feel, and behave. Some of us will rigidly hold onto and strive to live according to unrealistic standards and ideals, and be unrelenting in our efforts to have ourselves and others live up to them. Rigidly held standards and ideals can fuel harsh self-criticism and perfectionism. Indeed, research affirms that self-criticism and perfectionism often contribute to symptoms of depression.

Unexpressed emotions and needs: For some individuals, unprocessed emotions and unattended needs can result in depression. Depression is, therefore, a signal calling for us to listen to what our feelings are telling us about our selves, other people, and the world around us. Emotions provide us with important information. Being able to identify, label, and express these feelings in words is important for us to understand what our concerns are and to identify the unmet goals or needs that are at the root of the depressed feelings we are experiencing.

Other causes:  Depression may also result from multiple other physical and psychological causes, or as a result of substance abuse. A thorough assessment by your physician and a psychologist provides the best opportunity to determine your best treatment options.

Mood

Some individuals struggle with varying moods. People diagnosed with bipolar disorder struggle with mood variation, including periods of experiencing unusually or somewhat elated moments or ‘highs’, followed by periods of ‘lows’ or depressed periods. During manic periods, individuals with bipolar disorder may engage in risky behaviours leading to financial or legal difficulties. Being aware of triggers or signs of an impending mood episode, developing strategies involving partners, addressing difficult thoughts, creating a more balanced world, and accessing support to adhere to treatment regimens, are all significant components of managing bipolar disorder.

The Depression, Mood & Grief Service at CFIR offers clients counselling and psychotherapy to support them to address depression, mood, and past and present grief and loss. We offer children, adolescents, adults, and couples psychological assessment and treatment of depression and other mood disorders. We provide a comprehensive psychological assessment of your depression and/or mood difficulties, including the use of psychological tests for the purposes of diagnosis and treatment planning. There are different causes of mood disorders, and different types of depression and bipolar conditions. Psychologists are skilled in assessing, diagnosing, and subsequently developing a tailored treatment plan to address the specific issues associated with your current depression and/or mood difficulties. We employ scientific, evidence-based treatments, including Acceptance and Commitment Therapy, Cognitive Behavioural Therapy, Emotion-Focused, Mindfulness, Psychodynamic-Mentalization-Attachment based therapies to help you overcome your symptoms and make deeper changes to your self.

Read more about our Depression, Mood & Grief Treatment Service.

by: Dr. Dino Zuccarini and Tatijana Busic

Finding a path toward recovery from your depression symptoms can be challenging, but is doable! In this third post in our depression blogs, we provide strategies to help you deal with depression symptoms associated with your thinking and how you might be processing your feelings, emotions, and needs.

We’ve offered you some tips to help take the first few steps toward feeling better. We suggest that you start your recovery journey by employing strategies for your self first, and then once you’ve started on those, our fourth blog post offers you strategies for your relationships.

Strategies for Your Self: Develop Structure, Routine, and Self-Care into Your Life

When we are depressed, we tend to become depleted of energy. We move less and feel tired. These circumstances can drain us of important mental and physical stimulation that we need for our well-being.

Put structure and everyday routine back into your life and begin to increase your level of self-care. Create a routine. Make sure to schedule activities that are meaningful or pleasurable to you. Include 20 minutes of physical exercise each day. Prepare healthy meals that will nourish your body and mind. Get good rest. If you are having difficulties sleeping, consult resources that will assist you to develop a soothing nightly ritual that will help you to unwind and relax and ultimately improve your sleep.

Learn How to Regulate and Soothe Stress, Negative Feelings and Emotions

With depression, we can struggle with our feelings and emotions – we feel too much or too little. When we are overwhelmed by strong, intense feelings and emotions, it is important to develop practices and strategies to effectively deal with these internal reactions.

Pause before you act on your thoughts and feelings and try to restore a sense of calm and ease. Learning how to restore calm and ease within ourselves is an important life skill. Make a list of activities that are calming and soothing for you, and engage in these activities when you are emotionally distressed. For example, sipping tea in a peaceful place, going for a walk, engaging in deep body and muscle relaxation, taking a warm bath, learning how to breathe rhythmically and deeply, visualizing peaceful and tranquil settings, quietly reading a book, and listening to calming music are examples of ways to enhance coping.

Try to remember, intense feelings and emotions mellow with time. Try to reassure yourself that these feelings and emotions will pass and you will be okay once again. Once we are calmer, we can begin to think about the thoughts and feelings we are experiencing that are contributing to our depression.

Challenge Negative Thoughts and Feelings about Your Self and Others

Negative views of our ‘self’ and of other people can create a deep sense of hopelessness, as discussed previously. In the midst of feeling depressed, pay attention to the thoughts, interpretations, assumptions, and beliefs you have about yourself or others. Do you notice a negative bias in how you are thinking or feeling about yourself and others?

Try to challenge these negative views and find counter-examples to these negative thoughts. Try to recognize good things about yourself and others at home, work, and in play. Practice noticing positive attributes about you and other people—at least once a day. You can also develop a list of positive things about yourself and other people in your life. Have your list handy and read it whenever you are feeling negative. Do not be surprised if your list of good things begins to grow as you start to engage in this exercise of positive appreciation.

Sometimes our negative thoughts and feelings towards others are grounded in real experiences in which others are behaving inappropriately toward us. If people are behaving toward you in a negative manner that is harmful (i.e., verbal, physical, emotional or sexual abuse), it is important to seek out support and professional help to find a way to address these circumstances.

Develop Self-Compassion in Place of Harsh Self-Criticism and Perfectionism

Sometimes a negative, critical voice toward our ‘self’ and others may be at the root of our depression. When left unchecked, this voice can make life unbearable.

Do you notice a highly critical or perfectionistic inner voice that pervades your life? How do you feel while and after you have berated, attacked, or criticized yourself? Probably not very good. Try to develop a more compassionate and understanding counter-voice at these times. Making mistakes and not meeting expectations and demands are bound to happen throughout our lives. It is part of being human. Remind yourself that no one is perfect nor do we need to be in order to be worthy, lovable, and valuable as human beings. Ask yourself if you would be as harsh toward others, such as a family member, partner or friend if they had not met an expectation? Would you be more understanding of others? Try to develop a kind, gentle, understanding and reassuring voice toward yourself in these moments.

Try to lighten the impact of this oppressive voice by reframing the self-criticism in positive terms. For example, ask yourself what you can learn from the present situation that may help you grow as a person in the future as opposed to harshly attacking yourself. Try to find constructive solutions to your mistakes or problems, rather than senselessly depleting your energy and berating yourself.

Try to find ways to challenge harsh self-criticism. Ask yourself, “How realistic are the expectations and demands that I hold of myself and others?”. Remember that human beings are limited in terms of what we can achieve. We can’t always meet all of our or others’ expectations or needs. In addition to negotiating our needs with those of other people in our lives, we also have to balance a lot of competing needs in different contexts, including work, family, and play.

Find counter-examples that contradict the extreme and global way you are putting yourself down. Create a more balanced and accurate view of yourself. Think about what is good enough and possible in your current life situation rather than how things should be in order to be perfect.

Be Mindful, Build Awareness of the Present Moment

When we are depressed our thoughts are often focused on worrying about the future or ruminating about the past. Depression impedes on our ability to live in the present moment, which often further aggravates the cycle of worry and negative rumination.

Try to notice these moments as they are happening without any judgment. Simply notice your ‘self’ thinking or feeling something that is connected to worry about the future or rumination about something that happened in the past. As you notice what is happening, try to gently shift your attention to your body. For example, if you are walking notice how the soles of your feet feel with every step you take. Practice using your senses to notice how things look, feel, taste and smell around you.

By gently shifting your attention to the present moment, you rest your awareness in the here and now of being alive. This mindful practice can help you to build an inner sense of refuge from the stresses of life. Also, this practice can occur under any circumstances and over time, will help you to develop greater resilience and freedom from the negative thought and emotional patterns associated with depression.

Identify, Label, and Access Emotions and Needs and Make a Plan of Action

Emotions provide us with important information about what our concerns, goals, and needs are for ourselves and in our relationships with others in the world around us. Depression is a signal, calling for us to listen to what our feelings are telling us about what concerns or goals have gone unmet, or what we might want or need for ourselves or in our relationships with others.

Being able to identify, label, and express these feelings in words is important if we are to appreciate what our concerns are and what we might need as individuals and from our relationships. When we figure out what our emotions are telling us, we can then develop a plan of action toward taking care of ourselves more effectively. We can develop strategies to address our goals and concerns, and meet our wants and needs in a manner that does not create further difficulties for us.

Try to identify and label your emotions. Pay close attention to the feelings that underlie what you are experiencing. For example, you may be feeling numb, but masked underneath resides hurt and sadness. Or you may feel outwardly sad, but are also angry deep down. This may not be easy to do at first and takes practice.

Also, try to tune into what the concerns, unmet goals or needs are that come with these feelings and emotions. What do you need for yourself in your sadness or anger? Write about your feelings in a journal with a particular focus on what these feelings are telling you about what you might need for yourself or in your relationships with others.

Begin to plan and create strategies of how you can go about meeting your goals, wants, needs, or desires in a manner that is constructive for you and for those around you. You may require support from others to help you organize your thoughts and to develop plans to have your goals, wants, or needs met.

Seek out Professional Support: Consulting with your Physician and a Registered Clinical Psychologist

Consulting with a physician may also be an important first step to assess your current mental health status. Depression can be associated with many biological and medical causes that require medical interventions.

Seeking the professional support of a registered clinical psychologist may be important to help you address the negative thoughts and feelings you are having about yourself, or others. Learning how to address perfectionism, self-criticalness, and process your emotions and clarify wants, needs, and goals can be challenging. Contact a registered clinical psychologist if you find that dealing with your thoughts and feelings on your own has become unmanageable.

Read more additional posts from the ‘Depression’ series:

• Depression: How Your Thinking Can Lead to the ‘Blues’ (Part One)
• Depression: The Role of Unprocessed Feelings and Emotions (Part Two)
• Combatting Depression: Strategies for Your Relationships (Part Four)

Learn more about our Depression, Mood & Grief Treatment Service.

by: Dr. Dino Zuccarini and Tatijana Busic

Do you find yourself struggling to cope with the intense feelings and emotions associated with depression?

In this second post of our four-part series about depression, we’ll provide you with a few of many psychological views of how unprocessed feelings and emotions might lead to depressed feelings. In the following post, we’ll provide you with various strategies you can use to deal with depression on your own, or in your relationships with others.

Feelings and Emotions Associated with Depression

Depression involves different types of difficult emotional experiences, including chronic negative feelings and emotions (e.g., fear, sadness, anger, worthlessness, guilt, shame, irritability, restlessness or lethargy, detachment and numbing). Depression is, of course, a broader mental health diagnosis that consists of many different features, as outlined in this series’ first post in which we addressed what is depression. Depression is different than normal grief in which we feel sadness for a prolonged period of time in the aftermath of the loss of a loved one (i.e., loss of a parent, child, sibling or friend).

Unprocessed Feelings and Emotions as Signals of Need in Depression

Our feelings and emotions provide us with important information about our self, others and the world around us. Depression is a signal to us—a calling for us to listen to our feelings, emotions, desires, and needs.

Some of us are unable to clearly identify, label or express our feelings and assert our needs. Being able to figure out our feelings, emotions, and needs is, however, critically important. It is important because our feelings and emotions guide us by providing us with a sense of what is significant to us in our environment both at home and work. Emotions signal to us that we have concerns, goals, and needs and that some type of action may be required by us to deal with these concerns, goals, and needs in our environment. When we do not attend to our feelings, emotions, and needs, we can create a world that feels false to us. We can become disconnected from what’s really important to us and in our relationships, which can result in hopelessness, anger, or detachment and withdrawn feelings.

In our relationships, it’s important to process our feelings, emotions, wants, and needs. Depressed individuals may have difficulties managing their emotions and figuring out what they need from others. If we can’t figure out our feelings, emotions, wants and needs, we won’t be able to approach our friends, family members, partners, or even employers with our concerns or needs. Some individuals become out of touch with how others can sometimes provide us with responses that can be valuable to us—-only if we actually know what it is that we need from others, feel entitled to ask for support, and risk expressing our vulnerabilities and needs to others (i.e., to listen to us, help us sort out our feelings, verbal reassurance or physical reassurance through a hug etc.) can we realize how others can be a source of contact-comfort, and soothing to assuage the distress in our everyday world.
When we can’t sort out our feelings, emotions, and needs, we can’t get in touch with ourselves and how others might be able to respond to us in ways that can make life better for us. Depression sets in as hopelessness grows—with depression, it becomes more and more difficult to reach for support and increasingly we withdraw, detach, or are irritable and angry, which pushes people further away from us.

Loss and Grief, Meaninglessness and Purposelessness

Life can be a symphony of losses. Many of us struggle to cope with unresolved losses that are accompanied by grief, and possibly a sense of meaninglessness and purposelessness. We can experience loss in many ways—loss of loved ones in our close relationships (i.e., death, separation), and the loss of self and identity as we transition through various life stages or as a result of unexpected changes to our mental or physical health.

We may experience the loss of a parent, partner, child or friend through death, separation or divorce—and experience normal grief. Some individuals will grieve these types of losses and eventually return to feeling better—albeit life is never the same with the loss of a loved one. Some individuals, however, will not recover as well. The loss may create a deep sense of loss and grief about the relationship with the loved one—this loss may also remind you of various other past losses in life in which your emotional needs were unmet—increasing a sense of loneliness, pain, guilt, shame, and isolation. When we have not appropriately grieved our losses, the pain and sadness of previous losses can accumulate and surface unexpectedly—prolonging your recovery time.

Loss of a loved one might also leave you with a shattered sense of your self, identity, and future—if so many of your life plans were associated with the lost loved one. Re-discovering who you are separate from your lost one can take time. Hopeless despair, sadness, and anger can also emerge when it is difficult to reconnect with others, and re-create a renewed sense of meaning and purpose after these types of losses.

We also experience loss and grief as a result of changes caused by normal lifespan changes (i.e., change in roles and identity), changes in our physical and mental abilities, and health status. When these changes occur, some individuals have to face loss related to unmet expectations and unachieved goals—the lost hopes of what we thought our lives would be. Changes in our life circumstances (i.e., children leaving home, loss of employment etc.), health status (i.e., mental and physical changes associated with illness or aging), alter our capacities and possibilities of functioning in ‘old’ ways. When we experience loss or a lot of change, we can lose our bearings and struggle to find meaning and purpose in life again. Over time, we can begin to feel hopeless about ourselves. You can lose a sense of vitality as you try to re-define what’s of importance to you in the aftermath of all of these changes.

How Psychotherapists at CFIR Can Help

Psychotherapists at CFIR can support you to deal with your emotions, including helping you to get to know your feelings and emotions, label them and figure out what they might mean to you. Some of us of have strong emotions that need to be dimmed somewhat but still understood. Sometimes strong emotional reactions come from unprocessed feelings, emotions and needs from our past relationships, and losses, or from losses in present-day life. Psychologists at CFIR provide cognitive-behaviors, existential-humanistic, emotionally-focused and psychodynamic therapy strategies to support you to deal with your emotions, understand what these important signals mean to you, and to help you to take action in the world that will promote self-growth and recovery from your losses.

In the next blog post of the series, we will be providing you with strategies on how to deal with your feelings of depression. We’ll be outlining strategies for ‘yourself’ and strategies for ‘your relationships’. Aside from seeking psychological services to help you with your symptoms, there are many things you can do to feel better on your own.

Read more additional posts from the ‘Depression’ series:

• Depression: How Your Thinking Can Lead to the ‘Blues’ (Part One)
• Combatting Depression: Strategies for Your Self (Part Three)
• Combatting Depression: Strategies for Your Relationships (Part Four)

Learn more about our Depression, Mood & Grief Treatment Service.

by Dr. Dino Zuccarini and Tatijana Busic

Are you tired of struggling with low energy, negative thoughts, and feelings that seem to absorb so much of your day? You may be suffering from the debilitating symptoms of depression.

This is part one of four in our blog series about depression. These posts have been created to help you consider what might be at the root of your feelings of depression. In the first two blogs, we write about some common causes of depression; particularly, about how you’re thinking and how the way you deal with your emotions might be causing or contributing to your feelings of depression. Finally, in the last blog, we provide you with strategies you can use to deal with depression on your own, or in your relationships with others.

What is Depression?

Depression has many different symptoms. When we’re depressed, we experience symptoms, such as, chronic negative feelings and emotions (e.g., sadness, worthlessness, guilt, irritability, restlessness or lethargy), loss of interest or pleasure in previously enjoyed activities, difficulties with attention, concentration and decision-making, changes in appetite or weight, fatigue, bodily aches and pain. Individuals suffering from depression are also typically bombarded by a chorus of negative thoughts about themselves, others and the world around them. These negative thoughts and feelings may be at the root of your depression.

How Our Thinking Paves the Road to Depression

There are several biological and psychological causes of depression. Let’s review a few ideas about how your thinking can contribute to depressed feelings.

1.  Negative Views of Our Self and Others

Your depression may be linked to negative thoughts and feelings you are having about yourself, others or the world around you. These negative thoughts and feelings can emerge from difficult life experiences at any time in our life—from childhood onward to present-day challenges we are facing in our lives. These difficult life experiences can affect how we might think and feel about our self and others (i.e., thoughts and feelings of inadequacy, worthlessness, incompetence, a sense of being unlovable and insignificant). When you think and feel negatively toward yourself and others for a long period of time, you can become hopeless. You can begin to attribute negative situations and events in your life to negative thoughts you have about your self. A sense of hopelessness about our self further blocks us from being able to achieve our goals and get our needs met. You might also believe that others think and feel the same way about you, which further deepens the hopeless feelings.

As a result of childhood or present-day challenging life experiences, we may have also developed a negative view of others. Others may have been harsh, inaccessible or unsupportive to us during some difficult life moments—and now, it may seem to us that all others are unreliable, undependable and untrustworthy, or potentially harsh and judging. These views of others may diminish the likelihood that we’ll be able to connect with friends or family for support when we are facing challenges and need others the most.

When we hold a negative view of ourselves and others as a result of past or present-day life experiences, we can begin to feel hopeless and less capable of meeting our goals, concerns, and needs, and unable to reach out during times when we are in need of others support and care. These negative views of ‘self ‘and ‘other’ cascade into feelings of depression over time.

2.  Unrealistic Standards, Ideals and Expectations Fuel Perfectionism and Self-Criticism

We all have standards and ideals that create expectations that then guide our thinking, behaviours and emotional reactions toward others. From childhood onwards, the outside world through our parents, teachers, and employers place expectations and demands on us. We also develop our own expectations about our own and other people’s behaviour (i.e., how we and others ‘should,’ ‘ought to,’ or ‘must’ think, feel, and behave). Our expectations can sometimes be unrealistic and unachievable, which can create a great deal of pressure and stress in our lives. Unrealistic expectations of others may also create difficulties in our relationships with others. When we are too overly driven by our own and other’s unrealistic expectations, we can become hopeless trying to keep up with all of these demands. We can also lose touch with what we are really feeling, preferring, desiring, wanting or needing for ourselves.

Some individuals maintain unrelenting, rigid standards and ideals about how they or others should perform in the world. In these circumstances, some individuals may have unyielding and high expectations about their performances. They may strive for perfection in their endeavours, and be self-critical and harsh toward themselves when they do not meet these expectations. A self-critical internal voice may emerge that continuously judges or berates the individual (e.g., ‘you dummy’, ‘you’re lazy’, ‘you’re weak’, ‘you screw things up all the time’). Research affirms that self-criticism and perfectionism are often cornerstones of depression.

Perfectionism and self-criticalness may initially work together inside of you to ensure that you perform well. You may criticize yourself to improve your performance so that you will see your self or others will see you in a more positive manner. The more we drive ourselves in this manner, the more we wind up feeling overwhelmed and stressed. We start living an unbalanced life that can feel overwhelming and stressful. Over time, perfectionism and a self-critical voice can create a sense of guilt for not performing adequately, and hopelessness about our self (i.e., global, negative view of your own self as inadequate, not good enough, and worthless). Some individuals can also be critical and harsh toward others for failure to live up to their demands. This can create difficulties when you are engaged in either constant conflict with others or others decide to disconnect from you and you becoming increasingly isolated over time.
CFIR psychotherapists can support you to deal with your negative views of self and other, and the unrelenting self-criticism and perfectionism that might be at the root of your depression. We integrate cognitive-behavioral, mindfulness and acceptance and commitment, and psychodynamic-based approaches to help you deal with the thinking that might be contributing to your depressed feelings.

Read more additional posts from the ‘Depression’ series:

• Depression: The Role of Unprocessed Feelings and Emotions (Part Two)
• Combatting Depression: Strategies for Your Self (Part Three)
• Combatting Depression: Strategies for Your Relationships (Part Four)

Read more about our Depression, Mood & Grief Treatment Service.

by: Dr. Dino Zuccarini, C.Psych.

Parent’s Grief Process in the Aftermath of Loss of a Child

Parents vary in terms of how they deal with loss—most parents will cycle through a wide range of emotional reactions. 

All parents face profound painful feelings and absorbing experiences of grief when a child dies. There can also be intense shock, confusion, and even denial about the loss. There is no loss more devastating than the loss of a child. This loss leaves parents disoriented and disorganized. Hopeless despair can immobilize parents from dealing with the tasks of everyday life, connecting to each other or other children. In hopeless, despair states, parents can experience existential distress—finding life to be meaningless and purposeless.

Parents will also vary in terms of how long the grieving process takes. Some parents will move toward sadness and grieving the loss, trying to make sense of the loss and what life will be like with the loss of their beloved one. They will reach out and connect to others (i.e., their partner, support systems), memorialize the loss of the loved one (e.g., scrapbook, rituals), and re-organize themselves and create a new sense of family identity with the remaining children—although the loss will continue to be felt, the intensity of the emotions will lift. Some parents, on the other hand, will hold onto grief for longer than others—remaining disoriented and disorganized in the aftermath of the loss—not being able to make sense of the loss in the present and the meaning of the loss in terms of the future. Some parents will be over-consumed by guilt and self-blame–feeling that they didn’t do enough to protect or care for their child, and even possibly feel shame and a sense of inadequacy and failure. Many parents will have an increased sense of fear about the surviving children, and a deep sense of isolation and loneliness in feeling disconnected from others who they feel may not understand their experience.

Others may experience intense anger at themselves, their spouse, hospital staff or whomever as a reaction to the loss of a loved one, and even resentment toward those who have children—while experiencing deep sadness and deep fears underneath. Some will enter into a state of numbing, withdrawal to escape the pain, and even turn to other maladaptive soothing behaviours, such as increased alcohol or substance use. Being stuck in guilt, shame, anger and resentment, or numbing withdrawal can prolong the grieving process and block a parent, couple and family from re-building a renewed sense of hope for the future and reshaping a new family identity in the aftermath of the loss of a beloved child.

Parents might express and deal with emotions differently—which will affect the grief process and how parents will journey through this difficult period. Parents who are able to express themselves and journey through this painful experience together can help assuage each other’s distress, make sense of the loss together, deal with the changes to the family, and re-build a sense of hope and future for themselves and remaining family members. A renewed sense of family identity can be created while holding onto the loving memories of the lost child.  Parents must re-define their family identity together. Parents who are emotionally isolated or withdrawn block the necessary engagement to deal with emotional distress and to engage in this meaning-making process that allows the couple and family to re-organize their sense of family identity and future in the aftermath of a loss.

The hardest part is when partners are in different places emotionally and cannot be present for each other (e.g., one is disorganized and the other sad). It is important to be able to reach out to other family members at this time as well for emotional and practical support in dealing with everyday tasks.

Strategies to cope with the loss of a child

1.  Express your emotions and needs to supporting, caring others. It is important to authentically express the wide range of emotions and reactions that are experienced in the aftermath of loss to maintain an emotional connection. It is important that parents take turns expressing their feelings, acknowledging each other’s emotional reactions and listening to what each parent might need. For example, Sara might be feeling hopeless, despair. It is important that she express her needs to her partner, Paul. She may need contact-comfort (e.g., a hug) or verbal reassurance from him (i.e., that the family and the rest of the children will be okay and that they will get through this together). Expressing needs for support and care when distressed is important in sustaining the connection and taking care and soothing each other’s emotional distress.

2.  Reach out for support and care. Isolation increases emotional distress. Ask loving family members and caring friends for practical support for tasks (e.g., helping with other children, home tasks etc.). This allows parents to deal with their emotions and other tasks related to the loss.

3.  Prepare yourself to deal with questions about the loss. Telling the outside world about the loss of a child can bring up emotions. Find a way to tell your story in a way that is comfortable for you (i.e., the amount of details that you feel comfortable sharing). If you feel others are asking too many questions, it is okay to let them know your limits (i.e., I only feel comfortable sharing this amount of information). 

4.  Healing takes time. Expect strong emotional responses for a sustained period of time and accept differences in how you are reacting to the loss. It is important to acknowledge emotions and accept that the intensity of these emotions will diminish over time. In the midst of painful emotions associated with loss, parents might benefit from reminding themselves that these emotions shall pass over time. It is important to accept that there will be moments in which you are both experiencing different reactions and will differ in your grieving process. Talk about your child and use his or her name—avoiding names does not allow you to come in touch with your feelings. Eventually, parents will be able to talk about their child with less of a reaction.

5. Ensure all family members emotional needs are addressed, including other children. If there are other children in the home, it is important to ask them about their sadness and help them along with their grief. Children can feel a wide range of emotions and have several needs at this time for contact-comfort, reassurance and physical affection.

6. Don’t make any big decisions in the immediate future (i.e., doing anything with clothing or toys of your loss child, returning to work, moving, making big changes to family routine and structure). During the initial phases of grief, the disorganization and disorientation may lead parents to make decisions that may not be beneficial for themselves or their family in the long run. Take time to deal with your child’s personal items. 

Some parents will want to return to work soon to restore some sense of normalcy in their lives, while some will return too early without having  healed enough and completed their grieving process—with dire consequences on their family and work life. Making big changes creates further disruption and emotional distress that may block the grieving process from unfolding. Other children will require structure and routine to hold them emotionally through the turmoil of loss—routine and structure allows for a sense of normalcy and provides children with a sense of safety and security.

7.  Rituals and honouring memories of the child. It is important to make sense of the loss and to create a narrative about the beloved child—the meaning of the child to the family and the positive experiences of love, joy, and connection that were experienced in the relationship with the child. Creating a scrapbook or ritual to construct this narrative will allow parents to hold onto the positive and loving memories of the child. Involve children, if appropriate developmentally, in this process. Also, plan on how you are going to deal with birthdays and the anniversary of your child’s death. Planning ahead of time can minimize distress. Creating a ritual around these dates can be helpful to deal with the emotions associated with the loss and remind parents and other children of the positive joy and loving memories of their beloved one.

8. Join a support group. Isolation makes emotional distress harder. Being able to share your feelings, and learn from others who have experienced the loss of a child can make the healing journey less isolated.

9. Consult a psychologist.  Psychologists can support you to understand your own, your partner’s and other family members’ emotional reactions to loss. Some parents, couples, and children will need extra support to move through a grieving process. Couple and family problems can emerge when the residue of unprocessed grief persists. 

What types of programs does the Centre provide to parents who have experienced the death of a child?

CFIR has several services that can support parents in dealing with the impact of loss of a child on the individual parent, the couple relationship and the family (i.e., other children and family relationships).

The Grief and Loss Service offers psychotherapy services to individual parents to support them through the devastating and intense emotional experiences in the aftermath of significant losses of loved ones, such as the loss of a child. Psychologists who are part of this service are experienced in supporting individual parents to deal with the different, and sometime complex, emotional reactions experienced in association with the loss of a child (see grief process below). Individual parents will vary in how they will deal with their own emotional reactions and how they will respond to their spouses or other children’s emotional reactions to the loss. Over time, and as the grieving process unfolds, most parents can expect that their emotional distress will lighten—although the loss of a child can continue to trigger emotional reactions upon reminder of the loss in future years. Loss of a child can be extremely disorienting, especially since a parent’s sense of self and family identity was so closely tied to the child who has died. For some parents, the emotional reactions and distress will seriously affect their ability to return to work and affect their sense of connection to their partner and/or other children. Some parents will have complex grief reactions that will be accompanied by symptoms of traumatic stress, depression and anxiety that are unremitting over time and that affect their capacity to function in their relationships at home or at work. One’s sense of self and the future can be shattered when the hopes and wishes held for a child and one’s sense of self and family identity is altered as a result of the death of a child. Psychologists at CFIR accompany individuals through their grieving process and support them to cope with losses and minimize the devastating impact of loss of a child on emotional well-being, relationships and occupational functioning. 

Psychologists in the Child and Family Psychology Service can support parents to address the emotional needs of other children in the family to adapt to these circumstances. Children grieve deeply as adults do—and sometimes they are blocked by their inability to put words to their complex emotional experiences. Helping children make sense of loss is a challenge to parents undergoing their own grief process, yet other children in the family will need more support than ever to make sense of the loss of a sibling. Losses of a sibling can create deep sadness and fears about future losses, create a sense of unpredictability, and increase insecurities that require increased parental emotional attention to their children. Psychologists in this service support children through their own grief process and support parents to deal with their children’s emotions and the impact of the loss on the entire family system. Children will deal with grief in developmentally appropriate ways—a psychologist can help you to understand how your child’s grief process varies depending on their stage of development and the types of strategies that should be used for connecting to them emotionally. Sustaining a healthy emotional connection with a partner and other children is important in supporting all members to grieve, make sense of the loss, and re-build a new sense of family identity and future in the aftermath of the loss of one member of the family.

The Relationship Service provides services to individuals and couples who are experiencing relationship difficulties. The loss of a child can have an impact on a couple’s emotional connection with each other. For some couples, each parent will be able to express their grief and respond to the other with nurturance, warmth, care and support that will decrease the emotional distress of loss. A parent’s connection to the other parent and their other children can be an antidote against the painful emotional distress associated with loss.  Connecting with a partner and children at a time of loss can buffer us from the distress of these painful emotions. The loving responsiveness and the accessibility of partners to each other’s emotions and the deeper meanings associated with the loss of a child helps each partner cope better with the intense emotional experiences in the aftermath of loss. When one partner shuts down, or withdraws by numbing and emotionally withdrawing to deal with their painful emotions, the other partner can feel rejected and abandoned during a critical moment of need for connection, support and care. Emotional distancing can create relationship distress and have a negative impact on the couples attachment bond. Psychologists at CFIR support couples to deal with loss together in a manner that deepens each partner’s capacity to express their emotions and needs to each other in the aftermath of loss, and to enhance each partner’s responsiveness to the other’s emotional reactions during this painful experience of loss.  

Read more about CFIR’s Depression, Mood & Grief Treatment Service.