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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Shame…everyone experiences it, but few talk about it. Brené Brown describes shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.” Experiencing shame can be unbearable, as it can often be felt with overwhelming intensity and power.

Shame is like a snowball, forming in childhood from our first experiences of feeling unlovable and unacceptable from unmet emotional needs from important others. The shame snowball builds throughout our lives with every experience similar enough to our earlier experiences. When toxic shame remains inside us, it can lead to depression, anxiety, low self-esteem, and many other psychological or relationship difficulties.

We have many protective psychological responses to shame that have developed along with the emotion itself. We can become critical of ourselves. We can withdraw from others, or detach from ourselves through self-harm and alcohol. We can attack others with our shame. Although these reactions serve a purpose, being that they relieve the intensity of shame at the moment, they do not help us very well in the long run. These protective reactions weaken our relationships and our sense of identity and self-esteem, which ultimately blocks us from living authentic lives and building strong relationships.

The first step in healing shame is to acknowledge shame experiences at the moment they are occurring. Once we’ve acknowledged our shame experience to ourselves, we can then speak about it with trusted others. Most importantly, we must be kind and build compassion toward ourselves in these moments of pain and struggle to heal the shame inside.

Therapists at CFIR can help you to heal the shame experiences that may be at the root of your anxiety and depression or that cause difficulty in your intimate relationships. We are here to help!

Whitney Reinhart, R.P. (Qualifying) is a qualifying registered psychotherapist, at the Centre for Interpersonal Relationships (CFIR) in Toronto. She supports adult and couple clients with a wide range of difficulties related to depression, anxiety, traumatic experiences, and interpersonal conflict.

Self-Harm – It’s More Than You Think

What is Non-Suicidal Self Injury?

Non-suicidal self-injury (NSSI), commonly described as self-harm, involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. Typically, when we think of NSSI we think of individuals who cut, burn, punch, or pinch themselves. In the psychological literature, these behaviours are referred to as direct NSSI. In an ideal setting, individuals who engage in self-harm behaviours either independently seek out psychological support in the form of therapy, or are noticed to be engaging in self-harm by individuals close to them and are encouraged to seek help at that time.

Indirect NSSI

However, individuals can also engage in other self-harm behaviours that are not as clearly noticed by others, since the methods of self-harm do not directly lead to bodily damage. These behaviours are termed indirect NSSI. 

‘Indirect’ methods of NSSI can include:

  • Involvement in abusive relationships
  • Substance abuse
  • Risky or reckless behaviour (e.g., reckless driving, bar fights, unsafe sexual practices)
  • Intentionally putting one’s body into physical danger (e.g., ‘daredevil’ acts)
  • Disordered eating behaviour

Since these activities are not often identified as self-injury, and can even be missed as warning signs by therapists, hospitals, and primary care physicians, it is crucial to notice problematic behaviours before their severity increases.

Men and Self-Harm

For a variety of reasons, individuals who identify as male are more likely to engage in indirect self-harm than those who identify as female (St. Germain & Hooley, 2012; Hooley & St. Germain, 2014). One such reason that has been proposed is that behaviors that have often been labeled as traditionally male expressions of anger and frustration sometimes contain indirect forms of NSSI (e.g., punching walls, picking fights with others, overconsumption of drugs and alcohol; Green & Jakupcak, 2016). Adherence to these traditional male gender norms is also associated with difficulties articulating thoughts and feelings, which can further increase an individual’s risk of engaging in self-harm (Levant et al., 2003). As a result, some men might not readily identify the intentionality behind some of the harmful actions described above.

Finding Help

Psychologists and therapists at CFIR are able to diagnose and guide the treatment related to direct and indirect self-harm for all individuals. We provide support to children, adolescents, adults, couples, and families who themselves struggle with self-harm, or have loved ones who do. We help clients establish solid networks of physical and emotional care and support. We also provide specific psychological treatment for individuals who self-harm, supporting them through the cascading negative emotions that may precede or accompany instances of self-harm.

Dr. Brent Mulrooney, C.Psych. is a psychologist in supervised practice at CFIR (Toronto). He has substantial interest and treatment experience in the realm of family functioning and relationships, anxiety and mood disorders, work and school success, addictions, violence (especially violence in the home), trauma, and gender identity and sexuality. Brent holds a PhD in School and Clinical Child Psychology from the University of Toronto, as well as a Masters degree in Applied Social Psychology from Memorial University of Newfoundland.

Depression: Two Types, Two Treatments

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.

How CBC Toronto Employees Helped to ‘Beat Blue Monday’

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

Accompanying You Through Your Losses and Grief

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.

Helping You To Cope With Postpartum Depression

by: Dr. Lila Z. Hakim, C. Psych.

Upon birth, many couples will require some time to get used to their new home circumstances. Learning how to create and adapt to sleep and feeding schedules that suit the reality of the couple can be challenging. Numerous issues related to sleep and feeding emerge that can create distress, particularly in the context of a lack of sleep and the novelty of figuring out and managing the newborn’s needs. The relationship will transition during this period to adjust to these new circumstances. 

For some women, this period becomes complicated by depression caused by numerous physical and psychological factors, including a growing sense of isolation, emotional residues of birthing problems, sleep difficulties, and a change in sense of self and identity. Feelings of depression during this period may also be accompanied by self-criticalness and identity challenges that can then increasingly spiral into hopelessness and despair. Partners may also struggle and find themselves slipping into states of anxiety and depression. They may experience similar challenges during this transition period. 

Psychologists and clinicians at CFIR are able to diagnose and guide the treatment of postpartum depression. We provide support individuals and couples to adjust to their initial challenges upon return to home with their newborn. We help individuals and couples establish solid networks of physical and emotional care and support to ensure that isolation is reduced. We support new parents by providing them with resources to connect to the outside community. We also provide specific psychological treatment for postpartum depression, involving both individual and couple sessions to support women to emerge from the cascading negative emotions and biological turmoil that may occur during this period.

Read more about our Fertility Counselling Treatment Service.

Perfectionism vs. Healthy Striving

by: Dr. Marie-Pierre Fontaine-Paquet, Psy.D., C.Psych.

In this post, we will define perfectionism vs. healthy striving, describe when perfectionism is a problem, and we’ll offer strategies for overcoming perfectionism. 

Defining Perfectionism 

Wishing to do things well and having high standards is often adaptive and can help you to pursue and achieve your goals in life. This healthy striving can be contrasted with perfectionism, which is a felt need to do things perfectly and to regard anything short of perfection as unacceptable. To help clarify the distinction between healthy striving and perfectionism, here are some characteristics of each one.

Characteristics of Healthy Striving:

  • Striving for high but achievable standards that result in feelings of satisfaction and increased self-esteem
  • Motivated by enjoyment of the process, enthusiasm, enjoyment of what you do, and desire for success and mastery
  • Efforts (not just results) give you satisfaction and a feeling of accomplishment
  • Self-esteem is not based on accomplishments and performance
  • Rewarding self or others for good performance
  • Seeing mistakes as opportunities for growth and learning
  • Bouncing back quickly from failure or disappointment

Characteristics of Perfectionism:

  • Repeatedly setting goals for yourself that are beyond reach and reason and not being satisfied by anything less than perfection
  • Motivated by fear of failure, obligation or duty
  • Driven to be the best, but unable to enjoy accomplishments
  • Feeling that your sense of self-worth and acceptance is based on accomplishments and performance
  • Criticism and judgment of self or others
  • Seeing mistakes as evidence of unworthiness
  • Becoming depressed when faced with failure or disappointment

When is Perfectionism a Problem?

Like many things, perfectionism can be viewed as a problem when it interferes with a person’s wellbeing and happiness, relationships, or functioning at school or work. This is not always easy to know. If you struggle with perfectionism, the high standards you hold for yourself or others may be so long-standing and ingrained that they may even be unconscious and outside of your awareness. You may have a self-critical internal voice that constantly judges and berates you for not being “______” enough (fill in the blank: smart, hardworking, rational, strong, attractive, thin, sexy… and the list goes on), but you may be more aware of ensuing feelings of guilt, shame, sadness, inadequacy, anxiety, helplessness and hopelessness. You may also be aware of feelings of anger, frustration and resentment when others fail to live up to your expectations, and perhaps this has caused difficulties in your relationships.

Perfectionistic thoughts and behaviours can place an individual at higher risk for depression (see blog ‘Depression: How Your Thinking Can Lead to the ‘Blues’’) and anxiety. Research shows that perfectionism is associated with several psychological problems, such as depression, anxiety, worry about being judged by other people, excessive anger, body image and eating disorder problems, and obsessive-compulsive behaviours.

Strategies for Overcoming Perfectionism

Building Awareness:

The first step to change is to first build awareness of what it is that you want to change. Since perfectionistic thoughts and behaviours can be automatic and unconscious, this may not be an easy task! One way of identifying perfectionistic thoughts is to notice situations in which you experience emotions such as anxiety, sadness, anger, frustration or shame, and to reflect on thoughts and interpretations that may be contributing to these feelings. You can also pay attention to situations in which you find yourself engaging in  perfectionistic behaviours (e.g., checking and rechecking your work, spending too much time cleaning, excessive organizing and list making, difficulty making decisions, procrastinating, exercising excessively to stay thin, etc.), and notice what you may be thinking and feeling in these situations.

Evaluating Your Standards

Here are some questions to consider when evaluating whether your standards are serving you well or whether you might benefit from challenging or altering them:

  1. The excessiveness of the standard (e.g., Can this goal be met?)
  2. The accuracy of the belief (e.g., Is it true that this standard must be met?)
  3. The costs and benefits of imposing the standard (e.g., Does it help me to have the belief or standard?)
  4. The flexibility of the standard or belief (e.g., Am I able to adjust my standards and change my beliefs when necessary?).

If you determine that a particular standard cannot be met or that the costs of having a particular standard or rule outweighs the benefits, you may want to consider loosening your standards for that particular issue. If you are unsure, you may consider asking the opinion of a friend or loved one whom you trust.

Making Changes to Perfectionism:

Rather than being unwilling to accept anything less than perfection, remind yourself that no one is perfect nor do we need to be in order to be worthy, lovable and valuable as human beings. Think about what is good enough and possible in your current life situation rather than how things should be in order to be perfect. Work on developing self-compassion in place of harsh self-criticism and perfectionism, and more compassion for others. Coping statements like “It’s okay to make mistakes” and “Nobody’s perfect” can be helpful in challenging perfectionistic thinking. People who struggle with perfectionism tend to go to great pains to control many different aspects of their lives, including their own behavior, the behavior of other people, and the environment in which they live. Because you often cannot control or predict things that occur, it can be helpful to find ways to tolerate some degree of uncertainty and ambiguity in your life.

If perfectionism is a problem for you, chances are that the high standards you hold for yourself or others are long-standing and ingrained. The thought of giving up these standards may be very frightening for a number of reasons, and changing these long-standing patterns can be difficult. You may find that it is too difficult to overcome your perfectionism alone or with the help of your family and friends. A psychologist can help you better understand your perfectionism and the role it plays in your life, and support you in changing these long-standing patterns. A psychologist can also support you in addressing problems often associated with perfectionism, including anxiety, depression, anger, eating disorders and relationship problems.

This blog is based on some parts of the book: “When Perfect Isn’t Good Enough: Strategies for Coping with Perfectionism” by Antony & Swinson (1998)

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