Part I: Complex Trauma & Relationship Distress

By: Katherine Van Meyl, M.A.

“We keep having the same fight over and over again.” 

“I feel so angry when he doesn’t listen to me, I feel out of control!” 

“Sometimes when we are talking, I just zone out and think of other things.”

“When I feel this way, I actually hate her, which is crazy, because I love her!”

I’ve noticed that people attend relationship therapy when they feel “stuck,” and are having the “same fight” repeatedly with their partner(s), leaving them feeling angry, resentful, hopeless, sad, and alone. I have seen people experience this regardless of their relationship structure (monogamous, non-monogamous, kinky), gender identity, and/or sexual orientation. You’re not alone! This is more common than you might realize.

Usually, something real is happening in the moment. For example, you might feel rejected and/or angry because your partner “cut you off” during a conversation. When you try to address this with your partner, your partner becomes defensive (“that wasn’t my intent!”), which further angers you. As a result of this experience, maybe you feel the need to “escape,” shut down, or get so angry you threaten to end the relationship. The depth of your emotions, how much you feel whatever you’re feeling, is often an indication that something deeper is going on. 

This is the work of therapy, figuring out all the textures and layers of what is happening “beneath the surface” in our relationships and learning to differentiate our past experiences from our present.

If you and/or your partner(s) identify with some of what is written here, you may benefit from Developmental Couple Therapy for Complex Trauma (DCTCT). This treatment was developed by Dr. Heather MacIntosh, C. Psych., to help couples cope with the long-term impacts of childhood trauma, including emotional, physical, and sexual trauma. Many clinicians at CFIR-CPRI have been trained in this approach.

The goal of DCTCT is to help couples learn how to tolerate, understand, and manage their own and their partner’s emotions, how to understand each other’s perspectives, and how to be present and engaged to meet one another’s emotional and attachment needs. 

The treatment involves four stages. In Stage One, the focus is on establishing a relationship with your therapist and understanding how trauma impacts relationships, attachment styles, sexuality, and shame. In Stage Two, the focus is on skill building, particularly mentalizing capacities and emotion regulation capacities. In Stage Three, the therapy moves towards understanding how you and your partner may be re-creating certain traumatic “scenes” from childhood (the vignettes above likely have elements that can be traced back to early childhood experiences). Without the ability to mentalize and regulate our emotions, stage three would be too triggering for couples. Finally, in Stage Four, learning is consolidated and treatment ends. I will expand more on this in a future blog post! Keep an eye out for it in early 2023.

As with most treatment models that have “stages,” people in relationships weave in and out of these stages at different times throughout treatment. That’s normal! This treatment model is a guide, but every relationship is different and therefore, may need more time in certain stages than others.

If you and/or your partner(s) are interested in learning more about trauma, how it impacts our relationships and how it can be treated, please get in touch. 

With guidance, it’s possible to start shifting these patterns in our relationships.

Katherine Van Meyl, M.A., is a trauma-focused psychodynamic therapist at the Centre for Interpersonal Relationships. Katherine works with individuals, couples and families with a specific focus on relational distress, trauma and PTSD. Katherine is supervised by Dr. Dino Zuccarini, C. Psych., for adults & couples and Dr. Lila Hakim, R.P., C. Psych., for families. 

‘Self-Object’ Experiences and Your Relationship

Being in a relationship can, at times, present its challenges. Immersing yourself in and making sense of the other person’s inner world (i.e., their thoughts, feelings, intentions, etc.) is no easy task to undertake. Each individual brings their own internal experience to the relationship, and some of those experiences can leave the other person struggling to attune to their partner’s needs. Heinz Kohut first proposed the concept of ‘self-object’ experiences in which the individual turns to others to have their self-esteem and self-related needs met. These others are often referred to as self-object and can include our partners and other important people in our lives. These experiences help us all maintain a positive and cohesive sense of self.

The majority of us desire and seek partners who make us feel better, and this generally means a partner who is understanding, positive, and affirming. We seek partners who we can look up to, admire, and rely on in stressful times. When we find ourselves in positive relationships, this helps regulate and integrate our emotional experiences and fortifies our sense of likeness and belonging. In such circumstances, our partners can act as a reliable and dependable source of self-object experiences.

On the other hand, when we find ourselves in relationships riddled with trouble and conflict, this may leave each individual with the sense that the other cannot provide self-object experiences reliably. At times, the presenting conflict between couples relates to a lack of needed self-object experiences, whether these problems relate to disengagement, finances, sex, parenting, etc. For example, disagreements about finances may relate to one partner’s self-object experience of safety and security that is fulfilled by saving compared to the other’s need for stimulation or soothing through buying. These common issues faced by couples often translate into underlying self-object needs and failed attempts to meet identified needs by the other. Within the pair, one person’s need for a particular experience may leave the other at odds with their own equally legitimate need.

One of the goals of couples therapy is to support the pair in becoming a more reliable source of self-object experiences that complement the relationship. To attain this objective involves clearly communicating needs, understanding the other’s self-object needs, and noticing its cues. Also, the ability to understand each other’s experience and, on occasion, tolerate failed attempts to meet self-object needs without perceiving these incidences as threatening are equally essential goals in couples’ work. Couples therapy can help reframe conflicts in terms of their underlying self-object needs and help improve an individual’s ability to meet their partner’s needs within the couple’s relationship.

Nancy Amirkhanian, M.A., R.P., is a Clinical Psychology Resident at Center for Interpersonal Relationships (Toronto). Regarding couples therapy, she works with partners to address various relationship issues, such as repairing ruptures due to infidelity, improving sexual and emotional intimacy, challenges with communication, and managing conflicts due to blended families, parenting, and finances. Nancy is currently completing her pre-doctoral residency at the CFIR under the direct supervision of Dr. Lila Z. Hakim, C.Psych. and Dr. Dino Zuccarini, C.Psych.

Attachment Style and Couple Sexual Issues

According to attachment theory, as a result of early year interactions with caregivers, we either become securely attached or insecurely attached—either anxiously or avoidantly attached.  Attachment style then influences sexuality in complex ways. Anxiously attached partners in the bedroom might be seeking out sex for reassurance of self or attachment fears.  For example, they may feel less positive about themselves (e.g., undesirable or unattractive), and/or have worries about the availability, accessibility, and responsiveness of their partner.  Strong sexual desire is fuelled by the need for self and attachment reassurance. Avoidantly attached partners are not motivated sexually in the same way.  These partners are more likely to focus on the pleasure-oriented aspects of sex only and have difficulties with feelings of closeness.  Some avoidantly attached partners will have sex for duty’s sake. Arousal and desire problems arise when anxiously or avoidantly attached partners are unable to fulfill these goals.  

The clinicians at CFIR support couple partners to discover the multiple ways in which securely attached partners experience and explore sexuality. The couple and sex therapy clinicians at CFIR use a wide variety of strategies to support couple partners to build more confidence in their sexuality, greater eroticism, and desire.

7 Signs Your Relationship May Need Help

by: Joshua Peters, M.A., R.P.

Relationships have never been easy and now it seems we’re in a space and time where technology and the way we connect are continuously growing and changing. The intimacy we have with someone can mean so much, yet it seems we consistently struggle to maintain the bond. How can we know if we are “getting it right” in our partnerships?

In speaking about the complexity of our relationships, famed relationship expert, Esther Perel notes that “companionship, family, children, economic support, a best friend, a passionate lover, a trusted confidante, an intellectual equal […] we are asking from one person what an entire village once provided.” In this paradigm, it can be hard to understand when our partners and our relationships maybe failing us. 

Here are some signs that indicate your relationship may need some work:

1. Lack of Communication 

In a world bursting with ways to communicate, it may be surprising to learn that ineffective communication remains a common issue in relationships. It’s impossible for your partner to know all your needs, feelings, and thoughts without talking about them. Communication is essential in overcoming relationship wounds, and very few relationships can survive without it.

2. Arguing with No Repair

Though constant arguing can sometimes be indicative of relationship distress – unrepaired conflict may be the real culprit. Arguments, when done sympathetically, are an essential part of relationship satisfaction. Repairing from a dispute allows partners to accept each ones’ differences and re-establish their love for one another. 

3. Loss of Curiosity

We are continually growing and changing as individuals and it crucial we remember to remain curious about our partners as they grow. The experience of curiosity and surprise is one of the essential processes in maintaining long-term desire. Partners in healthy relationships are happy to explore their partner’s unique perspective of the world.

4. Mind Reading

This familiar refrain, “Look, I know you’re angry…” exposes a common misstep in many relationships. Often experienced in conjunction with a loss of curiosity, partners start assuming they are always in each other’s “bad books” even before a problem is revealed. Stay tentative about your perceived experience of your partner, especially in times of distress. You might be surprised by the difference between how they feel and how you thought the feel!

5. Loss of Priority

It can be hard to find a balance between work, children, friends, and family in today’s busy world. How you prioritize your relationship may look different to you, so it’s crucial that you discuss this with your partner. Failure to explore this in a discussion could leave your partner feeling unloved and unimportant. 

6. No Hurt – Only Anger

When we’re most distressed it may feel instinctive to get angry. Though anger is an important emotion in that it tells us something isn’t working, it isn’t usually helpful in resolving conflict. Instead, opting to express our more vulnerable and hurt emotions allows our partner to understand and ultimately care for us when necessary. 

7. Blaming your partner

It takes two to tango! Though one partner may sometimes be experiencing more distress, it’s beneficial to recognize that your relationship is co-created by both of you. Take note of how you may be contributing to the dynamic between you and your partner.

Couples experiencing any of these relationship difficulties at heightened levels may feel like they are insurmountable problems. However, exploring these issues can provide a needed check-in for your relationship. Moreover, what you discover can inspire you and your partner to reimage what your relationship could become. Couples therapy offers an excellent opportunity to explore these struggles and move towards growth. The skilled clinicians at CFIR can help you and your partner better understands your current distress and support you to build a more resilient and healthy relationship.

Trusting Again in The Aftermath of Emotional Injuries

by: Dr. Dino Zuccarini, C.Psych. & Dr. Lila Z. Hakim, C.Psych.

Our ability to trust another person is core to our being able to create and sustain close intimate relationships. When we are able to trust another, we reap the emotional rewards of feeling connected to others. Trust is an antidote against any sense of isolation and non-belonging as it allows us to develop relationships in which others can be experienced in a manner that feels emotionally safe and secure. We initially learn to trust others in our relationship with our parents, then our peers, and eventually our relationship partners. Sometimes when we have difficult early relationship experiences we lose our bearings in terms of whom to trust and how to trust another person.

Trust can be eroded when we are hurt, frightened, or angered by the behaviour of those to whom we are most attached. Emotional, sexual, or physical abuse or neglect in our early years, or past and current relationships can breakdown our capacity to trust another, particularly when abuse or neglect occurred by someone who we expected to be a source of safety and security for us. At other times, betrayals and emotional injuries arising from a perceived lack of support from our relationship can also alter our sense of the other person’s reliability, dependability, and trustworthiness. Sexual and emotional affairs, betrayals, and emotional injuries in close couple relationships also erode and create serious ruptures to the attachment bond between partners. These types of emotional injuries in our family of origin and our relationships with friends and partners can leave emotional residue. These injuries then become triggers that are activated in our relationships and that block us from feeling safe and secure with others.

We help you to learn how to trust again in the aftermath of different types of incidents that have eroded your trust in relationships. 

The Couples Therapy Service at CFIR offers clients comprehensive assessment, psychotherapy, and counselling to address a wide range of relationship and/or sexual issues for both individuals and couples. In terms of treatment, we offer individual, couple, and group therapy to help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills (e.g., communication, problem-solving and negotiation skills), and address sexual issues that interfere with sexual satisfaction and fulfilment, regardless of sexual orientation.

Read more about our Couples Therapy Service.

Improving Your Sex Life: How We Help You

by: Dr. Lila Z. Hakim, C.Psych. & Dr. Dino Zuccarini, C.Psych.

Sexuality is an essential part of who we are. At CFIR, we promote healthy sexuality. A crucial first step is to ensure that individuals and couples have access to accurate information about sex and how our bodies work, and an understanding of the physical (e.g., contraception, sexually-transmitted infections) and emotional risks involved in expressing ourselves sexually. Healthy sexuality also suggests being comfortable with ourselves (i.e., liking our bodies, finding ourselves attractive, being aware of and accepting our desires and fantasies, feeling capable sexually, knowing our sexual boundaries and asserting our limits), being able to experience sexually arousing feelings, communicating our sexual desires, and engaging in satisfying intimate-sexual relations with others. 

Sexuality, however, can also be a source of great distress. Distress can occur when we do not have accurate knowledge or information or are experiencing sexual functioning problems or sexual and pornography addictions. Some of our sexual issues flow from a lack of, or inaccurate, learning about how our bodies actually function, or distress over fears of pregnancy or sexually transmitted infections. A lack of knowledge can create anxiety about decisions and choices and sexual expressions. 

Sexual functioning problems related to desire, arousal, and orgasm are also a source of emotional distress for individuals and couples. The causes of such issues are vast. Sexual functioning is affected by a wide range of organic, biological, and medical issues, as well as social, cultural, and psychological factors. Some of us become overly consumed by negative thoughts and emotional reactions about oneself (e.g., our bodies, genitalia, sexual performance), or our sexual partner. We may also engage in relationship or sexual patterns that diminish arousal and the desire or interest in sex. Some individuals experience sexual pain or other difficulties during sexual intercourse due to a complex blend of physical or psychological factors. 

Some individuals will struggle with sexual or pornography addictions, including the use of internet porn, massage parlours, or risky sexual encounters. In these situations, individuals and their relationship partners may experience significant distress. Sexual functioning issues, regardless of their origins, can block an individual and couples from experiencing positive feelings, such as joy and pleasure, within the sexual aspect of the relationship. Sexual issues can also spill over into other aspects of the relationship, including emotional and physical intimacy. 

Psychologists and clinicians at CFIR have published research and theoretical articles in peer-reviewed journals, and written book chapters in the area of couple and sex therapy. We help you by providing a comprehensive psychological assessment to help you understand the causes of your sexual difficulties and then develop the most appropriate treatment plan to address underlying causes. We are well-informed about contraception, sexually transmitted infections, and the physical aspects of sexual functioning, and the psycho-social issues associated with these topics. We also support clients to develop sexual authenticity by helping them to clarify desires and remove blocks to the expression and assertion of their sexual needs in relationships. We also help to resolve sexual functioning issues to restore one’s sexuality as a source of joy, sensuous pleasure, and connection. 

The Sex Therapy Treatment Service at CFIR offers clients comprehensive assessment, psychotherapy, and counselling to address a wide range of relationship and/or sexual issues for both individuals and couples. Regarding treatment, we offer individual, couple, and group therapy to help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills (e.g., communication, problem-solving and negotiation skills), and address sexual issues that interfere with sexual satisfaction and fulfillment, regardless of sexual orientation. 

Read more about our Sex Therapy Treatment Service

Emotional, Physical and Sexual Intimacy: The Cornerstones of Secure Attachment Bonds and Good Mental Health

by: Dr. Dino Zuccarini, C.Psych. & Dr. Lila Z. Hakim, C.Psych.

When communication breaks down, unprocessed negative emotions accumulate.” 

Emotional, physical, and sexual intimacy can be considered essential components of adult attachment bonds. Our capacity to engage in an intimate manner contributes to our ability to form and maintain mutually satisfying, long-term relationships. Emotional intimacy allows partners to feel seen, heard, and understood. Emotional closeness is core to developing satisfying couple physical and sexual intimacy.

When partners feel emotionally close, physical touch and sexual contact seem less threatening and more rewarding. A solid emotional connection allows individuals to be present and engage moment-by-moment in encounters involving intimate physical and sexual contact. Within this context, more intimate, arousing, pleasurable, and erotic encounters are then possible. On the other hand, when partners lack emotional closeness, they feel distanced or engage in circular, escalating conflicts as they strive to be understood and have their needs met by the other. Negative feelings and emotions begin to accumulate when partners are unable to intimately engage.

In some cases, a partner may fear intimacy, or lack the skills to engage in an intimate manner about their feelings, needs or desires, or lack knowledge about how to respond to the other’s feelings. When communication breaks down, unprocessed negative emotions accumulate. Unable to process their feelings and needs, partners engage in rigid, negative patterns with one another. They begin to distance from each other, experience separation fears, and engage in high-conflict exchanges in their effort to protect themselves from the growing sense of disconnection in the relationship.

Psychologists and clinicians at CFIR help individuals and couple partners learn how to identify, express, and assert their selves in their relationships to others. We also support individuals and partners on how to exit from difficult relationship patterns and become more accessible and responsive to one another. Healthy relationship and sexual functioning are important in maintaining a good sense of ourselves. Both our physical and mental well-being is improved when we have the ability to create and sustain intimate relationships with others both outside and inside the bedroom. In fact, research affirms that many individuals struggle in their efforts to maintain relationship and sexual satisfaction throughout their lives, and that dissatisfaction in these areas of life can have an impact on our mental and physical health.

Read more about our Relationship & Sex Therapy Treatment Service.