Key Points:

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

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

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

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

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

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

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

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

References:

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

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

By: Dr. Peter Egeto, C.Psych (Supervised Practice)

Everyone has this thought run through their head when they’re having trouble focusing on a work task, school assignment, or other commitment. It is a very frustrating obstacle, so why can’t we just focus?

Attention is the first, and crucial step to apply our thinking power to a task. Without it, we’re unable to learn, problem solve, or think clearly. There are lots of reasons why our attention can be challenged. 

Anxiety often takes attention away from the task at hand. Evolutionarily, anxiety developed partly to help us survive by looking for threats in the environment. Although your project deadline may not be a life or death “threat,” the emotion still kicks in and draws your attention away from the work you’re trying to do.

Alternately, some people’s brains develop differently, and have trouble controlling their attention. This is referred to as attention deficit/hyperactivity disorder (ADHD). People with ADHD have great difficulty focusing because they are easily distracted by other thoughts or things in their surroundings. It can feel like your head is a vortex of racing thoughts, which can make a simple task frustrating or daunting.

How can I focus better? 

Luckily, there are ways to optimize your attention. Completing a neuropsychological assessment is a good way to tease apart whether your attention is hindered by anxiety, or potentially ADHD. It can also offer solutions tailored to your unique issues. Anxiety management strategies can free up your attention, while ADHD can be managed with medication, therapy, or both. 

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

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

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

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

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

Stress, anxiety, and low mood are frequent problems, especially now in times of social distancing and socioeconomic uncertainty. Because of recent social distancing measures, few people are now able to use or access traditional face-to-face psychological services. The research shows that while equally effective as traditional face-to-face therapy, few people access teletherapy due to novelty alone and because they perceive it as less effective than face-to-face services. In the last decades, hundreds of meta-analyses, systematic reviews and robust clinical trials have supported the effectiveness of teletherapy (e.g., Andrews et al., 2018; Newby et al., 2016; Hedman et al., 2014; Hedman et al., 2013; Hedman et al., 2013; Mewton, Wong & Andrews, 2012; Metwon, Smith, Rossouw, & Andrews, 2014; Olthuis et al., 2016; Primer & Talbot, 2013; Williams & Andrews, 2013; Titov et al., 2018). 

Rather than having you sort through hundreds of meta-analyses and clinical trials, let me summarize some of this research for you. This extensive research conveys four important messages:

1. Teletherapy services increase access to mental health services. Compared to face-to-face therapy, teletherapy offers greater flexibility in terms of scheduling, requires no travel, and can connect those living in rural with a therapist from urban centres.
   • Teletherapy ensures effective care and treatment despite social distancing measures.
   • Canada, Australia, Denmark, Norway, the United Kingdom, and Sweden have all successfully implemented teletherapy services. These teletherapy clinics have allowed people to connect and receive treatment services regardless of location and requiring no travel. 
     1. The most notable example is the Mind Spot Clinic, located in Sydney, Australia, which had served more than 33,990 Australians from all across the country as of 2016. 
     2. Another example closer to home is the Online Therapy Unit located in Regina, Saskatchewan, which has helped connect people all across the province to receive mental health care, even those located in rural and remote areas. As of January 2020, 5,503 clients had been enrolled for treatment services with the Online Therapy Unit.
2. Telepsychotherapy is safe and confidential 
   • Technological advancements in the last 20 years now allow clinicians to offer teletherapy that is both safe and confidential. 
   • Therapists can monitor and ensure a client’s progress even from a distance, whether through online questionnaires or frequent clinical contact. 
   • New video conferencing technologies ensure that information transmitted virtually remains private and confidential. 
3. Teletherapy is as effective as face-to-face therapy
   • Research on teletherapy has shown that it’s as effective as face-to-face therapy for treating issues such as depression and mood disorders, generalized anxiety, social anxiety, panic attacks, OCD, PTSD, chronic pain, sexual functioning, grief and loss, substance use as well as overall wellbeing, and interpersonal functioning. 
   • When offered as video sessions, teletherapy has also been shown to be as effective as face-to-face therapy for dealing with couples and families.  
4. Assessments services can be done via teletherapy
   • Just like for therapy, teletherapy research has supported its efficacy in providing assessment services. 
   • For example, the MindSpot Clinic mentioned had provided assessment services to 25,469 Australians. 
   • Video sessions and questionnaires administered online allow clinicians to assess clients just like face-to-face sessions.

When to Seek Help

In this period of social distancing, stress, low mood, loneliness, anxiety, and scarcity have been increasingly challenging to manage. If you find that recent events have heightened the intensity of difficult feelings and thoughts or that they have been present for more than two weeks, seeking help can be your very courageous next step. 

The Centre for Interpersonal Relationships offers teletherapy services. Secure, confidential, and compassionate clinical services with registered psychologists and psychotherapists are accessible by video or phone from home. We’re staying connected! Visit www.cfir.ca to learn more.

Dr. Miguel Robichaud, C.Psych. is a psychologist (Supervised Practice) at CFIR Toronto’s location.  During his graduate studies, Dr. Robichaud’s work involved establishing the Telepsychotherapy Unit founded in 2016 and located at the Université de Moncton in New Brunswick, www.etherapies.ca. The Telepsychoptherapy Unit develops, studies, and implements self-guided online therapy programs to help adults deal with low to moderate symptoms of anxiety and depression.  His work at CFIR is supervised by Dr. Rylie Moore, C.Psych. and Dr. Dino Zuccarini, C.Psych. 

Life can seem like a circus at times. We can feel like we are goofy clowns needing to always act silly or angry lions having to growl at everything. We could feel like brave acrobats, smiling in the face of danger, but needing to engage in death-defying stunts. We could feel like cyclists trying to balance on one wheel, contortionists trying to fit into impossible spaces, jugglers keeping all the balls in the air at once, or majestic elephants dancing to others’ tunes. Most of the time, we feel like ringmasters trying to keep all our different acts running smoothly, as part of a big show.  

Life presents its challenges in a similar vein. Sometimes our needs are about doing better in some areas, like managing our time and achieving the goals we have set for ourselves. At other times, we want to reduce our distress by managing our difficult emotions or problematic behaviours, like addictions. Deeper still, we need help with understanding our unhelpful patterns or in dealing with relationship issues. We could need help with managing our social situations or our physical pain. We might wish to work on our issues as individuals, or as parents, couples or families. We might need assistance in coming to terms with traumatic issues that happened decades ago, or yesterday. Perhaps we need to find ourselves, our identities, or our own answers to life’s challenging existential and spiritual questions. Often, we can feel that we are trying to manage more than one of these challenges, again as part of some big show. 

Psychotherapy is a framework that attempts to be an answer to these varied questions and challenges that present themselves to us. Psychotherapy can be the big tent, the space where all these different roles, problems, needs, wants and desires reach awareness, exploration, discussion, insight, and resolution. People often view psychotherapy as applicable only to others and not to their own problems. We often experience ambivalence about psychotherapy, with one part our self moving towards getting help, while another part wanting to avoid it at the same time. There are too many preconceived notions and stigmatizing ideas about psychotherapy in the media and culture around us to list here. Needless to say, such notions and ideas hurt rather than help. As discussed above, psychotherapy remains an important framework for a wide range of life’s problems. The various styles and techniques of psychotherapy, such as psychodynamic therapy, CBT, Rogerian client-centered therapy, ACT, DBT, EFT, IFS, mindfulness-based therapies, and so on, address one or more of these complex problems. Experienced practitioners can integrate many different styles of psychotherapy to tailor the treatment to each individual for addressing their scope of problems. If someone has even a dim awareness that their problems would be helped by talking to someone, they should seek professional help for their own unique issues. Psychotherapy is a big tent, and in a skillful and meaningful way, it addresses the challenges of life at many levels. It helps us to live and work freely, it helps the show to go on.

Dr. Ashwin Mehra, C.Psych. is a psychologist at the Centre for Interpersonal Relationships (CFIR). He provides psychological assessment and treatment services to children, adolescents, adults, couples and families, and supports them to understand and overcome a wide range of difficulties related to anxiety and mood disorders, traumatic experiences, substance use and addictions, and interpersonal difficulties.

Cognitive-Behavioural Therapy (CBT) is a form of psychotherapy that addresses psychological issues by focusing primarily on the cognitive and behavioural dimensions of your emotional and behavioural concerns (i.e., the way that your thoughts, beliefs or thinking influences your emotional and behavioural responses). CBT also focuses on problem solving, finding solutions, improving coping, helping clients to challenge distorted cognitions (e.g., thoughts, beliefs) and change problematic behaviours. Your emotional or behavioural responses are also changed through exposure to specific situations, cues, narratives or places that trigger distress and maladaptive responses. Homework is often assigned.

Different treatments focus on different aspects of your concerns, including behaviours, cognitions, emotions, perceptions, and relationships. The psychologists, psychotherapists and counsellors working through CFIR are trained and skilled in providing various types of psychological treatments. They are also dedicated to discovering what will work best for you. Contact us today to book your initial appointment or to arrange a free 30-minute consultation.

It is estimated that 1 in 5 Canadians will experience mental health difficulties each year (https://cmha.ca/media/fast-facts-about-mental-illness/). These high rates suggest that not only is it important to recognize the symptoms of mental health difficulties, but it is equally important to be aware of treatment options. Treatment for mental health disorders may include self-help (e.g., books, apps, peer support), medication, individual, couple, or group psychotherapy, or a combination of medication and therapy. 

When considering treatment options, recent research indicates that patients with depressive and anxiety disorders were more likely to refuse medication, and more likely to engage in psychotherapy.(1) The researchers thought that this is due to patients recognizing that their problem may not only be biological and that there are no quick fixes for mental health. This is really important data – it tells health care providers and patients that psychotherapy should be offered as front-line treatment. 

Psychology Month, which takes place in February, is a month devoted to highlighting how psychology can help others live a healthy and happy life, improve workplace environments, and help governments to develop good policies (see http://www.cpa.ca/psychologymonth/). In celebration of this month, here are five things to know about seeking treatment through psychotherapy. 

1.  Acknowledge when you need help. It can be really hard to say to ourselves, “okay, I need help.” Naturally, we will try everything we can before we seek help from others. I understand needing psychological help as the equivalent of needing to expand our toolbox. It’s like trying to dig out of a hole when all you have is a shovel. So, what do you keep doing with only a shovel? You keep digging, and digging, and digging, only to keep getting stuck. Give yourself permission that it is okay to need help – and that identifying this is, in fact, a true strength. Once you have begun to see this, don’t wait! Don’t wait until you are no longer able to go to work or see friends. 

2.  Find a good match – and then be authentic. The old adage of “if at first, you don’t succeed, try, try again” is applicable to finding the right therapist. Psychologists and psychotherapists work from many different treatment models, including cognitive-behavioural therapy, acceptance and commitment therapy, emotion-focused, psychodynamic, and integrative models of treatment. (For more information on what these models look like, check out https://cfir.ca/DifferentTreatmentsArticle.php). Therapists will also have their own style with clients. The fundamental piece of finding a good therapist is that you feel connected, understood, and validated by the therapist. We know that a large factor of change that happens in therapy comes from the relationship you have with your therapist.(2) If you do not feel a good relationship within the first few sessions, try addressing it with the therapist, or don’t be afraid to find someone else. Be sure to maintain an open and authentic stance with them – share your thoughts and feelings to help them get to know all of you so that together you can make meaningful change. 

3.  Try out new skills and tools. The media often shows a typical therapist in a sweater vest, sitting in a chair with glasses and a notepad, while their patient lies on a couch and stares at the ceiling. Psychotherapy has greatly changed with the increasing use of tools over and above talk therapy, including learning to calm the nervous system with breathing and mindfulness techniques, challenging unhelpful thoughts or processing difficult emotions, and learning communication tools. Therapy also looks to explore and understand your current perceptions and emotions, and how these relate to your early experiences. This can help to understand key themes contributing to your difficulties today. We are complex beings – with a history of experiences with parents and caregivers, friendships and romantic relationships, and bosses and employers. We carry our early experiences with us, like packaged up suitcases. But sometimes we don’t look in the old luggage to understand it – so we stay stuck. Once you learn new tools and gain new insight, apply these to your everyday life to help make changes.(3)  

4.   It will get harder before it gets better. Clients often feel a sense of relief following the first or second session when they begin to tell their story, acknowledge that they need help, and feel understood by another person. However, therapy can become more challenging as one begins to make changes or is faced with identifying their difficulties or beliefs that are contributing to them getting stuck. 

5.  Change takes time – so stick with it. Research shows that over fifty percent of clients see improvements in their difficulties with an average of 12 sessions.(4) Change does not happen immediately, and it will depend on the severity and chronicity of symptoms. A client once disclosed frustration after several sessions, stating that she “should already be better,” and that she must be a failure if she has not already improved. Change in psychotherapy is not black or white – nor is it a pass or fail. Allow yourself to get stuck and experience the difficulties that are coming up from therapy, and recognize some of the small pieces that are changing in your life. 

To find out more information about seeking services from a psychologist or psychotherapist at CFIR, visit https://cfir.ca/WhatToExpect.php .

REFERENCES

1. Swift, J.K., Greenberg, R.P., Tompkins, K.A., & Parkin, S.R. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy, 54, 47-57.

2. Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277.

3. Ronan, K. R., & Kazantzis, N. (2006). The use of between-session (homework) activities in psychotherapy: Conclusions from the Journal of Psychotherapy. Journal of Psychotherapy Integration, 16(2), 254-259.

4. Hansen, N. B., Lambert, M. J. and Forman, E. M. (2002), The Psychotherapy Dose-Response Effect and Its Implications for Treatment Delivery Services. Clinical Psychology: Science and Practice, 9: 329–343. doi:10.1093/clipsy.9.3.329