This article is part of a series based on experiences I lived as a psychologist, client or simple observer.

When we were studying for the Ph.D. in Clinical Psychology, we had to conduct two internships of one year each. These internships, to be carried out at authorized Hospitals or Mental Health Services, were the core of our practical training. For the first one, I chose the Centre for Psychological Services at the University of Ottawa. This institution offered psychotherapy for the population at large at highly discounted rates. Most of the clients were seen by the interns. 

As we had nice offices there (the building had been recently restored) we spent most of our day in them, either seeing clients, studying or just talking amongst us. The load of work was intense given that all our sessions with clients had to be recorded (audio or video). We then had to listen to our tapes and bring the material to group supervisions. For every five hours of therapy we had, we needed to take four hours of supervision. Our days were long but the best part was still to come. 

Given that in Ottawa many people worked 9 to 5, most clients of the Centre wanted to come after that hour. The Centre was open, Monday to Friday, from 5 to 9 pm. But the atmosphere was different. There were few professors around, almost no noise and ten or fifteen interns ready to see clients, talk with each other or make an escapade to one of the small and inexpensive restaurants around the University to have dinner. 

We learnt plenty during the internship: to work long hours and see several clients; to deal with paperwork and bureaucracy; to talk and discuss cases in supervision and in individual meetings. Most of all we learnt how to be a therapist, how to understand what is affecting the client, how we can help, how to convey this to the client. 

As the months were passing, we were honing our clinical skills. Granted that we always learnt something new, indeed we still do, and therefore we had more time to read and to look at the bigger picture. 

One day I came to the realization that many clients who came to the Centre had ages finishing in nine. We discussed that in our evening conversations and most interns shared that sensation. 

Three of us went to see the Director of the Centre to tell him about this phenomenon and to ask him for permission to review the files, without looking at the name of the client, and record the age at intake. 

The Director thought about it and two days later called us in. He agreed on several conditions: it should be conducted on a Saturday when no clients were seen and it had to be anonymous. 

As we are talking about many years ago, there were no computer records of the clients, everything was paper based and the files were just the typical office style light brown folder holding the material inside. 

The three of us went on a Saturday and took several hours to retrieve files one at a time and register the age of the client when s/he attended the first interview. 

The results were clear. By far, the number that appeared the most was nine. The second one, in order of frequency, was zero. The rest of the numbers were ordered in an apparently random fashion.

Although we were expecting number nine to be the most frequent, we were surprised by the amplitude of the difference to the other numbers. We were also surprised by the appearance of number zero in second place. A logical situation in retrospect, but we admitted that we had not thought about it. 

The results were clear. The question then was “why?”. Although this was a casuistic study with no scientific rigor, I believe that the motives for some clients to demand therapy at ages ending in nine are the following:

People who are not satisfied with their work/relationships/social aspects of their life might feel embarrassment, anger, depression or many other feelings at the notion of turning 20, 30, 40, 50, etc. The previous birthday to those, namely 19, 29, 39, 49, etc., becomes a trigger to the countdown. Having a round birthday, e.g., 40, might be unwelcome but at least it might carry the hope of a better decade. Having a birthday ending in nine not only signals the advent of the round birthday but also the termination of a decade that does not satisfy them. The “nine status” might lead some people to apply the handbrake and go through life instead of developing it. There aren’t many redeeming points in being a nine. 

The issues that those clients brought to therapy show that our intuition was not off the mark. Many clients feel that they want to do something to change their life. We then see that, besides all the negative connotations that becoming something-nine might have, it has a very positive one. 

It brings the client to therapy, s/he has a clear list of issues that they want to look at and change and best of all, most clients have the motivation to do it. Therapy is never an automatic event, but some apparently negative things that happen to people might open an opportunity to face their troubles, understand them, solve them or make important decisions about their present and their future. 

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

Key Points:

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

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

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

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

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

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

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

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

References:

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

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

I often wonder about capacity – my own and that of others. Will I be able to manage the physical and emotional demands being asked of me throughout my day? Where do I begin?

As autonomous individuals, we are required to make choices. We do so daily. Even choosing not to come to a decision is a choice in and of itself; inaction comes with its own set of benefits and consequences. Some of our choices come easily to us, and we do not tend to give them too much thought. Others weigh more heavily on us and require us to give more of ourselves to the decision-making process. Every choice we make is emotional.

In therapy, one is often encouraged to think about capacity as a finite resource. Often, clients are taught to conceptualize capacity as a battery that will deplete itself throughout the day. If every choice I make is emotional, I need to be aware of the implications. The more I expend my resources throughout the day, the less I have left to work with. By increasing my self-awareness, I can find ways to allocate my daily battery so that I have the capacity to show up in the ways that matter most to me. 

1. Start with a check-in

It can be helpful to gauge my battery life first thing in the morning to determine my capacity meter for the day. This can allow me to lean into self-compassion and place realistic expectations of myself.

Example: After an adequate night’s sleep, a good amount of physical activity throughout the week, and sufficient nutrition and socialization, I am waking up with 100% battery.

2. Prioritize by your values

Often, our days are full of non-negotiable tasks as well as personal responsibilities. If everything is important, nothing is important. Therefore, I need to know what is important to me. Asking myself what I value most can help me determine how much of my battery I am going to need to save for the things that matter most to me. Without doing so, I may deplete my battery on tasks that drain my battery, leaving me with less capacity to get through my day.

Example: As I am working on a report for a client, I receive a text message that requires my input on an upcoming family trip. I value work and I value family. I understand that making the decision regarding the family trip is one that will weigh on me, and one that will deplete more of my battery than I am currently willing to give. I can set a boundary by communicating that I will require some time to process the trip and I will not be responding until the following day. This allows me to hold on to more of my resources for the day, and allows me to allocate them accordingly.

3. Allocate accordingly 

If I know what I value, I can choose to allocate my battery accordingly. I do not attribute the same weight to every decision that I make. As well, the more choices I make throughout the day, the more I deplete my battery. By increasing my awareness of this, I can save more of my attention for the choices that tend to be more emotional for me.

Example: I can choose to schedule the tasks that demand more of me earlier on in the day, or I can arrange to take care of myself in ways that will help my battery ‘stay charged’. 

We all have the capacity to choose. I encourage you to lean into curiosity regarding some of the choices that you have been making lately, and whether they are serving you in the ways that you have intended for them to. As always, the choice is yours.

Oksana Halkowicz, M.Psy works under the clinical supervision of Dr. Ashwin Mehra, C.Psych and provides psychological services to children, adolescents, and adults experiencing a wide host of problems related to mood, anxiety, depression, and interpersonal relationships. She works from a psychodynamic approach and integrates therapeutic techniques from dialectical behavioral therapy (DBT), cognitive behavoral therapy (CBT), and emotion-focused therapy (EFT).

Imagine having to over-explain your experiences of discrimination to a therapist, just to have that very same experience invalidated. It’s as though what you’ve just shared did not happen. You’re left confused, feeling misunderstood, and questioning your reality. Perhaps feeling worse than before meeting your therapist, why would you even continue?  

This surprisingly common experience highlights the importance of cultural competence—the understanding and acceptance of norms other than your own. This requires more than simply following a checklist; it requires the ability to openly embrace different ways of being, which at times, you may disagree with. In Canada, there is a clear—and striking—underrepresentation of ethnic and sexual minorities in the mental health profession. What are, if any, the practical consequences of this, one may ask? 

The Ontario Health Study tells us that mental health services are consistently underutilized in minority communities. Interview-based research gives us some insight as to why. A common thread in these studies is that many individuals encounter varying forms of discrimination (i.e., both “microaggressions” and overt discrimination) from professionals and begin to feel like “therapy is not for them”.

Mental health does not discriminate—and as unfortunate as this is, the data suggests that your care provider may. While there is an active effort to understand and teach the ability to perceive and appreciate subtle differences in the cultural experiences of any given client, at times there simply may be no substitute for shared experience. 

Demographic factors are not the only thing to take into consideration when selecting a therapist, but clients should not be made to feel ashamed if they choose to do so. By and large, most clinicians offer free consultations. Meet with them. See what they are like. Be explicit with your concerns and ultimately, you make the decision if you feel understood—whether the therapist looks like you or not.

Ola Kuforiji, M.A., is a registered psychotherapist (qualifying) at the Centre for Interpersonal Relationships. He provides therapy with for individuals and couples (with a special interest in ethnocultural and sexual minorities) under the supervision of Dr. Lila Z. Hakim, C.Psych.

Reesa Packard, R.P., Ph.D. (Associate at CFIR – Ottawa) was on the airwaves with 1310News’ Sam Laprade! The two shared an engaging discussion about managing mental health throughout the pandemic and beyond. This conversation is one you don’t want want to miss.

To learn more about how clinicians at CFIR can help you online or by phone, go to www.cfir.ca

Some people come to therapy only after having exhausted other options. For those with limited experience trying to understand themselves and the nature of their problems more deeply, therapy may seem pointless or airy-fairy. “How will talking about my problems make any difference?” is something incredulous clients ask me. I can appreciate this question because therapy is a time-consuming and expensive investment, so people want to be sure that it’s going to help. People may benefit from therapy for many reasons. This post is dedicated to clarifying these reasons.

Research has time and time again showed that the relationship between the therapist and client is one of the most potent forces for change in therapy. Many clients discount this fact. Nonetheless, having a reliable, non-judgmental, and attuned professional who can help you make sense of your experiences can lower feelings of loneliness and shame because these feelings intensify when we are alone with our distress or when we hide ourselves from others. The confidentiality afforded to clients in therapy and – often, as a result – the emotional depth and openness achieved, makes the process of treatment quite different than what is experienced by venting or seeking advice from your friends and family. Therapists are trained to notice patterns in your thinking and behaviour as well as understanding the meaning and context of your feelings so that you can understand yourself more deeply. As you come to trust your therapist over time, the depth of the conversations you have lends itself to ever deeper realizations of factors that organize and shape your behaviour so that you make choices that diverge from the well-worn path that makes you feel stuck.

Therapy is a place to process and reflect on your emotional experiences. Why does this matter? Simply put, emotions are information. People often forget or dismiss emotions – especially difficult ones – as needless encumbrances to daily living. “I’m rational” or “they’re emotional” are usually code for “emotions are for the weak” or “emotions are pointless.” The reality is that emotions are profoundly crucial to helping us understand what we do and do not like and cues us into action to make meaningful changes in our lives. If we are depressed, it might mean that we are unsatisfied with the quality of our relationships or feel hopeless about our ability to initiate actions that would enhance our career satisfaction. Paradoxically, doubling down on rationality and dismissing, minimizing, or rejecting emotions is inherently an emotionally driven process. Indeed, some people have grown up or currently exist in especially emotionally invalidating worlds that have compelled them to disconnect from their emotional experiences in order to manage pain and distress or be accepted by others. In other words, inflexible and rigid beliefs about the dominion of rationality over emotions are rooted in our attempts to limit experiencing pain and suffering. However, our ability to connect to others, to move toward things that interest us, and feel excited by the world necessitate having access to our emotions. More difficult emotions like anger, sadness, anxiety, shame, and guilt signal to us what we need more or less of and organize our behaviour to make the appropriate changes. Habits based on avoiding those complicated feelings disconnects us from our needs. Just like we need physical pain to cue us to something that needs attention, emotions cue us to essential things in our world.

Understanding our behaviours or thought processes at work, in relationships, and all parts of our life is the first step toward making important changes. We are all shaped by early life experiences that impact the assumptions we make about ourselves, others, and the world around us. As a result, people are often moving through the world as adults using assumptions and filtering information through the prism of their childhood experiences. Understanding this cycle, challenging your assumptions and biases, and deliberately making different choices to challenge outdated modes of thinking, feeling, and being can be profoundly empowering.
Notably, a focus on new behaviours is limited by those currently living in abusive environments that make change dangerous. In these cases, it would be vital to focus more on safety and problem-solving effective solutions.

Finally, therapy can help you manage your symptoms more effectively. Mental health professionals understand your symptoms, what typically helps others who have experienced similar forms of difficulty, and can provide you with information drawn from scientific research and teach you skills that will help you manage your distress.

Dr. Sela Kleiman, C.Psych. is an Associate at CFIR (Toronto). In individual therapy, he helps adults struggling with depression, anxiety, grief, as well as those trying to cope with the effects of past and/or current verbal, emotional, physical, and sexual abuse. Dr. Kleiman has published numerous academic articles on topics that include suicide prediction, racial and social attitudes, and racial and sexual discrimination, and he’s completed his Ph.D. in clinical and counselling psychology at the University of Toronto.

These days, finding the ‘right’ therapist can be an involved process. Part of the challenge is that there are so many distinct kinds of psychotherapy. Some of the better-known forms of therapy include cognitive-behavioural therapy (CBT), psychodynamic therapy, and client-centered therapy. With so many different approaches, you may find yourself wondering, “How do I know which approach is right for me?”

Fortunately, therapists at the Centre for Interpersonal Relationships (CFIR) are trained in a wide array of major therapeutic approaches. Moreover, many therapists increasingly recognize the value that each approach brings. For instance, CBT can help people develop healthier ways of thinking and behaving, while psychodynamic therapy can help clients better understand their personality and improve their relationships. So, it’s easy to wonder, “Why not take advantage of both approaches?“

Great question! In light of the unique strengths of each form of therapy, therapists are increasingly incorporating elements of different approaches to meet the individual needs of clients; this practice is referred to as ‘integrative therapy.’ In essence, integrative therapy is an evidence-based approach that makes use of the wisdom and tools contained in a variety of other psychotherapy traditions. Importantly, there is also excellent research demonstrating the high value and effectiveness of integrative therapy.

There’s an interesting quote that I believe nicely illustrates the flexible and adaptive nature of this approach:

“If all you have is a hammer, everything looks like a nail.”

Abraham Maslow

By taking advantage of the rich diversity of tools found in the best approaches to therapy, integrative therapists can flexibly respond to the diverse challenges and concerns that clients face. As a result, clients often report feeling understood as a person, instead of as a diagnosis or problem. So, if you’re wondering which type of therapy is right for you, integrative therapy might be just what you’ve been seeking.

Adam Blake, M.Sc., is a therapist at CFIR’s Toronto location. Adam provides individual therapy with adults who struggle with anxiety, panic, OCD, depression, trauma, dissociation, attention deficits, issues related to sexuality and relationships, self-worth, assertiveness, spirituality, and vocational/work concerns. His approach to psychotherapy is integrative and draws on empirically-supported principles from well-established traditions, including humanistic, existential, cognitive-behavioural, psychodynamic, and acceptance and commitment therapy.

Over the past 35 years, there has been a substantial amount of research conducted to identify psychotherapy treatments that work. Research suggests that many different types of treatment approaches might be beneficial for a wide variety of disorders. It is vital that a clinician who is providing you treatment is trained in empirically-supported treatment interventions so that you know that you are getting the most scientifically investigated treatment interventions. 

Recently, evidence-based practice has come to mean more than empirically-supported treatment (Canadian Psychological Association, 2012). Evidence-based practice involves the thoughtful and informed use of the psychological research base to inform clinical treatment practice. It’s also essential that your clinician be able to attend to a wide range of individual differences and personal client factors (e.g., attachment style, coping styles, cultural factors) in treatment, as well as consideration and use of research in supporting clients in their healing process. 

The clinicians at CFIR are invested in providing empirically-supported treatments, tailoring treatment to individuals based on their needs and individual differences, and ensuring that we are kept abreast of leading-edge research related to your presenting issues.

At Centre for Interpersonal Relationships (CFIR), we believe it is important for your clinician to be flexible in offering a variety of scientific, evidence-based treatments to address the cognitive, emotional, behavioural and relational aspects of your concerns. Providing you with different possibilities for change is fundamental to us because we know that no one treatment fits all!

Different treatments focus on various aspects of your concerns, including behaviours, cognitions, emotions, perceptions, and relationships. We’ve compiled a list of a few scientific, evidence-based psychological treatments available at CFIR along with the focus of the treatment approach:

Acceptance and Commitment, Compassion & Mindfulness-based therapies (ACT, MBSR)

Acceptance and Commitment, Compassion & Mindfulness-based therapies (ACT, MBSR) are forms of psychotherapy that support an individual to learn how to observe, be less reactive, accept and be non-judgmental of internal thoughts or emotional reactions. ACT helps you to act from core values as opposed to being entangled in the thoughts and emotional responses that are at the root of your concerns. Developing a more compassionate outlook towards your self is also essential for remediation of various mental health concerns. Treatment focuses on developing the capacity to observe, adopt a non-judgmental stance toward thoughts and feelings, and diminish reactivity while anchoring the self in core values to promote clarity in thinking and action.

Cognitive-behavioural therapy (CBT)

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 you to challenge distorted cognitions (e.g., thoughts, beliefs) and change problematic behaviours. Your emotional or behavioural responses transform through exposure to specific situations, cues, narratives or places that trigger distress and maladaptive responses. Homework is often assigned.

Eye Movement Desensitization and Reprocessing

Eye Movement Desensitization and Reprocessing is a form of treatment that came to be from a context of treating patients to deal with and process distressing memories of past traumatic experiences. It’s currently used to treat a broader range of psychological issues. Treatment involves visual or auditory bilateral stimulation with a primary focus on the integration of distressing aspects of past, and present experiences and increasing adaptation and resilience by building inner resources to address these experiences.

Motivational Interviewing 

Motivational interviewing is a form of counseling that helps individuals achieve changes by increasing their motivation to change difficult behaviours. Treatment targets ambivalences about changing, and becoming increasingly aware of the problems, consequences, and risks of these behaviours. Motivation is increased to create a better future consistent with an individual’s values and principles.

Psychodynamic, Attachment-based, Mentalization therapies 

Psychodynamic, attachment-based, mentalization therapies focus on how past and current relationship experiences have influenced a person’s present patterns (i.e., thoughts, thinking about self and other, emotional reactions toward self and others, and behaviours) and relationships. Psychoanalytic-oriented approaches have a rich, historical tradition beginning with Freud and Jung to present-day scientifically validated psychodynamic approaches. The goals of psychodynamic-mentalization and attachment-based therapies are to increase an individual’s self-awareness about these patterns to promote change in the present-day. 

Concerns flow from internal conflicts, dynamics, and patterns that create difficulties for our self and block us from building meaningful lives and relationships. Defenses and self-protective strategies that prevent access to earlier emotionally overwhelming experiences are diminished over time to promote more adaptive functioning, self-growth, and change. Treatment focuses on cognition, emotion, and interpersonal dimensions of your difficulties. Your interpersonal relationships, both with your therapist and others, are explored to understand and change how one experiences oneself and relates to others in interpersonal relationships. These approaches tend to focus on the self and relational issues underlying your symptoms and distress, as opposed to targeting symptoms directly.

Systemic therapy 

Systemic therapy is a form of psychotherapy that understands problems evolving in interactions and interaction patterns with other individuals and systems. Treatment focuses on the impact of your couple partner, children, family, work and socio-cultural system on your self and your relationship with others.

Clinicians at CFIR can help you or someone you care about address the concerns, issues or struggles that life may occasionally present. 

Most private extended insurance plans, as well as Medavie/BlueCross (RCMP, Veterans Affairs, Canadian Armed Forces) and CUPE, cover CFIR services. 

Contact us today. Help is available right now for you and your loved ones! We also offer video-based appointments.

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.