When faced with a challenging or traumatic life experience, many clients often expect that “getting over it” is the goal. These instances, particularly those that are traumatic in nature, reshape how our brains process events, emotions, and relationships. Ongoing and fruitless attempts to reduce symptoms may in fact worsen one’s distress (Harris, 2006). While problem-solving strategies are highly adaptive in the outside world, they are not always applicable within our internal psychological worlds. The more time and energy we spend trying to rid of these negative experiences, the more we may suffer in the long term. Alternatively, compassionate healing recognizes that recovery is a process rather than a destination. Instead of erasing the past, clients are guided towards creating safety, self-understanding, and growth (Harris, 2006).

Though it’s natural for our initial response to distress to be “I want this to go away,” some clients benefit from altering that relationship with difficult thoughts and feelings. Though they are uncomfortable, they are approached with compassion and curiosity rather than the perspective that they are something to “get over.” We experience some form of distress on a daily basis, so allowing room for unpleasant feelings, sensations, and urges to come and go without struggling with them actually helps in reducing their frequency or severity (Harris, 2006). Once we can separate ourselves from our thoughts, we are able to see them as passing events rather than absolute truths. By this perspective, healing happens not by “getting over it,” but my embracing what is, while striving for what can be.

Erin Rehmann, M.A., is a therapist and psychometrist at CFIR. She is supervised by Dr. Mard Becard, C.Psych. Erin provides individual psychotherapy to individual adults with a wide presentation of mental health difficulties, specializing in anxiety, depression, self-esteem challenges, trauma, and emotional dysregulation. She utilizes an integrative and collaborative approach, primarily using person-centred, cognitive behavioural, and acceptance and commitment therapy. Erin also provides psychological assessments to adults with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. 

Harris, R. (2006). Overview of ACT: A brief introduction to Acceptance and Commitment Therapy. Retrieved from https://static1.squarespace.com/static/509ad2ede4b011ec832812ed/t/5b896b1870a6ad36f8841834/1535732505180/Russ+Harris+-+Overview+of+ACT.pdf

Trauma occurs when the stress of a situation overcomes our ability to cope, and mindfulness can help us process this while better allowing us to regulate emotionally (Larsen et al., 2021). A key concept related to this is the idea of a window of tolerance (Siegel, 1999). Our window of tolerance is where we can still cope with what is happening, maintain regulation of our nervous system in a way that allows us to be grounded in the present, and behave in ways that serve our values and outcome goals. When dysregulated, we can move in two directions; towards a state of complete shutdown and disconnection with the world or towards an activated state of anxious thought and overwhelming fear that leads to a desire to fight or flee from a perceived threat. The state of shutdown can be seen in individuals who, when overwhelmed, move into feelings of hopelessness and helplessness and appear depressed or withdrawn from the world, unable to connect with others. When individuals move in the other direction, their anxiety propels them to attack others or run away from difficult situations to protect their sense of self and feeling of safety.

With mindfulness, we can identify the cues from our bodies and emotions to determine when we are about to move away from our window of tolerance. Mindfulness also provides various tools and strategies to help us move back toward the window of tolerance through awareness and non-judgment.

An example of a mindfulness-based practice I use with clients in a state of fight or flight is three-part yogic breath, in which awareness is drawn to feeling the rise of the lower, mid and upper regions of the abdomen as they expand. By placing the palms together with just the middle fingers touching while the others are separated, we can begin to notice if each of the regions of the abdomen is rising on the inhale. This awareness can foster a focus on the breath that can draw an individual back toward their window of tolerance. Over time, they can be encouraged to lengthen their exhalation relative to their inhalation, facilitating this movement from anxiety towards balance.

Conversely, when a client is moving towards emotional shutdown, mindfulness can be used to bring them back to their window of tolerance. A simple technique is to ask the client to allow their inhale to be slightly longer than their inhale. For those who find these overwhelming, gentle, rhythmic movements like gently rubbing a stone or rolling their shoulders up, back, and down continuously can help return the client’s basic level towards their window.

Mindfulness approaches can be integrated into any therapeutic modality but are integral to approaches such as mindfulness-based Cognitive Behavioural Therapy and Acceptance and Commitment Therapy. Our therapists at the CFIR can help you learn how to build mindfulness skills to process trauma and emotionally regulate it.

Mr. Jeffery Driscoll, B.SC., B.Ed., is a counsellor at the Centre for Interpersonal Relationships (CFIR) supervised by Dr. Ashwin Mehra, C.Psych, Psychologist. Mr. Driscoll is registered as both a teacher in Ontario and a yoga instructor and provides integrated therapy through a mindfulness lens to adults and seniors. Given his years of experience in yoga and education, he is skilled at helping individuals navigate life transitions or find greater career or relationship meaning and joy. He works with individuals who are experiencing a wide range of psychological, relationship and career difficulties relating to grief, life changes, aging, mood disorders, trauma, sexuality, sleep disturbances and interpersonal conflicts. He integrates mindfulness with Cognitive-behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavioural Therapy (DBT), Emotion-Focused Therapy (EFT), Existentialist, Systemic, Adlerian and Psycho-dynamic therapy.

Reference

Larsen KL, Stanley EA. Leaders’ Windows of Tolerance for Affect Arousal-and Their Effects on Political Decision-making During COVID-19. Front Psychol. 2021 Oct 26;12:749715. doi: 10.3389/fpsyg.2021.749715. PMID: 34764917; PMCID: PMC8575779.

Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. Guilford Press.

Trauma is an emotional response to an experience of a stressful, frightening or disturbing event which is difficult to cope with and makes us feels out of control. A traumatic experience not only impacts our mental and emotional health but also our physical health and overall well-being (Quinn, 2023). A person exposed to trauma may feel a wide range of emotions during the event, after it occurred, and also for a long time afterwards. Such experiences leave an individual feeling shock, anger, overwhelm, helpless, shameful or guilty (Leonard, 2020). Below are three types of traumas that people may experience:

1. Acute stress or acute trauma results from a single unexpected event or dangerous incident. Examples of acute trauma include physical, emotional or sexual assault, being diagnosed with a life-threatening illness, childbirth, serious injury or accident, experiencing a natural disaster, witnessing crime or loss of a loved one. Acute trauma also includes secondary trauma or vicarious trauma, which is defined by the indirect exposure or trauma from someone else’s trauma, for example, hearing about a traumatic incident faced by a friend or witnessing a road accident, learning of traumatic incidents through electronic media. The effects of acute trauma may last from days to months memories (DSM-5-TR). A few common effects are irritability, anxiety, disturbed sleep, concentration problems and intrusive memories (DSM-5-TR). 
2. Chronic trauma results from repeatedly being directly exposed to traumatic incidents or to repeated traumatic events affecting other people. Examples of chronic trauma include being exposed to domestic violence or witnessing another family member being constantly abused, being a victim of bullying, or participating in war. The effects of chronic trauma may last from months to years, making it hard to get through everyday life and impact how we view ourselves and others. A few common effects are anxiety, disturbed mood, feelings of shame & guilt, and trouble regulating emotions. (World Health Organization, 2019)
3. Complex trauma results from exposure to multiple traumatic events that may or may not be intertwined. It results from series of childhood experiences or repeated traumatic experiences during early development. Examples include childhood abuse, chronic neglect or abandonment, being exposed to interpersonal or domestic violence, racism or discrimination. The impacts of complex trauma on an individual may be long-lasting and may make them feel disconnected from themselves and others. A few effects are flashbacks of the events, memory lapses, nightmares, interpersonal relationship troubles, headaches and constantly being on ‘alert’. (World Health Organization, 2019)

Anyone can be negatively impacted by various types of traumas. They may have emotional outbursts, find it hard to cope with their feelings, or socially withdraw from others. Therapists employ different scientific and evidence-based therapeutic techniques to help individuals build resilience, process and work through trauma. CFIR-CPRI has many clinicians available to help you better understand experiences and emotions you may experience.

References:

American Psychiatric Association. (2022). Trauma- and Stressor- related disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_Disorders

Leonard, J. (2020, June 03). What is Trauma? What to know. Medical News Today. https://www.medicalnewstoday.com/articles/trauma#definition

Quinn, D. (2023, August 03). Trauma. Types of Trauma: The 7 Most Common Types & Their Impacts. https://www.sandstonecare.com/blog/types-of-trauma/

World Health Organization. (2019). Disorders specifically associated with stress. In International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/991786158Lakshmi Mupparthi, M.A, R.P is a psychotherapist working under the supervision of Dr. Melodie Britt, C. Psych, at Centre for Interpersonal Relationships (CFIR) and practices a trauma-informed approach. She works with individuals and couples navigating challenges related to stress, relationships, trauma, conflict, attachment and self-esteem.

Trauma and chronic stress deeply affect our bodies and minds, leaving lasting imprints in our cognitive and physiological memory. Physiological memory stores the physical sensations and reactions tied to traumatic experiences, which can resurface through triggers and lead to recurring distressing symptoms. 

Body-based therapies recognize the vital role of the body in trauma healing. By integrating body and mind, these therapies provide effective tools to unlock deep healing potential. They encourage us to reconnect with our bodily sensations, movements, and postures, tapping into the wisdom of the body. This process allows for the exploration and release of tension, leading to increased body awareness. 

A key aspect of body-based therapies is learning to regulate our physical responses. Therapists can help clients gain a better understanding of their bodily impulses and sensations, guiding them in safely navigating trauma-related sensations. By gradually learning skills to regulate arousal levels, we can regain control over our bodies, promoting resilience and regulation. 

Body-based therapies also focus on integrating traumatic experiences into our overall narrative. By bridging cognitive and physiological aspects of trauma, we can form a coherent and compassionate understanding of our journey. This integration cultivates a sense of safety, healing, and wholeness. 

Recognizing the interconnectedness of our bodies and minds is crucial for healing trauma and chronic stress. Body-based therapies offer powerful pathways to overcome these challenges while honouring the wisdom of the body. By embracing these approaches, we can embark on transformative journeys toward healing, resilience, and a renewed sense of well-being. 

Grabbe, L. (2017). The Trauma Resiliency Model: A “Bottom-Up” Intervention for Trauma

Psychotherapy. Journal of the American Psychiatric Nurses Association, 24(1). https:/

doi.org/10.1177/1078390317745133 

Fisher, J. (2011). Sensorimotor Approaches to Trauma Treatment. Advances in psychiatric

treatment,17, 171–177. doi: 10.1192/apt.bp.109.007054 

Fisher, J. (2019). Sensorimotor Psychotherapy in the Treatment of Trauma. Practice Innovations,

4(3), 156-165. https://janinafisher.com/wp-content/uploads/2023/03/sensorimotor

psychotherapy-trauma.pdf 

Laura McKinney, B.A., is a therapy and assessment practicum student working under the supervision of Dr. Lila Hakim, C. Psych., currently completing her master’s in psychology. As a practicum student, Laura offers therapy at a discounted rate. She is passionate about helping clients heal from trauma and chronic stress. Please check out her profile on the Toronto team page on the CFIR website for more information.”

Cancer can completely upend your life and the lives of those who love you. It not only affects you physically, but also has profound emotional and psychological consequences for everyone involved. From the moment you receive the diagnosis to the often challenging or even excruciating medical treatments, cancer brings a whirlwind of difficulties that can lead to symptoms of posttraumatic stress. People living with cancer may have symptoms of post-traumatic stress at any point from diagnosis through treatment, after treatment is complete, or during recurrence. This can range from experiencing irritability, hypervigilance, and sleep disturbances, to loss of interest in life and feeling detached from oneself or reality.  

In simple terms, the trauma of cancer can greatly reduce your ability to handle and cope with stress and emotions, narrowing your “window of tolerance.” Within this window of tolerance, we usually feel safe, calm, and capable of effectively managing stress and emotions. However, cancer pushes us to our limits, often causing this window to shrink. It becomes much more challenging to find that sense of safety and calmness in the face of overwhelming stress. 

However, survivors of cancer also often report experiencing posttraumatic growth (PTG) after their journey. PTG refers to the positive psychological changes that can occur in people following the experience of a traumatic event or significant life crisis. PTG can include improved relationships, new possibilities for life, a greater appreciation for life, increased personal strength, and spiritual development. 

PTG coexists with personal distress and does not diminish the emotional impact of traumatic events or the amount of work that it takes to achieve it. It is not a universal or inevitable outcome for all people who experience trauma, but by working with a mental health practitioner, you can work towards achieving PTG. Embracing the potential for posttraumatic growth means embracing the opportunity to discover new paths and possibilities that may have never been considered before. It means finding a deeper appreciation for what life has to offer and a renewed sense of purpose. 

Cancer-related post-traumatic stress. National Cancer Institute. (n.d.). https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq  

Jim, H. S., & Jacobsen, P. B. (2008). Posttraumatic stress and posttraumatic growth in cancer survivorship: A Review. The Cancer Journal, 14(6), 414–419. https://doi.org/10.1097/ppo.0b013e31818d8963  

Tedeschi, R.G. & Calhoun, L. (2004). Posttraumatic Growth: A New Perspective on Psychotraumatology. 21(4). https://www.bu.edu/wheelock/files/2018/05/Article-Tedeschi-and-Lawrence-Calhoun-Posttraumatic-Growth-2014.pdf 

Laura McKinney, B.A., is a therapy and assessment practicum student working under the supervision of Dr. Lila Hakim, C. Psych., currently completing her master’s in psychology. Alongside her placement at CFIR, Laura is training as a therapist at Princess Margaret Cancer Centre, where she is working with individuals living with cancer. As a practicum student, Laura offers therapy at a discounted rate. Please check out her profile on the Toronto team page on the CFIR website for more information.

By Davey Chafe, MA, RP(Q)

Too often emotions are dismissed as weakness or as something that clouds our judgment from more “rational” thinking. However, emotions are very important for effective communication and give us vital information about our environments and the people within them. For example, if someone wrongs us or mistreats us and we become angry, it signals that we may need firmer boundaries with this person. In the same way, if we suffer a loss and feel sadness and grief, it may signal for closeness and support from people around us.

Over time, we learn how to listen to, and trust these emotional cues to help us navigate our worlds. However, if we experience traumatic events that we have difficulty coping with, it is not uncommon for people to develop negative changes in mood which can include distorted views of the self (e.g., self-blame and criticism), persistent negative emotional states (e.g., fear, horror, anger, guilt, or shame), feeling detached from others, and inability to experience positive emotions, such as happiness, satisfaction, or even loving feelings (American Psychiatric Association, 2022). These emotional disturbances can be present even without a diagnosis of PTSD or other trauma-related disorders. When this happens, people will often develop a negative relationship with their emotions, often leading to ignoring, avoiding, or no longer trusting their feelings.

Not feeling our emotions can lead to unhelpful coping strategies over time that allow us to “escape” the severe, negative emotions that can come with experiences of trauma. Unfortunately, avoiding these feelings can often result in new or worsening symptoms as our underlying emotions will look for new outlets. The energy from these emotions may manifest as symptoms such as anxiety, outbursts of anger, feeling low or depressed, dissociation, or substance use to avoid these negative feeling states. This is where therapy can help.

The hard part of this work is facing the feelings we have been avoiding, sometimes for years. If these feelings are not acknowledged and worked through, the emotional signals continue to go unheard, and we will continue to experience symptoms. Therapy can help by creating a safe place to begin unpacking and exploring these feelings through building safety and stability in our bodies and then learning to develop a relationship with our feelings again. As we process traumatic events and memories in a safe and productive way, it allows us to get back in touch with our bodies, our emotions, and the meaningful roles and relationships in our lives.

Davey Chafe, M.A., R.P. (Qualifying), is a Clinical Psychology Resident at CFIR in the final year of his PhD at York University and works with both individuals and couples in therapy. Throughout Davey’s clinical training, he has gained experience in a broad range of settings. He has worked with Emotion Focused Therapy for individuals and couples and Dialectical Behavioural Therapy for couples through York University, CBT for Mood and Anxiety at Brampton Civic Hospital, and with individuals and groups treating PTSD, mood disorders, and anxiety through community trauma initiatives. In addition to clinical work, Davey has been involved in psychotherapy research for over 10 years and has published in peer-reviewed journals and attended international conferences to present his clinical work. He is currently being supervised by Dr. Dino Zuccarini, C.Psych, Dr. Lila Hakim, C.Psych, and Dr. Aleks Milosevic, C.Psych.

REGULATING NERVOUS SYSTEM RESPONSES TO TRAUMA

Please see blog post: PART I: TRAUMA AND THE NERVOUS SYSTEM prior to reading this post

There are many different ways to regulate our nervous system. Body-based or somatic approaches are accessible and can create lasting changes to our feelings, thoughts, and behaviours. 

HYPERAROUSAL:

1. Hand on heart: 
   • place your hand on your heart and start to notice the gentle contact between your hand and your chest. Notice the weight of your hand on your chest.
   • Notice the temperature (e.g., warm or cold)
   • Notice any sensations (e.g., tingly, spacious, energized, airy)
   • Notice if the sensation starts to spread
   • Notice your breathing 
   • Deep breathing
2. Deep breathing:
   • Inhale for 4 counts; hold for 4 counts; exhale 8 counts
   • *try: inhaling through your noise and exhaling through your mouth (making an “O” shape with your mouth)
3. Belly breathing:
   • Place your hand on your belly
   • Inhale for 4 and actively expand your stomach
   • Hold for 4 
   • Exhale for 8 and collapse your stomach 

HYPORAROUSAL:

1. Posture change: 
   • Elongate your spine (*imaging your spine being pulled up to the top of your head)
   • Pull your shoulder back 
   • Gently push your chest out 
   • Take a few breaths here
2. Breathing:
   • Inhale for 8 counts; hold for 4 counts; exhale for 4 counts
3. Grounding through contact:
   • Stand up and notice your feet on the floor; elongate your spine and start to peddle your feet to apply more weight to one foot at a time; notice activation of muscles in your legs and glutes; bring attention to sensations (e.g., pressure, energized) and temperatures in your feet.  

Whitney Reinhart, M.A., R.P., is a psychotherapist who provides psychological services to adults and couples experiencing a wide range of issues, with a special interest and expertise in trauma and relationships. She uses a variety of trauma-informed approaches, including sensorimotor psychotherapy, somatic experiencing, and parts-based therapies.  

When we experience threat, our nervous system reacts in the best possible way for that situation, either by fight, flight, freeze, submit, or cry for help. When we experience threatening situations or traumas where we aren’t able to mobilize and run to safety or fight back, we will freeze or submit. In freeze, we feel stuck; there is an internal sense of danger and threat, but we are unable to move or act. In submit, we collapse; everything goes offline, our muscles become flaccid, and breathing decreases. 

When we have unresolved trauma (chronic or acute; attachment-based or threat to body), we can go throughout our lives reliving the trauma through our nervous system – often leaving us in a chronic state of hyperarousal (fight, flight, freeze, attach) or hypoarousal (submit). In chronic hyperarousal, our nervous system is geared up and activated. For example, we might find ourselves feeling irritable and on edge (fight), using substances for relief, distancing from relationships (flight), relying heavily on others, clinging to avoid abandonment (attach/cry for help), feeling frozen and/or experiencing panic attacks and flashbacks (freeze). In chronic hypoarousal, our nervous system is shut down and numbed out, and can result in us feeling depressed, ashamed, disconnected, unable to think, and passive.  

If you identify with some of these internal experiences, therapy is a great step for understanding your nervous system responses, what you had to do to stay safe, and how to regulate your nervous system. 

Stay tuned for Part II on regulating your nervous system.

Whitney Reinhart, M.A., R.P., is a psychotherapist who provides psychological services to adults and couples experiencing a wide range of issues, with a special interest and expertise in trauma and relationships. She uses a variety of trauma-informed approaches, including sensorimotor psychotherapy, somatic experiencing, and parts-based approaches. 

Complex post-traumatic stress disorder (C-PTSD) is a relatively new diagnosis for understanding how past events can impact our mental health in the present. If you’re struggling with difficult symptoms, you might have wondered if they could be due to complex trauma. 

Complex trauma involves experiencing a series of events of a threatening or horrific nature, where escape is difficult or impossible. These events overwhelm an individual’s capacity to control or cope with the stressor. They can occur in childhood or adulthood, and could include (but aren’t limited to):

• Domestic violence
• Physical abuse
• Sexual abuse, harassment, or assault
• Neglect or abandonment
• Racial, cultural, religious, gender, or sexual identity-based oppression and violence
• Bullying
• Kidnapping
• Torture
• Human trafficking
• Genocide and other forms of organized violence

Those with complex trauma develop post-traumatic symptoms such as flashbacks, avoiding reminders of the events, and feeling constantly “on edge” or hypervigilant. But due to the prolonged and pervasive nature of the trauma, those with complex trauma develop additional symptoms that are important to recognize.

The first is trouble with affect regulation. This means they might have trouble calming down after a stressor or have strong emotional reactions. On the other end of the scale, they may often feel emotionally numb, or not able to experience positive emotions such as joy. 

Secondly, individuals with complex trauma struggle with negative self-concept. This means they often have strong beliefs that they are worthless, or a failure. They might feel intense guilt or shame in relation to these beliefs.

Finally, individuals with complex trauma often have issues in relationships with others. They might have trouble sustaining relationships and feeling closeness to other people. They might have short, intense relationships, or avoid relationships altogether.

Complex trauma often occurs across generations (sometimes referred to as intergenerational trauma), due to a lack of resolution of previous traumas and prejudice and discrimination that results in the oppression of entire families and groups.

Always consult with an experienced mental health professional if you believe that you may have complex trauma or another condition. Regardless of the cause of your symptoms, there are many treatment options available that can help you achieve your goals and feel better. 

Camille Labelle, BSci, is a therapist working at the Centre for Interpersonal Relationships (CFIR) under the supervision of Dr. Lila Hakim, C.Psych. They provide individual therapy to adults who have experienced single-incident or complex trauma or are seeking support for other mental health conditions such as anxiety or depression. They use an integrated approach including emotion-focused therapy (EFT) and cognitive behavioural therapy (CBT) to empower people to process their experiences, understand their reactions, and change their lives. 

References

Ford, J. D. & Courtois, C. A. (2020). Treating Complex Post-Traumatic Stress Disorders in Adults, 2nd ed: Scientific Foundations and Therapeutic Models. New York, NY: The Guilford Press. 

World Health Organization. (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed). https://www.icd.who.int/  

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.