Winters are a hard time for so many of us – we can get stuck in routines, retreat more within the comfort of our homes, and perhaps most challenging, we find ourselves reflecting on ourselves and our relative contexts. In fact, this particular time of year is synonymous with seasonal affective disorder (SAD), an experience that is so common it has become a (uninvited) household name and guest. 

Mental health challenges tend to be more acutely challenging this time of year, as it becomes more difficult for us to maintain self-care routines, try to get adequate sleep, and feel well balanced – we tend to slip back into old habits, enter into more relational struggles with our loved ones, and generally feel less satisfied and resilient. Small stresses can take us down, and we find ourselves stuck with distressing thoughts, and uncomfortable emotions. What if it didn’t have to be that way?

Cognitive-Behavioural Therapy (CBT) is an evidence-based and often gold-standard approach anchored to client needs to address the unhelpful thinking and behavioural patterns that underly the challenging emotions that hold us back. 

How does it work? 

Work with a cognitive-behavioural therapist involves developing a treatment plan that is tailored to address a number of client goals. It is a short-term treatment that generally lasts between 8-24 sessions. CBT focuses on finding solutions, providing strategies and techniques to improve coping and reduce distress, designed to help clients challenge difficult thoughts and beliefs, and change problematic behaviours. A number of specific interventions have been developed stemming from a cognitive-behavioural perspective: Dialectical Behavioural Therapy (DBT), Exposure and Response Prevention (ERP), Mindfulness-Based Cognitive Therapy (MBCT), and Acceptance and Commitment Therapy (ACT). 

The CBT Clinic

On January 16^th, 2023, the Centre for Interpersonal Relationships (CFIR) opened its doors to The CBT Clinic. CFIR is poised to provide cognitive-behavioural therapy in a client-centered fashion, tailored to your specific needs. The CBT Clinic includes a large number of empathic and caring mental health professionals that can see clients virtually, and in-person at our sites in Ottawa and Toronto. 

Dr. Marc Bedard, C.Psych. is a psychologist and neuropsychologist at the Centre for Interpersonal Relationships (CFIR). Dr. Bedard provides psychological services to individual adults experiencing a wide range of psychological and relationship difficulties related to mood and anxiety disorders, trauma, eating disorders, sleep disruptions, and interpersonal betrayal. He works from a client-centered approach and integrates therapeutic techniques from object relations, ego, and self-psychology psychotherapies, emotion-focused therapy (EFT), and cognitive-behavioral therapy (CBT). He also provides neuropsychological assessment services to individuals with acquired brain injury, post-concussive difficulties, and to diagnose issues related to neurodivergence (e.g., Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder). Dr. Bedard is the Director of the Cognitive Behavioural Therapy Clinic (CBT-C) at CFIR. 

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.

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.

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