WADING THROUGH YOUR MENTAL HEALTH TREATMENT OPTIONS—CONSIDERING YOUR NEXT STEPS TOWARD BRIGHTER, CALMER DAYS

Each year, millions of Canadians suffer from mild to debilitating bouts of depression and anxiety. “It’s so hard to figure out what next steps to take when your attention, concentration, emotional distress and basic sense of vitality are so affected by declining mental health” says Dr. Lila Z. Hakim, C.Psych, Centre Director at the Centre for Interpersonal Relationships in both downtown Ottawa and Toronto.

Figuring out your next steps isn’t so easy. Clients are often overwhelmed by the numerous choices and decisions that have to be made about treatment possibilities and who might be the appropriate mental health professional to help them.

Decades of research on depression and anxiety point to biological, attachment, developmental, childhood trauma, socio-cultural context, environment, emotional, cognitive, behavioural, personality and interpersonal factors as possible precipitators of symptoms. What’s causing you to be depressed and anxious can be complex to sort through.

“CFIR mental health clinicians employ a biopsychosocial model to understand and capture a broad picture of the factors that may be affecting your well-being. It’s not always so simple that there is only a sole factor underlying your symptoms—sometimes many factors have to be considered to address the different layers underlying a person’s distress” cautions Dr. Hakim, C.Psych., “and it’s important to find a practitioner that can understand your depression and anxiety in complex ways. For example, sometimes it’s not just about changing thoughts and how you are thinking about a situation.”

Choices and decisions also have to be made about treatment —medication and/or psychological treatment and what type of psychotherapy might be best for you. Adding to the burden of decision-making is the recent advent of computerized psychological treatments—where treatment involves minimal contact with a care provider. Dr. Hakim, C.Psych. offers several suggestions to help you wade through these complex waters.

“It’s always important to have a general physical health exam to rule out physical causes for your depression and anxiety. Your physician can help you with decisions about which medication might be best for you, and there’s even testing you can have done that can inform you about which medications might have lesser side effects for you. Physicians have different levels of training in mental health treatment and do provide medication options. You might want to also seek out a professional trained as a mental health practitioner along with your visit to your doctor”, according to Dr. Hakim, C.Psych.

Whether you decide to take medication or engage in psychotherapy as a first line treatment approach will depend on you. Numerous research studies, however, have been conducted to guide clients on this subject. Dr. Hakim, C.Psych provides insights from these studies; “Research shows that psychotherapy is effective for mild to moderate symptoms, and a combination of both medication and psychotherapy might be the way to go for individuals with severe and debilitating symptoms. Medication increases neurotransmitters in your brain and can make you feel better, and adding psychotherapy to the mix improves outcomes because the other possible factors underlying your depression and anxiety symptoms still have to be addressed.”

When it comes to choosing what type of psychotherapy might be right for you, clients have further complex decisions in front of them. Dr. Hakim, C.Psych. provides further guidance to help you sort through these decisions. “Some mental health care professionals provide clients with support to change the way they think about situations, or provide skills and strategies to deal with distress and symptoms (e.g., Cognitive-Behavioural Therapy). These types of approaches try to help the client to feel better by managing symptoms, yet there are often many potential factors underlying anxiety and depression. Other mental health care professionals will work with your past and present-day experiences to help you gain awareness and insight into your emotions, self and relationship patterns, self-protection and defences that interfere with healthy functioning. These approaches help you to find more adaptive responses to everyday life but requires a deeper exploration of and engagement with the individual’s emotions, self and past experiences (e.g., Psychodynamic Therapy).”

Some individuals may prefer to learn strategies to diminish symptoms and feel good without deeply understanding themselves by exploring their pasts and emotional reactions to every day life while others may want to understand themselves more profoundly. “The idea that our past influences our present-day experience is a commonly held notion in the field. The way we think and feel about ourselves, think and emotionally react and respond to others, and how we behave and relate to others in our present-day is highly influenced by our past experiences” according to Dr. Hakim, C.Psych. Her final word on this topic is “that finding a mental health clinician who can flexibly work with you and integrate different psychotherapy models might provide more opportunities to work on different factors underlying depression and anxiety symptoms.” This view of treatment is the basic philosophy that underlies the treatment approach offered by the over 75 mental health clinicians at Dr. Hakim, C.Psych.’s centre. They offer flexible treatment options to work with different factors underlying anxiety and depression, and can move between symptom and distress management to working with deeper underlying factors causing your distress.

Finally, Dr. Hakim, C.Psych. shares her perspective on computerized psychological treatment. ‘In Ontario, free computerized psychological treatment services are offered, which is good and I do refer my clients to these sites as an adjunct to the treatment I am providing. Computerized treatment isn’t for everyone and doesn’t necessarily capture the complex factors underlying a unique individuals struggles with depression and anxiety. Sitting alone in front of a computer with only intermittent meetings with a mental health care professional may not allow for the necessary support and treatment related to the numerous factors underlying symptoms. Depression and anxiety have attachment, developmental, emotional, personality and interpersonal factors that are difficult to address on a computer.”

Integrative Therapy: What is it? Why is it important?

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.

Six Reasons to Book Your Appointment at CFIR Toronto Today

Did you know that Centre for Interpersonal Relationships (Toronto) opened the doors to our new, spacious office located at 790 Bay St. in June 2018? Our relocation is an exciting chapter in the story of CFIR as we continue to provide accessible and flexible mental health services for children, adolescents, adults, couples, families & groups. There are a lot of good reasons to consider coming to CFIR’s Toronto location for an appointment. Here are six that immediately come to mind:

1. Vast Clinical Experience – Psychologists at CFIR are skilled professionals ready to address the cognitive, emotional, behavioural, interpersonal and socio-cultural dimensions of your concerns. 

2. Location – 790 Bay Street is a medical office building located in the heart of downtown Toronto. CFIR is now just steps from major downtown hospitals including Women’s College Hospital, Mount Sinai Hospital, Sick Kids Hosptial. We’re also in very close proximity to College Subway Station, and buses as well as the PATH (our underground walkway through the business district). On-site and underground paid parking is available.

3. Broad and Flexible Treatment Options – We believe it is crucial for your clinician to be able to be flexible in offering a variety of scientific, evidence-based treatments to address the various facets of your concerns. No one treatment fits all, so we provide you with different possibilities.  At CFIR, we take an integrative approach to treatment, to ensure we tailor them to each client’s needs. 

4. One Stop for All Mental Health Issues – CFIR provides a wide-range of specialized services to support you:

Treatment Services:

  • Adolescent Psychology
  • Adoption
  • Anger & Emotion Regulation
  • Anxiety & Stress
  • Attention Deficit & Learning Challenges
  • Career & Workplace
  • Child Psychology
  • Couples Therapy
  • Depression Mood & Grief
  • Eating Weight & Body Image
  • Family Psychology
  • Fertility Counselling
  • Forensic Treatment
  • Health Psychology
  • Interpersonal Relationships 
  • Multicultural
  • Neuropsychology
  • Obsessive-Compulsive
  • Personality
  • Rehabilitation Psychology
  • Self-Growth & Self-Esteem
  • Sex Therapy
  • Sexual Addiction
  • Sexuality Gender & Relationship Diversity
  • Substance Use
  • Trauma Psychology & PTSD

Assessment Services:

  • Adoption Assessment
  • Alcohol & Drug Evaluation
  • Attention Deficit & ADHD
  • Autism Spectrum & Developmental Disorder
  • Career & Vocational
  • Couples & Pre-Marital
  • Disability Injury & Accident
  • Fertility & Third-Party Reproduction
  • Forensic Assessment
  • Immigration & Refugee
  • Neuropsychological Assessment
  • Personality & Interpersonal Functioning
  • Psychodiagnosis & Mental Health
  • Psychoeducation Assessment
  • Trauma & Dissociation

5. Remote Support that Can Come to You – We make it easier to address your concerns by offering you a secure, confidential and private way for you to get the care that you need via our optional SecureVideo Telepsychology Service.*

6. Coverage by Most Insurance Plans – Private extended insurance plans (as well as Medavie/BlueCross (RCMP, Veterans Affairs, Canadian Armed Forces) and CUPE) provide coverage for CFIR services.  Our Psychologists are approved providers of the Canadian Interim Federal Health Program (IFHP) for Refugees.  

Clinicians at CFIR will conduct a comprehensive assessment to identify the factors that have contributed to your concerns. The assessment is followed up with a treatment plan to address your issues and provide you with a sense of the treatment duration, and what type of progress and change you can expect over time.

There you have it, six solid reasons to book your initial appointment at CFIR – Toronto today. With offices in Toronto and Ottawa, we’ll get you started on your journey towards positive change.  Click here to request your session.

*SecureVideo Telepsychology Services are only available for Ontario residents. 

How We Approach Treatment Options at CFIR

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.

CFIR OTTAWA is moving to its new home JULY 4TH, 2022. Click here for more details.