The Big Tent of Psychotherapy

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

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

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

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

What is CBT and How Can It Help You?

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.

What to Consider When Choosing Psychotherapy Over Medication

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://www.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, visit https://www.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

The Impact of Traumatic Events in Our Life: Healing in the Aftermath

by: Darcy Minick, Masters Candidate and Dr. Dino Zuccarini, C.Psych.

Are you struggling with the after-effects of past traumatic experiences in your present day? Many of us will experience at least one traumatic incident in our lifetime --- an unpredictable, out of the ordinary experience or incident that yields overwhelming helplessness, fear, powerlessness or intense isolation from others. The emotional residue of these traumatic incidents can wreak havoc inside of us, and interfere with our capacity to be intimately engaged in our important relationships. Traumatic incidents can shatter our sense of self and identity and our sense of the world around us.

In this post, we will provide you with some basic facts about trauma, and how these difficult life experiences may be affecting your life in the present day.

The good news though is that trauma can be healed. As Peter Levin has put it: “Trauma is a fact of life. It does not have to be a life sentence ... And there are so many things that we can do in prevention and healing."

What is Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder?

In the fields of medicine, psychiatry, clinical and counseling psychology, two different diagnostic categories have been used to understand trauma:

Post-Traumatic Stress Disorder (PTSD) develops after an overwhelming life experience, such as accidents, war, abductions, sexual assault and violence, or natural disasters such as floods or earthquakes. These types of traumatic incidents involve us experiencing either actual physical harm or the threat of physical harm to ourselves.

Complex Post-Traumatic Stress Disorder (Complex PTSD) results from stressors that may have occurred repeatedly and chronically in our lives. Sexual or physical abuse, often from early in life, over the course of childhood and in the context of the family, domestic abuse or military deployments into dangerous locales can all be causes of Complex PTSD. 

As a result of these experiences, our bodies and minds employ their natural defense systems --- our fight, flight, freeze responses --- to offset the threat. It is important for us to be able to eventually relinquish this natural defense system and return to normal levels of emotional and physiological arousal in our bodies --- that allows us to feel safe in the world again. Our ability to do so, however, can be impaired as a result of momentary or chronic traumatic experiences. Traumatic experiences can create a basic rupture, or loss of connection --- to our self, our family, and the world around us. Instead, we can be left with a sense of danger, insecurity, and disconnection in our lives. Restoring a sense of safety and security, learning how to make sense of the traumatic experience that we’ve endured, and re-connecting to our self and others again in the aftermath of this incident is critical to the healing process. Without such healing, many physical and psychological symptoms can emerge in our lives.

Common Symptoms of Trauma

Physical reactions can include the following:

• Bodily aches and pains
• Sudden sweating and/or heart palpitations
• Changes in sleep patterns, appetite, interest in sex
• Easily startled by noises or unexpected touch
• Tensions that some people will soothe with the use of alcohol or drugs and/or overeating

Emotional reactions can include the following:

• Flashbacks --- feeling like the trauma is happening now
• Feelings of guilt and shame
• Fear and/or anxiety, or depression
• Attempts to avoid anything associated with trauma
• Hyper-alertness or hyper-vigilance
• Feelings of detachment, or dissociation
• Inability to trust self or other
• Upsetting memories of the trauma, or lost memories
• Suicidal thoughts

How Can an Unresolved Trauma be Healed?

"When treated thoroughly, healing can lead not only to symptom reduction, but long-term transformation.” Peter Levine.

People are usually surprised when they begin to understand that some of the psychological and physical symptoms they have experienced are caused by previous traumatic experiences. Many people will get through this period with the help of family and friends, and the support of a therapist.

Here are some tips on how to cope, or diminish emotional and physical distress associated with trauma-related symptoms:

1. Mobilize a support system --- reaching out and connecting with others
2. Commit to an exercise routine --- energetic exercise like jogging, aerobics, bicycling, walking --- can help modulate our natural defence system.
3. Explore exercises and strategies to promote relaxation and diminish the impact of traumatic stress, including - breathing, relaxation, or exercise like yoga, stretching, massage hot baths prayer and/or meditation, listening to relaxing guided imagery, listening to music and viewing art or progressive deep muscle relaxation.
4. Try to find humour and the brighter, lighter sides of life -- doing so can counter the negative effects of traumatic stress;
5. Maintain a balanced diet and sleep cycle as much as possible, which includes not over-using stimulants like caffeine, sugar, or nicotine --- increasing arousal can create negative effects for individuals whose natural defence systems are in overdrive as a result of traumatic stress.

Psychotherapy is an essential component of your healing process. Research affirms that therapy can help you to process the intense emotions associated with traumatic incidents and diminish trauma-related symptoms.

CFIR's Trauma Psychology & PTSD Service offers individuals and couples assessment and treatment of different types of traumatic stress. A comprehensive psychological assessment is conducted to understand the psychological impact of trauma on an individual’s self-development and personality, his or her present-day distressing cognitions, emotions and behaviours, and relationship functioning.

We employ a phase-specific treatment model that integrates trauma-focused, cognitive-behavioural, psychodynamic, ego-state, mindfulness-based, and experiential strategies to address the debilitating symptoms associated with traumatic stress. Our phase-specific and compassion-focused approach allows us to develop customized treatment options that meet the unique needs of every individual or couple.


Read more about our Trauma Psychology & PTSD Treatment Service.