Wednesday, October 21, 2015


Dr. Lila Hakim, C.Psych. & Dr. Dino Zuccarini, C.Psych.

Many of us will experience a self or existential crisis during our lifetime. These crises are usually precipitated by life transitions. Life transitions that can trigger a crisis include: aging, changes in relationship status (i.e., marriage, separation and divorce), betrayals and loss of loved ones (e.g., death of parent, partner or child), changes in our identity (e.g., children leaving home, loss of youth, and perceived attractiveness), and recognition of our own mortality and the end of our life. Such moments may spawn a search for meaning, purpose, and connection to others and the world around us, or result in a downward spiral and deepening crisis involving hopelessness, despair and anxiety, and suicidal ideation.

Some individuals struggling with such crises have spent numerous years disconnected from their own selves by virtue of not pursuing their authentic feelings, needs, and desires in the world. Instead, these individuals may have surrendered to the expectations and demands of others. Recognition of the freedom to create one’s entire world may be daunting for some individuals in these circumstances, but is key to the recovery from such a crisis. 

Some individuals experience a mid-life crisis brought upon by specific concerns about mid-life transitions and an impending sense that a decline is imminent. Mid-life can involve a reframing of life and deep reflection on life in terms of years left to live. With parents passing away, children moving out of the family home, and dissatisfaction with self (i.e., physical and bodily changes related to aging, dissatisfaction with relationship, career and accomplishments), some individuals will experience despair and hopelessness. A crisis can ensue upon realization of the passing of time with very few opportunities to change life’s course. This realization may precipitate intense emotions, a desperate search and effort to change one’s life. Seeking out younger partners, drastic changes to physical appearance, or career may ensue.

The Self-Growth and Self-Esteem Service at CFIR supports clients to deal with particular life issues that involve one’s questioning of the purpose, meaning, and value of one’s life, and difficult feelings associated with being alone and isolated. Such moments can leave us questioning past and current decisions related to our choices in occupation, residence, and relationship partners.


Dr. Aleks Milosevic, C.Psych.

Our deepest sense of our own worth or value is an important part of our self-esteem. Having a positive sense of self-esteem involves being able to hold a solid sense of being a good person, making life decisions that are respectful toward ourselves, and having a sense of worth and competency. Our early childhood experience in our family of origin has a significant impact on how our self-esteem develops. Peer relations and then relationship partners also have an impact on our self-concept. Our relationships to others will play a role in how we view ourselves, the confidence we have in our selves, and our deepest sense that we are good and competent individuals; in short, we are more likely to have a good sense of our own value and worth. This good sense of our own value and worth affects how we talk to ourselves, the choices and decisions we make for ourselves in everyday life, and how we will experience and manage our relationships with others. Healthy self-esteem adds to our sense of resilience.

Individuals with low self-esteem often struggle to come in touch, or maintain, a sense of being a good and competent person. Typically, individuals with low self-esteem experienced challenging early life environments that may have involved harsh criticalness about appearance, intelligence, or clothing by family members or peers, bullying and teasing, emotional, physical, and sexual abuse and neglect, obstacles that blocked achievement, or mistreatment based on social identity (e.g., gender, sexuality, race) or on a learning or physical disability. As a result of these experiences, one might be more self-critical, preoccupied by doubt and uncertainty, overly driven by perfectionistic standards and ideals, have less belief in one’s ability to achieve or accomplish, or experience an increased sense of anxiety, loneliness, and shame that block them from building relationships with others.

When we did not develop a positive sense of self-esteem, we are less able to tolerate challenging life moments and sudden life changes, to cope with adversity and perceived failure, or to deal with work and relationship issues. Lower self-esteem diminishes our ability to deal with these moments. Life challenges and financial, relationship, and career difficulties or failures can also have an impact on our self-esteem.

Some individuals have overly-inflated self-esteem or fluctuating self-esteem. In cases of overly-inflated self-esteem, an individual may be compensating for low self-esteem. Typically, this includes over-working, or over-achieving at the expense of mental, physical health, and relationships. They may also overestimate what they are able to achieve or accomplish, and set unrealistic goals with the intention of improving their sense of value and worth. Sometimes individuals oscillate between periods marked by anxiety and depression as they shift from experiencing low to overly high self-esteem. 

There are many dimensions to self-esteem. CFIR psychologists and clinicians in our Self-Growth & Self-Esteem Service are skilled in being able to understand how your self-esteem developed, and the necessary steps to foster a positive and healthy sense of self-esteem in the ‘here and now’.


Dr. Dino Zuccarini, C.Psych. & Dr. Lila Hakim, C.Psych.

Being able to communicate in an efficient and effective manner in a relationship is important. Each individual in a relationship will have his or her own feelings, needs, wants, desires, opinions, and values to share on a wide range of topics from intimacy needs, children and parenting issues, relationship to in-laws, household roles, duties and tasks, finances, and balancing life-work and family demands. Inevitably partners will have different expectations about how to address these topics. Effective communication strategies allow individuals or couple partners to be able to navigate life’s issues in a manner in which both partners feel valued, seen, and heard. Individuals or couple partners who are also equipped with conflict resolution, problem-solving, and negotiation skills are able to deal with difficult relationship moments in which there is disagreement and when problem resolution seems impossible.

When partners are distressed, they tend to fall into negative communication patterns that escalate into negative displays of emotion or withdrawals. Couples who are ill-equipped to resolve problems and are unable to negotiate, stay stuck in conflict and eventually engage in high-conflict interactions or distancing.

CFIR psychologists and clinicians are skilled in supporting you to develop solid relationship communication skills. We help you to learn how to resolve your problems, express and assert yourself, and negotiate with others on topics of great concern to you.

The Relationship and Sex Therapy Service at CFIR offers clients comprehensive assessment, psychotherapy, and counselling to address a wide range of relationship and/or sexual issues for both individuals and couples. In terms of treatment, we offer individual, couple, and group therapy to help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills (e.g., communication, problem-solving and negotiation skills), and address sexual issues that interfere with sexual satisfaction and fulfilment, regardless of sexual orientation.


Dr. Dino Zuccarini, C.Psych. & Dr. Lila Hakim, C.Psych.

Our ability to trust another person is core to our being able to create and sustain close intimate relationships. When we are able to trust another, we reap the emotional rewards of feeling connected to others. Trust is an antidote against any sense of isolation and non-belonging as it allows us to develop relationships in which others can be experienced in a manner that feels emotionally safe and secure. We initially learn to trust others in our relationship with our parents, then our peers, and eventually our relationship partners. Sometimes when we have difficult early relationship experiences we lose our bearings in terms of whom to trust and how to trust another person.

Trust can be eroded when we are hurt, frightened, or angered by the behaviour of those to whom we are most attached. Emotional, sexual, or physical abuse or neglect in our early years, or past and current relationships can breakdown our capacity to trust another, particularly when abuse or neglect occurred by someone who we expected to be a source of safety and security for us. At other times, betrayals and emotional injuries arising from a perceived lack of support from our relationship can also alter our sense of the other person’s reliability, dependability, and trustworthiness. Sexual and emotional affairs, betrayals, and emotional injuries in close couple relationships also erode and create serious ruptures to the attachment bond between partners. These types of emotional injuries in our family of origin and our relationships with friends and partners can leave emotional residue. These injuries then become triggers that are activated in our relationships and that block us from feeling safe and secure with others.

We help you to learn how to trust again in the aftermath of different types of incidents that have eroded your trust in relationships. 

The Relationship and Sex Therapy Service at CFIR offers clients comprehensive assessment, psychotherapy, and counselling to address a wide range of relationship and/or sexual issues for both individuals and couples. In terms of treatment, we offer individual, couple, and group therapy to help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills (e.g., communication, problem-solving and negotiation skills), and address sexual issues that interfere with sexual satisfaction and fulfilment, regardless of sexual orientation.

Read more about our Relationship & Sex Therapy Treatment Service.


Dr. Lila Hakim, C.Psych. & Dr. Dino Zuccarini, C.Psych.

Sexuality is an important part of who we are. At CFIR, we promote healthy sexuality. An important first step is to ensure that individuals and couple partners have access to accurate information about sex and how our bodies work, and an understanding of the physical (e.g., contraception, sexually-transmitted infections) and emotional risks involved in expressing ourselves sexually. Healthy sexuality also involves being comfortable with ourselves (i.e., liking our bodies, finding ourselves attractive, being aware of and accepting our desires and fantasies, feeling capable sexually, knowing our sexual boundaries and asserting our limits), being able to experience sexually arousing feelings, communicating our sexual desires, and engaging in satisfying intimate-sexual relations with others.

Sexuality, however, can also be a source of great distress. Distress can occur when we do not have accurate knowledge or information, or are experiencing sexual functioning problems or sexual and pornography addictions. Some of our sexual issues flow from a lack of, or inaccurate, knowledge about how our bodies actually function, or distress over fears of pregnancy or sexually transmitted infections. A lack of knowledge can create anxiety about decisions and choices and sexual expressions. 

Sexual functioning problems related to desire, arousal, and orgasm are also a source of emotional distress for individuals and couples. The causes of such problems are vast. Sexual functioning is affected by a wide range of organic, biological, and medical issues, as well as social, cultural, and psychological factors. Some of us become overly consumed by negative thoughts and emotional reactions about oneself (e.g., our bodies, genitalia, sexual performance), or our sexual partner. We may also engage in relationship or sexual patterns that diminish arousal and the desire/interest in sex. Some individuals experience sexual pain or other difficulties during sexual intercourse due to a complex blend of physical or psychological factors.

Some individuals will struggle with sexual or pornography addictions, including the use of internet porn, massage parlours, or risky sexual encounters. In these situations, individuals and their relationship partners may experience significant distress. Sexual functioning issues, regardless of their origins, can block an individual and couples from experiencing positive feelings, such as joy and pleasure, within the sexual aspect of the relationship. Sexual issues can also spill over into other aspects of the relationship, including emotional and physical intimacy.

CFIR psychologists and clinicians have published research and theoretical articles in peer-reviewed journals, and written book chapters in the area of couple and sex therapy. We help you by providing a comprehensive psychological assessment to help you understand the causes of your sexual difficulties and then develop the most appropriate treatment plan to address underlying causes. We are well-informed about contraception, sexually-transmitted infections, and the physical aspects of sexual functioning, and the psycho-social issues associated with these topics. We also support clients to develop sexual authenticity through supporting them to clarify desires and remove blocks to the expression and assertion of their sexual needs in relationships. We also help to resolve sexual functioning issues to restore one’s sexuality as a source of joy, sensuous pleasure, and connection.

The Relationship and Sex Therapy Service at CFIR offers clients comprehensive assessment, psychotherapy, and counselling to address a wide range of relationship and/or sexual issues for both individuals and couples. In terms of treatment, we offer individual, couple, and group therapy to help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills (e.g., communication, problem-solving and negotiation skills), and address sexual issues that interfere with sexual satisfaction and fulfilment, regardless of sexual orientation.


Dr. Dino Zuccarini, C.Psych. & Dr. Lila Hakim, C.Psych.

Emotional, physical, and sexual intimacy can be considered essential components of adult attachment bonds. Our capacity to engage in an intimate manner contributes to our ability to form and maintain mutually satisfying, long-term relationships. Emotional intimacy allows partners to feel seen, heard, and understood. Emotional closeness is core to developing satisfying couple physical and sexual intimacy.

When partners feel emotionally close, physical touch and sexual contact seem less threatening and more rewarding. A solid emotional connection allows individuals to be present and engage moment-by-moment in encounters involving intimate physical and sexual contact. Within this context, more intimate, arousing, pleasurable, and erotic encounters are then possible. On the other hand, when partners lack emotional closeness, they feel distanced or engage in circular, escalating conflicts as they strive to be understood and have their needs met by the other. Negative feelings and emotions begin to accumulate when partners are unable to intimately engage.

In some cases, a partner may fear intimacy, or lack the skills to engage in an intimate manner about their feelings, needs or desires, or lack knowledge about how to respond to the other’s feelings. When communication breaks down, unprocessed negative emotions accumulate. Unable to process their feelings and needs, partners engage in rigid, negative patterns with one another. They begin to distance from each other, experience separation fears, and engage in high-conflict exchanges in their effort to protect themselves from the growing sense of disconnection in the relationship.

CFIR psychologists and clinicians help individuals and couple partners learn how to identify, express, and assert their selves in their relationships to others. We also support individuals and partners on how to exit from difficult relationship patterns and become more accessible and responsive to one another.  Healthy relationship and sexual functioning are important in maintaining a good sense of ourselves. Both our physical and mental well-being is improved when we have the ability to create and sustain intimate relationships with others both outside and inside the bedroom. In fact, research affirms that many individuals struggle in their efforts to maintain relationship and sexual satisfaction throughout their lives, and that dissatisfaction in these arenas of life can have an impact on our mental and physical health.


Dr. Dino Zuccarini, C.Psych.

We all have a personality. Our personality is shaped by a wide range of factors, including genetic, psychological, and environmental. Some individuals develop personalities that will allow them to have a good sense of self and have healthy relationships with others. These individuals experience an overall positive sense of self (i.e., healthy self-esteem, positive sense of lovability, worth and competence, and the capacity for healthy self-reliance and autonomy) and are able to create healthy interpersonal relationships at home and work. A solid and overall positive sense of self and others allows us to tolerate uncertainties, ambiguity, and aloneness in relationships and in life in general. It makes us more confident to direct our lives in a meaningful, purposeful, and authentic manner. 

These individuals also tend to be flexible in how they think and emotionally react to themselves and others. This allows for adaptation particularly in difficult and stressful life moments. These individuals may also have greater capacities to self-soothe when emotionally distressed, yet also be comfortable reaching for others when efforts to assuage his or her distress fail. They will also be able to identify, label, and assert authentic feelings, emotions, and needs in relationships while empathizing and connecting to the feelings, emotions, and needs of others. The capacity to reflect on and empathize with one’s self and others (e.g., intentions, motivations, feelings, emotions, needs and desires) is also essential to develop a healthy sense of self and others, and essential to create healthy interpersonal relationships. These capacities allow us to appropriately adapt our self to others and our environment as opposed to acting too hastily on our own thoughts, feelings, and needs. These capacities also allow us to assert our authentic selves and respond to others’ authentic selves. Maintaining an open, present, curious stance about one’s own and others’ intentions and motivations also allows for greater reflection and more time to observe reality, as opposed to jumping to conclusions about our selves or others. Being present-focused and non-defensive is most important in developing healthy interpersonal relationships.

Due to complex factors, including such circumstances as emotional, physical and/or sexual abuse, and experiences of neglect, some individuals will develop an overall negative sense of self and overall negative sense of others. They will further experience a wide range of problems, including rigid, inflexible negative thinking or beliefs about themselves or others. Rigid, negative thinking about our self and others can create serious emotional distress and challenges in managing our emotions (e.g., intense emotional outbursts, moments of deep hopelessness and despair, depression and anxiety, chronic emptiness, withdrawal or detachment from others). These individuals further struggle with maintaining a sense of their own and others’ boundaries. Some individuals will engage in self-sabotaging and self-injurious behaviours, and express suicidal tendencies to deal with intense feelings and impulses.

Individuals experiencing personality and interpersonal difficulties also report an unstable sense of self and others in relationships. They may experience over-sensitivity to rejection, abandonment, and punishment. An overly negative or overly inflated sense of self and others may also be evident. An unclear or altering sense of self, identity, values, and principles may further contribute to emotional distress. Relationships may be difficult as a result of an inability to tolerate aloneness, an over-dependency on others or hyper-self reliance, or ongoing emotional chaos, conflict, or avoidance in interpersonal relationships. These relationship difficulties create interpersonal chaos and create difficulties sustaining long-term relationships. Finally, these individuals may also experience other mental health issues, including eating disorders, mood and anxiety disorders, and substance use issues.

The Personality Service at CFIR offers clients comprehensive psychological assessment and treatment of difficulties associated with personality and interpersonal functioning that create long-term challenges in their everyday functioning at school, work, or home. A comprehensive and lengthy assessment procedure is required to diagnose a personality disorder to ensure appropriate treatment planning. When personality issues are present, treatment is typically required for a lengthy period of time (i.e., up to 2 years). Clients must be motivated to change and be committed to attend regularly scheduled sessions.

Read more about our Personality Treatment Service.


Dr. Lila Hakim, C.Psych.

Parents are often challenged by the shifting parenting strategies required to respond to their children’s changing developmental capacities and needs. When child-caregiver interactions meet children’s developmental needs, positive mental health outcomes are more likely in the short-term and down the road. 

Developmentally Sensitive Parenting: Child-caregiver interactions are important in a child’s development. These interactions have a long-lasting impact on our children’s self development, the quality of relationships with others, and their overall psychological well-being. Parenting requires sensitivity to a child’s emerging developmental needs. 

Sometimes parents are unable to respond to developmental milestones, which then affects the child’s self-development. When parenting is out of sync with these important developmental milestones, it can be disruptive to healthy development and potentially compromise the security of the parent-child bond and the mental well-being of the child. In these circumstances, children and adolescents may begin to experience psychological symptoms and distress. CFIR psychologists can help you to parent in a manner that is sensitive to these developmental milestones. We help you develop strategies to respond to your children’s changing capacities and needs.

Parenting through Separation & Divorce: Parenting a child in the context of separation and divorce can be challenging. Learning how to talk to your children about separation and divorce in a developmentally-appropriate way is important to support children to deal with this difficult life transition. Often emotional distance, anger, and hurt in the primary couple relationship will have coloured home life for a long period of time prior to separation or divorce. Loss and grief experienced by the family breakdown and the eventual termination of the parent’s relationship have a reverberating effect on children. Learning how to effectively deal with children during the separation and divorce process supports parents and their children to ensure healthier psychological outcomes. CFIR psychologists can support you to address parenting issues in the context of separation and divorce, including navigating through emotionally difficult conversations associated with the various transitions involved in separation and divorce (i.e., leaving family home, child access, co-parenting).
Co-parenting: In the aftermath of divorce, parents are often challenged to create a new parenting relationship, particularly when children are young. Although the couple relationship did not work, parenting continues to be a shared responsibility. Developing an effective co-parenting strategy minimizes the impact of separation and divorce on children. Often this requires divorced parents to develop a collaborative strategy of care, despite the fact that their relationship is ending. Our clinicians can help you to resolve your co-parenting conflicts and develop a satisfying co-parenting relationship in the aftermath of separation and divorce.

Step-parenting: Bringing a step-parent into a child’s world can be challenging. Often parents are unsure of how to integrate the step-parent into the child’s world. The role of the step-parent must be clarified in a manner in which the child’s relationship with both of their parents is not harmed in any manner. Step-parents have a role to play in their step-children’s lives, but the process of integration is crucial to how this relationship will evolve. CFIR psychologists and clinicians are skilled in supporting you to develop a healthy blended family environment.


Dr. Lila Hakim, C.Psych.

Our rehabilitation and health psychologists can help you to address the psychosocial impact of pain, injuries and disabilities in your life.


Acute and chronic pain can be a serious and debilitating life issue. Pain is often associated with physical limitations that require life adjustments. Pain tends to be accompanied by a wide range of emotional issues including depressed mood, low motivation, hopelessness, grief, anger, or anxiety. In addition, we may experience problems with concentration or memory as a result of pain and low mood or anxiety. The experience of pain can have an impact on how we view our selves and our sense of autonomy, which can affect our couple, family, and work relationships.

Disability and Injuries

Regardless of the manner in which a person is injured, whether gradually through a work-related task, or suddenly such as through a slip-and-fall or motor vehicle accident, there are a host of emotions that can occur that can affect engagement in everyday life activities (e.g., socializing). In the case of a sudden injury, a number of traumatic stress symptoms can occur, such as nightmares and flashbacks. Avoidance of important activities, such as driving, can also serve to worsen our emotional state and sense of autonomy, and affect our recovery. 

Regardless of the manner in which a person is injured, whether gradually through a work-related task, or suddenly such as through a slip-and-fall or motor vehicle accident, there are a host of emotions that can occur that can affect engagement in everyday life activities (e.g., socializing). In the case of sudden injury, a number of traumatic stress symptoms can occur, such as nightmares and flashbacks. Avoidance of important activities, such as driving, can also serve to worsen our emotional state and sense of autonomy, and affect our recovery. 

Engagement in physical treatments can be affected by emotional issues such as traumatic stress, low motivation, hopelessness, or anxiety. Considerations about returning to the workforce and how to engage in life roles (e.g., parental, couple) are important to resolve. Accessing support from friends and family can be difficult at times, resulting in the feeling that nobody understands your pain and limitations.


At CFIR, we help you to cope and manage your experience of pain and adapt to your injuries and disabilities. In terms of your pain, your experience of pain is influenced by our thoughts, emotional reactions, and everyday stress. Certain ways of thinking and emotionally reacting to the world can heighten the perception of pain and intensify the pain we are experiencing. Environmental stressors, relationship problems, and a lack of social support can also influence how we view our pain and limitations. We will help you to address these psychological challenges, including making lifestyle adjustments, to support you to cope with your pain. In terms of your injuries and disability, we will also help you deal with the psycho-social aspects of your injury and disability by supporting you to adapt your lifestyle and build new skills to deal with your physical incapacities. We’ll also help you deal with the grief, helpless, hopeless and anxious feelings that can accompany changes to your physical health status.


Dr. Dino Zuccarini, C.Psych.

Our health psychologists can help you to cope with a wide range of health concerns.  

Chronic Illness: Individuals experiencing chronic illnesses, such as diabetes, HIV, hypertension, and irritable bowel syndrome (IBS), suffer from debilitating physical symptoms that influence how they function in everyday life. Management of these medical conditions requires medication and lifestyle modifications. A psychologist can support individuals to adapt to the lifestyle changes required to manage chronic illness, including adhering to treatment regimens as well as dealing with the psychological and emotional aspects of the debilitating side effects of treatment or the disease itself. Often overlooked is the importance of our psychological and emotional well-being in dealing with a chronic illness. Depression and anxiety can emerge as we adapt to our new medical realities. Our psychological and emotional functioning can exacerbate or worsen our experience of a chronic, manageable illness.

Life Threatening Illness: Individuals experiencing life threatening illnesses experience physical health issues associated with the disease process and treatment that can influence their emotional well-being and psychological functioning. Being calm and relaxed and maintaining a positive sense of emotional well-being during medical treatments, while challenging, can buffer clients from the distress associated with medical procedures and hospitalizations. Making sense of, and coping with, the negative emotional reactions associated with uncertainty can alleviate our emotional distress during these difficult life moments. Adapting to treatment regimens and medical appointments can create emotional distress. Treatments can also affect our psychological functioning, which alters our sense of self and the world around us. Anxiety and depression can also grow out of the uncertainties of our medical circumstances.
Terminal Illness: Facing a terminal illness precipitates a wide-range of emotional reactions, including fear, anger, sadness, and grief. Moving toward acceptance is an internal journey. The disease process and treatment of the disease can bring about debilitating side-effects, and can also affect our emotional and mental health status, and our psychological functioning. Making sense of our circumstances and lives, and dealing with the emotions associated with a terminal diagnosis can be overwhelming.
Smoking Cessation, Weight Concerns, Healthier Lifestyle: Whether you’re looking to quit smoking, lose a few pounds, or make healthier lifestyle choices, there are several stages one goes through to change behaviours. Whether contemplating change or actively attempting to change, maintaining healthy behaviours requires us to be attentive and mindful to the self and environmental triggers that stimulate us to engage in these behaviours. Learning how to maintain healthy behaviours, including adopting new coping strategies to address underlying stress and emotions, is an important component of behavioural change. When motivation to change an unhealthy behaviour wanes, deeper issues associated with self-esteem, self-worth, trauma, and abuse may also be present. Sometimes unhealthy behaviours serve as a source of soothing the self and dealing with difficult emotions from our past and present-day life. 


You don’t have to be alone while struggling with the physical and psychological aspects of your condition. A CFIR health psychologist can meet with you for a free consultation to help you better understand how he or she may support you through your journey with a health-related or lifestyle adaption. We offer clients comprehensive assessment and psychological treatment to address the psychological aspects of managing chronic, life-threatening or terminal illnesses or promoting healthy behaviours. CFIR clinical and health psychologists work with clients to address a wide range of psychological issues that may emerge as we encounter challenges in our efforts to manage our physical health concerns or face life threatening or terminal illnesses. We provide you with knowledge and emotional support to diminish your sense of isolation and to assuage distress associated with fear and hopelessness as you face challenges associated with health and illness. In terms of lifestyle adaptations, we can help you manage these stages of change, deal with underlying self and relationship, or past traumatic issues, and help you to find more adaptive coping mechanisms for the purpose of allowing you to live the healthier life you desire.

Read more about our Neuropsychology, Rehabilitation & Health Psychology Treatment Service.


Dr. Lila Hakim, C.Psych.

Upon birth, many couples will require some time to get used to their new home circumstances. Learning how to create and adapt to sleep and feeding schedules that suit the reality of the couple can be challenging. Numerous issues related to sleep and feeding emerge that can create distress, particularly in the context of a lack of sleep and the novelty of figuring out and managing the newborn’s needs. The relationship will transition during this period to adjust to these new circumstances. 

For some women, this period becomes complicated by depression caused by numerous physical and psychological factors, including a growing sense of isolation, emotional residues of birthing problems, sleep difficulties, and a change in sense of self and identity. Feelings of depression during this period may also be accompanied with self-criticalness and identity challenges that can then increasingly spiral into hopelessness and despair. Partners may also struggle and find themselves slipping into states of anxiety and depression. They may experience similar challenges during this transition period. 

CFIR psychologists and clinicians are able to diagnose and guide the treatment post-partum depression. We provide support individuals and couples to adjust to their initial challenges upon return to home with their newborn. We help individuals and couples establish solid networks of physical and emotional care and support to ensure that isolation is reduced. We support new parents by providing them with resources to connect to the outside community. We also provide specific psychological treatment for post-partum depression, involving both individual and couple sessions to support women to emerge from the cascading negative emotions and biological turmoil that may occur during this period.

SUPPORT FOR PERINATAL ISSUES (including traumatic birthing experiences & stillbirth)

Dr. Lila Hakim, C.Psych.

The period prior to and during birth can create significant distress for women. Women can experience high degrees of anxiety in the period just prior to the birth of a child, whether or not a low- or high-risk pregnancy is anticipated. Learning how to cope with the distressing thoughts and emotional reactions associated with anxiety may alleviate some of these symptoms. 

During the birthing experience, some women will have frightening experiences (e.g., surgical complications, neglect or ill-treatment during or after delivery, or physical trauma as a result of a difficult delivery). Women experiencing traumatic births may feel isolated and dismissed when sharing their fearful or painful experiences. They can feel hopeless about finding others to connect to about what has transpired. These types of experiences can result in post-traumatic stress in the form of recurring images, flashbacks, and painful emotional memories of what transpired during their delivery. These reactions to the event need to be processed fully in order to heal.

Finally, the emotional impact of loss of a child during birth can have a devastating impact on both partners. These effects are further complicated by the post-partum physical status of the woman. Dealing with intense grief associated with the loss of a child is a difficult process for both partners. A partner’s view of him/herself, the relationship, and the future may be altered. The loss can also have an impact on emotional and physical closeness and result in relationship deterioration.

CFIR psychologists and clinicians are skilled in addressing the post-traumatic stress associated with painful or difficult birthing experiences. We support individuals and couples in coping with the grief associated with the loss of a child. We assist individuals and couples to deal with tragic loss through education, emotional support, and processing of such traumatic experiences. We help you find a way forward during this difficult time.


Dr. Lila Hakim, C.Psych.

Maintaining physical and emotional well-being during pregnancy and while preparing for birth is important. Numerous medical tests, nutritional issues, home preparations for the newborn, and other life adjustments are required. Couple partners can sometimes become anxious about managing these changes, overwhelmed by the adjustments required, and struggle to work effectively as a team to manage medical, nutritional, and lifestyle alterations associated with pregnancy. There is a multitude of tasks to attend to in preparation for birth and a newborn. For some individuals and couples, this transition can be a significant source of distress. If pregnancy complications occur, partners can experience intense negative emotions and anxiety. Some partners have difficulties supporting each other as they try to make sense of the available medical information, and strain in the relationship may emerge at this time.

CFIR psychologists and clinicians are well-educated about the medical, nutritional, and lifestyle alterations that are typically faced during pregnancy. We support self and partner care throughout pregnancy, and work to create a solid relationship between partners during this period.


Dr. Lila Hakim, C.Psych.

The decision to end a pregnancy can come about for many reasons (e.g., medical factors, interpersonal or sexual trauma, not feeling ready or having the desire to engage in parenthood). For some individuals, considering whether or not to end a pregnancy may come with many emotions including confusion, guilt, shame, or grief. Some individuals may have difficulties coming to terms with perceived social or family pressures. In addition, the medical process of terminating a pregnancy can be physically and emotionally difficult for some women.

This distress can add to the layers of emotional distress already experienced as a result of the decision to terminate the pregnancy. At times, difficult or conflicting emotions may not surface until after the termination has occurred. Accessing professional support can be an important means to fully process the complex feelings related to a pregnancy termination.

CFIR psychologists and clinicians are committed to providing a safe therapeutic environment wherein each individual is respected and can feel free to fully discuss all aspects of their decision to end a pregnancy. Our clinicians provide emotional support and resources to clients facing such decisions, and help them to navigate through the complex thoughts and feelings they may experience.


Dr. Lila Hakim, C.Psych.

Pregnancy loss can be associated with a significant amount of emotional distress for a woman and her partner. Individuals may feel alone, frightened, angry, sad, grief-stricken, guilty, and shameful as a result of such an experience. The physical recovery process may occur more quickly than the time it takes to heal emotionally from the pregnancy loss. The loss can further negatively affect communication and intimacy in your relationship. Sexual issues may emerge due to complex feelings about the possibility of conceiving again. Working through these challenging feelings is important for healing and moving forward.

Supporting couple partners to comfort and support each other during this time is essential to emotional recovery and sustaining a strong relationship in the aftermath of loss. Moments of loss activate a deep need within us to have close emotional and physical proximity to our loved ones. We promote partners to develop closer relationships to journey through these difficult emotional experiences together. 

CFIR psychologists and clinicians provide a compassionate and caring therapeutic relationship to support women, men, and couples to come to terms with the inner emotional reactions and meanings that can emerge during these moments of loss.


Dr. Lila Hakim, C.Psych.

Individuals and couples who are pursuing assisted fertility treatments experience unique challenges. The numerous considerations associated with assisted reproduction can be overwhelming. Preparing for medical procedures can also create challenges in terms of sifting through complex information, making decisions, and altering life and work schedules to facilitate treatments. Medical procedures may also be a source of distress, and can contribute to high levels of stress and anxiety. Research affirms that individuals undergoing this process experience stress and distress at levels similar to those of other serious medical conditions. These circumstances can undermine the individual’s and couple’s emotional and physical health, which also impacts the fertility treatment process.

For individuals and couples considering assisted reproduction, counselling prior to engaging in fertility treatments provides an important source of information and support to fully prepare for the process. Research has shown that many individuals and couples find fertility counselling prior to treatment to be important and helpful, even if they did not expect it to be beforehand. Whether the choice to pursue medically-assisted reproduction is related to personal or partner infertility, a same-sex relationship, or a choice to become a single parent, fertility counselling can greatly assist in preparing for forthcoming procedures and potential stressors associated with them (e.g., IUI or IVF). In the case of third-party reproduction (e.g., Donor Sperm or Egg, Surrogacy), there are many considerations to think through beforehand, such as the choice of donor or surrogate and disclosure to children in the future. 

During the course of fertility treatments, decisions about whether to continue or discontinue can also be distressing. There may be a sense of loss or grief following unsuccessful cycles. We work to assist individuals and couples in managing the course of treatment and related decisions, and openly discuss potential alternatives as individuals or couples set out to explore other ways of becoming parents.

To support you through this process, CFIR psychologists and clinicians provide comprehensive counselling in preparation for fertility treatments in accordance with established counselling guidelines. We prepare reports and communicate with fertility clinics to assure the continuity of your care. We are also familiar with assisted reproduction and alternative options and are in a good position to support individuals and couples to prepare for and manage their fertility treatment. We also help partners cope with the intense emotional reactions and deeper meanings associated with unsuccessful fertility treatment cycles. CFIR psychologists and clinicians also work to improve our clients’ coping efforts and strengthen their resilience.


Dr. Lila Hakim, C.Psych.

Dealing with fertility-related problems can be extremely distressing for individuals and couples. Anxiety, depression, fears, doubts, guilt, shame, and despair may be experienced when there are biological barriers to conception. The stress of a fertility problem can affect one’s sense of emotional and sexual intimacy in relationships. Sometimes a negative self-concept and a sense of failure and anger can spill over into other areas of life, exacerbating couple conflicts and leaving partners feeling emotionally distressed. Partners may become emotionally disconnected, which deepens the sense of loneliness, isolation, and helplessness that can already be experienced as a result of dealing with a fertility issue. The stress associated with fertility-related issues can undermine an individual’s and couple’s emotional health, which can result in anxiety and depression, and negatively affect intimacy and sexual interactions in the relationship. 

Exploration of the deeper meanings associated with infertility or fertility is also an important aspect of the healing process. With couples, reconnecting emotionally can help to counteract feelings of isolation and loneliness. Strengthening the couple relationship ensures that each partner can turn to the other for support in moments of vulnerability to lessen distress and restore a sense of calm and comfort in their lives. Partners become a stronger team in facing fertility challenges and the difficult emotional experiences involved. 

CFIR psychologists and clinicians support individuals and couples dealing with fertility-related issues in coping and dealing with the negative thoughts, distressing feelings, and emotional reactions, and any relationship issues that may have emerged as a result of fertility problems. We also provide clients with education to deal with infertility so they are empowered throughout this journey.

CFIR psychologists and clinicians are active in research in the area of fertility. We have published scientific articles in the area of fertility counselling and are involved in ongoing research in this area.


Dr. Dino Zuccarini, C.Psych.

Life can be a symphony of losses. Many of us struggle to cope with unresolved losses from either the past or present day. We can experience loss as we transition through various life stages (i.e., childhood onward toward the end of life). Some individuals will experience loss as a result of unmet needs, separation, divorce, or death of loved ones, or unfulfilled goals and potentials. Some of us will experience a deep sense of loss as we inevitably experience changes in our physical and mental abilities, health status, and roles and identity. The emotional residue and grief associated with these losses, when left unaddressed and unprocessed, can evolve into anxiety and depression.

In terms of overcoming your grief, we help you to understand the meanings of your losses, and to process the unresolved or complicated emotional residue from these losses. Unprocessed grief and loss can affect our emotional well-being, our functioning in everyday life, and our interpersonal relationships. We support you throughout your grieving process so that you may move forward with your life with a renewed sense of meaning, purpose, and hope. CFIR psychologists and clinicians employ psychodynamic and experiential approaches to support you through the process of dealing with past and present-day losses.


Dr. Dino Zuccarini, C.Psych.


Depression can bring about debilitating symptoms, both of a physical and emotional nature. Depressed individuals typically find themselves experiencing hopeless feelings, disruptions to sleep and eating patterns, a loss of pleasure in everyday life, and possibly thoughts about suicide or death. Often individuals who are depressed have physical symptoms, including aches and pains.
Finding a path toward recovery can be challenging, but the good news is depression is treatable; recent research indicates that psychotherapy is extremely important in your recovery from depression.

When depressed, we can become bombarded by an internal chorus of negative thoughts and feelings about our selves other people, and the world around us. We can be overly self-critical of our selves and others, or may find ourselves struggling to come to terms with deep feelings of loss. At these times, it can be difficult to imagine a way to restore our vitality, hope, and optimism for life. When the severity of your symptoms seriously disrupts your capacity to function at home, work, or school, consider consulting with a psychologist immediately.

Negative thoughts and feelings about ourselves and others: Healing requires us to try to make sense of and deal with the distressing negative thoughts, feelings, and emotional responses that lie at the root of our depression. Depression is often linked to negative thoughts and feelings we hold about ourselves, of other people, and of the world around us. The origins of these thoughts and feelings can extend back into our childhoods and onward to the present day. These negative thoughts can create a sense of hopelessness about our selves and the world around us. A negative, critical voice and overly rigid standards and ideals can also be at the root of your depression.

We all have standards and ideals that we internalize from childhood onward about how we should be. These standards and ideals create expectations about our own and other people’s behaviour and guide us in terms of how we ‘should,’ ‘ought to,’ or ‘must’ think, feel, and behave. Some of us will rigidly hold onto and strive to live according to unrealistic standards and ideals, and be unrelenting in our efforts to have ourselves and others live up to them. Rigidly held standards and ideals can fuel harsh self-criticism and perfectionism. Indeed, research affirms that self-criticism and perfectionism often contribute to symptoms of depression.
Unexpressed emotions and needs: For some individuals, unprocessed emotions and unattended needs can result in depression. Depression is, therefore, a signal calling for us to listen to what our feelings are telling us about our selves, other people, and the world around us. Emotions provide us with important information. Being able to identify, label, and express these feelings in words is important for us to understand what our concerns are and to identify the unmet goals or needs that are at the root of the depressed feelings we are experiencing.
Other causes:  Depression may also result from multiple other physical and psychological causes, or as a result of substance abuse. A thorough assessment by your physician and a psychologist provides the best opportunity to determine your best treatment options.


Some individuals struggle with varying moods. People diagnosed with bipolar disorder struggle with mood variation, including periods of experiencing unusually or somewhat elated moments or ‘highs’, followed by periods of ‘lows’ or depressed periods. During manic periods, individuals with bipolar disorder may engage in risky behaviours leading to financial or legal difficulties. Being aware of triggers or signs of an impending mood episode, developing strategies involving partners, addressing difficult thoughts, creating a more balanced world, and accessing support to adhere to treatment regimens, are all significant components of managing bipolar disorder.

The Depression, Mood & Grief Service at CFIR offers clients counselling and psychotherapy to support them to address depression, mood and past and present grief and loss. We offer children, adolescents, adults, and couples psychological assessment and treatment of depression and other mood disorders. We provide comprehensive psychological assessment of your depression and/or mood difficulties, including the use of psychological tests for the purposes of diagnosis and treatment planning. There are different causes of mood disorders, and different types of depression and bipolar conditions. Psychologists are skilled in assessing, diagnosing, and subsequently developing a tailored treatment plan to address the specific issues associated with your current depression and/or mood difficulties. We employ scientific, evidence-based treatments, including Acceptance and Commitment therapy, Cognitive Behavioural Therapy, Emotion-Foucsed, Mindfulness, Psychodynamic-Mentalization-Attachment based therapies to help you overcome your symptoms and make deeper changes to your self.


Dr. Lila Hakim, C.Psych.

Anxiety tends to be accompanied by a wide range of physical and psychological symptoms. Individuals experiencing anxiety may have physical complaints such as shortness of breath, heart palpitations, sweating profusely, or feeling dizzy. Chronic fearful arousal can interfere with sleep, concentration, and attention, and affect overall functioning. These physical symptoms are often accompanied by negative and self-critical thoughts about one self, catastrophic fears, and thoughts of terrible things happening to oneself or loved ones. Some individuals will engage in certain behaviours (e.g., checking, counting, handwashing), or avoid certain places or social situations to deal with their anxiety.  Anxiety can be manifested in different ways---individuals can struggle with different types of anxiety, including: agoraphobia, generalized anxiety, panic, social anxiety, and specific phobias.

Anxiety may be rooted in difficult early or present-day life situations. For some of us, early childhood experiences in which we lacked appropriate and sufficient nurturance and support may have resulted in a vulnerable sense of self that is prone to anxiety in everyday life. For others, difficult, negative life experiences with family, friends, peers, and relationship partners may have undermined our safety and security in such a way that our confidence in our selves and others was drastically altered.

Deep self-vulnerability may emerge when the unprocessed emotions and unmet needs associated with these past and present-day life events are not addressed. As a result of these experiences, we begin to think about, or emotionally react to our selves, others, and the world, in ways that constrict us from being able to move freely in the world or create relationships with others. We can begin to overly anticipate danger, or bad things happening to us, and engage in behaviours to cope with the anxiety. These behaviours then stop us from participating fully in life, and become a further source of distress. 

Sometimes stress, especially when long-lasting, can overwhelm us and result in us feeling anxious. Some individuals have stress for days prior to tests, public speaking, or appointments, which impairs their ability to cope with life’s daily tasks. Their functioning becomes significantly impaired and our anxiety response to life increases. Being able to cope with stress increases our sense of confidence, and improves the quality of our lives, and diminishes our anxiety.

Work stress can also undermine our sense of emotional and physical well-being, and as a result bring about chronic anxious feelings. Burnout can result from long-term stressors that are unresolved. Being able to cope with work stress is important to prevent burnout. Work stress and burnout are caused by multiple factors that require attention to ensure we are creating a good quality of life in our work lives. Work stress and burnout can have a long-lasting impact on our sense of selves and our relationships when not addressed. When we are overly stressed and experiencing burnout, life’s smallest tasks can bring about anxious feelings. 

The Anxiety, Stress & Obsessive Compulsive Service at CFIR offers clients a comprehensive assessment and diagnosis of your anxiety issues to facilitate appropriate treatment planning. We employ short-term and long-term, scientifically-validated interventions to address the specific type of anxiety you are experiencing. Cognitive-behavioural, psychodynamic, and experiential approaches are employed to help you resolve issues related to anxiety or stress.

Read more about our Anxiety, Stress & Obsessive-Compulsive Treatment Service.


Dr. Aleks Milosevic, C.Psych. 

We are hard-wired to express emotions, including anger. Anger is a complex emotion that can be either adaptive or maladaptive. Anger can be a healthy primary emotion that is expressed to protect us in moments in which we might be violated, threatened by someone, unfairly treated, criticized, or frustrated. It is a natural part of the fight or flight response when we perceive danger in our world. Anger motivates us to protect ourselves by taking some type of action to stop or confront a threat. Anger can then fuel us to express and assert ourselves. In this way, anger can be an important signal, something good for us, as it tells us it’s time to take action to take care of our selves in our environments.

Anger can also be a secondary emotion. A secondary emotion covers up some other underlying feeling or emotion you may be experiencing in a situation. Other emotions such as hurt, sadness, grief at loss, loneliness or fear can be at the root of your anger. For example, sometimes we are angry when we are tired or in pain. In these cases, our anger protects us from the more vulnerable feelings or emotions. We may express anger because we are unaware of or unable to figure out our underlying feeling or emotion. Some of us might feel emotionally unsafe expressing vulnerable feelings or emotions in the presence of others. Anger in this case can serve to push people away from us when we are feeling vulnerable. In close relationships, expressing vulnerable feelings allows your relationship partner to feel closer to you, whereas defensive anger can create emotional distance between partners.

Anger, when uncontrollable, chronic, or prolonged can be very unhealthy, or a bad thing, for us and other people in our life. Uncontrollable anger or rage results in displays of intense emotion that can very destructive; it is often accompanied by verbal abuse and sometimes it can be accompanied by physical abuse. It is experienced as hurtful, frightening, intimidating and humiliating, and controlling. Often, deeper psychological or physiological issues underlie such irrational and unpredictable expressions. Finally, chronic, or prolonged anger, whether toward others or a situation, can have negative health consequences when stress hormones and cortisol are released. Over time, chronic anger can put your physical health in jeopardy by creating health problems (i.e., high blood pressure, headaches, digestive problems, insomnia etc.). Chronic, unresolved anger can also contribute to the development of psychological problems, including depression, anxiety, and substance abuse.

At CFIR we can help you become aware of your anger, distinguish whether it is adaptive and primary, and help you overcome chronic negative anger states that have a negative impact on you and your relationships with others at home or at work. The Anger & Emotion Regulation Service at CFIR offers individuals an opportunity to learn how to manage difficulties with the experience and expression of anger in their relationships.

A comprehensive psychological assessment is conducted to understand the nature of your difficulties with anger. Understanding the historical, internal, and external factors that may contribute to your anger is important in setting out an appropriate treatment plan. We employ scientifically-validated interventions in our approach to the treatment of anger problems. We integrate cognitive-behavioural, emotion-focused, and psychodynamic-interpersonal interventions to support you to manage your uncontrollable and/or chronic anger response.