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

Therapy: Are You Covered?

Is your therapist covered by your workplace insurance?

Can you afford the number of required sessions to help you by either using your insurance coverage or paying 'out of pocket'?

Not all mental health care practitioners are covered by workplace insurance programs. Clients who don't review their workplace insurance prior to receiving psychological services can find themselves feeling very disappointed, and out of a lot of money when they find out that they are not covered for their sessions. It's important to find out how much coverage you have, and to figure out how much 'out of pocket' money you'll need to be able to attend sessions consistently and until a significant change has been realized. It's important to learn at the outset about how many sessions you'll be able to afford with your insurance coverage and ability to pay 'out of pocket'.

Registered psychologists tend to be covered by most workplace insurance programs. However, if you are seeing a psychotherapist or social worker, you'll want to verify whether their services are covered under your program. At Centre For Interpersonal Relationships (CFIR), psychotherapists and social workers are supervised by a registered clinical psychologist, and receipts are issued under the supervising psychologist. Some insurance companies will accept these circumstances, while others will not. It's up to you to verify with your insurer whether your insurer will cover your sessions.

Since most individuals will require more sessions than their insurance covers, it's important for you to evaluate whether you can afford to pay for sessions 'out of pocket' once your insurance has run out. It's important to have these discussions with your therapist to ensure that your treatment is not disrupted by lack of financial resources. Based on your insurance, and ability to 'pay out of pocket', your therapist may determine given your presenting concerns, that other treatment options may be better for you (i.e., workshops or group therapy, or seeing a psychotherapist or joining our Reduced Cost Services program). In the event that you find yourself out of insurance dollars, and your ability to pay 'out of pocket' reduced, you may want to alter the number of sessions you attend per month or take a break from therapy until which point your workplace insurance kicks in again.

CFIR offers you different options to ensure accessibility and affordability of services. If you have run out of insurance and are having difficulties paying for services 'out of pocket', our counsellors, who are supervised by our psychologists, can be seen for a fraction of the cost of seeing a psychologist. Referral to our counsellors is seamless and ensures continuity of your treatment with minimal disruptions.

How CBC Toronto Employees Helped to 'Beat Blue Monday'

by: Roselin Leonard, CFIR Marketing Manager

Monday, January 15, 2018 (the third Monday in January) marked what’s come to be known as Blue Monday, also known as “the most depressing day of the year”. A time when the impact of holiday spending, frigid temperatures, and long carb-loaded days laden with low motivation hits hard.


While the theory behind Blue Monday has yet to be scientifically proven, symptoms of the winter blues feel undeniable for many of us. According to CAMH British Columbia, 2-3% of Canadians will experience Seasonal Affective Disorder (S.A.D) in their lifetime. This makes up about 10% of all depression cases.


When Kai Black, Executive Producer at CBC Music in Toronto, heard about the Blue Monday phenomena, he knew it was a great starting point for a discussion about mental wellness at CBC. He envisioned an event that would raise mental health awareness and offer valuable resources to help counteract the effects of Blue Monday. Once his vision was realized, the wheels of action were set in motion.


Kai engaged CBC Toronto’s abilicrew–an amazing ‘Employee Resource Group’ for CBC employees with disabilities and their allies–to create something great. Let’s just say, they did not disappoint. The team transformed Kai’s idea into ‘Beat Blue Monday’, now an annual event.

“The event today rose out of a need to communicate to staff that this is not just the saddest day of the year, but it’s a good day to find out how you can deal with your own sadness at this time.” – Kai Black

Centre For Interpersonal Relationships (CFIR) was thrilled to be invited back to ‘Beat Blue Monday’ alongside other local exhibitors for yesterday’s festivities at the Toronto Broadcasting Centre. More exciting than the invitation itself was the opportunity to connect with employees eager to learn more about mental and physical wellness and strategies to beat the blues.

CFIR Clinical Director and Psychologist, Dr. Aleks Milosevic C. Psych. getting prepped for a great time at CBC Toronto

Our team and other exhibitors came ready with smiles, knowledge, information, and swag.

Dr. Aleks Milosevic C. Psych., Dr. Lila Z. Hakim C. Psych. and Dr. Joshua Peters M.A., R.P. meeting representatives from Mood Disorders Canada.

The entertainment was fun, informative and elevated the festivities to another memorable level!


CFIR Clinical Director and psychologist, Dr. Lila Z. Hakim, C. Psych. joined CBC personalities including the host of CBC Radio’s Day 6, Brent Bambury, CBC Sports host Scott Russell, and CBC Music's Raina Douris and Angeline Tetteh-Wayoe in a game show testing their 'emotional intelligence'.

Lisa Clarkson (Executive Director, Business & Rights and Content Optimization at CBC and Executive Sponsor for the Beat Blues Monday Event) introduced the ‘Mayfield Magnetics’, the top Grade 12 vocal jazz class in Ontario and the winners of 2016’s CBC Music Class Challenge. 


An acapella performance by The Mayfield Magnetics at 'Beat Blue Monday'.

Members of a few CBC Employee Resource Groups came out to share valuable information. 

'Beat Blue Monday' 2018 was a wonderful experience. Sincere congratulations to Kai Black, Helen Kugler, Sylvie MacLean, CBC's Engagement & Inclusion team, the CBC Toronto’s EAP, the abilicrew, DiversifyCBC and outCBC for a successful event and for their ongoing commitment to–and investment in–the mental wellness of CBC employees.

Think you might have a case of the winter blues? 

Dr. Lila Z. Hakim, C. Psych. offers a few helpful tips below to start feeling good again **:

Nourish Your Body

Many of us experience cravings for certain foods when the winter season blows in and our bodies develop a yen for carbohydrates. Carbohydrates are directly linked to the production of the neurotransmitter serotonin, an emotion regulator that helps you feel emotionally stable, less anxious, calmer, more focused and energetic.

When that 3 p.m. craving for a savoury or sweet snack hits, it’s your body’s way of self-medicating, seeking to improve your mood by boosting your serotonin levels. Listen to your body and give yourself that much-needed serotonin lift.

Instead of calorie-dense, sugary breads and sweets that offer a quick mood-boost and then a crash, consider healthier alternatives such as fruits, nuts, and yogurt.

Get Active!

Physical activity increases not only the calming neurotransmitter serotonin, but also increases dopamine, the emotion and pleasure neurotransmitter, and endorphins, your pain-relief and pleasure neurotransmitters. Incorporating movement into your day (climbing stairs, going for a walk, etc.) gives your body the activity it needs to keep your mood up throughout the day.

Make Sleep a Priority

Sleeping excessively (or hibernating) is normal in the winter and is often a reaction to the cold, but for some, ongoing insomnia or difficulties falling or staying asleep create difficulties that can lead to the blues. Provide yourself with a space at home that includes comforting objects (such as a warm blanket, beautiful objects, etc.) to calm your stress hormones. Aim to get exactly the amount of sleep you need to feel fully rested and ask a professional if you are unsure about how much rest is the ideal amount.

Do Things that Light You Up

Find activities in your life that give you a sense of pleasure and meaning, that involve curiosity, exploration, and interest­–this could be collecting or building things, researching something you love like travelling, or caring for other people. Artistic endeavours like creating and listening to remarkable music are also great options. Pleasure, curiosity, exploration, and interest all stimulate dopamine, which makes you feel exhilarated and alive!


Which strategies do you find most effective for curing winter blues? Feel free to share your comments or feedback below.


(**Note: If you or a person you know is experiencing regular symptoms of depression, it is important to seek medical attention from a physician. If you don’t have a family doctor, click here for additional information and options via Ontario.ca.)

ReSolution ReVolution: Tips for Achieving Your Goals in 2018

By: Kamala Pilgrim, Ph.D., C. Psych (Interim Autonomous Practice)

It’s the time of year again when millions of us are thinking about all the goals we want to achieve. We typically start off excited to follow through with our well-intentioned resolutions. We say to ourselves with conviction, “This year I’m making some changes!” Our lives seem fresh and rife with opportunity – but by about January 10th we run out of steam, begin avoiding, or just give up on our goals. Psychologists note that one of the reasons resolutions tend to dissolve rapidly is because it is difficult to withstand the discomforts that are part and parcel of making changes. The ability to tolerate and adapt to challenges with a sense of awareness, openness, and focus, and taking effective actions that are guided by what we truly value, is key to creating and maintaining the life you want (Harris, 2008). Following are seven strategies to help you begin to move in the direction of your dreams:

1. Get crystal clear on your values

Resolutions are often framed as goals and not based on our core values. The difference is a value is a path on which we would like to continue moving over time while a goal is an outcome that we can reach…or not (Harris, 2008). The desire to be energetic is an example of a value, whereas wanting to join a gym is a goal. It is more effective for goals to follow our values, not the other way around. When our values are foremost, our lives develop greater meaning as our decisions are rooted in what we really care about. We also are more willing to make an effort if we understand how we believe attaining our objective will enhance our life.

To get started on clarifying your values, ask yourself the following:

• What matters most to you in life?
• How do you wish to feel each day?
• How do you want to interact with yourself and others?

2.  Adopt S.M.A.R.T goals

Next, consider resolutions that reflect these core values.

E.g., If you want to feel more enthusiastic what actions can you take to get there?

Break these down into smaller steps based on behaviours you can do that are:

Specific

Measurable

Achievable

Results-based and

Time-bound

Develop short-term (can be done in the next few days and weeks), medium-range (can be done in a month or two), and long-term (can be done in the following six months) objectives that are in line with these S.M.A.R.T criteria.

3. Visualize

Regularly reflecting on your values is critical to making them paramount to your life. It is important to remember what matters most to you and to allow those factors to seep into your psyche. Spend a few minutes every day, picturing in vivid detail how you will feel, act, and behave toward yourself and others when you are making choices in accordance with your values. Engage all five of your senses in this process whenever possible.

4. Know your pitfalls and trick your future self

Track your efforts to meet goals. Then reflect on times when you tend to fold in the face of temptation, throw in the towel, or procrastinate. Use this knowledge to set your future self up for success.

E.g., If you notice you never get out to the gym once you’ve arrived home from work, pack your workout bag the night before and go right after you leave the office.

5. Welcome hiccups

Develop and practice a self-compassionate attitude toward setbacks which will inevitably come. Instead of berating yourself, speak to yourself at these times the way you would to someone you love.

6. Practice mindfulness

Mindfulness is a state of awareness that involves paying full attention, on purpose, to everything happening in the present moment, without judgment (Kabat-Zinn, 2012). Since we spend so much of our time either worrying about the future or dwelling on the past, we miss out on the now, which is the only place where our power to make changes lies. Though a by-product of this practice is that the things we observe such as, distressing thoughts, feelings, and physical sensations will decrease in intensity, it is not the purpose. The aim is to make space for these experiences without resisting or attempting to escape them and to return to your core values to guide your actions. Doing this will both sharpen areas of the brain that govern self-control and build tolerance of uncomfortable thoughts, feelings, and sensations. You can begin to develop this skill by practicing the following meditation every day:

“Sit in a chair or crossed-legged on a pillow. Take five, deep, smooth breaths in and out. On the end of your fifth exhalation, allow your breath to flow in naturally without any attempt to control it. As you breathe in mentally say the words, “inhale”, as you breathe out, mentally say, “exhale”. When the mind shifts to thoughts, practice noticing them as if they are clouds passing through the sky, and come back to your meditation. When an emotion arises, bring awareness to where you feel it in your body and breathe into and around the area(s) providing it with as much space as possible. Return to your meditation.”

Start with two minutes of meditation practice and work your way up to fifteen to twenty minutes.

As you pursue your values and related goals, unhelpful thoughts and emotions (I.e., those that would take you away from your values if you give them credence) will emerge. Use a similar strategy of gently acknowledging them and coming back to focusing your attention on the choices that align you with your most cherished values in the present moment.

7. Make goal engagement rewarding

If we are constantly in self-control mode, your body and brain will surely rebel. As much as possible, pair your goals with something pleasurable:

E.g., Write in your favourite café, light scented candles while doing housework, exercise while listening to music you enjoy.

Just make sure that whatever your chosen accompaniment, it is guided by your core values.

If you put these techniques into practice on a consistent basis, you can make some gains in achieving your goals.

CFIR psychologists are also always available to offer you support in defining and sticking to your objectives this new year 2018!

For more information please see the following sources: 

• Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter.

• Kabat-Zinn, J. (2012). Mindfulness for Beginners: Reclaiming the present moment – and your life. Boulder, CO: Sounds True.

• McGonigal, K. (2012). The willpower instinct: How self-control works, why it matters, and what you can do to get more of it. New York, NY: Avery.