The ways we think about and understand events, situations, and relationships in our lives have a direct impact on our behaviour and emotions. Cognitive behavioural therapy (CBT) is an empirically based psychotherapy which aims to address and identify unhelpful thinking styles, such as negative and anxious thinking, with the goal of changing the way a person behaves and ultimately how a person feels. It has been shown to be effective in treating a range of problems including mood and anxiety disorders and eating disorders.
The focus of CBT treatment is on what is unfolding for you here and now, rather than on exploring your past. It aims for a thorough understanding of your thinking, behaviours, and emotions. In collaboration with your therapist, you will identify areas that would be important to focus on in therapy and, together, you will develop treatment goals. During a course of CBT treatment you will learn to become better acquainted with your patterns of thinking, identify unhelpful thinking styles and behaviours, and develop helpful skills and techniques to challenge and change these. With the goal of fostering agency and an independent use of skills learned in therapy, you will be encouraged to reflect on the material covered in sessions and apply new skills and strategies on an ongoing basis between sessions.
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy (ACT) is a form of a cognitive behavioural therapy (CBT) based on the idea that psychological pain and suffering are perpetuated and increased when a person attempts to control or avoid painful experiences in his or her life. This pain and suffering play a role in preventing the person from living a life in accordance with his or her core values. Instead of challenging thoughts (as in CBT), ACT uses mindfulness, acceptance, identification of values, and commitment to actions as a way to help individuals change unhelpful behaviours that prevent them from experiencing life more fully. ACT is an evidence-based therapy approach which has been used in health and rehabilitation psychology (e.g., treatment of chronic pain, smoking cessation, traumatic brain injury), and in treatment of anxiety and mood disorders as well as other presenting problems.
During sessions, you may use techniques including mindfulness (awareness of the here and now, without attachment or judgment), cognitive defusion, behavioural analysis, acceptance (acknowledgment and allowance of a range of experiences), and commitment to values-based living (identifying your core values and living in accordance with them). Together, these strategies aim to help you navigate a way of living more fully and have an improved quality of life.
Motivational interviewing (MI) and Motivational enhancement therapy (MET)
We may sometimes experience ambivalence about and have different levels of readiness to engage in behaviour change. This can prevent us from moving forward in productive and effective ways toward our goals. Motivational interviewing (MI) and Motivational enhancement therapy (MET) are often used as parts of cognitive behavioural therapy (CBT) to help explore, better understand, and resolve a person’s ambivalence about behavioural change (e.g., quitting smoking, engaging in therapy). MI is an evidence-based psychotherapy. It was initially developed within the context of substance use problems but is now used more widely to resolve ambivalence and promote motivation related to changing a variety of behaviours.
MI is collaborative, goal-oriented, and directive. The goal of MI and MET is to assess the readiness to engage in change, and promote and develop internal motivation for change, as opposed to relying on external motivators (e.g., your spouse, parents, friends). In session, you will find that the therapist responds to your ambivalence in a neutral way rather than contradicting or fighting it (i.e., the therapist “rolls with resistance”). You and your therapist will work to examine ambivalence, and develop self-motivational statements and a plan for committing to internally motivated change.
Many individuals develop self-defeating patterns (“schemas”) of thinking, feeling, and behaving early on in life and these are often repeated and developed over time. As a result, these patterns, which can also develop later in life, interfere with a person having his or her needs met or accomplishing his or her goals. Schema-focused therapy is focused on helping the person recognize and change long-standing maladaptive patterns and develop healthier alternatives. It integrates principles of cognitive behavioural therapy (CBT), behaviour therapy, object relations, and gestalt therapy. Schema therapy has been used in the treatment of personality disorders, depression, and other complex interpersonal difficulties.
With your therapist, you will identify your most prominent schemas through an interview or the use of a questionnaire. You will also build emotional awareness and engage in experiential tasks whereby you will learn to notice your patterns in your daily life. Lastly, you will work to change your typical thinking styles and behaviours by developing and implementing more adaptive and helpful thoughts and behaviours.
Interpersonal Therapy (IPT)
Interpersonal difficulties can play a significant role in the origin and maintenance of a person’s psychological distress. Interpersonal therapy (IPT) focuses on your relationships and interpersonal dynamics or events with a particular emphasis on life changes or transitions (e.g., marriage, divorce, change in role such as becoming a parent), conflicts with others (e.g., within family, at work), or grief related to loss of a significant other. When such changes occur, our needs might not be met and we may experience a lack of social support. By exploring these facets, IPT aims to understand your interpersonal dynamics in the interest of reducing psychological distress. IPT is an empirically validated treatment whose effectiveness has been demonstrated in treating a range of presenting problems including depression, anxiety, and eating disorders.
In collaboration with your therapist, you will explore your relationships and how they impact your psychological well-being. A thorough understanding of your relationships and interpersonal patterns will be developed and you will work with your therapist to examine your role within a given relationship or conflict. During sessions, you might focus on assessing your expectations within relationships, your interpersonal needs, and whether your communication approach reflects your intentions. You will develop coping strategies, explore and resolve conflicts, and learn effective communication skills as a way to address your interpersonal dynamics with the goal of improving your psychological distress.
Stress management and relaxation
Stress is an inevitable part of life and a certain level of stress may be helpful in motivating us to pursue our goals and be prepared for situations that are important to us (e.g., stress motivates us to prepare for an important presentation). However, stress may also increase beyond this useful level and exert a negative impact on our physical and mental health, our relationships, and daily functioning. When we understand harmless situations to be stressful and experience chronic stress, our bodies start to be “on alert” for danger thereby activating our “fight-or-flight” response and depleting our physical and emotional resources. Relaxation techniques have been shown to be effective in activating our parasympathetic nervous system (“rest and digest” response) which helps conserve our energy as it decreases our arousal, slows down our heart rate, lowers our blood pressure, and regulates our digestion.
In collaboration with your therapist, you will explore types of thought and behaviour, and situations that may be stress provoking while becoming familiar with the way you experience and manifest stress (e.g., pounding heart, loss of sleep, etc.). In addition, you will focus on developing effective ways of managing stress and draw upon relaxation techniques such as deep breathing, progressive muscle relaxation, imagery, and grounding to assess which relaxation strategies are most effective for you. You may also explore assertiveness skills or assess your sleep patterns, as interpersonal dynamics and sleep may be affected by stress or play a role in maintaining stress levels.
Mindfulness based stress reduction (MBSR)
Mindfulness is a practice which helps us learn how to pay attention (to our thoughts, emotions, body sensations, environment) in the here and now, with curiosity, and without judgement or attachment. Mindfulness-based stress reduction (MBSR), developed by Dr. Jon Kabat-Zinn and his colleagues at the Stress Reduction Clinic at the University of Massachusetts Medical Centre, draws upon principles of mindfulness to manage stress. MBSR has been used in treatment of medical problems (e.g., chronic pain, insomnia, fatigue) and psychological problems (e.g., anxiety, grief) which might impact a person’s quality of life.
MBSR is a patient-centered approach that focuses on learning, developing, and practicing mindfulness meditation skills as a way to develop a new relationship with your thoughts, feelings and body sensations, and a way to manage stressors. You will be asked to practice newly acquired skills regularly and on an ongoing basis between therapy sessions.
Emotion focused therapy (EFT)
Emotions help us identify what is important to us in a given situation and thus help us organize our actions. To function adaptively in our daily lives, we need to be aware of our emotions and their function. We face significant challenges if we avoid or fear our emotions. Emotion-focused therapy (EFT) is based on the idea that emotions serve an adaptive function and help provide a source of information, meaning, and growth. EFT is an empirically supported psychotherapy and its effectiveness has been demonstrated in treating depression, trauma, interpersonal difficulties (e.g., interpersonal trauma, complex grief, unresolved emotions toward significant others), as well as other presenting problems. It has been used in individual as well as couples’ therapy.
Empathy and collaboration with your therapist are essential components of EFT. During your sessions, you and your therapist will work together to help you identify, understand, and accept your emotions as well as help you learn how to express, regulate, and transform them. In the safety and comfort of therapy, you will have the opportunity to experience your emotions as they arise, become aware of them, and learn which emotions you can rely on as adaptive guideposts and which emotions are maladaptive and require change. You will draw upon your own resources, resilience, and agency in order to work with emotions and change maladaptive emotional states as a way to meet your goals and needs.
Grief & Bereavement
When we experience loss of a loved one or of someone who was important to us, we might find it challenging to adjust to the significant changes that follow. Such a loss can impact our sense of self, our beliefs, and our daily life. Grief can manifest in numerous ways: some of us might become angry, while others might withdraw or become depressed. Each person may take a different amount of time to adjust to their loss (bereavement) and may experience this time in very different and unique ways.
Keeping your experiences and emotions to yourself or denying that you may be experiencing strong and difficult emotions may prolong your pain and suffering. In the safety of the therapy session and at a pace that is comfortable for you, you and your therapist will explore your loss as a way to allow you to mourn and express your grief. Throughout the sessions, you will think about ways in which you may be able to acknowledge this loss while adjusting to life without the person you lost and moving toward a place of acceptance. You will also explore ways of coping effectively and ways in which you can practice self-care.
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