Five rules for approaching our feelings with greater wisdom and effectiveness.

David B. Feldman Ph.D.

Building Emotional Intelligence Isn’t as Hard as You Think

Source: Pixabay

Dozens of times a week, we ask friends, family, and even strangers, “How are you?” Given this fact alone, you’d think our society was very interested in how people feel.

But all of us know that this question generally doesn’t get an honest answer. Instead, most people reply with, “good,” “fine,” or at least, “okay.” If we’re really honest with ourselves, most of us would be a bit uncomfortable if we got a more genuine answer.

For many of us, it can feel risky to get in touch with our feelings, let alone to express them to others. I was recently speaking with a close friend who was genuinely hurt by something his father posted in a family chat room. He had been ruminating about it for days. And yet, when I suggested that he bring it up with his dad, his answer was straightforward: “No,” he told me. “We don’t talk about feelings in our family.”

Psychologist Marc Brackett, the founder of the Yale Center for Emotional Intelligence, argues that this tendency to avoid feelings, though understandable, can be a real disadvantage.

In one experiment, Brackett and his colleagues divided middle-school teachers into two groups. One group was placed in a good mood by recalling positive classroom experiences, while the other group was placed in a bad mood by recalling negative classroom experiences.

Then, they all were asked to grade the same essay. The teachers who were in a worse mood scored the essay a full letter grade lower than those in a better mood. But here’s the real kicker: Most of the teachers said they thought their mood had no influence on their grading, even though it clearly had.

Whether we like it or not, our feelings affect our thinking and behavior. Being out of touch with these feelings just means we’re at the mercy of them. So, it behooves us to get to know them better.

Our ability to understand and regulate our feelings is what psychologists often call “emotional intelligence.” Luckily, emotional intelligence isn’t a fixed commodity, but rather something we can build by learning what Brackett calls “emotion skills.”

He has developed a system, organized around the acronym R.U.L.E.R., which has been used in nearly 2,000 schools across the world to teach such skills to children and teenagers. But it can be equally applicable for helping all of us develop greater wisdom about our feelings and use them to our advantage.

Here are the five skills you can start practicing now:

R: Recognize

The first step toward productively managing any feeling is to recognize that we’re having it. Although this may sound easy, it’s equally easy to ignore our feelings. Have you ever said, “I don’t care,” about a situation when you really did? Have you ever gotten a head or neck ache, only to later realize you were actually feeling emotionally stressed?

To better recognize our feelings, Bracket suggests using a technique known as the “Mood Meter.” At its heart, this technique involves asking yourself two simple questions:

  1. How much energy does this emotion have?
  2. How pleasant is this emotion?

Emotions can be high in both, low in both, high in energy and low in pleasantness, or low in energy and high in pleasantness. Emotions high in both energy and pleasantness include joy, excitement, and optimism, while emotions low in both include sadness and depression. Anxiety, anger, and frustration are examples of feelings high in energy but low in pleasantness, whereas calmness and contentedness are examples of feelings low in energy but high in pleasantness. By at least identifying in which of these categories our feelings fall, we lay a foundation for wisely dealing with them.

U: Understand

The next emotion skill involves understanding our feelings. In short, this involves asking the question, “Why am I feeling this way?” Because this wide-open question is notoriously difficult to answer, in his book Permission to Feel, Brackett suggests some more specific questions we can ask ourselves to figure out the reasons behind our feelings. Here are a few of them:

  • What just happened? What was I doing before this happened?
  • What happened this morning, or last night, that might be involved in this?
  • What has happened before with this person that might be connected?
  • What memories do I have about the situation or place in which this emotion occurred?

Understanding the causes of our feelings can help provide clues about how to address them. If I’m feeling anxious because my new boss reminds me of a person from my past who was cruel to me, I’ll want to deal with the situation very differently than if my anxiety results from a particular managerial decision my boss just made. Of course, it could be both—so it can take serious time and introspection to really sort out what we’re experiencing and why. Be patient and keep at it.

L: Label

It’s not enough simply to recognize and understand an emotion; we also can benefit from finding the right word to describe it.

Many of us have a relatively limited emotion vocabulary. Some of us stick with two words: bad and good. Others might have three or four: happy, sad, mad, and scared. Still others may not use emotion words at all, but prefer figures of speech like, “on top of the world” or “burning up.”

But in actuality, there are thousands of words to describe emotions in the English language alone. We certainly don’t have to memorize all of them, but Brackett suggests that more accurate labels are usually better for us. In his words, “We know from neuroscience and brain imaging research that there is real, tangible truth to the proposition that ‘if you can name it, you can tame it.’”

For a start, knowing precisely what feelings we’re experiencing can give us clues about how to manage them. Although you may recognize that you’re experiencing a negative, high-energy emotion, both “stressed” and “overwhelmed” might fit that general description. But which of these labels most accurately describes our feeling really matters, because they mean different things.

“Stress” generally means we feel that what we’re trying to do or handle exceeds our capabilities, whereas “overwhelmed” means there’s just too much of it, regardless of our capabilities. If we’re feeling overwhelmed, the best approach may be to reduce our workload the best we can, whereas if we’re feeling stressed, the best approach may be to upgrade our capabilities by learning new skills or reorganizing the way we do things.

E: Express

If the R, U, and L of R.U.L.E.R. are about getting into touch with our emotions, the E and R are about what to do with them.

There are lots of reasons we hesitate to express our feelings. Especially when emotions fall on the negative end of the spectrum, we may be afraid they’re inappropriate, will embarrass us, or will somehow injure the person we express them to.

According to Brackett, however, “Hurt feelings don’t vanish on their own. They don’t heal themselves. If we don’t express our emotions, they pile up like a debt that will eventually come due.” So it’s important to express them in some way.

But this doesn’t mean we should let our emotions run wild, saying everything that’s on our minds to everyone we wish. According to Brackett, the skill of expressing our feelings “means knowing how and when to display our emotions, depending on the setting, the people we’re with, and the larger context.”

If we’re feeling hurt by something our boss said, for instance, it’s in our best interest to express this differently than if a close friend said something similar to us. Depending on the level of trust, we may make ourselves more vulnerable to our friend than our boss, expressing our feelings in greater depth or detail. If there’s a good chance we could lose our job, we may even choose not to express our hurt at all to our boss, instead confiding in and seeking support from someone else.

R: Regulate

The final emotion skill involves determining how to cope with our feelings.

Whether or not we choose to express them, feelings impact us. Regulating our emotions involves dealing with them in a way that allows us to best meet our personal and professional goals—or at least prevent our feelings from interfering with them. This certainly doesn’t mean ignoring our emotions; as already discussed, this doesn’t work well. Instead, it involves learning to accept and deal with them wisely.

Techniques for helping us cope with our feelings run the gamut, and we should strive to use ones that work for us. Relaxation videos abound on YouTube and can help us soothe strong emotions. Meditation phone apps can be used to facilitate mindfulness, which may help us accept our feelings. Physical exercise can help us to “work out” our feelings and feel more grounded in our bodies.

But emotion regulation can also be very simple. “You can’t stand your neighbor? Avoid her,” writes Brackett. “Your parents are coming to visit and you don’t want them to see some of your more outré artwork? Hide it until they leave. You’re tired? Splash some water on your face.” The important thing is to acknowledge our feelings—not avoid them—and then take productive steps toward dealing with them.

Learning to be more emotionally skilled isn’t a panacea. It won’t eliminate all our negative feelings or bring about a constant state of bliss. Such goals are probably impossible. But part of emotional intelligence is realizing that our feelings aren’t our enemies. In fact, if we approach them wisely, they can be some of our best friends. Let’s all get to know these friends a little better.

About the Author

What Is Toxic Shame?

What is Toxic Shame?When shame becomes toxic, it can ruin our lives. Everyone experiences shame at one time another. It’s an emotion with physical symptoms like any other that come and go, but when it’s severe, it can be extremely painful.

Strong feelings of shame stimulate the sympathetic nervous system, causing a fight/flight/freeze reaction. We feel exposed and want to hide or react with rage, while feeling profoundly alienated from others and good parts of ourselves. We may not be able to think or talk clearly and be consumed with self-loathing, which is made worse because we’re unable to be rid of ourselves.

We all have our own specific triggers or tender points that produce feelings of shame. The intensity of our experience varies, too, depending upon our prior life experiences, cultural beliefs, personality, and the activating event.

Unlike ordinary shame, “internalized shame” hangs around and alters our self-image. It’s shame that has become “toxic,” a term first coined by Sylvan Tomkins in the early 1960s in his scholarly examination of human affect. For some people, toxic shame can monopolize their personality, while for others, it lies beneath their conscious awareness, but can easily be triggered.

Characteristics of Toxic Shame

Toxic shame differs from ordinary shame, which passes in a day or a few hours, in the following respects:

  • It can hide in our unconscious, so that we’re unaware that we have shame.
  • When we experience shame, it lasts much longer.
  • The feelings and pain associated with shame are of greater intensity.
  • An external event isn’t required to trigger it. Our own thoughts can bring on feelings of shame.
  • It leads to shame spirals that cause depression and feelings of hopelessness and despair.
  • It causes chronic “shame anxiety” — the fear of experiencing shame.
  • It’s accompanied by voices, images, or beliefs originating in childhood and is associated with a negative “shame story” about ourselves.
  • We needn’t recall the original source of the immediate shame, which usually originated in childhood or a prior trauma.
  • It creates deep feelings of inadequacy.

Shame-Based Beliefs

The fundamental belief underlying shame is that “I’m unlovable — not worthy of connection.” Usually, internalized shame manifests as one of the following beliefs or a variation thereof:

  • I’m stupid.
  • I’m unattractive (especially to a romantic partner).
  • I’m a failure.
  • I’m a bad person.
  • I’m a fraud or a phony.
  • I’m selfish.
  • I’m not enough (this belief can be applied to numerous areas).
  • I hate myself.
  • I don’t matter.
  • I’m defective or inadequate.
  • I shouldn’t have been born.
  • I’m unlovable.

The Cause of Toxic Shame

In most cases, shame becomes internalized or toxic from chronic or intense experiences of shame in childhood. Parents can unintentionally transfer their shame to their children through verbal messages or nonverbal behavior. For an example, a child might feel unloved in reaction to a parent’s depression, indifference, absence, or irritability or feel inadequate due to a parent’s competitiveness or over-correcting behavior. Children need to feel uniquely loved by both parents. When that connection is breached, such as when a child is scolded harshly, children feel alone and ashamed, unless the parent-child bond of love is soon repaired. However, even if shame has been internalized, it can be surmounted by later positive experiences.

If not healed, toxic shame can lead to aggression, depression, eating disorders, PTSD, and addiction. It generates low self-esteem, anxiety, irrational guilt, perfectionism, and codependency, and it limits our ability to enjoy satisfying relationships and professional success.

We can heal from toxic shame and build our self-esteem. To learn more about how to do so and the eight steps to heal, read Conquering Shame and Codependency: 8 Steps to Freeing the True You.

©Darlene Lancer 2015

Darlene Lancer, JD, MFT

Darlene Lancer is a Licensed Marriage and Family Therapist and expert on relationships and codependency. She’s the author of Conquering Shame and Codependency: 8 Steps to Freeing the True You and Codependency for Dummies and six ebooks, including: 10 Steps to Self-Esteem, How To Speak Your Mind – Become Assertive and Set Limits, Dealing with a Narcissist: 8 Steps to Raise Self-Esteem and Set Boundaries with Difficult People, and Freedom from Guilt and Blame – Finding Self-Forgiveness, available on her website and Amazon. Ms. Lancer has counseled individuals and couples for 28 years and coaches internationally. She’s a sought-after speaker in media and at professional conferences. Her articles appear in professional journals and Internet mental health websites, including on her own, where you can get a free copy of “14 Tips for Letting Go.” Find her on, Soundcloud, Twitter @darlenelancer, and at

7 Ways Psychotherapists Can Get in the Way of Psychotherapy

Verified by Psychology Today

Trained curiosity and assessment are not the soul of psychological change.

Posted Oct 13, 2019

Source: StartupStockPhotos/Pixabay

There is a vast gulf between diagnosable issues as seen through the lens of psychological expertise and the essence, identity, strengths, and hopes of a person before me. Psychotherapists mean well, but at times we all stray outside of the bounds of helpfulness. Here are seven ways psychotherapists get in the way of psychotherapy:

1. Interrogating

When people come into session in the midst of an emotional storm, the last thing they need is to be inundated with endless questions on the basis of an agenda that is likely intended more to fulfill organizational protocols than to promote a foundation of therapeutic empathy and rapport.

Questioning always runs the risk of interrogation. The details learned about people’s lives ever tempt helping professionals toward distraction. There is a distinct difference between a personality and a person, a diagnosis and a destiny. It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.

2. Pathologizing

The concept of “mental disorder” is rigid and misleading. In short, diagnosis is description, and by and large, mental health diagnosis provides description of “software” issues rather than “hardware,” so to speak. It’s a language of understanding what type of struggle a person is experiencing. When therapists refer to people by these diagnostic labels, we may overgeneralize a person’s experience and distance ourselves from a critical resource: the powerful, complex, and fluid process of therapeutic understanding, the power center of effective therapy.

3. Shaming

We ever risk a false sense of expertise about people’s lives against the backdrop of anxiety about our own. If we’re not careful, we may find ourselves reinforcing the tyranny of the perceived should. Should is shame‘s accomplice, and therapists must take care not to aid and abet them.

4. Sympathizing

Researcher Brené Brown (2010) rightfully proclaimed, “Empathy fuels connection, while sympathy drives disconnection.” Saying you understand is unhelpful and probably not true. And let’s be honest: It’s usually a ploy to rush people out of their emotional state, which sends the message, “I really don’t care enough to walk with you through your suffering.”

Gerd Altmann/Pixabay
Source: Gerd Altmann/Pixabay

5. Lecturing

Psychologist and psychotherapy researcher Les Greenberg (2002) wrote, “Darwin, on jumping back from the strike of a glassed-in snake, having approached it with determination not to start back, noted that his will and reason were powerless against even the imagination of a danger that he had never even experienced. Reason is seldom sufficient to change automatic emergency-based emotional responses.”

With a surge in cognitive therapies, there has been a surge in their wrongful implementation, with many therapists engaging in power struggles to convince people of faulty beliefs in order for new, more positive truths to simply work some magic ripple effect into their lives.

As an emotion-focused therapist, I have been prone to, for instance, encourage couples to engage in safer, softer, and more emotionally responsive interactions, yet when I have stood on my own soapbox, encouraging them to do so out of pace with their own readiness, I have violated my own guidance. Miller (1986) observed that people will “persist in an action when they perceive that they have personally chosen to do so.”

6. Babbling

Silence can provoke anxiety, even for therapists, who think they should surely be redirecting, conjecturing, advising. I find myself observing people in therapy watch me watch them watching me watch them. And I have found a power in it. Like a Rorschach ink blot, presence has power in and of itself to nudge a person’s anxiety so it presents and speaks up for itself.

My former colleague, Blanche Douglas (2015), wrote: “There was a method in Freud‘s madness when he prescribed the analyst be as undefined as possible, not disclosing details about his life and sitting behind the patient out of sight, saying little. This forced the patient to make meaning out of an ambiguous situation, and the only way he could do this was by recourse to his own experiences.”

7. Methodologizing

If a psychotherapist is lifeless or their technique too technical, their efforts to help may be worthless. Therapy, in this case, is not a relationship but a poor excuse for scientific experimentation. The mechanisms of some psychotherapies undermine their therapeutic value. When we fixate on therapeutic modality, we run great risk of missing prime opportunities to interject the most valuable therapeutic tool we have to offer—ourselves.

Cristofer Jeschke/Unsplash
Source: Cristofer Jeschke/Unsplash


As a new therapist, I remember trying hard to demonstrate my own capacity for psychological insight—even though, I must confess for my wise professors’ sake, I was certainly not trained to be an egotistical show-off. Fortunately, somewhere along the way, I started to better understand and experience the disparity between knowing and being. All these years, I am still learning each day how to lean into the latter. There is something powerful in it, not just in the experience of the therapist but in the experience of the therapy.

The family therapy pioneer Lynn Hoffman, who sadly died in 2017, gave a language of values for sitting with clients—the non-expert position, relational responsibility, generous listening, one perspective is never enough.

If a therapist is not fully present as a warm, accepting, genuine, caring, and appropriately vulnerable person, the power center of therapy remains turned off. Whatever insight may come along the way, meaningful, sustainable change requires transformative experiencing. Analysis without encounter is nihilistic, all the apparatus of thought busily working in a vacuum. Only in the context of authentic relationship and therapeutic alliance can I grasp and catalyze the breadth and depth of formidable resources already existing within my clients.

This article originally appeared at

8 Types of Internal Conflict and How to Find Peace of Mind ⋆ LonerWolf

I really like the process described in this article for dealing with internal Conflicts. It describes them and  a detailed process for combatting/making peace.


8 Types of Internal Conflict and How to Find Peace of Mind ⋆ LonerWolf

Your mind and heart feel like they’re split in two.

You want to do something, but another part of you is screaming “NO WAY!”

You believe in something, but you just cannot condone an action that belief teaches.

You feel like something is right, but then you also feel like it’s wrong.

How can you make any sense of all this mess, all this internal conflict? You feel like your brain is melting and you’re starting to get desperate.

If you feel like you’re going a little bit crazy, or the confusion is getting too much to handle, stop right now. Pause what you’re doing, close your eyes, and take a deep breath. For the next minute, focus on your breathing coming in and out. In this article, I hope to help you get to the root of your internal conflict and how to find peace of mind.

What is Internal Conflict?

Internal conflict is the experience of having opposing psychological beliefs, desires, impulses or feelings. In the field of psychology, internal conflict is often referred to as “cognitive dissonance,” which is a term that refers to holding conflicting and inconsistent thoughts, beliefs, and attitudes. This mental struggle can occur at any point in life over any topic such as relationships, work commitments, religious beliefs, moral standpoints, and social ideologies.

An example of internal conflict would be a person who believes in women’s rights but does not condone abortion. Internal conflict can often be seen in relationships where one person loves their partner, but they don’t feel emotionally available. In the religious world, internal conflict often occurs when one is faced with a doctrine or teaching they are uncomfortable propagating.

Why Does Internal Conflict Occur?

Your worst battle is between what you know and what you feel. – Anonymous

When we experience any kind of internal conflict, what is really happening is that there is a disagreement between our heart and head.

As shown by research conducted by places such as the HeartMath Institute, our hearts carry their own special kind of intuitive intelligence. As we were raised in societies that were (and still are) dominated by the mind, we become very confused and disconcerted when our hearts get involved in everyday matters. It is very easy to listen to the mind, mindlessly obey what others teach us, and logically plan our lives. But our hearts carry their own special kind of intelligence, an intelligence that is nonlinear, subtle, and often very abstract. There is no formula or set of rules that are attached to the heart’s intelligence: it is up to us to tune into the voice within, which is often what confuses us so much.

Our head intelligence is what helps to give our lives structure, direction, and practical application. But our heart intelligence is what breathes life and truth into this framework of our life journeys. Without listening to our hearts, we live soulless, unfulfilling, and inauthentic lives. But without listening to our heads, we live in absolute chaos.

As we can see, balance is needed. We need to listen to both the heart and head, but often, we tend to value one over the other which is what causes us to experience internal conflict.

So why does internal conflict occur? It occurs because we lack equanimity and balance between the heart and head. Our heart says one thing, but our mind says another: and both shout at the same intensity. When our actions don’t match our values, the inevitable result is a feeling of discomfort, even shame. So which do we listen to, when, and why? We’ll explore the answer to this question soon, but first, we need to understand what creates internal conflict in the first place.

What Creates Internal Conflict?

We experience internal conflict for a number of reasons. Often, there is no one “single cause” or origin, but there are a number of factors which include:

  • The beliefs and rules we inherited from our parents
  • The religious beliefs, dogmas or creeds we were indoctrinated to believe
  • The societal values and ideals we adopted growing up

Quite simply, the more mental beliefs, ideals, expectations, and desires we have, the more likely we are to suffer from internal conflict.

8 Types of Internal Conflict

There are many different types of internal conflict, and I will attempt to cover as many as I can below. Pay close attention to which ones you resonate with.

1. Moral Conflict

Moral conflict arises when we hold conflicting beliefs about something to do with our personal ethics. For example, moral conflict could occur when a person believes in human rights but doesn’t believe in euthanasia. Or a person could value telling the truth, but lie to save another person’s life.

2. Sexual Conflict

Sexual conflict often overlaps with other types of internal conflict such as religious or moral conflict. For example, a person might be a faithful Christian but they discover they’re homosexual. Or a person might value monogamous relationships when sexually they are better suited to polygamous relationships.

3. Religious Conflict

Religious conflict is quite common because it revolves around belief and beliefs are very mind-orientated, making them particularly fragile. Examples of religious conflict could be believing in a loving God, but finding it hard to accept that this “loving” being sends people to hell for eternity. Or a person who is religiously faithful, but also believes in the use of medical marijuana (which is still classified as a drug). When faced with scientific facts, religious conflict may arise within a person who values both truth and their religious belief.

4. Political Conflict

Political conflict arises when a person feels split between their own beliefs and their political party’s beliefs. For example, a person may believe in America but doesn’t believe in paying taxes. A person may align with one party but disagree with their treatment of the healthcare system. Or a person may believe in the political philosophy but struggle to support the politician propagating it.

5. Love Conflict

Love conflict is what happens when we love someone, yet we want to do something that hurts them. For example, we may love our children, but believe we have to smack them to make them obedient, which causes us to feel guilty. Or we may love our partners, but find their habits to be intolerable which causes us to act out. We may also love a person and wish to keep them, but realize we have to let them go.

6. Self-Image Conflict

Your self-image is the mental idea you have about yourself, e.g. “My name is Karen. I’m a patient, loving, and compassionate person. I’m a disorganized artist who supports the rights of animals … etc.” Internal conflict arises when we are met with evidence that contradicts our beliefs about ourselves. For example, a person who believes they’re honest might lie on their resume to get their dream job. Someone who takes pride in eating healthy might not want to give up smoking. A person who identifies as an empath may feel constant resentment towards another person. Or a person may believe they’re ethical but might enjoy buying clothing that contributes to sweatshops.

7. Interpersonal Conflict

Interpersonal conflict overlaps with other types of internal conflict such as self-image and love conflict. This type of conflict occurs in social situations when you want to be one way, but find yourself acting in another way. For example, Sally hates talking about sports, but she finds herself faking interest in what her coworkers talk about. An introvert doesn’t have much energy but creates a high-energy facade to fit in with others. Or someone is offended by a friend but says nothing even though they want to.

8. Existential Conflict

Existential conflict involves feelings of discomfort and confusion about life, particularly when two opposing beliefs or desires arise. For instance, hating life but loving life at the same time. Or wanting to live life to the fullest, but not wanting to make any changes or get out of your comfort zone. Existential conflict can also be directed towards the world, for example, wanting to save our planet, but at the same time believing that it’s doomed.

Please note that all of these examples of internal conflict frequently overlap with each other. This list is also not definitive, so feel free to leave a comment if you believe I’ve left any types of internal conflict out.

How to Find Peace of Mind

All war originates within as internal conflict. And what is the root cause of internal conflict? Attachment to beliefs, desires, and expectations.

Quite simply, all our suffering occurs when we believe our thoughts, instead of seeing them for what they truly are: passing fluctuations of energy within the brain. Do we control our thoughts? No. Otherwise, we would always choose to think happy and harmonious thoughts. We don’t even know what our next thought will be, or what our next ten thoughts will be because they all spontaneously arise and fall within the mind. If we don’t control these thoughts, then how can they possibly mean anything about us unless we give them meaning?

If you can truly understand what I’ve just written, you’ll find that a lot of your internal conflict dissipates very quickly. Simply sit down for however long you want, and try to notice where your thoughts come from. Do you control them? Or … are they controlling you?

Aside from that, here are some other tips which I hope can help you find more peace of mind and clarity:

  • Distinguish between intuition and fear. The intuitive voice within your heart is very clear, strong, and unemotional. However, the fearful voice is vague and emotionally-charged. Learn how to distinguish between these two voices because they are often confused. Read more about following your intuition.
  • In the long-term, what would be the wisest choice? When our heart dominates, we tend to make rash, poorly thought-out decisions. This is where the head comes in: foresight. Foresight is wisdom. With the limited knowledge you have right now, what would appear to be the wisest decision in the long-term?
  • Weigh up the pros and cons. If you’re struggling to find clarity, divide a page into two sides. List all the pros of your decision on one side and the cons on the other.
  • Figure out your number one priority. Internal conflict often appears when we have no clear priority. What is your biggest priority at the moment? What do you value the most?
  • What mistaken beliefs are fuelling your confusion? What false, misleading, limiting or second-hand beliefs are causing the conflict within you? Write down your problem on a page and next to it ask “Why?” For example, you might want to keep your job but also crave to stay at home with your kids. Asking why relentlessly, you might discover that you believe that staying at home with your kids makes you a failure, and you’ve adopted this belief from society.
  • Be ruthlessly honest: what are you scared of? Fear always underlies internal conflict. What is inflaming your cognitive dissonance? What are you truly scared of? Sometimes discovering your underlying fear helps you to gain more clarity and direction.
  • What is the “lesser of two evils”? If you had to choose – gun to your head – what decision would you make?
  • Adopt a future perspective. From the perspective of you resting on your deathbed, what would you regret the most?
  • What is resisting the flow? One easy way to examine what is “not meant to be” is to examine what is causing the most resistance in your life. Remember, life flows effortlessly. It is our thoughts and desires that cut the flow. So, explore what is creating the most resistance in your life. Are you clinging to a ship that sailed long ago?
  • What is a more loving approach? Are you honoring your authenticity or honoring what you “think” you should do/be? What approach or choice is more aligned with the truth, with love?
  • Is there a more important underlying issue? Sometimes internal conflict actually hides deeper issues that need to be explored to find a resolution, such as negative self-beliefs, unresolved shame or childhood wounds.
  • Relax your mind. Relaxing your mind is a great way to develop new perspectives. Try meditating, listening to soothing music or practicing mindfulness. Often the best answers come when we aren’t looking for them.
  • Choose to stop participating. Do you need an answer right this very moment? Sometimes allowing life to move in the direction it wants is a better option than forcefully blazing a path. As teacher Wayne Dyer once wrote, “Conflict cannot survive without your participation.”

I hope these tips can help you find more peace of mind. Remember that it’s completely normal to experience internal conflict – there is nothing weird about you. Also, when it comes to internal conflict people tend to romanticize the heart and believe that we should only listen to whatever the heart wants. But this is an imbalanced approach: we need to use the heart as well as the brain so that internal harmony is created.

Bounce Back Today – CMHA BC

Source: Bounce Back Today – CMHA BC

  • It’s not always easy to know when our mental health is at risk. We have ups and downs and get used to having a few bad days here and there. Sometimes we’re the last ones to notice there are more bad days than good.

    Taking this quiz can help you start living life more fully and point you towards steps you can take to start feeling better.


Tapping Away Distress with Emotional Freedom Technique (EFT)

Our emotions and our physical body seem to be paradoxical partners. Though we know they live alongside each other, we are not always aware of their intrinsic connection.

But, while watching our emotions we will notice bodily behaviours, such as change in breath, tensing of muscles, rushing of blood, etc, that prove the interconnectedness of the body and emotional world. So what would happen if they worked together? What if we could heal one by healing the other?emotional-freedom-technique-healing

The body and emotions are sometimes connected to their own detriment; when a person holds anger, guilt, or sadness inside for too long it causes many health problems. So what if, instead of going to a doctor or taking pills, we worked from the inside out and healed our emotions?

The Chinese discovered long ago that the body contains complex circuits of energy that move through the body. These energy circuits, called the meridians, are the founding blocks of acupuncture, acupressure, and many other healing techniques used today.

What the EFT (Emotional Freedom Technique) tapping technique does is focuses and stimulates certain meridian points on the body by tapping on them with our fingertips. The result is a miraculous shift in emotions, and consequently in body and spirit.

EFT works on both the emotional and physical plane, being a highly constructive technique for both physical ailments such as soreness, chronic pains, high blood pressure, etc; or emotional state such as depression, guilt, or anxiety.

study examining the effects of EFT therapy in veterans with PTSD symptoms as compared to a group receiving standard mental health care, showed improvement in veterans receiving the EFT treatment after 6 sessions, resulting in 90% of the group no longer meeting PTSD clinical criteria; compared to the 4% in the standardized group.

These results are consistent with other studies that tested the effectiveness (along with the long-term effectiveness) of EFT treatment.

Other studies demonstrate how EFT can improve the health of people with a history of trauma in a very short amount of time –

How to do EFT?

This technique can be done by anyone, anywhere, and has therapeutic results for many. The technique is specific but can be done at any time, and for however long you want or need.

While traditional therapy can cost a lot, and works over a longer amount of time, EFT tapping can lead to peace of mind and improved health, in a shorter span of time. And as opposed to traditional therapy, what EFT does is empowers the patient to heal themselves.

A patient once lamented to her EFT coach that she regrets not being able to be there for herself at an earlier time, as she was learning to do at that present time. She wished she had these healing tools back when she was in a fragile or anxious state.

The coach responded that there is no time and space; as you heal in the present, you are healing your past, present, and future.

Step one:

Focus on the emotion or issue that you wish to work with; this can also be a goal you wish to achieve. Set one goal at a time as not to combine issues. Set your aim such as: the shame my mother made me feel, reaching my full potential in a (specific) activity, the fear I have of snakes, the anger I feel toward…etc.

You can also specify a physical ache or pain you wish to diminish, such as a sore body part or a chronic pain.

Step two:

Test the emotion. Set a number from 1-10 on how intense the issue stands before working on it. This allows you to compare the before and after effects. If a problem is marked with an 8 before hand and goes down to a 4 later on, then you know you have improved by 50%, and still have 50% left to work on.

  • For emotional work, bring up the emotion or memory in order to assess its intensity and discomfort.
  • For physical pains, merely focus on the discomfort in the body.
  • For goals in performance, set a specific goal which you’d like to achieve. For example: Hitting a difficult note.

Step three:

Acknowledge and accept. This step consists of a phrase that both acknowledges your issue, and accepts yourself in spite of it. This phrase is to be said as you are tapping, to keep the aim in continuous motion and attention.

The phrase is as such:
“Even though I have this _______, I deeply and completely (love and) accept myself.”

For example:
“Even though I have this fear of spiders, I deeply and completely accept myself.”
“Even though I have this shame, I deeply and completely accept myself.” Etc.

Feel free to change the structure to fit your experience, such as instead of saying, “Even though I have this humiliation from my mother…” you can just as well say, “Even though I was/felt humiliated by my mother…” etc.

Step four:

Tapping is generally done with tips of your fingers (index and middle finger). For wider areas, like the top of the head, the collarbone and under the arm, four fingers are used. On sensitive areas, like around the eyes, you can use just two.

Tapping starts at the top of the body and works its way down, balancing and stimulating the body’s energy pathways. Below see the diagram of the energy points. Now tap away, using a firm but gentle pressure.

Order of tapping points, from top to bottom:

Karate Chop (KC)
Top of the Head (TOH)
Beginning of the Eyebrow (EB)
Side of the Eye (SE)
Under the Eye (UE)
Under the Nose (UN)
Chin Point (CH)
Beginning of the Collarbone (CB)
Under the Arm (UA)

When through with the tapping cycle, sit within yourself and assess your symptom again. The tapping does not have to completely eradicate the problem, but lessen it bit by bit until resolved within yourself.

EFT tapping has an amazing effect on many people, both emotionally and physically, and works to move the stuck energy throughout us. A few minutes can diminish the effects of emotional trauma and add replenished movement to a person’s journey.

How Journaling Your Thoughts can Transform Your Life

This is a great little article on Journalling – the way I like to suggest people journal.

— Rory —

Source: How Journaling Your Thoughts can Transform Your Life

Life moves in cycles, a constant dance between beginning and end, birth and death. Our days mirror this dynamic, the mornings ushering in the new day’s sun, along with a host of new possibilities and adventures.

Night brings darkness, and ending, and a space of contemplation and reflection before we pass to the other side—in most cases only temporarily—before being born once again the next morning.

In modern culture, we have lost many of the rites and rituals that mark the progression of time and honor the cycles of growing, dying, and starting anew.

As a result, we so often find solace in habits, which appeal to our need for ritual. I think its important to provide structure to one’s life without falling into the often stifling space that routine manifests. Instead, try to approach your mornings — and your evenings — with a sense of sacredness.

These simple practices will help you greet the day with a clear head, welcome the night with a sense of completion and transform your life ~

Morning Pages: Empty out the clutter

“It is impossible to write Morning Pages for any extended period of time without coming into contact with an unexpected inner power.” ~ Julia Cameron

The concept of morning pages was popularized by Julia Cameron, author of The Artist’s Way. This magical book provides the reader with a number of powerful practices and shifts in perspective to help cultivate more creativity and freedom in writing. Morning Pages are, in my opinion, perhaps the most energy-shifting exercise in the whole book.

You start with a notebook, preferably something cheap so you don’t run into the problem of wanting to fill a fancy journal only with deep and eloquent thoughts.

Your morning pages may at times be deep and eloquent, but they will undoubtedly be silly, perhaps peevish, and occasionally shallow at other times.

Then, notebook in hand, sit down and write whatever is tumbling around in your head. Complain about your neighbor. Offer a prayer of thanks to God. Write a poem. Just get it out, onto the page. Write until you fill three pages, or about fifteen minutes.

Putting it down in ink gives all those bouncy thoughts a place to live, giving you more space to face your day with a clear head.

Morning Meditation: Swim to the middle of the lake

“The best way to meditate is through meditation itself.” ~ Ramana Maharshi

David Pond, author of Chakras for Beginners, offered this simple but effective meditation to help bring about a sense of clarity in the morning.
Find a comfortable seat, where you won’t be disturbed for at least fifteen minutes. Gently close your eyes and take a few calming breaths. Give yourself the opportunity to fully come into your body, noticing any sensations either physical or emotional that appear.

Now, envision yourself standing on the edge of a large lake. At your feet you see algae clinging to tree branches and murky water filled with silt and mud. Further out, sun glints off the clear center of the lake. Begin to wade in, stepping through the detritus, feeling the slimy rocks under foot.

Keep going, getting further into the water. As you make progress, you begin to see the water clearing. Soon, your feet lose contact with the bottom and you swim, all the way to the center of the lake, where the water is cool, clear, and beautiful.

The lake is your mind. Every morning when we wake up it’s filled an accumulation of stuff that bogs us down. Swim out to the center, the place that shines with pure, clean water, and begin your day from that perspective.

Evening Pages: Review so you can rest easy

“Control what you can control. Don’t lose sleep worrying about things you don’t have control over, because at the end of the day, you still won’t have any control over them.” ~ Cam Newton

Evening Pages have the same general concept as Morning Pages, with a slightly different perspective. As Cameron says, “With Morning Pages, you are prioritizing the day ahead of you (whenever that day begins for you). With Evening Pages, you are reviewing a day that has already happened–and that you are powerless to change.”

Evening Pages gives you the opportunity to get out all of the things you wanted to say, but couldn’t. Whether you had to keep silent in front of your boss, you thought of the perfect reply too late, or you found yourself too scared to express your truest thoughts and feelings, this is your chance to say it, so you don’t lie in bed having conversations with yourself that disrupt your sleep.

Evening Meditation: Drift off to dreamland

“May you fall asleep in the arms of a dream, So beautiful, You cry when you awake.” ~ Michael Faudet

In order to let yourself drift gracefully to sleep, try this modified version of Yoga Nidra. Lie on your back, in a comfortable position on your bed. Make sure you’re warm and your head is supported. Place your hands with your palms facing up a few inches away from your hips, and let your feet rest about a foot or so apart.

Gently close your eyes, and focus on your breathing. Sense the air as it enters through your nostrils, dives into your lower lungs, then cycles back out. Don’t force deep breathing, just let it come naturally. After a little while, shift your attention to your body. Sense the different points of contact with your bed and your blankets, moving from your head to your feet, and back again.

Now, begin a gentle body scan, not forcing anything, but slowly and easily moving your consciousness through each part of your body. Traditional Yoga Nidra begins with the right thumb, but you can start wherever feels most natural. Pause for a few seconds on each point in your body, from your thumb, to each of your fingers, to your wrists and forearm, and so on. Chances are good you’ll be deep in sleep well before you finish.

Start and end your day with intention

With these practices, you can set up a powerful beginning and a relaxing end to every day. Move through your days with clarity, and let sleep come unimpeded by the stress and often frantic thoughts that move through us over the course of a normal day. Try it for a week, and see what changes you can bring about!



Book Review: “When The Body Says No: The Cost of Hidden Stress”

I love this book and using many of the concepts with clients. Very thought provoking and not the average read. But an eyeopener and with words to live by.

Here is a link to a great review of the book.




Petition to Exempt Psychotherapy from HST

There is a new petition hosted on the Canadian House of Commons website, to exempt psychotherapy services from HST:

“We, the undersigned, citizens of Canada, call upon the House of Commons to remove the HST on psychotherapy as a piece of the overall effort to make mental health care as accessible as possible to the citizens of Canada.”

This is the link to the petition, and to more information about it:

Consider signing, and sharing the link with others – every signature makes a difference!

Healing Your Shame and Guilt Through Self-Forgiveness | Psychology Today

Source: Healing Your Shame and Guilt Through Self-Forgiveness | Psychology Today

“True confession consists of telling our deed in such a way that our soul is changed in the telling it.”     -Maude Petre

We hear a lot about the importance of forgiving those who have harmed us, but what about forgiving ourselves? Is that important as well? I believe that it is.

When we harm someone it is normal and healthy to feel bad about it, to experience regret and to wish we could take it back or do something to make the person feel better. What isn’t healthy is to continually beat ourselves up for our offense and to determine we are a bad person because of it. The first experience is generally thought of as guilt, while the second is considered to be shame.

(There is little agreement, even among professional therapists, as to the exact difference between guilt and shame so I don’t want to get sidetracked into discussing this controversy. For our purposes I will present to you what I consider to be the most helpful information about the issue).

Shame and guilt can feel very similar—with both experiences we feel bad about ourselves. But guilt can be understood as feeling disappointed in oneself for violating an important internal value or code of behavior. Feeling guilty can be a healthy thing: it can open doors leading to positive behavior change. With shame one can also feel a disappointment in one self but no value has been violated. As Gershen Kaufman explained in Shame: The Power of Caring, “The meaning of the two experiences is as different as feeling inadequate is from feeling immoral.”

Shame is incredibly unhealthy, causing lowered self-esteem (feelings of unworthiness) and behavior that reinforces that self-image. As we are learning more and more, shame can be an extremely debilitating emotion. Shame is responsible for a myriad of problems, including but not limited to:

* Self-criticism and self-blame;

* Self-neglect;

* Self-destructive behaviors (abusing your body with food, alcohol, drugs, cigarettes, self-mutilation, being accident-prone);

* Self-sabotaging behavior (starting fights with loved ones, sabotaging jobs);

* Perfectionism;

* The belief that you do not deserve good things;

*  Intense rage (frequent physical fights, road rage);

* Acting out against society (breaking the rules, breaking the law);

* Continuing to repeat the cycle of abuse through either victim behavior or abusive behavior.

Some have explained the difference between shame and guilt as follows: When we feel guilt we feel badly about something we did or neglected to do. When we feel shame we feel badly about who we are. When we feel guilty we need to learn that it is okay to make mistakes. When we feel shame we need to learn that it is okay to be who we are.

I believe that self-forgiveness is the most powerful step you can take to rid yourself of  debilitating shame. This is particularly true for those who have been abused, but it applies to everyone.  Self-forgiveness is not only recommended but absolutely essential if we wish to become emotionally healthy and have peace of mind. It goes like this: the more shame you heal, the more you will be able to see yourself more clearly—the good and the bad. You will be able to recognize and admit how you have harmed yourself and others. Your relationships with others will change and deepen. More importantly, your relationship with yourself will improve.

In my book, It Wasn’t Your Fault: Healing the Shame of Childhood Sexual Abuse through Self-Compassion I wrote about how compassion is the antidote to shame. Self-compassion acts to neutralize the poison of shame, to remove the toxins created by shame. Self-forgiveness is an important aspect of self-compassion. It acts to soothe our body, mind and soul of the pain caused by shame and facilitates the overall healing process

The Obstacles to Self-Forgiveness

Many people experience a lot of resistance to the idea of self-forgiveness. You may view self-forgiveness as “letting yourself off the hook,” as if self-judgment is the only way to improve. But negative self-judgment and self-blaming can actually act as an obstacle to self-improvement. The more shame you feel about your past actions and behaviors, the more your self-esteem is lowered and the less likely it is you will feel motivated to change. And without self-forgiveness your level of shame will cause you to defend yourself from taking on more shame by refusing to see your faults and not being open to criticism or correction.

The good news is: You can resolve to change your behavior and forgive yourself at the same time. In fact, the more you forgive yourself, the more you will be motivated to change. Self-forgiveness opens the door to change by releasing resistance and deepening your connection to yourself.

Still another reason you may have difficulty forgiving yourself is that you may have a powerful need to “be good” and to be seen as “all good” in the eyes of others, as well as yourself. This need to be “all good” may have started because your parents or other caretakers may have had this unreasonable expectation of you and may have severely punished or abandoned you when you made a mistake. Now you may find that you are equally critical of yourself and equally unforgiving.

If you have harmed others and resist forgiving yourself you may ask, “Why should I forgive myself? It won’t help those I’ve harmed.” The most powerful reason: If you do not forgive yourself, the shame you carry will compel you to continue to act in harmful ways toward others and yourself. And forgiving yourself will help you to heal another layer of shame and free you to continue becoming a better human being. Without the burden of self-hatred you have been carrying around you can literally transform your life.

How to Forgive Yourself for the Harm You Caused Others

Forgiving yourself for the ways you have hurt or harmed others will probably be the hardest thing that you will ever have to do in order to heal your shame. In fact, it may be the hardest thing you ever have to do in your life. This is especially true if you have repeated the cycle of abuse by harming another person in the same ways you were abused.

For example, it may seem impossible to forgive yourself for abusing a child. After all, you know first-hand how much child abuse damages a child. And you know first-hand how much the shame that accompanies abuse can devastate a person’s life. Here are some examples of what clients have shared with me regarding the shame they felt:

“How could I possibly abuse my own child the way I was abused? I knew how much it devastated me to be beaten by my father. And yet I turned right around and did it to my own children. It’s unforgivable.”
“I promised myself I would not treat my children the way I was treated. And yet to my horror the very same words my mother said to me came out of my mouth. Those horrible, shaming, devastating words, “I hate you. I wish you had never been born.’ How can I forgive myself for saying those horrible words to the people I love most in the world?”
“I feel like a monster. The shame I feel for molesting my daughter is so intense I can’t even describe it. I couldn’t have done anything worse to her. I’ve affected her life is such a horrible way. She must feel so betrayed. She must hate me and I don’t blame her.”

Four Avenues Toward Self-Forgiveness

As difficult as it may seem to be able to forgive yourself for the harm you have caused others, the good news is that there are several effective ways to go about it:


2. Common humanity

3. Earning Your Forgiveness: Taking responsibility, apologizing and making amends

4. Asking for forgiveness from your higher power.

As you read the following suggestions, choose the ways that you relate to the most, the avenues that resonate the most with you and your situation.

Self-Understanding Can Lead to Self-Forgiveness

If you were abused as a child and then repeated the cycle of abuse with your own children it is vital that you gain some self-understanding. Understanding that the trauma(s) you experienced created problems within you that were out of your control can go a long way toward forgiving yourself for the ways that you have hurt others. For example, understanding that your addiction—whether it be to alcohol, drugs, sex, food, shopping, or gambling —has been a way to self-medicate and to cope with anxiety and fear, can help you to stop beating yourself up for the harm your addiction caused those close to you. Understanding that the reason you have become abusive toward your children or your partner or have developed a pattern of allowing others to abuse you comes directly from your abuse experiences will hopefully help you to stop chastising yourself for these behaviors.

Research shows that the long-term effects of trauma (such as abuse in childhood) tend to be most obvious and prominent when people are stressed, in new situations, or in situations that remind them of the circumstances of their trauma. Unfortunately, becoming a parent creates all three of these circumstances for someone who was abused in childhood. First time parenthood, in particular, is stressful and almost always triggers memories of our own childhood traumas. This sets the stage for child abuse.

In addition, the sad truth is that those who were abused or neglected in childhood are more likely to become abusive or neglectful of their own children than someone who didn’t have these experiences. There are certain traits that you may have that predisposed you to treat your children in abusive or neglectful ways. These include: an inability to have compassion toward your child; a tendency to take things too personally (this may have caused you to overreact to your children’s behavior by yelling, calling them names or hitting them); being overly invested in your children looking good (and you looking good as their parent) because of your lack of self-confidence; and an insistence on your children “minding” you or respecting you to compensate for your shame or lack of confidence.

And there is still another reason that is not often discussed that can cause a parent to become abusive: seeing your own weakness or vulnerability in your child. Those with a history of having been victimized often develop a tendency to hate or despise weakness. If you saw weakness in your child you may have been reminded of your own vulnerability and victimization and this may have ignited your own self-hatred, thus causing you to lash out at your child.

Your own experiences of abuse and/or neglect may have prevented you from developing the qualities necessary to be a good parent.  For example, if your mother did not emotionally bond with you, you may have found it difficult, if not impossible to bond with your own children; if your parents looked to you to meet needs that should have been met by other adults in their life, you may have repeated this pattern; and if your mother did not protect you from the abusers in your life, you may not have protected your own children from the abusers in your life.

Forgive yourself. You didn’t know any better.

Common Humanity and Gaining Compassion for Yourself

Kristin Neff, Ph.D is an associate professor in human development at the University of Texas at Austin and is a pioneer who first established self-compassion as a field of study. In her construct of self-compassion, she names recognition of the common human experience—or what she calls, “Common Humanity,” as the second fundamental element of self-compassion. In her book, Self-Compassion (2011) she states that “self-compassion honors the fact that all human beings are fallible, that wrong choices and feelings of regret are inevitable…”

The truth is, we have all harmed others. In fact, every single person on this planet has harmed at least one other person in ways that have shaped that person’s life. Knowing this and knowing that you are not alone, can help you to have compassion for yourself and to forgive yourself. Feeling compassion for yourself does not release you from taking responsibility for your actions (we’ll discuss this later on in this blog). But it can release you from the self-hatred that prevents you from forgiving yourself and free you to respond to the situation with clarity. Rather than tormenting yourself with guilt and shame, having compassion for your own suffering and for the suffering of those you have harmed can help you achieve the clarity necessary for you to think of ways you can help those you have harmed (we will also discuss making amends and repairing the harm later in the blog ).

Acknowledging the interconnected nature of our lives is another aspect of Common Humanity. The truth is, who we are, how we think and how we behave is inextricably interwoven with other people and events. (Neff, 2011). In other words, you didn’t get to where you are today all by yourself. Your tendency to be a victim or your tendency to be abusive did not just happen. You must continue to look for the causes and conditions that lead you to these unhealthy behavior patterns.

When you examine your mistakes and failures it becomes clear that you did not consciously choose to make them and even in those rare cases when you did make a conscious choice, the motivation for your actions was colored by your abuse (or other) experiences. Because of the shame you have carried you closed your heart to others, you became blind to how your actions were harming others. In addition, outside circumstances also contributed to you forming your particular patterns. These outside circumstances can be any of the following: genetics, family experiences—including the way your parents interacted with each other and the way they interacted with you—and life circumstances such as poverty, family history and your cultural background.

As Kristin Neff wrote in Self-Compassion: “When we begin to recognize that we are a product of countless factors, we don’t need to take our ‘personal failings’ so personally. When we acknowledge the intricate web of causes and conditions in which we are all imbedded, we can be less judgmental of ourselves and others. A deep understanding of interconnectedness allows us to have compassion for the fact that we’re doing the best we can given the hand life has dealt us.”

Exercise: Your Sins and Omissions

Write a list of the people you have harmed and the ways you have harmed them.
One by one, go through your list and write down the various causes and conditions that led you to this action or inaction. You’ve already made the connection between your harmful actions and the fact that you were abused or neglected. Now think of other precipitating factors such as a family history of violence and a family history of addiction, as well as more subtle factors such as: stress due to financial problems or marital problems.
Now ask yourself consider why you didn’t stop yourself from harming this person.. For example, were you so full of rage that you couldn’t control yourself? Did you hate yourself so much that you didn’t care how much you hurt someone else? Had you built up such a defensive wall that you couldn’t have empathy or compassion for the person you harmed?
Now that you have a (you have a) better understanding of the causes and conditions that lead you to act as you did, see if you can apply the concept of Common Humanity (Neff, 2011) toward yourself: You were an imperfect, fallible human being and like all humans sometimes do, you acted in ways that hurt someone else. Honor the limitations of your human imperfection. Have compassion for yourself. Forgive yourself.

Earning Your Forgiveness

If you continue to find yourself resisting forgiving yourself, ask yourself this question. “Why wouldn’t I want to forgive myself?” If your answer is “I don’t deserve it,” that is your shame talking. If you are still feeling like you don’t deserve forgiveness, perhaps you believe you need to earn it.

How do you earn forgiveness? First of all, you need to admit to yourself and others the wrongs you have committed. Unless you tell the complete truth about how you have harmed others, first to yourself and then to the person or people you have hurt (if at all possible), you may not believe you deserve to be forgiven. (And incidentally, unless you admit what you did to harm the person or people you have harmed, they may not be willing to forgive you).

Dwelling on your mistakes does no one any good, including the person you harmed.

When you take responsibility for your actions you may feel more shame at the moment, but before long that feeling of shame will be replaced with a feeling of self-respect and of genuine pride (as opposed to false pride).

To prepare yourself for this process:

Spend some time thinking seriously about how your actions or inaction have harmed the person.

Completing the following sentence may help in this process:

“I harmed ________by___________________.”

Write down all the ways your action or inaction harmed this person.

“I caused______________to suffer in the following ways______________.”

The next step is to go to those you have harmed and admit what you have done to hurt them. It is important that you tell those you have harmed that they have a right to their anger and that you encourage them to voice their anger directly to you. Make certain, however, that you do not allow anyone to verbally abuse you or to shame you.  Taking responsibility may also include admitting to others, such as other family members, how you abused or neglected your victim.


Your admittance of what you did to harm others is doubly powerful if it is accompanied by a heartfelt, sincere apology. One of the most frequent comments that I hear from those who were abused in childhood is that they wish the offender would admit what he or she did and apologize to them for it.  Think of an incident when you felt wronged by another person. What did you want from that person in order to forgive him or her? Most people say they want an apology. But why is this the case? It isn’t just the words, “I’m sorry,” that we need to hear. We need the wrongdoer to take responsibility for his or her action and we need to know that the wrongdoer feels regret or remorse for having harmed us.

Apology can remove the cloak of shame that even the most remorseful person carries around. On the other hand, if you don’t experience enough shame when you wrong someone else, apology can help remind you of the harm you caused. The act of having to apologize to someone usually causes us to feel humiliated. Remembering that humiliation the next time you are tempted to repeat the same act can discourage you from acting on your impulse.

When we are able to develop the courage to admit when we are wrong and to work past our fears and resistance to apologizing we develop a deep sense of respect in ourselves. This self-respect can, in turn affect our self-esteem, our self-confidence and our overall outlook on life. When I apologize to you I show you that I respect you and care about your feelings. I let you know that I did not intend to hurt you and that it is my intention to treat you fairly in the future.  If you apologize for abusing or neglecting a child, even though that person is now grown, you will not only validate his or her experience but help the person to stop blaming himself or herself  for the abuse.

How to Give A Meaningful Apology

A meaningful apology is one that communicates what I call the three R’s–regret, responsibility, and remedy.

1. A statement of regret for having caused the inconvenience, hurt or damage. This includes an expression of empathy toward the other person showing that you understand how your action or inaction harmed him or her.

2. An acceptance of responsibility for your actions. For an apology to be effective it must be clear that you are accepting total responsibility for your actions or inaction. This means not blaming anyone else for what you did and not making excuses for your actions.

3. A statement of your willingness to take some action to remedy the situation. While you can’t go back and undo or redo the past, you can do everything within your power to repair the harm you caused. Therefore, a meaningful apology needs to include a statement in which you offer restitution in some way, an offer to help the other person, or a promise to take action so that you will not repeat the behavior. In the case of emotional or physical abuse, you can enter therapy or a support group to make sure you do not abuse anyone again. You can offer to pay for your victim’s therapy or you can donate your time or money to organizations that work to help victims of abuse.

For more information on how to give a meaningful apology refer to my book, The Power of Apology, John Wiley and Sons, 2000.

Ask Your Creator or Higher Power for Forgiveness

When we face the truth about how we have hurt others, sometimes severely, the feelings of guilt and shame can be overwhelming. Often, the only way we can find compassion for ourselves or self-forgiveness is to reach out to something bigger than our individual selves.

Whatever your religious or spiritual beliefs, asking your higher power for comfort, compassion and forgiveness can be a powerful step in forgiving yourself. This may be as simple as praying to God to forgive you for your sins, or it may involve a more structured gesture. For example, the act of confession within the Catholic church is essentially an apology to God. It has all the important components of apology–a statement of regret, an acceptance of responsibility for one’s actions, a promise to not repeat the offense, and the request for forgiveness. In the Jewish tradition it has long been the custom to seek forgiveness from family members, friends, neighbors, and colleagues during the time of the High Holy Days.

You may also wish to pray to your higher power for help in your process of self-forgiveness. Many of my clients have reported that by doing this they believe they received help in this endeavor.

If you have learned from your mistake, and do not wish to repeat it, then you no longer need to feel guilt or shame about it. Forgive yourself and let it go.

If you find you are still overwhelmed with guilt or shame about how your past behavior has affected someone, it will be important to realize and remember this truth: The most effective method of self-forgiveness is for you to vow that you will not continue the same behavior and not hurt someone in the same way again.


Chart of James Fowler’s Stages of Faith |

See a chart explaining James Fowler’s stages of faith development

Source: Chart of James Fowler’s Stages of Faith |

In his book 1981 book Stages of Faith , James W. Fowler developed a theory of six stages that people go through as their faith matures based on the Piaget stages and Kohlberg stages. The basic theory can be applied, not only to those in traditional faiths, but those who follow alternative spiritualities or secular worldviews as well. In his 1987 book A Different Drum, M. Scott Peck offered a simplified version focusing only on the four most common stages. See also: Erikson stages



Simplified version by M. Scott Peck

Stage 1

Intuitive-ProjectiveThis is the stage of preschool children in which fantasy and reality often get mixed together. However, during this stage, our most basic ideas about God are usually picked up from our parents and/or society.I. Chaotic-AntisocialPeople stuck at this stage are usually self-centered and often find themselves in trouble due to their unprincipled living. If they do end up converting to the next stage, it often occurs in a very dramatic way.

Stage 2

Mythic-LiteralWhen children become school-age, they start understanding the world in more logical ways. They generally accept the stories told to them by their faith community but tend to understand them in very literal ways. [A few people remain in this stage through adulthood.]

Stage 3

Synthetic-ConventionalMost people move on to this stage as teenagers. At this point, their life has grown to include several different social circles and there is a need to pull it all together. When this happens, a person usually adopts some sort of all-encompassing belief system. However, at this stage, people tend to have a hard time seeing outside their box and don’t recognize that they are “inside” a belief system. At this stage, authority is usually placed in individuals or groups that represent one’s beliefs. [This is the stage in which many people remain.]II. Formal-InstitutionalAt this stage people rely on some sort of institution (such as a church) to give them stability. They become attached to the forms of their religion and get extremely upset when these are called into question.

Stage 4

Individuative-ReflectiveThis is the tough stage, often begun in young adulthood, when people start seeing outside the box and realizing that there are other “boxes”. They begin to critically examine their beliefs on their own and often become disillusioned with their former faith. Ironically, the Stage 3 people usually think that Stage 4 people have become “backsliders” when in reality they have actually moved forward.III. Skeptic-IndividualThose who break out of the previous stage usually do so when they start seriously questioning things on their own. A lot of the time, this stage ends up being very non-religious and some people stay in it permanently

Stage 5

Conjunctive FaithIt is rare for people to reach this stage before mid-life. This is the point when people begin to realize the limits of logic and start to accept the paradoxes in life. They begin to see life as a mystery and often return to sacred stories and symbols but this time without being stuck in a theological box.IV. Mystical-CommunalPeople who reach this stage start to realize that there is truth to be found in both the previous two stages and that life can be paradoxical and full of mystery. Emphasis is placed more on community than on individual concerns.

Stage 6

Universalizing FaithFew people reach this stage. Those who do live their lives to the full in service of others without any real worries or doubts.
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Conflict and the Thinker/Feeler Struggle in Relationships

The thinking/feeling dichotomy was first connected to individual differences in psychological types (personalities) by Carl Jung. It is used in the Myers-Briggs Type Indicator’s personality typology and addresses natural differences in how individuals make decisions and experience emotions.

It is also the cause of a great deal of tension and conflict for couples that naturally differ on this dichotomy.

The terms used for descriptive purposes here can be misleading. For instance, someone with a feeling response orientation is not inherently more able to feel or less able to think than someone with a thinking response orientation; and someone with a thinking orientation is not inherently more able to think or less able to feel than someone with a feeling orientation (Reinhold, 2007).

These terms are used to address fundamental differences in the perceptual and experiential processes automatically triggered when thinking- and feeling-response-oriented individuals are sorting out and expressing what they are thinking and feeling. (Please note that this interpretation differs significantly from those of Carl Jung and the authors of the Myers-Briggs Type Indicator.)

Although human beings are aware that people differ in how they come to conclusions and experience and express emotions, few understand that these differences in self-expression are driven by innately different perceptual and experiential frames of reference. Of particular note is a fundamental difference in the experience of emotions when conflicts arise—a difference of such magnitude that role-reversal comprehension is not possible. These differences are a constant in interactions between thinking and feeling individuals, easily confirmed by observation of one’s personal and professional relationships.

Those with thinking response orientation:
  • Process thoughts and experience emotions with an objective, fact-based frame of reference.
  • Base decisions on objective criteria of cause and effect.
  • Automatically seek a logical explanation for what is happening when conflicts arise.
  • Have a self-grounded sense of logical consistency in thought, action, and emotion.
  • Interpret anything expressed or done that does not make logical sense as automatically invalid.

Those with feeling response orientation:

  • Are wired to facilitate harmony in human relationships.
  • Have a natural sensitivity to issues of fairness and inclusion.
  • Are tuned in to the tone of communication. If it is not said nicely, it is not nice.
  • Are susceptible to feeling guilty or bad out of proportion to objective reality when conflicts arise.
  • Have a susceptibility to feeling hurt and rejected when responded to in an emotionally neutral or blunt manner.

Thinking/Feeling Couples

The usual cause of difficulty for couples that differ on this dichotomy comes from a fundamental difference in how they experience and express emotions. The moment harmony is disrupted, most feeling-response-oriented individuals feel bad, as if they have done something wrong. Knowing they have not, in fact, done something wrong does not usually help. They feel bad anyway.

When these feelings are triggered, they may immediately apologize, hoping to restore harmony and neutralize the guilt they are experiencing, or they may get upset with their partner for doing something that caused them to feel that way. Neither of these responses makes much sense to a thinking-response-oriented individual.

Why would a person feel guilty and bad simply because someone disagreed with them; much less suggest that the other is at fault for causing them to feel that way? From the thinking-oriented perspective these responses do not make logical sense and are therefore invalid.

Choice is not an option here. Very much like the degree to which someone is left-handed, right-handed, or ambidextrous, the manner in which feeling- and thinking-oriented individuals experience and express thoughts and feelings is natural and normal—just different.

The Challenge in Communication

In essence, two naturally disparate perceptual frames of reference for making sense out of the same reality have been activated. The feeling partner seeks validation for how they are feeling about the situation, while the thinking partner seeks validation for why they think their partner’s feelings do not make logical sense. Neither can provide a response that meets the other’s criterion for being heard.

Without intention or awareness, the explanations that each provide for justifying their own natural and normal responses de facto invalidate the natural and normal responses of their partner. Issues of little import can trigger emotionally charged exchanges that leave both parties psychologically battered, blaming each other for the damage done, while the issues themselves remain unresolved. The conflict resolution challenge is significantly magnified when the couple also differs on the extroversion-introversion dichotomy.

Conflict Resolution Approach

I have been using a natural differences questionnaire based on the Myers-Briggs Type Indicator with all couples and families since 2000. Information on natural differences has proven to be consistently accurate.

In fact, the accuracy of the information above is such that most thinking-response-oriented partners have been able to accept its validity. Feeling-response-oriented partners have usually been more ambivalent. Although the information provides concrete validation regarding their emotional sensitivity and reactivity, it does not provide them with much relief from the feelings that get triggered when conflicts arise.

If they accept the premise that natural and normal differences in response orientations are at play, they have to acknowledge that their partner

  1. cannot experientially relate to how they are feeling when conflicts arise and, therefore,
  2. is not at fault for the feelings their comments can trigger.

The inequity inherent to this difference in experiencing emotion is such that some feeling-response-oriented partners have great difficulty accepting it. Fortunately, once most thinking-oriented partners have a logical explanation for their partner’s feel-based responses, they have been able to soften their responses in general and become more considerate and accommodating when conflicts arise. This change has helped many feeling partners contain the resentment they automatically experience during conflict.

The intensity of the explosive exchanges that some thinking/feeling couples are dealing with is such that adherence to a timeout rule is an absolute necessity if they hope to replace their destructive conflict resolution process with a healthier one. It is understandable why some feeling-response-oriented partners have a hard time adhering to this time out rule. After all, extroverted/feeling-oriented individuals have a particularly difficult time letting go before their partner has acknowledged the validity of how they are feeling.

The fact remains that once an issue has become emotionally charged and abusive, the possibility of a meaningful resolution no longer exists. Partners with strong extroversion, intuition, and feeling-response orientations may have a particularly difficult time accommodating this timeout rule.

The level of psychic distress (disruption of self) that some experience is so extreme that efforts by their partner to withdraw may trigger desperate, even violent behaviors to prevent their partner’s exit before a resettling response has been provided. However, a way must be found to contain these emotions if they hope to replace their destructive process with a healthier one.

Consequently, depending on the perceived volatility of the conflicted exchange, the person calling for a timeout may:

  1. Agree to a future time to reconvene and try again, before their next counseling appointment.
  2. Wait until their next counseling session to address the issue.
  3. Contact the counselor to see if an earlier date can be scheduled to meet.

The timeout is almost always called for by the thinking partner and resented by the feeling partner.

Tip for thinkers: Seek to understand and accommodate your partner’s areas of sensitivity rather than attempt to help them understand why they should not feel that way.

Tip for feelers: Use logic-based constructs when explaining why they are upset. Example: “Even though you do not understand why I get upset when you say that, the fact remains that every time you say that I get upset. Given the predictability of my response, why do you keep saying that?”

Once most couples realize that natural differences are at play, and that neither is intentionally responding the way they do in order to get his or her own way, they are able to accommodate and compromise in areas that had not been possible before.

Reinold, Ross. (21 March, 2007). E-mail correspondence.


Mental Health Services, Help and Support: Ottawa-Carleton

Source: Ottawa-Carleton, ON : Mental Health Services, Help and Support :

Walk-In Counselling

Confidential personal counselling services are available for current Carleton University students. Our primary responsibility is to alleviate distress and more
1125 Colonel By Dr., Ottawa, ON, K1S 5B6 Map
17 years and up

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The Walk-in Clinic at Crossroads helps families to get started on the road to understanding. Do you have any concerns about your child’s behaviour, more
1755 Courtwood Crescent, Ottawa, ON, K2C 3J2 Map
613-723-1623 x333
Up to 12 years

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South-East Ottawa Community Health Centre works with the diverse community of South-East Ottawa and with partners throughout the region to provide and advocate more
1355 Bank Street, Ottawa, ON, K1H 8K7 Map
All ages

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Trained and experienced counsellors at The Counselling Group (TCG) provide a full range of counselling and support services for children, adolescents, and more
2255 Carling Ave, Ottawa, ON, K2B 7Z5 Map
613-722-2225 x352
All ages

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The UOHS offers services for students, staff and community members experiencing mental health issues. Please note only students registered with UOHS are eligible for counselling services. more
100 Marie Curie Pvt, Ottawa, ON, K1N 6N5 Map
All ages

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Wabano’s Mental Health Walk-in Counselling is a free counselling service for First Nations, Métis, and Inuit clients of any age or gender. It offers the more
299 Montreal Road, Ottawa, ON, K1L 6B8 Map
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* A free (i.e. no-fees) service that operates 7-days a week, evenings and weekends. * Clients are seen on a first-come, first-served basis. * No referrals more
312 Parkdale Avenue, Ottawa, ON Map
16 years and up

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Offers a variety of programs including * Counselling and Referral * Early Years Centre for children ages 0-6 * Children and Youth Services * Services for more
2 MacNeil Court, Ottawa (kanata), ON, K2L 4H7 Map
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Support for Life’s Challenges Free Counselling Services No Appointment Necessary Trained Professional Counsellors No referral is required for the more
2255 Carling Avenue, Ottawa, ON, K2B 7Z5 Map
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Counselling and Therapy

Counselling Services provides caring, confidential, professional counselling for Algonquin students* at no cost. To book an appointment, visit or call the more
1385 Woodroffe Avenue, Ottawa, ON, K2G 1V8 Map
613-727-4723 x7200
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Non-profit organization dedicated to promoting good mental health, developing and implementing support systems and services and encouraging public action to more
1355 Bank Street, Ottawa, ON, K1H 8K7 Map
All ages

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Confidential personal counselling services are available for current Carleton University students. Our primary responsibility is to alleviate distress and more
1125 Colonel By Dr., Ottawa, ON, K1S 5B6 Map
17 years and up

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The Paul Menton Centre is responsible for the coordination of academic accommodations and support services for students with disabilities. Some of our more
1125 Colonel By Dr., Ottawa, ON, K1S 5B6 Map
All ages

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CFIR’s Neuropsychological Assessment Service provides comprehensive psychological assessments to support clients in understanding their brain functioning as more
388 Albert St., Ottawa, ON, K1R 5B2 Map
18 years and up

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The Walk-in Clinic at Crossroads helps families to get started on the road to understanding. Do you have any concerns about your child’s behaviour, more
1755 Courtwood Crescent, Ottawa, ON, K2C 3J2 Map
613-723-1623 x333
Up to 12 years

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Community-based, non-profit organization offering a wide range of social and community services. Services offered to Blackburn Hamlet, Beacon Hill, more
1980 Ogilvie Road, Ottawa, ON, K1J 9L3 Map
All ages

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The Ottawa Hospital has a variety of mental health services which include inpatient and outpatient programs (including first episode psychosis, eating more
501 Smyth Road, Ottawa, ON, K1H 8L6 Map
16 years and up

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South-East Ottawa Community Health Centre works with the diverse community of South-East Ottawa and with partners throughout the region to provide and advocate more
1355 Bank Street, Ottawa, ON, K1H 8K7 Map
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The Centre for Counselling and Pastoral Services at Saint Paul University offers bilingual individual and couple counselling. These services are provided by more
223 Main Street, Ottawa, ON, K1S 1C4 Map
All ages

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Trained and experienced counsellors at The Counselling Group (TCG) provide a full range of counselling and support services for children, adolescents, and more
2255 Carling Ave, Ottawa, ON, K2B 7Z5 Map
613-722-2225 x352
All ages

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The UOHS offers services for students, staff and community members experiencing mental health issues. Please note only students registered with UOHS are eligible for counselling services. more
100 Marie Curie Pvt, Ottawa, ON, K1N 6N5 Map
All ages

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The Wabano Centre for Aboriginal Health is an urban health centre that: Provides quality, holistic, culturally-relevant health services to Inuit, Métis and more
299 Montreal Road, Ottawa, ON, K1L 6B8 Map
All ages

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Attachment Consultation and Education Service (ACES) – Consultation, assessment, treatment and education for children and youth (birth – 18 years) with a focus more
600 Sanatorium Road, London, ON, N6H 3W7 Map
Up to 18 years

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Day treatment programs

Hospital that specializes in wide range of mental health services including: * inpatient and outpatient services for youth and adults * specialized mental more
1145 Carling Avenue, Ottawa, ON, K1Z 7K4 Map
16 years and up

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Attachment Consultation and Education Service (ACES) – Consultation, assessment, treatment and education for children and youth (birth – 18 years) with a focus more
600 Sanatorium Road, London, ON, N6H 3W7 Map
Up to 18 years

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Drop-in centres

Community-based, non-profit organization offering a wide range of social and community services. Services offered to Blackburn Hamlet, Beacon Hill, more
1980 Ogilvie Road, Ottawa, ON, K1J 9L3 Map
All ages

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Consumer/survivor membership-run mutual support organization. PSO staff, volunteers and members offer peer support, telephone information and referrals, and more
211 Bronson Avenue, Ottawa, ON, K1R 6H5 Map
18 years and up

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Housing and Home Supports

Community-based, non-profit organization offering a wide range of social and community services. Services offered to Blackburn Hamlet, Beacon Hill, more
1980 Ogilvie Road, Ottawa, ON, K1J 9L3 Map
All ages

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Provides housing and support services to people living with serious mental illness. Housing options include: * Salus Shared Living – large, modern houses more
2000 Scott Street, Ottawa, ON, K1Z 6T2 Map
16 years and up

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South-East Ottawa Community Health Centre works with the diverse community of South-East Ottawa and with partners throughout the region to provide and advocate more
1355 Bank Street, Ottawa, ON, K1H 8K7 Map
All ages

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St.Pascal Residence provides permanent housing with some support of daily living for adults with special needs and mental health disabilities. We are more
2454 ch. du Lac, Saint-pascal Baylon, ON, K0A 3N0 Map
18 years and up

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Offers a variety of programs including * Counselling and Referral * Early Years Centre for children ages 0-6 * Children and Youth Services * Services for more
2 MacNeil Court, Ottawa (kanata), ON, K2L 4H7 Map
All ages

Add to Info Cart is Canada’s #1 Top Rated Bilingual Senior Care Directory. The most up-to-date and comprehensive Canada-Wide information on: Assisted Living, more
Physical address not provided
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Assertive Community Treatment (ACT) teams

Hospital that specializes in wide range of mental health services including: * inpatient and outpatient services for youth and adults * specialized mental more
1145 Carling Avenue, Ottawa, ON, K1Z 7K4 Map
16 years and up

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Self-help, Mutual Aid and Support Groups

Provides information, support and education to help individuals, family members and caregivers/professionals who are living with or providing care for someone more
1750 Russell Road, Ottawa, ON, K1G 5Z6 Map
All ages

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A peer support group for all affected by mental illness. Each meeting there is an opportunity support one another through sharing, listening and prayer. more
2414 Ogilvie Road, Ottawa, ON, K1B 3R9 Map
13 years and up

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This program aims to support Francophones struggling with a mental health disorder in their recovery process and to encourage them to participate in community more
346 chemin Montréal, Ottawa, ON, K1L 6B3 Map
16 years and up

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Parkinson’s Society Ottawa is a regional partner of Parkinson Society Canada (PSC), which is a national, health charity with more than 240 chapters and support more
381 Kent Street, Ottawa, ON, K2P 2A8 Map
All ages

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Registered charity that aims to improve mental health in Canada by mobilizing and engaging Canadians to drive fundamental changes that result in: * increased more
151 Slater Street, Ottawa, ON, K1P 5H3 Map
All ages

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Consumer/survivor membership-run mutual support organization. PSO staff, volunteers and members offer peer support, telephone information and referrals, and more
211 Bronson Avenue, Ottawa, ON, K1R 6H5 Map
18 years and up

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South-East Ottawa Community Health Centre works with the diverse community of South-East Ottawa and with partners throughout the region to provide and advocate more
1355 Bank Street, Ottawa, ON, K1H 8K7 Map
All ages

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Offers a variety of programs including * Counselling and Referral * Early Years Centre for children ages 0-6 * Children and Youth Services * Services for more
2 MacNeil Court, Ottawa (kanata), ON, K2L 4H7 Map
All ages

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The Society provides information, support and education to people with Alzheimer’s disease and related dementias, and supports families, physicians and more
20 Eglinton Avenue West, Toronto, ON, M4R 1K8 Map
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Our overall objective is to provide people suffering from mood disorders a strong, cohesive voice at the national level to improve access to: * more
3-304 Stone Road West, Guelph, ON, N1G 4W4 Map
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Finances and Money

Community-based, non-profit organization offering a wide range of social and community services. Services offered to Blackburn Hamlet, Beacon Hill, more
1980 Ogilvie Road, Ottawa, ON, K1J 9L3 Map
All ages

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Community Health and Resource Centres

Carlington Community Resource Centre is a community-based health and social service centre. Various services including: the Assertive Community Treatment (ACT) more
900 Merivale Road, Ottawa, ON, K1Z 5Z8 Map
All ages

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Centretown Community Health Centre provides a full range of health and social services to individuals and families who live or work in Ottawa South, the Glebe more
420 Cooper Street, Ottawa, ON, K2P 0M6 Map
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Community-based, non-profit organization offering a wide range of social and community services. Services offered to Blackburn Hamlet, Beacon Hill, more
1980 Ogilvie Road, Ottawa, ON, K1J 9L3 Map
All ages

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Pinecrest-Queensway Community Health Centre is a community based, multi-service centre working in partnership with individuals, families and communities to more
1365 Richmond Road, Ottawa, ON, K2B 6R7 Map
All ages

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Provides a variety of services to residents in the Sandy Hill area. Services include: Addictions Counselling; Food; Healthy Living; HIV/AIDS; Hepatitis C; more
221 Nelson Street, Ottawa, ON, K1N 1C7 Map
All ages

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Somerset West Community Health Centre offers a range of services to Ottawa residents in the Somerset West area. Services include: Medical care by nurses, nurse more
55 Eccles Street, Ottawa, ON, K1R 6S3 Map
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South-East Ottawa Community Health Centre works with the diverse community of South-East Ottawa and with partners throughout the region to provide and advocate more
1355 Bank Street, Ottawa, ON, K1H 8K7 Map
All ages

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Offers a variety of programs including * Counselling and Referral * Early Years Centre for children ages 0-6 * Children and Youth Services * Services for more
2 MacNeil Court, Ottawa (kanata), ON, K2L 4H7 Map
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Transportation, adult day programs, support programs, social recreation for rural seniors more
1128 Mill Street, Manotick, ON, K4M 1H2 Map
65 years and up

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General Community Mental Health Services

Non-profit organization dedicated to promoting good mental health, developing and implementing support systems and services and encouraging public action to more
1355 Bank Street, Ottawa, ON, K1H 8K7 Map
All ages

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Trained and experienced counsellors at The Counselling Group (TCG) provide a full range of counselling and support services for children, adolescents, and more
2255 Carling Ave, Ottawa, ON, K2B 7Z5 Map
613-722-2225 x352
All ages

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Offers a variety of programs including * Counselling and Referral * Early Years Centre for children ages 0-6 * Children and Youth Services * Services for more
2 MacNeil Court, Ottawa (kanata), ON, K2L 4H7 Map
All ages

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Hospital that specializes in wide range of mental health services including: * inpatient and outpatient services for youth and adults * specialized mental more
1145 Carling Avenue, Ottawa, ON, K1Z 7K4 Map
16 years and up

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Private Practice Professionals and Commercial Businesses


Bytowne Homecare Services is a community-based service that provides important assistance to supplement the efforts of family caregivers, friends, neighbors, more
1 Thorncliffe Place, Ottawa, ON, K2H 9N9 Map
18 years and up

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Programme de jour pour adulte offre une multitude d’activités sociales, récréatives et éducative dans l’objectif de: -Maintenir la more
159 rue Murray, Ottawa, ON, K1N 5M7 Map
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1 in 5 people will have some sort of mental health problem in their life. If you are experiencing a mental health crisis yourself, or you know someone who is, more
Physical address not provided
All ages

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Services for francophones who are living with mental health problems. Court Outreach: a program that helps francophones who are experiencing mental health more
338 chemin Montréal, Ottawa, ON, K1L 6B3 Map
613-742-0988 x610
16 years and up

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Pari Home Care offers a full range of non-medical in-home services for seniors and persons who are physically challenged or recovering from illness or surgery. more
2638 Innes Road, Ottawa, ON, K1B 5B0 Map
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Lawyer referral organization that helps people with all disabilities including people who are deaf, hard of hearing, people with physical disabilities, mental more
400 Coventry Road, Ottawa, ON, K1K 2C7 Map
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Individualized home and non-medical care services to seniors and their families who need assistance with daily living needs Quality services provided to more
352 Hamilton Ave S, Ottawa, ON, K1Y 1C5 Map
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Providing residential treatment services, foster care services and community based respite programs for over 15 years. Services are provided in the Ottawa more
47 Landsdowne Ave., Carleton Place, ON, K7C 4K3 Map
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Services provided include: Occupational Therapy Speech Language Therapy Social Work Child and family services Mental Health and Addictions Services more
4200 Labelle, Ottawa, ON, K1J 1J8 Map
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Primary Care to Mental health and addictions resource map for Champlain Sub-regions more
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Francophone community health organization that offers integrated mental health and addiction services as well as housing services to vulnerable individuals, more
162 Murray Street, Ottawa, ON, K1N 5M8 Map
16 years and up

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Facilitates community reintegration for people living with mental illness or concurrent disorders by offering housing supports in order to prevent more
162 rue Murray Street, Ottawa, ON, K1N 5M8 Map
613-789-5144 x226
16 – 65 years

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The Support Within Housing program facilitates community reintegration for people living with mental illness or concurrent disorders by offering housing more
162 rue Murray Street, Ottawa, ON, K1N 5M8 Map
613-789-5144 x226
16 – 65 years

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Residential treatment services for children aged 8 years old and older. Services for youth with acting out behaviours, mental health / abuse issues, and more
34 Mayo Ave, Ottawa, ON, K2E 6X5 Map
8 years and up

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MHH provides free, anonymous, confidential information and referral services and supports for people experiencing mental health issues or to their families, more
All ages

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The professional association for Speech-Language Pathologists (SLP) and Audiologists in Ontario. Their website has a Private Practice Referral Line for finding more
410 Jarvis Street, Toronto, ON, M4Y 2G6 Map
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Founded in 1977 to unite and promote the emerging profession of art therapy in Canada. Art therapy combines the creative process and psychotherapy, more
Parksville, BC, V9P 2G7 Map
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Looking for a psychologist? The Canadian Register of Health Service Providers (CRHSPP) has a national directory of qualified psychology providers. more
368 Dalhousie Street, Ottawa, ON, K1N 7G3 Map
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Kids Help Phone is Canada’s only bilingual phone and on-line counselling service for youth. It’s free, anonymous and confidential. Professional more
439 University Avenue, Toronto, ON, M5G 1Y8 Map
5 – 20 years

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Parkinson Society Canada (PSC) is a national, not-for-profit, organization with more than 240 chapters and support groups working nationwide.   As the more
4211 Yonge Street, Toronto, ON, M2P 2A9 Map
All ages

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Non-profit association that seeks to transform the mental health sector to be an inclusive society where people achieve full social inclusion. Promotes more
140 Holland Street West, Bradford, ON, L3Z 2Y5 Map
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Therapy Dog services are provided across Canada by St. John’s Ambulance in a wide range of community settings such as: hospitals, seniors residences and care more
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Our mission is to improve the health and quality of life of people with physical, emotional, and social challenges through partnerships with companion and service animals. more
1010 Polytek St, Ottawa, ON, K1J 9H9 Map
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Therapists Spill: 12 Ways to Accept Yourself | Psych Central

Source: Therapists Spill: 12 Ways to Accept Yourself | Psych Central

Therapists Spill: 12 Ways to Accept Yourself For many people self-acceptance is hard to come by on a good day. It’s tenuous, a glass with tiny cracks, at best. On a bad day, when you’ve made a mistake or two, don’t like how you look or feel absolutely miserable, your self-acceptance is in shards.
Fortunately, self-acceptance is something we can nurture. Look at it as a skill that you can practice versus an innate trait that you either have or don’t.

Below, clinicians reveal 12 ways we can cultivate self-acceptance.

1. Set an intention.

“Self-acceptance begins with intention,” according to psychotherapist Jeffrey Sumber, MA. “It is vital that we set an intention for ourselves that we are willing to shift paradigms from a world of blame, doubt and shame to a world of allowance, tolerance, acceptance and trust,” he said. This intention acknowledges that self-loathing simply doesn’t lead to a satisfying life. “If I set my intention that a life with self-acceptance is far better than a life of self-hatred then I begin a chain reaction within my being geared to a life of peace,” Sumber said.

2. Celebrate your strengths.

“We are much better collectors of our shortcomings than our strengths,” according to Ryan Howes, Ph.D, a psychologist in Pasadena, California. Psychologist John Duffy, PsyD, agrees. “[Many people] fail to see their strengths and cling to antique scripts they carry about their lack of worth,” he said.

Duffy helps his clients hone in on their strengths and abilities by writing them down. If you’re having a tough time coming up with your list, name one strength each day, he said. Start with something basic like “I’m a kind person,” said Duffy, also author of The Available Parent. “Typically, lists evolve as the script loses its strength, and people recognize they are intelligent, and creative, and powerful, and articulate, and so on. Sometimes, we can’t see ourselves until we clear the weeds,” he said.

Howes suggested making a similar list: “Make a list of all the hardships you’ve overcome, all the goals you’ve accomplished, all the connections you’ve made, and all the lives you’ve touched for the better. Keep it close by, review it frequently, and add to it often.”

3. Consider the people around you.

What kinds of people do you surround yourself with? Sumber suggested asking yourself these questions about the people in your life:

Who speaks negatively to me? Who reinforces negative self talk? Why do I allow such people to hurt me? Are they just doing my own dirty work because I’m not willing to choose a different reality?

4.Create a support system.

Distance yourself from people who bring you down, said Joyce Marter, LCPC, a psychotherapist and owner of Urban Balance, LLC. Instead, “Surround yourself with people who accept you and believe in you,” she said.

5. Forgive yourself.

Past regrets can prevent us from practicing self-acceptance. Forgive yourself, and move on. “Whether it’s about something you’ve done or a personality quirk that resulted in a social faux pas, it’s important to learn from the mistake, make efforts to grow, and accept that you can’t change the past,” Howes said.

When the tinges of remorse resurface, remember these words, he said: “I made the best decision with information I had at the time.” “The behavior or decision might not seem correct in hindsight, but at the time it seemed like the best choice,” Howes added.

6. Shush your inner critic.

Many people equate their inner critic with a voice of reason. They think their inner critic is simply speaking the truth. But if you wouldn’t say it to a loved one, it’s not honesty or sincerity. It’s unwarranted — and harsh — judgment.

To quiet your inner critic, Marter suggested choosing a realistic mantra. “I believe in the power of mantra and encourage clients to select a mantra that is normalizing, calming and encouraging during times when the inner critic rears its ugly head,” she said. For example, you could use: “I am only human, I am doing the best that I can and that is all I can do,” she said.

As Marter said, “Our mistakes and our imperfections are not bad or wrong or failures–they are the fingerprints of humanity and opportunities for learning, healing and growth.”

7. Grieve the loss of unrealized dreams.

“Many of our problems with self-acceptance come from our inability to reconcile who we are as compared with the idealized dreams of our youth,” Howes said. Maybe you dreamed about becoming an Olympic athlete or a multi-millionaire or staying married forever or having a big family, he said. Whatever your dreams or goals, mourn that they didn’t come to pass, he said. Then “get back to being the best you possible.”

8. Perform charitable acts.

“When you sacrificially give to others, you see how your deeds are a positive influence on other lives. It becomes more and more difficult to maintain the idea that you are no good when you see how your deeds help other people,” Howes said.

9. Realize that acceptance is not resignation.

Marter described acceptance as letting go of the past and the things we cannot control. This way, “you can focus your energy on that which you can [control], which is empowering,” she said. In fact, for some people accepting that they have a problem is the first step to making positive changes, she said.

10. Speak to your highest self.

Marter suggested readers try the following activity that includes imagining and interacting with your highest or best self.

I often ask my clients to visualize their highest and best self that lies deep within them. I ask them to imagine that highest self stepping outside of them and looking at them in their current life circumstance or situation. I ask the client to imagine what this highest or best self advises them to do.

This process of visualizing a separation or detachment from the current [or] suffering self often helps clients tap into the wisdom that already lies within them — their highest self — to promote healing.

This exercise teaches clients how to be their own best parent and demonstrate empathy, compassion and love towards the self. I advise clients to take a few minutes to meditate and practice this visualization whenever they are in crisis [or] need some direction or some self-soothing.

11. Be kind to yourself.

Many people are hesitant to show even a shred of self-kindness because they see it as selfish or undeserved. But the key to self-compassion is “to understand that weakness and frailty are part of the human experience,” according to Deborah Serani, PsyD, a psychologist and author of Living with Depression. “Coming to accept who you are involves loving yourself because of your flaws, not in spite of them,” she said. You’ll find more on practicing self-compassion here and here.

12. Fake it ‘til you make it.

If you’re unconvinced that you’re a worthy person, keep the faith and keep at it. Keep practicing self-compassion along with the other suggestions. “Most of us do not have direct communication from our deity of choice, yet we take the leap and trust that our God is true and real. The same goes for our self-acceptance. I first must think and do before I know,” Sumber said.

Brad Pitt’s turn to therapy after Angelina Jolie was most important move of his life | Fox News

Brad Pitt has revealed to GQ magazine that he began psychotherapy following his split from Angelina Jolie, back in September, 2016.  Since then, he has stopped using alcohol and other ways of burying his feelings and says he has dramatically improved  his life.  In the interview, he sounds smart and sensitive, serious and self-possessed.

This comes as no surprise to me. The most important choice in life that anyone will ever make is whether to unearth and understand his or her life story and “own” it, or whether to run away from it–to anesthetizing amounts of alcohol or cocaine or marijuana or sex or power.

Brad Pitt may well have saved his life–metaphorically or literally–when he decided to let another human being listen to him, encourage him,  challenge him and insist he start looking at himself, honestly, which is the only way to start truly loving oneself.

How do I know?  It literally saved my life, too, when depression struck me, and the late, great Dr. George Weinberg helped me wrestle it to the ground.  I am not exaggerating a bit when I tell you that I am not sure I could have won that war, without him.

I intend to repay that favor, in service to my own patients, for the rest of my life.

Myths about psychotherapy abound–that it is self-indulgent, that it is a way of pinning the blame on others for one’s problems, that it takes many years and hundreds of hours to achieve any real results.  They’re all falsehoods fueled by the fear of self-examination, which actually requires no small measure of personal courage and integrity.

Here’s the truth:  Psychotherapy, properly practiced by a professional with real skill, is one of the most powerful forms of healing that has ever existed.  It can defeat major depression, paralyzing anxiety, eating disorders, addiction, even psychosis. And its benefits can begin after just one hour, then continue to build and build.

If a person were to commit to just a dozen hours with a determined therapist, in fact, I believe that that time could very well turn out to be some of the most important that he or she will ever spend. Ever.  Period.

Psychotherapy can not only defeat illness, but can also unleash a person’s God-given potential to be clear-thinking, capable, creative, compassionate and courageous.

You don’t have to be ill or weakened to decide to get therapy.  You just have to decide you want to be stronger.  Because psychotherapy can revolutionize your existence.

That’s how powerful human empathy, properly harnessed, actually is.  And that’s a miracle.

Here’s another miracle:  You don’t have to be a movie star to reach out for the kind of healing that helped Brad Pitt turn his life around.  I have treated actors and CEOs and US Senators, but I have also treated store clerks and salesmen and engineers and longshoremen.

There are talented psychotherapists in every city in America–including yours.  You owe it to yourself and everyone you will interact with, for the rest of your life, to schedule your first hour with one of them, today.

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team.

It’s Time To Get Men Talking About Depression | Joshua R Beharry

Source: It’s Time To Get Men Talking About Depression | Joshua R Beharry

 April 7th is World Health Day, and this year the World Health Organization (WHO) is running a campaign called “Depression Let’s Talk“. I fear that when we talk about depression, we often don’t take it as seriously as we need to, so I’m glad the WHO is talking about it.

The WHO notes that women are affected more by depression than men (at least in terms of confirmed diagnoses), yet men account for 3-4 times the number of suicides compared to women. Depression is one of the leading risk factors for suicide.


Eight years ago, I didn’t know much about depression. Seven years ago, I wanted nothing more than to escape it’s pain, and I tried to take my own life. The worse part is, my story is not unique.

Depression is a devastating illness — it can become so painful that its victims can become convinced that there is no way out other than to take their own lives. The reality is that, particularly when left untreated, depression can kill. I’m lucky to still be here.

I, like many men, found depression too hard to talk about. When I began to realize something more serious was going on with my health, I was too ashamed to admit I needed help. All over the world, boys learn that men don’t cry, that men don’t ask for help, and that real men don’t need help anyway.

I suffered in silence for months until my symptoms — lack of sleep, low energy, low mood, and suicidal thoughts — became too much to hide from my family. I reached out when I thought I had hit rock bottom. But I had waited too long, and even though I had met with my doctor and started treatment, I got worse before I began to recover.

 When I was depressed, I felt isolated and alone. I thought no one could understand what I was going through, that somehow my pain was far worse than anyone else’s. As I began to recover, I realised how many people have felt the same way and how wrong I was. Through therapy, medication, lifestyle changes, and determination I was able to start re-building myself.

It wasn’t until I started working for a Movember-funded project at the University of British Columbia to create an online resource called HeadsUpGuys that I began to fully recognize just how much these male expectations — men don’t cry or show vulnerability, men don’t need help, men are supposed to be indifferent to pain — had influenced and restricted my recovery, almost to the point of costing me my life.

In other men’s recovery stories, I often hear my own story — guys too ashamed to reach out, guys not wanting to look weak. It’s heartbreaking to hear the same story repeated by so many men, but also inspirational to know others have been able to recover as well.

Now that I’ve become more open about my experiences, other men have come up to me — guys I’ve known for years — to tell me they know what depression is like, that they too have struggled. Half the time though, the conversation ends with “Josh, this stays between us.” Stigma around depression still exists. In order to really begin fighting depression, men need to break the silence and not feel ashamed for not feeling well. A few other things men need to understand include:

  1. Depression has nothing to do with personal weakness. Depression is a serious health condition that affects millions of men every year. It’s no different than if you develop diabetes or high blood pressure — it happens and we show our strength by building supports and working to get better.
  2. It’s okay to seek support. Sometimes we need an outside perspective for a different take on what might be contributing to depression. Consulting a professional who has knowledge of depression and treatment options is the smartest thing to do.
  3. Ignoring depression won’t make it go away. I used to think I already knew all the answers and that talking with someone wouldn’t be any help. I learned the hard way that this couldn’t be further from the truth. Often, things that seem like a huge deal in my mind weren’t as stressful when I talked about them more openly with a friend or doctor.

There are effective treatments for depression, there is no shame in seeking support, and there is no reason to wait. Thank you to the WHO and World Health Day for opening up this much needed conversation. Let’s keep it going.

Share this article to help a guy in your life who might be suffering but isn’t ready to seek
help for himself — recovery from depression is possible.

Psychotherapy revival: Can “talk” therapy change our brains and genes? | Genetic Literacy Project

“Talk therapy” has fallen out of fashion as being more art than science. But new research suggests that psychotherapy may have a biological basis, and is quite useful in certain situations.

Source: Psychotherapy revival: Can “talk” therapy change our brains and genes? | Genetic Literacy Project


Is Sigmund Freud in history’s rear view mirror? Is psychotherapy a dying art?

Visiting a psychiatrist today could result in a prescription for a drug or possibly a brain scan if the problem is seen is threatening. But there was a time when more likely than not the prescription would have been psychotherapy — the act of sitting down and talking with a therapist about problems.

Has the practice of couch-based “talk therapy” become obsolete in the wake of advancing knowledge about the brain and mental disorders? Or has it just fallen out of style?

While many prominent psychiatrists have continued to tout the value of psychotherapy, others have expressed doubts about the technique. It does have recognized value; it’s estimated that for mood disorders like depression, psychotherapy works about 60 percent of the time. So we ask the question: Is drug therapy the appropriate default for addressing psychiatric problems.

The answer of course is “it depends.” Views are changing, however, as we come to better understand what goes on during therapy at the biological level. Scientists recently found that in some cases, the work of a “paid friend” may have an impact on a patient’s genes, biology and brain function, and they also identified biological changes that can predict how well talk therapy can work.

In an editorial in Psychiatric Times, Allen Frances, emeritus chairman of psychiatry at Duke and former chair of the Diagnostic and Statistical Manual (DSM-IV) task force, wrote that “Psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first.”

And the American Psychological Association, while acknowledging that drug therapy has been used more and more often over the past several decades, still maintains that “talk therapy” can sometimes be more useful than more biologically based drug therapy.

A number of studies have shown some biological changes that arise from therapy, some genetic variations that can dictate how well therapy may work and genetic variations that exist exclusively in some psychological conditions.

What does this spate of findings suggest about the benefits and limits of psychotherapy?

Where it came from, what it does

Psychotherapy, as practiced in today’s psychiatrist’s or psychologist’s office, is often a way for someone who has intractable troubles that may have non-biological dimensions (losing weight, quitting smoking, depression, anger, anxiety, etc.) to develop a relationship with a counselor. Techniques are used so that the two can find successful ways for the patient to cope. Three key factors are part of any psychotherapy approach: attachment (emotional engagement between the patient and practitioner), empathy (understanding and articulating the patient’s perspectives), and ultimately, fear extinction (the ability to face and overcome psychological obstacles).

Psychotherapy first arose in practice (as far as we know) in 1880, when a doctor named Joseph Breuer used it on a female patient who called it a “talking cure” and “chimney sweeping.” Breuer abandoned the use of the technique, but one of his students, Sigmund Freud, expanded on the practice, essentially founding the modern psychiatric movement. By the early 20th century, nearly every American practitioner was using some form of talk therapy.

However, whether Freud succeeded at making psychotherapy a scientific exercise is still somewhat up for question. Some psychiatrists and biologists have pointed to Freud’s theories as having no basis in the biology of the brain, and looked instead at more biological answers to mental disorders. However, since the biological basis of behavior hasn’t exactly been revolutionizing our understanding of mental disorders, “talk therapy” remains.

Freud, for his part, never gave up believing the biological basis of his theory:

The deficiencies in our description would probably vanish if we were already in a position to replace psychological terms by physiological or chemical ones. Biology is truly a land of unlimited possibilities. We may expect it to give us the most surprising information and we cannot guess what answers it will return in a few dozen years to the questions we have put to.

Biological basis?

It’s taken much more than a few dozen years to get remotely close to the point Freud had hoped for, but we are getting closer:

  • Scientists have discovered several neurochemical and physiological events underlying the three pillars of psychotherapy (attachment, empathy, and fear extinction). Oxytocin, arginine vasopressin and the mu-opioid receptor all play a role in controlling attachment, while receptor genes for oxytocin and the arginine receptor, as well as activity in the anterior cingulate cortex and superior temporal sulcus regulate empathy. Fear extinction appears regulated by the neurotransmitter NMDA, and activity in the hippocampus, amygdala, and other brain regions. Antagonists (or agonists) of neurotransmitters may help enhance the effects of psychotherapy, researchers speculate.
  • A British and Australian study of children receiving psychotherapy for anxiety disorders responded differently to the therapy, depending upon the allele of a serotonin transporter gene promoter they carried. Children with one genotype (the “short short” variety of the promoter) were significantly more responsive to behavioral therapy than those with another, “long” version.
  • Another British review noted a number of studies linking the success or failure of psychotherapy to a large number of neurotransmitters, proteins and other biological events in the brain. The reviewers also noted that current studies are too small to demonstrate whether any certain gene variant is powerful enough to alter the course of a mental disorder, or whether the right genes are being studied.

These studies have prompted biologists and psychologists to look at whether genetic variation and environmental influences can provide biomarkers of a sort, predicting whether a certain psychotherapy technique could be effective. Further, psychotherapy could be enhanced by combining “talk therapy” techniques with drugs, genetic testing, and other neurobiological tools to treat mood, anxiety, or other psychological disorders. There’s even a new name for this new field: “therapygenetics.”

Maybe Freud’s dream wasn’t just a dream, after all.

Andrew Porterfield is a writer, editor and communications consultant for academic institutions, companies and non-profits in the life sciences. He is based in Camarillo, California. Follow @AMPorterfield on Twitter.

Exercise, psychotherapy better than drugs for cancer fatigue: study – The Globe and Mail

Source: Exercise, psychotherapy better than drugs for cancer fatigue: study – The Globe and Mail

Cancer patients may ease fatigue more effectively with exercise and psychotherapy than with medication, a recent study suggests.

Researchers examined data from 113 previously published studies involving more than 11,500 cancer patients with fatigue. Patients were randomly assigned to treat their exhaustion with exercise or psychotherapy, or both, or with drugs.

Exercise and psychotherapy were associated with a 26 per cent to 30 per cent reduction in fatigue during and after cancer treatment, the study found. Drugs, however, were tied to only a 9 per cent decline in fatigue.

“Patients need to try exercise or psychotherapy before they reach for a pharmaceutical,” said lead study author Karen Mustian of the University of Rochester Medical Center in Rochester, New York.

Cancer-related fatigue is common and may be tied to the effects of tumors or treatments, researches note in JAMA Oncology. Unlike other types of exhaustion, just getting more sleep or giving aching muscles a break from strenuous activities can’t address fatigue associated with tumors.

Fatigue tied to cancer can persist for years and may be worsened by other cancer-related health problems like depression, anxiety, sleep disturbance and pain.

It’s not clear why exercise and psychotherapy may be more effective than drugs, Mustian said by email.

“We do not know for sure why exercise works, but some research is beginning to suggest it is due to anti-inflammatory effects and also improvements in physical function – cardiovascular, pulmonary and muscular,” Mustian added. “In terms of psychotherapy, the most beneficial form was group therapy that used a cognitive behavioral approach to educate patients, help them to change the way they think about fatigue and managing it, and adopting behaviors to help alleviate it.”

Most participants in the studies were female, and almost half of the studies involved women with breast cancer.

Age, gender, cancer type and forms of exercise didn’t appear to influence how effective exercise or psychotherapy was relative to medications, researchers found.

Overall, the analysis included 14 drug studies, mostly looking at stimulants or drugs designed to promote wakefulness.

Among the 69 evaluations of exercise, most looked at aerobic activity alone or in combination with other types of movement.

Of the 34 psychological interventions tested in the studies, most involved therapies focused on behavior and education.

One benefit of the current study is that researchers were able to pool the data from several individual research efforts that were, alone, too small to draw meaningful conclusions about the relative advantages of different treatments, the authors note.

Limitations include the varied designs in the studies, which made it difficult to assess how factors such as race, education, income or other demographic differences might have impacted the results, the researchers also point out.

Even so, the findings confirm previous research on interventions to ease cancer-related fatigue, Dr. Jens Ulrich Rueffer, head of the German Fatigue Society in Cologne, said by email.

“We already knew that exercise and/or psychological interventions were beneficial for treating cancer-related fatigue,” said Kerry Courneya, a researcher at the University of Alberta, in Edmonton, Canada.

“What we learned from this new meta-analysis is that exercise and psychological counseling are roughly equal in their benefits for cancer-related fatigue,” Courneya, who wasn’t involved in the study, added by email. “And both appear superior to current pharmaceutical treatments.”

Chronic insomnia best treated with psychotherapy 1st – Health – CBC News

People with chronic insomnia should try cognitive behavioral therapy before medications, suggests a prominent group of U.S. doctors.

Source: Chronic insomnia best treated with psychotherapy 1st – Health – CBC News

Chronic insomnia is defined as at least three restless nights per week for at least three months.

Chronic insomnia is defined as at least three restless nights per week for at least three months. (Alyssa L. Miller, Flickr cc)

While the American College of Physicians (ACP) can’t say cognitive behavioural therapy (CBT) outperforms medications for chronic insomnia, the group does say psychotherapy is less risky than drugs.

“Sometimes we forget that sleep medications have the potential for serious side-effects in some patients, while cognitive behavioural therapy is very low [risk] to patients,” said Dr. Wayne J. Riley, ACP president.

“The evidence is clear that CBT and sleep hygiene can be long lasting, life long, durable and delivered at a lower cost,” said Riley, who is also affiliated with Vanderbilt University in Nashville.

About 6 to 10 per cent of people in the U.S. have insomnia. Through loss of productivity, the condition is estimated to have cost the country about $63 billion US in 2009, according to the ACP committee that wrote the new guideline, which is published in the Annals of Internal Medicine.

Chronic insomnia is defined as at least three restless nights per week for at least three months.

“We wanted to take a deep dive into the literature for what makes a big difference with insomnia,” Riley told Reuters Health.

The ACP commissioned two reviews of insomnia treatments. One focused on medications, and the second focused on psychological and behavioural treatments.

Medication and ‘sleep driving’

Overall, the first review found that some medications may improve sleep over a short period of time, but those come with the potential for changes in thinking and behaviour. Additionally, there is a risk for infrequent but serious harms.

The U.S. Food and Drug Administration says medications for insomnia should only be used for short periods. The agency warns those drugs may impair people during the daytime, lead to “sleep driving,” behavioural changes and worsening depression.

The review of psychological and behavioural treatments found that CBT for insomnia improved overall sleep with a low risk of harms, the researchers report.

Evidence collected separately for the two reviews found that “side-effects can be quite severe with the use of insomnia medications in contrast to CBT, where there are minimal side-effects,” said Riley.

CBT for insomnia is typically delivered in four to six one-hour weekly sessions. People are taught behavioural techniques such as sleep restriction and stimulus control, and they are also taught sleep hygiene.

When chronic insomnia isn’t helped by CBT alone, the ACP advises patients and doctors to consider a short course of medication. That discussion should touch on the potential benefits, harms and costs of medication, the ACP says.

Doctors should encourage patients with insomnia to engage in CBT, according two researchers whose editorial was published with the reviews and the guideline.

‘Prescription not the best solution in the long term’

But, they admit, CBT for insomnia might not be covered by insurance and is likely not available at doctors’ offices, write Dr. Roger Kathol, of the University of Minnesota in Minneapolis, and J. Todd Arnedt, of the University of Michigan Medical School in Ann Arbor.

“Unless access to and unencumbered payment for value-based behavioural interventions, such as CBT (for insomnia), in medical settings become a reality, patients with chronic insomnia will continue to receive suboptimal treatment and experience suboptimal outcomes,” they write.

Alternatives to in-person CBT for insomnia include group therapy session, telephone counseling, online lessons and self-help books, Riley said.

The ACP recommendations are similar to that of the American Academy of Sleep Medicine (AASM), said Dr. Alcibiades Rodriguez, who is medical director of NYU Langone Medical Center’s Comprehensive Epilepsy Center-Sleep Center in New York City.

The AASM’s 2008 practice guidelines for treating chronic insomnia endorse psychotherapy as a first-line treatment and suggests it be used when medications are prescribed.

“The recommendations made by the ACP will appeal to a broader group of physicians to make them aware of this,” said Rodriguez, who was not involved with the new recommendations. “Then the doctors know just giving patients who come to their office with sleep problems a prescription is not the best solution in the long term.”