Common Presenting Issues in Individual Therapy

Depression

While all of us feel down sometimes, there is a point at which low mood begins to get in the way of living a fulfilling life. This may take the form of persistently sub-optimal mood or an inability to experience joy. It may be a more intermittent, severe depression that occurs once in a while and which results in a withdrawal from life and one’s relationships. It may be a bipolar depression that features periods of very high energy, impulsivity, and sometimes irritability. Both Depression and Bipolar Disorder can occur with various levels of severity, and can occur alongside other symptoms or problems.

Treatment for depression almost always involves some aspect of Cognitive-Behavioural Therapy (CBT), which will help you to change your thoughts and behaviours in order to improve your mood. This might also involve integrating Insight-Oriented Therapy/Psychodynamic Therapy to look at aspects of your childhood and early relationships that might be relevant.

Anxiety

Anxiety is a normal part of life, and something that we can all relate to. It typically has both a physical component (tension, increased heart rate, shallow breathing) as well as a cognitive component (worry, rumination). Many of us, however, experience anxiety that is intense, excessive and persistent, and that interferes with our daily functioning. These levels of anxiety can be quite distressing and all-consuming, and can take a number of different forms, some of which are detailed below.

Generalized Anxiety

People with generalized anxiety experience persistent worry across multiple areas (money, work, relationships, health). They will often report that they have always been “a worrier”, or have always felt tense, and will sometimes refer to it as being part of their personality. It is often the case that as one specific worry recedes, another comes to the forefront, making it seem that the anxiety is a moving target that can never be resolved.

Social Anxiety

Social Anxiety Disorder is characterized by persistent anxiety about social situations due to fear of being negatively evaluated by others. This anxiety can be related to performing in any way in public, from socializing, to presenting at work, to eating in public, to raising one’s hand in a classroom setting. As with other anxiety disorders, there is a kind of “snowball effect” whereby anxiety about the anxiety develops (i.e., people with social anxiety worry that their anxiety will cause others to judge them, thereby making the anxiety worse).

Obsessive-Compulsive Disorder (OCD)

OCD involves unwanted and disturbing thoughts, images, or urges (obsessions) that intrude into one’s mind and cause a great deal of anxiety or discomfort, which one then tries to reduce by engaging in repetitive behaviors or mental acts (compulsions). People suffering with OCD are well aware that their compulsions are at best ineffective and at worst highly destructive to their quality of life, but they struggle to overcome them. The usual treatment for OCD is a specific type of Cognitive Behaviour Therapy (CBT) that helps one break free of their old patterns of compulsivity.

Panic

For people whose anxiety manifests as panic, the world can become a very frightening place. Panic attacks involve bouts of anxiety so severe and physical that a person might think that they are having a hard attack or are going to die. Often a person who experiences panic attacks will begin to anticipate future panic attacks, and this anticipatory anxiety can set a destructive cycle in motion. If left untreated, panic can lead to agoraphobia, a condition in which a person avoids leaving their home or safe place in order to avoid experiencing panic symptoms.

Posttraumatic Stress Disorder (PTSD)

Sometimes in the aftermath of a traumatic experience, people suffer from severe anxiety that takes the form of PTSD. PTSD is characterized by intrusive memories or images of the trauma. In this way, a person with PTSD essentially ends up reliving the traumatic event over and over. People with PTSD can experience emotional numbness, feeling on edge or hypervigilant, difficulty sleeping, irritability, and persistent negative thoughts about the world and their future. In order to avoid the distressing thoughts and emotions associated with the trauma, people with PTSD avoid anything that reminds them of the event, and this avoidance often interferes with normal daily activities. Therapy for PTSD is often delivered using Cognitive Processing Therapy (CPT).

Regardless of what form a person’s anxiety takes, we target it on two basic levels:

  1. Addressing the physical component of the anxiety (the fight-or-flight feelings) by providing training on getting grounded and feeling safe. This typically involves an integration of Relaxation Training and Mindfulness-Based Psychotherapy
  2. Addressing the cognitive component of the anxiety. Examples of this include changing the story that you are telling yourself about the anxiety and possibly decreasing your anxiety about your anxiety. For longstanding anxiety, it might be helpful to examine potential childhood roots of your fears.

Stress

We all deal with stress on a daily basis, and most of us have developed ways of coping that generally serve us well enough. There are times in all our lives however, when things overwhelm our usual coping capacities. Maybe it is a string of stressors that come so close together that we don’t have sufficient time to recover from one and prepare for the next. Maybe it’s just too many uncontrollable things in our environment, or maybe it’s the final straw after a period of intense stress that leads us to realize that we are burned out. Therapy for stress and burn-out typically combines instruction in stress-management and Relaxation Training, and might incorporate aspect of Acceptance and Commitment Therapy (ACT), or Insight-Oriented Therapy aimed at addressing other factors (e.g., assertiveness, boundary-setting, perfectionism, self-esteem issues) that might be contributing to one’s distress.

Low Self-Esteem

One of the most common themes underlying depression, anxiety, and relationship issues is low self-esteem. Many of us, sometimes despite outward indications of confidence, success and competence, struggle to feel self-love, self-compassion, and a sense of intrinsic worthiness. In the context of a positive therapeutic relationship one can explore the roots of low self-esteem and learn to see themselves more clearly, opening up possibilities for self-love and self-compassion. This work might involve a variety of approaches or an integrative approach, depending upon the individual.

Recovery from Childhood Abuse

The effects of childhood abuse can be long-lasting. The child copes the best they can in the midst of the abuse, grows up and establishes their own safety, overcoming the abuse in many ways. Often, however, they realize that despite all of their strength and resilience, they continue to carry the effects of the abuse later in life in the form of anger, shame, anxiety, and possibly difficulty trusting and relating to others. Insight-Oriented Therapy and also Dialectical Behavioural Therapy (DBT) are useful approaches to addressing the sequelae of childhood physical, sexual, and emotional abuse.

Chronic Pain

Chronic pain has a significant psychological component. When a person is in frequent or constant pain, it invariably affects their thoughts, behaviour, and emotions. As is the case with so many psychological problems, a feedback loop is established: the worse a person’s pain is, the more negative, sedentary, tense, and sad they tend to get, but the same applies in the other direction. This opens up a very powerful potential path of change through chronic pain-focused psychotherapy. Chronic pain therapy aims to change thoughts behaviour and mood in order to alleviate physical pain. This therapy typically involves a combination of CBT, Relaxation Training, and Mindfulness-Based Psychotherapy.

Relationship Issues

Therapy is a great way to learn about oneself and how one relates to others. Sometimes people seek therapy in an attempt to better understand a relationship that they are in, and possibly improve it. They might also come to therapy hoping to gain insight into why they are having a hard time leaving a relationship that they feel is not good for them. Often, people present in therapy hoping to better understand why they have a pattern of conflict in all or most of their relationships; they long for a stable relationship but have not been able to achieve one and are wondering about their own contribution to this pattern. This type of therapy is typically delivered using Insight-Oriented Therapy.

Grief & Bereavement

While grieving is a natural part of life, sometimes our reaction to a loss leaves us struggling to continue to live in a meaningful way. The loss might be the death of a loved one (human or pet), the loss of a job, the loss of a relationship (child moving away, loss of a friendship, break-up or divorce), the loss of one’s youth, or even the loss of a dream. Therapy can help a person work through their feelings about the loss, address any limiting thoughts or beliefs that might be complicating their grief, and find a way forward toward a meaningful life again.

Personal Growth

Therapy is not always about addressing symptoms or minimizing distress. We also help clients to break out of old patterns, gain insight into their personality and relationships (past and present), address limiting beliefs or fears, gain clarity regarding future ambitions, navigate difficult decisions, and learn to better understand and communicate their feelings. Typically, therapy aimed at Personal Growth relies heavily on Insight-Oriented Therapy and Motivational Interviewing.

Common Presenting Issues in Couple Therapy

Communication Issues

By far the most common goal that couples have in therapy is to improve their communication. Some couples argue about the same topic for years without ever getting resolution or compromise. Others argue about a lot of different little things, and aren’t sure why. Still others argue about the way that they argue. Some of these arguments escalate to the point that partners become dysregulated and say and do things that they later regret - things that cause lasting damage to their bond. Other couples rarely or never argue, but they also don’t talk; often there are assumptions made about each other that are inaccurate and contribute to misunderstandings. Communication Retraining helps couples better regulate their emotion, listen to each other and make each other feel heard, and communicate clearly in ways that decrease conflict and increase intimacy.

Conflict Resolution

Some couples present with a specific conflict that they have been unable to resolve on their own. It is often a longstanding conflict in which each of them has become somewhat polarized in their own position. Couple therapy aimed at conflict resolution almost always involves some degree of Communication Retraining, and then moves into a Solution-Focused Therapy phase of generating possibilities, compromises, and ideas for how each partner can get what they most need from the other.

Emotional Disconnect

Couples can become disconnected over time, co-existing and moving through life together often without conflict but also without connection. These couples often report that they feel more like “co-parents” or “roommates”. They have often become out of touch with what’s going in on each other’s life, and are no longer sharing their hopes, dreams, fear, and needs with each other. In some cases, couples will say that they have always struggled to feel close, while others say that they long for the connection they felt in the early days of their relationship. Emotion-Focused Therapy (EFT) is the treatment of choice for these couples.

Sexual Disconnect

It is not uncommon for couples to become disconnected sexually. Sometimes this occurs after a particularly stressful period of life, and other times it is the result of a slow process of drifting apart. Maybe one partner is always the initiator, or maybe there is a mismatch in terms of libido. Some couples report that they have never had the sexual connection that they would like with each other, despite loving each other deeply. Whatever the case, couple therapy can help couples to reconnect sexually by enhancing communication between couples regarding their feelings and needs, and helping them to change their patterns of interaction.

Infidelity (and other Betrayals)

Infidelity is extremely difficult to weather without professional help. It often constitutes a traumatic event, and accordingly emotions run extremely high in its aftermath. The very foundation of an intimate relationship is shaken when one partner has turned toward someone other than their partner for intimacy, and couples need help to rebuild that foundation. We take a very specific approach in helping couples heal from infidelity, with a focus on increasing empathy, facilitating productive communication, restoring trust, and rebuilding intimacy. Our specific approach incorporates aspects of both Emotion-Focused Therapy (EFT) and Solution-Focused Therapy.

Parenting and Blended Family Issues

The stress associated with parenting will sometimes bring couples to therapy. It may be adjusting to the high-stress, high-demand days of parenting infants and young children, where couples can come to feel exhausted, disconnected, and even resentful of each other. It might be the difficult teen years where emotions run high and couples might struggle to maintain a united front. It might be challenges associated with blended families, such as negotiating boundaries and learning to navigate potentially difficult relationships. Whatever the case, couple therapy can help couples to communicate more effectively about these issues and get to the heart of what each partner most needs. This work often involves some degree of Communication Retraining, and also often involves Emotion-Focused Therapy (EFT) and/or Solution-Focused Therapy.

Loss of a Child

When a couple endures the loss of a child there is typically an extended period of shock, during which their main focus is on surviving each day, and taking care of any other children or dependents they might have. At some point, as the shock begins to wear off, they might realize that they feel quite disconnected from each other, the world, even themselves. Often bereaved parents fall into a pattern of unconsciously avoiding each other’s pain, in order to modulate their own pain and continue to function and survive. The grief becomes a gulf between them. Couple therapy can help partners re-connect and support each other through the long recovery after the loss of a child, and restore a sense of safety and security within the couple. Emotion-Focused Therapy (EFT) is the treatment of choice here.

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