Ask Our Therapists: Real Answers from CITC Clinicians
Use the form below to submit your question to the CITC team. We’ll do our best to respond within two business days, and, with your permission, share the question and answer here to help future visitors find the information they need.
Common Questions Answered by Therapists at CITC
How will I know if I’m making progress in therapy? What are some signs of improvement?
Answered by Dr. Lorena Hsu, Clinical Psychologist
Working with a therapist can foster the conditions for deep personal growth. But knowing whether you’re making progress during therapy may not always be clear. You might wonder “Is this actually helping?” or “Shouldn’t I be feeling better by now?” The reality is that progress in therapy does not always come in the form of dramatic breakthroughs or transformations. More often, it happens gradually through small, subtle shifts over time in how you think, feel, and relate to yourself and others.
So how can you tell if you’re making progress in therapy? An earlier and important sign of progress is an increased sense of self-awareness. You may begin to understand your thought, emotional, and coping patterns more clearly, what may have contributed to these patterns, and how they may not be serving you in your life. Self-awareness is essential for change because you can’t change what you don’t recognize.
Another important sign of progress is that you are better equipped to deal with difficult emotions. You may still get anxious, sad, or angry, but you are better able to pause and respond more intentionally, rather than react, to situations. Similarly, you might find that usual triggers bother you less often, or that you recover more quickly from difficult moments.
Some clearer signs of progress may involve an increased sense of connection with life and relationships. You might re-engage in activities you used to enjoy, notice improved communication and less conflict in your relationships, pursue life goals, and generally feel more capable of coping with life’s challenges and uncertainties. As well, you may notice that you are more regularly applying and integrating the tools and strategies learned in therapy into your daily life.
Even when you’re making progress in therapy, it may not always feel that way. Therapy often involves exploring difficult or painful experiences, and sometimes it may feel more challenging before it starts to feel better. But a key sign of progress is your ability to face the discomfort involved in talking about painful memories or emotions. Also, progress is not linear—life happens and you may still have challenging days and fall back into old patterns from time to time. But a meaningful sign of growth is that you’re able to navigate these setbacks in new and healthier ways.
When you’re in the midst of your healing journey, it can often be difficult to see how far you’ve come. With the support of a therapist who has been on that path with you, you can reflect together on the progress you’ve made, as well as openly explore any areas where you may feel stuck or unsure. A therapist can help to revisit your therapy goals, track changes in your symptoms and functioning, and highlight meaningful gains that you may not have noticed on your own.
How does Interpersonal Therapy (IPT) improve communication and relationships?
Answered by, Dr. Carolina McBride, Clinical Psychologist
IPT is based on the premise that there is a strong relationship between mood and interpersonal relationships. When an individual is feeling depressed, stressed, or overwhelmed, this will impact their relationship. Likewise, when there are difficulties in interpersonal relationships, this will have an impact on how someone is functioning.
Therapy acts directly on this relationship with the goals of IPT being to improve mood while also improving interpersonal functioning. IPT therapists focus specifically on helping people improve their communication, improve their relationships, and increase their social support. Therapy also focuses on helping people become aware of how their own mood may be disrupting their relationships and, therefore, their social supports.
We know that when people are depressed, for example, they tend to withdraw socially and may become more irritable with others. This withdrawal and irritability, however, has a direct impact on how they are treated, and it may extinguish the support they actually need.
IPT helps people understand the connection between their mood and what is going on interpersonally in someone’s life. Strategies to help improve communication, understand patterns of relating and problem solve stressors that are happening in a person’s life are the foundations of this type of therapy.
How can therapy help with obsessive compulsive disorder (OCD)?
Answered by Lauren Greenwood, Registered Psychotherapist (Qualifying)
Therapy can be incredibly effective for OCD, especially when it’s tailored to address both the intrusive thoughts and the compulsive behaviours that keep the cycle going. The gold-standard approach is Exposure and Response Prevention (ERP), a form of cognitive-behavioral therapy (CBT) that helps you gradually face fears while resisting the urge to engage in rituals or avoidance. Over time, this teaches your brain that you can tolerate uncertainty, anxiety, or discomfort without needing to perform compulsions to feel safe.
Treatment for OCD also often includes mindfulness and acceptance-based strategies, which help individuals relate differently to their thoughts—observing them with less judgment and less urgency to control or “fix” them. With consistent practice, therapy can help reduce distress, build resilience, and restore a sense of freedom and confidence in daily life.
What are the early signs of depression?
Answered by Shahana Sittampalam, Registered Psychotherapist (Qualifying)
Recognizing early signs
Depression doesn’t always appear the same way. For some, it feels like sadness or emptiness; for others, irritability, exhaustion, or loss of interest. You might notice changes in sleep such as too much or too little or shifts in appetite and energy. Concentration can waver, motivation drops, and even simple tasks start to feel overwhelming. Some people become quieter and more withdrawn, while others push through their days on autopilot.
How depression affects you
Depression touches both body and mind. You might feel slower or physically heavy. Thoughts can turn self-critical or hopeless, making it hard to feel connected or optimistic. Emotions may flatten or swing unpredictably. These reactions are not weaknesses; they reflect how stress, biology, and environment interact. Life experiences, genetics, and hormonal or seasonal changes can all contribute.
Understanding the range of depression
Depression can take many forms. Some people experience short, intense episodes that come and go, while others live with longer-lasting low mood. It can accompany anxiety, trauma, or chronic stress. Sometimes it appears after major life events; other times, it arises without a clear cause. Recognizing these variations helps reduce stigmas. There is no single way depression “should” look.
Taking meaningful steps
If these feelings last more than a couple of weeks or begin to interfere with relationships, work, or daily functioning, it may be time to seek help. Talking to a therapist or doctor is a strong first step. Effective treatments include psychotherapy, medication, lifestyle changes, and social support. With time and care, mood and energy can improve, and life can start to feel manageable again.
What is EMDR Therapy and when is it used?
Answered by Julia Friedman, Registered Psychotherapist
EMDR, which stands for Eye Movement Desensitization and Reprocessing, is an evidence-based approach for treating many therapeutic concerns. EMDR is used when individuals are experiencing distress related to past traumatic or highly stressful experiences that continue to affect their emotions, thoughts, or behaviours. It is most well-known in the treatment of post-traumatic stress disorder (PTSD) but is also effective for anxiety, depression, grief, and other conditions linked to unresolved memories. EMDR can be helpful when traditional talk therapy alone has not fully reduced trauma-related symptoms.
It is a structured, 8 phase approach that helps individuals process traumatic or stressful memories that are thought to be ‘stuck’, meaning they have not been fully processed by the brain and remain stored in a way that continues to trigger the same intense emotions, physical sensations, and beliefs experienced at the time of the event, rather than being integrated as part of a past experience. With guidance from a trained EMDR practitioner, a client holds a traumatic memory in their mind while simultaneously engaging in bilateral stimulation (BLS). This process allows the mind to move naturally toward healing by activating the brain’s innate ability to process information. Through this, clients can develop more adaptive beliefs about traumatic events, helping to restore a sense of psychological safety and reduce the emotional intensity previously associated with the memory.
How can family members support someone with OCD?
Answered by Dana Solnik, Registered Psychotherapist
Supporting a loved one with OCD can be both challenging and deeply meaningful. The “sticky” nature of obsessions and compulsions—and the frequent requests for reassurance that often accompany them—can be difficult to navigate. However, with self-compassion, empathy, education, and self-care, you can feel better equipped to provide meaningful support and help your family member thrive. Below are some key strategies to make this journey more effective and rewarding:
- Educate yourself about OCD and its best-practice treatments.
Approach your family member’s experience with curiosity and openness. Learn what they find most challenging and where they need the most support. If appropriate, consider attending a therapy session with them to gain insight into how you can reinforce their recovery and contribute to a team-based approach to treatment. - Prioritize self-care and self-compassion.
Supporting someone with OCD requires patience and emotional resilience. Taking time to “fill your own bucket” ensures you have the energy, empathy, and strength to stay consistent and supportive throughout the process. - Lead with empathy and validation.
Some obsessions and compulsions may seem irrational or even illogical, but it’s important to remember that OCD is not something your family member can simply “get over.” Validate their struggles rather than minimizing them. Empathy and understanding can make a profound difference in their recovery journey. - Avoid providing excessive reassurance.
Reassurance-seeking is a common symptom of OCD. While offering reassurance may temporarily reduce anxiety, it reinforces the compulsive cycle over time and prevents your family member from developing healthier coping strategies. Collaborate with your loved one—and their therapist, if possible—to create a plan for how to respond when reassurance-seeking occurs.
Supporting a loved one with OCD is an ongoing process that requires patience, understanding, and collaboration. By staying informed, setting healthy boundaries, and encouraging evidence-based treatment, family members can play a vital role in their loved one’s recovery. With empathy and consistency, you can help foster an environment where healing, growth, and resilience are truly possible.
How can therapy help with ADHD in adults?
Answered by Scott Boulton, Doctoral Practicum Student at the Adler Graduate Professional School
Over the years, a number of evidence-based therapies for adult ADHD have been developed—including ADHD coaching and cognitive-behavioural therapy (CBT)—and these approaches are helping adults build the tools, habits, and emotional resilience they need to thrive.
Not long ago, ADHD was thought to be a childhood condition that faded with age. Today, we know that while visible hyperactivity often decreases, other challenges—like difficulties with attention and focus, time management, or emotional regulation—can persist into adulthood. Therapy for adults with ADHD helps people understand how the condition affects their lives and equips them with strategies to manage symptoms and daily demands more effectively.
ADHD coaching focuses on developing practical organization and planning skills that supports the needs of adults with ADHD; when used properly, simple tools like day planners can make the difference between surviving and thriving. Coaching also provides structure and accountability, helping adults overcome common obstacles such as procrastination, avoidance, and inconsistent motivation.
CBT for ADHD addresses the emotional and cognitive patterns that often accompany the disorder. Many adults with ADHD grow up believing they are lazy or incapable, which can lead to frustration, shame, and low self-esteem. CBT helps break these cycles by showing how thoughts, emotions, and behaviours interact—and how positive change in one area can transform the others. CBT and mindfulness techniques can also improve emotional control, helping adults pause before reacting, tolerate frustration, and recover more quickly from setbacks. Over time, therapy can help adults replace self-criticism with self-confidence.
Adults with ADHD struggle with many of the same mental health challenges that non-ADHD adults do. But ADHD brains work differently, and therapy for adults with ADHD has to be adapted to meet their particular needs. That’s why it’s so important to seek out therapists who know how to make therapy work with ADHD, and not against it.
How are parents involved in the therapy process for their children?
Answered by Dr. Leah Enns, Clinical Psychologist
Parental involvement is a critical component of a child’s therapeutic process, and the nature of that involvement varies based on the child’s age, developmental stage, and presenting concerns. For younger children, particularly those in early and middle childhood, parents are often active participants in therapy. This may include parent–child sessions where skills such as emotion regulation, communication, or behavior management are practiced in real time. Therapists also meet regularly with parents to provide psychoeducation about the child’s difficulties, coach them in implementing therapeutic strategies at home, and ensure consistency between home and therapy environments. At this stage, parents serve as the primary agents of change, helping to generalize skills beyond the therapy room.
For older children and adolescents, parental involvement typically becomes more consultative and supportive, balancing the teen’s growing need for autonomy with the family’s ongoing role in fostering change. While therapy may focus more directly on the adolescent’s thoughts, feelings, and behaviors, parents are often included in periodic check-ins to address family dynamics, improve communication, and coordinate strategies that promote progress at home and school. The level of parental participation also depends on the issues bringing the child to therapy, conditions such as anxiety, depression, or trauma may require a greater focus on emotional support and understanding, whereas behavioral concerns often call for structured parent training or family-based interventions. Across all developmental stages, the therapist’s goal is to build a collaborative partnership with parents, aligning their efforts with the child’s therapeutic goals to create a consistent, supportive environment for growth.
How does trauma affect the body and nervous system?
Answered by Dr. Niki Fitzgerald, Clinical Psychologist
Experiencing or witnessing a traumatic event such as a significant accident, physical or sexual assault, or even a potentially life-threatening near miss can have profound effects on a variety of levels. In the early days afterwards, a person may be on high alert to any other signs of potential danger resulting in a sense of jumpiness and a significant reaction to any unexpected loud sounds. Sleep might be disrupted by thoughts of the incident when trying to get to sleep or by nightmares of the event. Things that in some way resemble elements of the trauma can also trigger the flight or fight response as the brain has associated with the reminder, such as a smell, sound, location, object, etc. to danger and is seeking to keep you safe. Without an actual threat in the moment, this reaction can range from a surge of nervousness to an all-out panic attack that can result in avoidance of any and all things that result in this response.
Equally profound is the impact that a traumatic event can have on a person’s beliefs about themselves, others, and the world. For some, they will question things they did or did not do, with the belief that had they acted differently; the bad thing would not have happened. Based on their experience of the event, people may notice negative changes in how they view others, such as believing they cannot trust anyone, or that the world is an unsafe place in which they have no power or control. For the majority of people, through speaking to trusted others about their experiences, these symptoms slowly dissipate over a month. For others though, these symptoms persist and can cause impairment in important life areas. The good news is, there are various evidence-based treatments (e.g., Cognitive Processing Therapy, Prolonged Exposure, and trauma-focused Cognitive Behavioural Therapy) that can help people safely process their experience and help them resume doing things that are important to them.
What’s the difference between an eating disorder and disordered eating habits?
Answered by Tisha Misquita, Clinical Therapist MEd, Registered Psychotherapist (Qualifying)
Many people have a complicated relationship with food and their bodies. Disordered eating refers to a wide range of irregular eating behaviours that may not meet the full criteria for a diagnosed eating disorder but can still have a significant impact on a person’s physical health, emotional well-being, and relationship with food and body. This can include chronic dieting, rigid food rules, emotional or stress eating, guilt after eating, or cycles of restriction and overeating. While these patterns may appear “normal” or even socially accepted, they often reflect an underlying struggle with body image, self-worth, or control.
Eating disorders, on the other hand, are serious mental health conditions that involve ongoing challenges with eating behaviours and intense thoughts or feelings about food, body, and weight. Common signs can include severe restriction of food intake or avoidance of certain foods or entire food groups, frequent binge eating episodes followed by feelings of loss of control, or purging behaviours such as self-induced vomiting, misuse of laxatives or diuretics, and excessive exercise. Individuals may also experience a distorted body image, extreme dissatisfaction with their body size or shape, or a preoccupation with food, calories, body weight, or dieting that interferes with daily life. Examples of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED), and avoidant/restrictive food intake disorder (ARFID). These conditions can have serious medical, emotional, and psychological consequences if left untreated.
It’s helpful to think of eating behaviours as existing on a spectrum or continuum. On one end is normal and flexible eating, and eating disorders on the other end. Disordered eating falls somewhere in between. Many individuals move back and forth along this continuum throughout their lives, and early recognition of disordered eating can be key in preventing the development of a full eating disorder.
Once I’ve started therapy, how do I determine when I can stop?
Answered by Dr. Carolina McBride, Clinical Psychologist
Therapy can be short-term or long-term, it’s up to you. You and your therapist will discuss your goals for treatment during the initial appointment. After the consultation your therapist can give you an idea of how long therapy will take and what the treatment plan will be. Generally, short term therapy for CBT and IPT is around 12-16 sessions. However, some find benefit sooner and it’s important for you to know that you are free to stop therapy at any point in time. I would encourage you to discuss how you are feeling in terms of progress with your therapist so that they can adjust accordingly.
Are virtual / teletherapy sessions as effective as in-person therapy?
Answered by Dr. Carolina McBride, Clinical Psychologist
Yes, there is now extensive research showing that virtual therapy can be just as effective as in-person therapy. It offers greater accessibility and flexibility for those with busy schedules or difficulty coming into the office. One of the main benefits of virtual therapy is that you can connect with your therapist from anywhere in Ontario, using any device with internet access.
We also offer phone sessions if you prefer this format over video. For clients with more complex or longstanding concerns, we may recommend in-person sessions, as physically coming into the office and engaging directly with a therapist can be therapeutic in itself.
However, virtual therapy is generally not recommended for children under 12, as therapists rely on non-verbal cues that may be harder to observe over video. It’s also important that children have a private, supportive environment to discuss personal experiences openly.
How can therapy help me communicate better with my partner or family?
Answered by Sarjana Shetty Clinical Therapist M.Psy, Registered Psychotherapist (Qualifying)
Therapy offers a safe and supportive space where you can learn to express yourself and truly listen to your loved ones. Through approaches like Emotionally Focused Therapy (EFT), based on attachment theory, therapy helps you look beneath the surface of arguments to uncover the deeper emotions, like hurt, fear, or longing, that often drive conflict. Instead of getting caught in the same frustrating communication cycles, you’ll begin to recognize these patterns together and learn healthier ways to reconnect. When people feel emotionally safe and understood, it becomes much easier to talk openly and resolve differences with kindness and respect.
Understanding attachment styles is another key to improving communication and deepening your bond. Attachment theory teaches us that everyone has natural ways of seeking closeness and handling stress in relationships. For example, some people crave reassurance when they feel uncertain, while others need space to calm down when things feel overwhelming. In therapy, you’ll start to see these patterns not as flaws, but as signals of deeper needs for safety and connection. Your therapist can help you and your partner (or family member) communicate these needs clearly and respond to each other with more empathy and compassion. Over time, you’ll notice that conversations feel less defensive and more caring, and that sense of emotional security strengthens your bond in lasting ways.
References:
Spengler, P. M., Lee, N. A., Wiebe, S. A., & Wittenborn, A. K. (2024). A comprehensive meta-analysis on the efficacy of emotionally focused couple therapy. Couple and Family Psychology: Research and Practice, 13(2), 81–99. https://doi.org/10.1037/cfp0000233
Preciado, S. (2019). Emotionally focused therapy with families. In L. Metcalf (Ed.), Marriage and family therapy: A practice-oriented approach (2nd ed., pp. 311–335). Springer Publishing Company.
How can therapy help teens cope with anxiety, academic pressure, or challenges with identity and self-esteem?
Answered by Mila Popvic, PhD Level Therapist
The teenage years are a time of big change. Teens are taking on more responsibility than ever, figuring out who they are, and are facing new expectations from school, friends, and family. With all of this growth can come stress, self-doubt, a pressure to meet certain standards, and an uncertainty of who they are, and what they want from life.
Therapy can help teens navigate these changes and pressures by providing a safe, nonjudgmental, and empathetic space to talk about what they’re going through. A therapist can help them make sense of their emotions and anxiety, manage academic or social pressure, and build healthy coping skills to feel more in control. In addition, teens also learn practical tools, like how to be kinder to themselves, challenge negative thoughts, set realistic goals, and communicate more effectively, all of which can boost confidence and self-esteem, while reducing stress. Therapy is a space where teens can explore their identity and values, gaining a stronger sense of who they are and what matters to them. Overall, therapy can help teens feel calmer, help them manage stress better, navigate pressures with more efficiency and motivation, understand who they are, and live a life that is aligned with their goals and values. These skills not only help teens feel more grounded and resilient now, but also serve as a strong foundation for adulthood, by supporting emotional wellbeing, healthy relationships, and confidence in navigating life’s challenges.
How can therapy help with sleep problems or insomnia?
Answered by Aaron Arkin, Registered Psychotherapist
Those that suffer from behavioural sleep issues, such as insomnia, typically have trouble falling asleep, staying asleep, or returning to sleep after an awakening. These problems lead to reduced sleep quantity and quality, as well as poor daytime performance and mood issues such as irritability, forgetfulness, and cognitive deficits.
Since this issue is behavioural, then clients need to learn how to think (cognitive) about their sleep, and act (behavioural) towards their sleep in more adaptable ways in order to improve their sleep. Cognitive Behavioural Therapy for Insomnia, or cbt-I, does exactly that – by teaching clients about Sleep, and how to think about it positively and act towards it adaptably, leads to improvements in sleep quality, sleep quantity, reduced wake time at night, and improved daytime performance.
How do I know if I have health anxiety? And how can I stop worrying about my health?
Answered by, Dr. Carolina McBride, Clinical Psychologist
There is nothing wrong with being health conscious and wanting to live well. Focusing on diet, nutrition, sleep and exercise are important in everyone’s life. For some, however, worrying about being healthy becomes an unhealthy preoccupation. If you find yourself repeatedly checking for signs of illness, researching symptoms online, seeking reassurance from your doctors or loved ones, or constantly worrying that something might be wrong with your body, you may be experiencing what’s known as health anxiety.
Health anxiety often stems from a heightened sensitivity to normal bodily sensations or uncertainty about health. At times, it can also come from having experienced a significant illness or witnessed someone going through a health crisis. Other times people may be suffering from chronic conditions and become understandably preoccupied and aware with how their body is functioning. Over time, this can lead to a cycle of anxiety and reassurance seeking. This can affect concentration, sleep, mood and relationships and your overall quality in life.
The first step is identifying that there may be a problem. If you believe that your focus on health has crossed over the line into health anxiety, it’s important to reach out to your family doctor or call us to book an appointment. Approaches such as CBT and IPT can be particularly effective in helping people break the cycle. This means developing new ways of interpreting physical sensations, learning skills to tolerate uncertainty, and help differentiate what symptoms are important to pay attention to and what symptoms are not. Slowly clients can address the underlying fears that drive and maintain their anxiety. If this sounds familiar, reach out so that you can regain your confidence and live fully in the present.
How can I break the cycle of overthinking before bed?
Answered by Aaron Arkin, Registered Psychotherapist
Lying in bed awake at night, and experiencing racing or ruminating thoughts, can certainly be detrimental to sleep. There are strategies discussed in our insomnia program that are designed to minimize or eliminate these ruminating thoughts at night which can lead to more healthy and restful sleep.
These strategies can involve adjusting ones’ sleep schedule, making time during the day for worries as opposed to worrying in bed, or providing alternative strategies to help reduce the amount of time it takes to fall asleep or return to sleep after an awakening.
Can therapy replace medication, or are therapy and medication used together?
Answered by, Dr. Carolina McBride, Clinical Psychologist
It is well known that combination treatment (psychotherapy plus medication) works very well for a lot of conditions. Combination treatment is generally more effective than therapy alone for moderate to severe depression. This is especially true for those who have not responded to single treatments.
Therapy alone is also an effective treatment, particularly for those who do not want to take medications and for those will acute stressors. Not everyone responds to medication in the same way and there are some side effects that come with any medication that you take. However, if your condition has not responded to psychotherapy alone or if you have been suffering for a long time, you may want to consider combination treatment.
Is it normal to feel worse right after a therapy session, before feeling better?
Answered by Heather Pearce, Registered Psychotherapist
The short answer is yes, it can be completely normal to feel worse right after a therapy session before feeling better. Therapy often involves exploring painful or difficult experiences, thoughts, and emotions, and that can feel heavy or draining. You might leave a session feeling raw, tired, or unsettled, even though that discomfort can be a sign that meaningful work is happening.
It’s also important to remember that progress in therapy isn’t always linear. Some sessions may feel productive and insightful, while others might feel more emotionally challenging, or you might even be feeling stuck. Both can still be valuable parts of the process. What matters most is that you and your therapist can talk openly about how you’re feeling, especially if you start noticing a pattern of leaving sessions feeling worse.
That said, there are times when feeling worse might suggest that something in your therapy sessions needs to be adjusted. For example, if you’re leaving sessions so emotionally overwhelmed that it’s difficult to return to your day afterward, it may be a sign that the work is moving too quickly or that you could use more time to regulate before finishing. In that case, you and your therapist might work on grounding strategies or create a plan for how to take care of yourself after sessions to help you have a smoother transition out of the session.
If you’re consistently leaving sessions feeling judged, dismissed, or pressured by your therapist, that’s also different. Feeling safe enough, understood, and respected is essential for therapy to be effective. If something feels off in your relationship with your therapist, it’s important to bring it up so you can explore it together. And if things still don’t change after that, it may simply mean the fit isn’t quite there. Finding someone whose approach feels more comfortable and aligned can make a meaningful difference.
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