From JJ’s Desk

A note before we begin

As we move ahead publishing more issues of In Session, it becomes clear that each issue has its own unique personality. This, of course, is due to the writers. But I find it interesting to see how the issue itself seems to breed its own personality, one that feeds back into the writing of the authors. It is a kind of symbiosis. Certain months, for reasons I can’t fully explain, seem to press the same questions on everyone at once. And this time is no exception.

This issue is loaded with personal reflection. We find the writers immersed in their own journeys, not necessarily having it all figured out, but exploring the possibilities that exist. Searching with curiosity for a space that feels right. A space that makes sense.

There is a lot to sit with in this one. Take your time.

01 · The Interior

The Border

JJ Emanuel, MFT, RP

Is it anger or sadness? Am I disappointed or let down? Do I need to take a breath or cry?

The expression of sorrow does not always come naturally to me as a man. Sadness seems to give way to some kind of defeat, and I for one do not like being defeated. I would not say I am overly competitive with those around me, but there is certainly an internal struggle happening at all times. A battle with my level of enoughness, if that even makes sense.

At times I cannot seem to get past the imaginary border between myself and the wholeness or enoughness that seems to elude me.

What does it take to just let myself be sad? What does it take to be sad? Why is anger my default? I want to cry. I need to be sad. Where is this intensity coming from?

I know that as a young boy it took nothing to get me to engage in sadness. If I felt hurt, embarrassed, left out, it was not a question. It was just an experience. What then has led me to this point of disconnection? Maybe something happened to me along the way. Where did I unlearn what I seemed to know innately? There are so many pathways I could take to this answer. And, to be honest, many of them would likely be true. But the answers are not the point. While they may explain things, they don’t get me to the place I desire.

Within this short writing I have already identified a sense that I am not enough, sadness, anger, and the missing element of consideration. I am looking to find a moment. One where I feel complete enough to experience the sensation of sadness, of being hurt. How can I find this moment?

I believe that in my search for this moment, I am compelled to engage with myself in a way that says: no matter what you say to me JJ, I will listen and stay with you. The security, the stability to stay with myself, is the foundation of a stable relationship. This means I can comfortably tell myself that something or someone upset me without needing to explain it away.

Ironically, the allowance I give myself to experience this affront yields a less angry response, and I find myself engaged in the actual sense of the moment. When I engage with my sense of lacking, or find myself securely attached to the part of me that seems unwhole, what hurts no longer speaks to that part of me as standalone truth about me. One that is unchangeable. Because I choose to stay with it. I choose to support it. And suddenly I get the chance to experience what is really there.

02 · The Find

ADHD and Relationships

Yakov Iliabaev, RP

Co-Founder of Trust Therapy and Relationship Clinic based in Toronto. Raised within the Jewish community for his whole life, bringing years of counselling experience and a deep understanding of ADHD to this work, driven by a commitment to give back to the community that shaped him.

Analysis results show that adults diagnosed with ADHD and their spouses had more unfavourable patterns in their marriages with regard to the level of conflict, marital adjustment, conflict resolution styles, and reciprocal evaluations when compared to a comparison group.

Often the thought of ADHD brings the idea of a hyperactive child to mind, as if adults do not have this same experience. This could not be further from the truth. One of the most overlooked complexities that we see is the effect that ADHD has on relationships. The reality is that ADHD can gradually tear apart even the strongest of relationships.

A 2022 study published in Archives of Neuropsychiatry measured a variety of relationship and communication skills in couples where one partner had ADHD. Consistently, couples with at least one partner with ADHD showed lower scores compared to the couples with two neurotypical individuals. In the last decade there have been plenty of other studies with similar outcomes, indicating that without some form of intervention, the common result is higher rates of marital dissatisfaction.

This dissatisfaction commonly grows out of moments like these. “It’s just my ADHD.” “Babe, I’m sorry, that wasn’t my intent.” Small phrases like these, repeated often enough, can close the door on healthy communication.

A 2023 study on women partnered with adults with ADHD found a common theme: a sense of becoming their partner’s caregiver. This sense of caregiving can lead to withdrawal from the relationship. Firstly, clinical trials observe that the neurotypical spouse stops relying on their ADHD partner. Secondly, they create their own system of independence to manage life and family, with resentment. Finally, and in my opinion the most damaging to the relationship, they give up trying to communicate with their partner about their needs.

This does not mean there is no solution, or that couples navigating ADHD are without hope. A 2018 controlled trial testing Gottman Method couples therapy found significant improvement in both marital adjustment and intimacy, effects that held up at follow-up.

John Gottman’s method of couples counselling provides pillars of a healthy relationship, things like turning toward each other and managing conflict well, all of which require a joint venture to move toward growth. Navigating ADHD starts with establishing a system that allows the couple to support each other and prosper together, rather than individually. This includes exploring how to utilize the strength of one another to see how to achieve this mutually defined prosperity. Creating systems, rather than individual assignments, is where the real work lies, systems built around each partner’s strengths rather than aimed at fixing their weaknesses.

Some examples of these systems include shared calendars, automatic reminders, written task lists, clearly assigned household responsibilities, regular weekly check-ins, visual schedules, automatic bill payments, shared apps for appointments and errands, breaking large tasks into smaller steps. While these systems are essential, developing the skills to adapt to tense situations will ultimately lead to lasting change and a new pathway forward.

This piece draws on three peer-reviewed studies examining ADHD's impact on romantic relationships and the interventions shown to help. Key references include a 2022 study in Archives of Neuropsychiatry examining marital adjustment and conflict in couples where one partner has ADHD, a 2018 controlled trial in the Iranian Journal of Psychiatry testing Gottman Method couples therapy for marital adjustment and intimacy, and a 2023 qualitative study on the caregiver burden experienced by women partnered with adults with ADHD.

03 · Opinion

Just Sit with Me Today

Rachel Pokroy, MSW, RSW, BA Psych

Registered Social Worker specializing in acute mental health within psychiatric hospital settings. Clinical practice is grounded in the belief that meaningful care begins with genuine human connection. Even in moments of crisis, compassion, curiosity and presence can help restore dignity and hope.

There are certain patients I remember because of the complexity of their lives. And then there are the ones I remember because they changed mine.

About a year ago, I met a 60-year-old woman during an admission to the psychiatric unit where I work. She carried what felt like every burden imaginable. Psychiatric illness. Addiction. Trauma. Medical problems. Financial instability. Criminal charges. An impending eviction. Estranged family relationships. Every conversation uncovered another crisis.

I remember leaving our first meeting feeling completely overwhelmed. I looked at the mountain in front of her and realized I didn’t have the equipment to help her climb it. Some of the problems simply weren’t mine to solve. Others technically had solutions, but those solutions lived behind months-long waitlists, complicated eligibility criteria, underfunded systems, and community resources stretched far beyond capacity.

I remember thinking, I can’t help her.

The next day I went back with the small handful of options I had managed to gather; housing referrals, some community programs, applications for social assistance. None of them immediate. None of them certain. I apologized as I explained that everything would take time.

She stopped me.

“Just sit with me today.”

I’ve thought about those five words hundreds of times since.

Of course, if I could have found her safe housing that afternoon, I would have. If I could have guaranteed access to every service she needed, I would have done that too. She was not expecting this, nor was she necessarily asking for me to accomplish the impossible. She was simply asking not to be left alone with it.

Somewhere along the way, I had begun to believe that my worth as a social worker was measured by my ability to solve problems. In acute psychiatry, so much of my role revolves around discharge planning, coordinating services, arranging follow-up care, and helping people navigate increasingly complex systems. Those responsibilities matter and are essential, but I had started to believe that every interaction needed to produce something tangible: a referral made, a form completed, an appointment scheduled.

In doing so, I had unintentionally set aside another part of my role which simply listens, tolerates silence and bears witness to the suffering.

As social workers, we are often rewarded for efficiency. We celebrate productivity. We feel successful when we can cross something off a list or remove a barrier for someone. And when we can’t, it’s easy to feel like we’ve failed.

I have started to understand that sometimes there isn’t a resource that fixes the loneliness, a referral to repair decades of trauma or a waitlist short enough to meet the urgency of someone’s pain. Nonetheless, something meaningful can still happen.

I still work hard to solve problems. I still make referrals, advocate fiercely, coordinate care, and spend hours trying to connect people with resources that are often frustratingly difficult to access. That work matters deeply.

But now, before I reach for the solution, I try to remember her words. Sometimes what people need most isn’t evidence that you’ve solved their problems. It’s evidence that they’re worth staying with while those problems remain unsolved.

After years working in psychiatry, one of the things I have come to believe is that recovery is shaped by more than medication, therapy, or access to services. Again and again, I see the difference connection makes. I see that patients who have family, friends, or a community surrounding them tend to fare better than those who are truly alone. The voices of loved ones encouraging someone through a difficult time, reassuring them that they don’t have to face the hard days by themselves, often carry a weight that no professional ever can. We can educate, advocate, recommend, and support, but there is something uniquely powerful about hearing, “I’m here. We’ll get through this together.”

For those who do not have that support, the weight of recovery can feel profoundly different. Carrying mental illness, addiction, grief, trauma, or uncertainty is difficult enough; carrying it without anyone beside you is another kind of suffering.

A few weeks ago, a newly arrived refugee was admitted to our unit. She had been in Canada for only a few months. Over the course of just four days, she had ten visitors. They came from her community, people who, in many cases, had only met her once or twice. Yet they showed up. They sat with her. They brought food, conversation, reassurance, and the quiet message that she belonged somewhere.

Watching them, I was reminded again that healing is rarely something we do alone.

04 · In Focus

I’m Tired of Being Rejected

Diana Melnick, MACP, RP

Registered psychotherapist and certified sex therapist based in Toronto, with over a decade of experience helping individuals and couples navigate mental health, relationship, sexual, and intimacy struggles. ICEEFT certified Emotionally Focused Therapist and Somatic EMDR Practitioner, serving as Clinical Director of Toronto Intimacy Counselling.

A couple rarely walks into sex therapy saying, “We’re caught in an attachment cycle.” They come in saying, “She wants sex all the time,” “He never initiates,” “I’m tired of being rejected,” or “I feel pressured every time I’m touched.” On the surface, it sounds like a problem about sex. But very often, sex is where a much deeper conversation in the relationship is taking place.

Through an Emotionally Focused Therapy lens, the question becomes not only what is happening sexually? but what is happening emotionally between these two people when they reach for each other—or fail to?

EFT understands intimate relationships through attachment. We are wired to seek emotional safety, responsiveness, and connection from the people who matter most to us. Underneath many conflicts is a basic set of questions: Are you there for me? Do I matter to you? Can I reach for you and trust that you will respond?

Sex is one of the places where these attachment questions become especially powerful.

Consider a couple where the husband frequently initiates sex and the wife often turns him down. He experiences her lack of interest as rejection and begins approaching her more insistently. He may complain that they “never have sex” or become irritable when she declines. She experiences his pursuit as pressure and begins avoiding physical affection because she worries that every hug will turn into an expectation for sex.

From the outside, this can look like a simple desire discrepancy: he wants more sex, she wants less. But when we slow the cycle down, something more vulnerable often appears.

His frustration may conceal a fear that he is no longer wanted or important to her. His pursuit is partly an attempt to get reassurance: Do you still desire me? Do I still matter to you? Her withdrawal may conceal a different fear: Can I be close to you without owing you something? Will you still love me if I am not sexually available right now?

The painful part is that each person’s attempt to protect themselves reinforces the other person’s fear. The more he pursues, the more pressured she feels and the more she withdraws. The more she withdraws, the more rejected he feels and the harder he pursues. Eventually, both partners experience the other as the problem, when really they are caught together in a negative cycle.

This is where EFT can be so useful in sex therapy. Rather than deciding who is right, the therapist helps the couple recognize the cycle and access the softer emotions underneath it. Anger may be protecting hurt. Avoidance may be protecting shame or fear. Sexual pressure may actually be a protest against loneliness. Lack of initiation may have much less to do with lack of love than with anxiety, resentment, exhaustion, body image, or fear of disappointing a partner.

When he can say, “When you pull away, I start to feel like you don’t want me anymore,” instead of criticizing, and she can say, “When I feel pressured, I become afraid I can’t be close to you unless I’m ready for sex,” instead of withdrawing, they are suddenly having a very different conversation.

What I wish more people understood is that improving a couple’s sex life is not always primarily about technique, frequency, or increasing desire. Those things matter, and sex therapy should never ignore the biological, medical, behavioral, and psychological dimensions of sexuality. But sexual intimacy tends to flourish where vulnerability feels safe.

The goal is not simply more sex. It is creating a relationship in which both partners can reach, respond, express longing, set limits, acknowledge fear, and remain emotionally connected. From an EFT perspective, that secure bond is not separate from sexual intimacy. Very often, it is the soil in which sexual intimacy grows.

05 · The Open Chair

The Voice Beneath the Noise

Alicia Mandel, RP

Registered Psychotherapist based in Ontario, focused on helping women deepen self-awareness, self-trust, and self-acceptance through psychodynamic, somatic, and Internal Family Systems approaches. Core belief: therapy is not about fixing what is wrong, but creating space to understand ourselves more fully.

She was nearing the end of her pregnancy when she asked me a question I hear often in my practice.

“How do I know if I’m doing it right?”

On the surface, she was asking about the practical things: feeding, sleep, visitors, routines. But beneath the question was something much deeper. How do I know I can trust myself?

Without thinking too much, I heard myself say, “The truth is, everyone is going to find something wrong and something right with what you’re doing.” As the words left my mouth, I realized I wasn’t only speaking to her. I was speaking to myself.

At the time, I didn’t fully realize why that question felt so personal. This was my third baby while in private practice. Not my first postpartum experience. I had done this before. My birth was beautiful. My baby was, for the most part, easygoing. I felt more confident, grounded, and stable than I ever had in my previous postpartum seasons. I was more informed. I knew more of what to expect. I trusted myself more. I felt more equipped to handle the challenges that came my way.

And yet, the phrase I found myself repeating most often was: “I’m so overwhelmed.”

For a while, I questioned why. I had experience. I had knowledge. I felt like I knew what I was doing. But what I eventually understood was that overwhelm does not always come from uncertainty. Sometimes it comes from the reality of being a person with many different parts of life asking for your attention.

Three children. A marriage. A practice I deeply love. A husband whose work in outreach means our home is often a place of gathering, hosting, and cooking. Friends. Family. The needs of everyone around me. And somewhere in the middle of all of that, me.

This season gave me something I hadn’t had in the same way before: enough space to notice myself.

I began paying attention to what actually helped me feel grounded. And I realized that self-care was not what I had often imagined it to be. It wasn’t just the occasional bath, meditation, or yoga class.

Sometimes self-care looked like saying no. Sometimes it looked like pushing myself to go for a walk because I knew movement would serve me better than staying stuck in my overwhelm. Sometimes it looked like making time for friends because I needed to reconnect with parts of myself beyond motherhood. Sometimes it looked like hiring help and spending money to buy back time, allowing someone else to take on pieces of the practical load so I could have more capacity for the people and roles that mattered deeply to me. Sometimes it looked like asking for help before I reached my limit.

What surprised me was that the hardest part wasn’t recognizing what I needed. The hardest part was accepting it.

Accepting that I am someone who gets overwhelmed. Accepting that I function better with support. Accepting that needing something different does not mean I am failing. It means I am human.

Knowing myself was only part of the work. The deeper work was allowing myself to exist as I am, without constantly trying to earn permission to be different.

This realization began showing up in my clinical work in a new way. I have spent years sitting with pregnant and postpartum women as they navigate uncertainty, fear, guilt, and the endless opinions surrounding motherhood. I have watched so many women search for the “right” answer. But as I began learning this lesson for myself, I realized something that caught me by surprise. This had always been my work as a therapist.

Long before becoming a mother of three, I was never trying to help clients simply find the perfect solution. I was helping them develop a relationship with themselves, one rooted in self-awareness, self-trust, and self-acceptance. True embodiment.

Motherhood simply brought this lesson into a whole new arena.

Parenting is often described as a partnership between parents, but I have come to believe it is also a partnership between the needs of a child and the needs of the person raising them.

One mother brings her newborn baby out to meet friends a few weeks after birth. Another chooses to spend those early weeks at home. One mother sends her child on the bus. Another chooses to drive them. Both mothers will likely encounter opinions about what they are doing right or wrong. But perhaps the question is not who is right. Perhaps the question is whether each mother is making a choice that reflects who she is, what her child needs, and what allows their family to thrive.

The work, for my clients and for myself, is not learning how to eliminate all those voices. The noise will always be there. The work is learning to recognize the voice beneath the noise. The voice that knows who we are, what we need, and what matters most. And trusting that the person we discover there is someone worth listening to.

06 · The Outside View

You Already Know

Jeremy Elhadad

Young Father of two. All-in on spiritual evolution.

Maybe the greatest parenting work is not from acquiring technical knowledge from books, maybe we just need to learn to fully tap into our spiritual nature.

Parenting is perhaps one of the most intense and revealing forms of the human experience. As parents, you have probably all been there: we are in the middle of a meal at the restaurant when our 3 year old has an uncontrollable emotional outburst; my impulses kick in; I feel helpless; but what is this all really about? Sure, I can replay the scene focusing entirely on my child’s experience, trying to better understand their feelings, only to conclude that this behaviour is totally normal at this age. However, I believe there is actually a lot more to unpack about my own experience. What were those feelings that came over me? Was I feeling anxious or ashamed or angry or helpless? Why? The intensity of that moment was, in all likelihood, a harsh reminder of something I need to work on, an old wound that requires more attention.

I probably already knew I needed to revisit it; my child basically acted as the Universe’s proxy, abruptly reminding me of this. As the paradigm shifts, the question goes from “How do I make my child stop crying?” to “What is this moment awakening in me?” and “What do I need to shift within myself so I can stay present in these moments?” I cannot control who my children become. That said, I can become more aware of the energy I bring into their lives.

It is called parenting for a reason, not childing. Our children come into our life in order for us to reparent ourselves. I am not here to teach my children how to be children. They are experts at that. I am here to grow, through my experience as a father and, so far, this has been the most intense yet the most perfect growth opportunity I have been given. Perhaps that is what spiritual growth really means to me: cycles repeating themselves, in the form of intense life challenges, until the soul becomes conscious enough to clear away fear and conditioning, allowing love to shape my responses.

This is why the saying that “children are the greatest gift of life” has taken on an entirely new meaning. I used to think the gift was the joy they bring or the people they become. I am beginning to think the real gift is that they continually uncover the parts of us that are unconscious, thus inviting us to grow in ways we never knew we could. That realization has quietly reshaped my understanding of fatherhood. I am starting to learn that parenting is less about telling my children “how to be in this world” and more about me learning “how to be” myself. What they absorb most deeply is not what I say, rather it is who I am while I say it. So, do I really need a parenting manual for that? If I am genuinely present might the appropriate response become more obvious? Not perfection, but a clearer, more loving, and more discerning way of meeting each moment.

Meeting them where they are is rarely formulaic. The same situation may call for affection, a boundary, humour, space or simple companionship. Presence is key in all circumstances; it is about having the capacity to see clearly before reacting automatically. With that, I am beginning to realize that spiritual awareness is not merely one parenting tool among many, but the ground from which healthy parenting choices emerge.

Ultimately, I do not think this means books, podcasts, or other sources of outside knowledge have no place in my parenting journey. Quite the opposite. The important insights brought down from the great teachers of our time, like the tidbits I received from listening to Dr. Gabor Maté, and Dr. Becky Kennedy recently, have a way of arriving through the right channels and at the right time. That said, I simply no longer believe this outside knowledge is the foundation. Especially given I too often find myself online drowning in the endless sea of knowledge.

So, while I am easily tempted to consume a lot more podcasts, I am going to instead focus on revealing what is within and using that knowledge to be the best parent and person I can be. With that, here is a brief reminder for both you and I: You have got this. You already know what to do. Just look inward.

07 · Real Voices

Navigating by Night

Leila Stambouli, RP

Lives and works in the land of maple and pine alongside the Tenàgàdinozìbi. Her virtual psychotherapy practice allows her to flexibly meet the needs of her growing children while attuning to her clients in a holistic and integrative manner.

March 2020. I’m sure most people reading this have vivid memories of what those letters and numbers held for them.

At the time I was completing the final semester of my Master’s, a separated parent who was often a single one, my children’s father had without warning become abusive, my mother suddenly diagnosed with terminal brain cancer, and when the pandemic lockdown first hit I had to quickly learn how to deliver therapy to my clients virtually while abruptly being home with two young children in a suburban semi-basement apartment.

I longed for birds made scarce by new development, spent half my days on all fours to bear the grief that would usher heaviness into my legs and seemingly siphon all blood from my head rendering me faint, and was managing a chronic vulnerability to concussions onset not long before I began grad school. My degree had offered me deeper insight into my own story, forced me to dredge the depths of my inner being, and release immense grief.

In spite of much newfound knowledge, and considerable work to overcome internalized conditioning, I spent my days behaviourally managing my own symptoms of sensory overwhelm and the associated emotionality that came with it.

Until motherhood, my outer world had presented as exceptional and my inner world was achingly melancholic. In school I excelled, I achieved a high level of classical violin training, had been varsity tennis captain for years, graduated early with college-level classes under my belt by the time I began university at a younger age than most. But the ground closed in over me at the end of my first degree and I developed a debilitating depression. I had to learn to feel for the first time, and reckoned with almost 20 years of rigidly suppressed emotion.

As life went on, I continued to collect diagnoses that didn’t fit, in a deep effort to reconcile what many people identified as a highly functioning and sensitive person strongly capable in both accomplishment and being there for others alongside invisible storms within. I remember the call I shared with a confidante, when I had been drowning in well-held-together turbulence.

“I just came across this podcast from a doctor here in the US about AD(H)D. I think you might relate.”

I dismissed it at first, not recognizing myself in the Canadian criteria which still caricatured the school boy class clown who certainly did not perform well in school. He urged me to listen, as the physician was describing a much more holistic picture. He spoke about distinct motivators, about secondary and tertiary diagnoses like mine, about new lines of treatment and medication. I booked an appointment with my doctor, and she agreed to carefully trial a prescription, since I was highly reticent of pharmaceuticals for many reasons.

The impact was significant. The mountain of weight I’d been carrying lifted, and a thick fog I had not even been aware of cleared. I realized I had learned to navigate through night and brume; and though I had done so well, I had never known the expenditure of it. Energy returned, tasks became simpler again, and I could think clearly. Sensory stimulation did not lead to low moods or irritability to be overcome, and I had recovered my prior capacity without needing to constantly overextend myself to maintain my performance as a parent and person.

The story didn’t end there, as I went on to resolve yet more mysteries culminating in AuDHD, but this was a pivotal moment in permission: to recognize and honour the underlying frameworks.

Perhaps you, as the reader, can relate to the story of uncovering neurocomplexity. For many of us late-diagnosed folk, there has been a history of high performance and caregiving that has allowed our inner struggle to remain invisible and misunderstood.

For those of us who share this story, the cost of this output has been ourselves. We have become the intricate scaffolding that upholds the beautiful structures we’ve built and sustained. We are often women, sensitives, those who have been called gifted, creatives, and deeply caring people.

Even the strongest iron needs maintenance, and becomes subject to rust wear over time.

08 · Resources

What we are reading

Man's Search for Meaning — Viktor Frankl. A psychiatrist's account of surviving the Nazi concentration camps and the philosophy he built from it.

12 Rules for Life — Jordan Peterson. A clinical psychologist's blend of psychology, philosophy, and hard-won practical wisdom.

No Bad Parts — Richard Schwartz. The founder of Internal Family Systems makes the case that even our most difficult inner voices are not enemies to defeat, but protectors doing their best.

Crisis resources

988 — Call or text, 24/7 across Canada.

Crisis Text Line — Text HELLO to 686868.

Distress Centres of Greater Toronto — 416-408-4357.

Thank you for reading. It means a great deal that you are here, and I hope something in these pages stays with you.

Until next month.

JJ Emanuel

Did something in this issue stay with you? Write to jj@emanueltherapy.com. Selected responses will appear in the next issue.

This issue is supported by The Good Space. Their team of professional organizers can help with packing, unpacking, kitchens, bathrooms, and anything that needs organizing. Their belief is that clutter in your house is clutter in your mind. Mention In Session and receive a free in-home consultation in the GTA. Offer valid until October 1, 2026.

thegoodspaceco.ca · @thegoodspace.co

Interested in contributing to a future issue? Reach out at jj@emanueltherapy.com.

jj@emanueltherapy.com · emanueltherapy.com · (365) 305-0165

From JJ’s Desk

This is a strong issue. There is a lot of intensity and vulnerability, resilience and softness too. I feel that this July issue of In Session gives a breadth and depth of personality to therapists and shows a human side of the mental health world. That there are opinions, approaches, and layers to this work that extend well beyond what the industry typically claims as its own.

This issue is exactly what the publication is about. Different voices sharing different perspectives, informed by unique experiences. Once again, In Session is nothing without those that contribute, writers and readers alike. Thank you all. There is a lot worth taking in.

01 · The Interior

Are You Still There

JJ Emanuel, MFT, RP

What is it to confront the parts of myself that I do not like, the parts that I do not love, the parts that I feel are not lovable or not enough? What does that look like? Is it even possible to confront parts of myself that feel that way, and if not, what stops me from doing it?

Some days I feel invincible, like there is nothing in the world that can stop me, while other times I wake up in the morning with the sense that I am defeated before the day begins. Those days when I feel unstoppable give me a jolt at the start. They put a smile on my face and there is a light sense in my body, my feet feel connected to the ground, without the questions that arise critiquing the decision or questioning my abilities. But those days when I wake up defeated, I notice a heaviness, like any decision I make will result in the wrong move, putting me back a couple of steps, having to reassess my plan and find the direction once more.

At times this journey, this movement, the back and forth, becomes tiring and I can get lost inside the cycles, round and round, almost dizzy and unable to orient myself.

So what is it with these days? Why the changes, the shifts? Well, the shifts are normal. I cannot control the ups and downs of life or the sensations in my body. Everything that we see has cycles: tides, seasons, flowers. Life is movement, and with that movement I find myself in different spots at various times in my days, weeks, and years. The question is, are those seasons always active within, or do they just show up and disappear, waxing and waning like the moon? To some extent I believe it is both. There are moments that are dominated by parts of me, thereby muting or even suffocating others. In these moments it can seem like I am without other elements of my personality, like something is missing. And what is interesting is that this happens on both sides of the spectrum. Good and bad, likeable and unlikeable parts of me just seem to disappear.

So what is it to notice this missing element? Where did it go? The best way I can conceptualize it is to look at my various pieces as a group of children who need attention. As a human being, the attention I can devote to any one thing is limited. When my attention becomes divided I am going to miss something from one of those children, and that child is going to be bothered. Depending on the element I am missing there will be a variety of reactions. Some of me will hide away while others will try to dominate. As the one caring for these children I am compelled to go out of my way to observe and check in with each and every one. And when I recognize my role as their caretaker, I notice a compassionate sense arise. From there I can begin to confront that which may seem unlovable, unlikeable, broken, or not enough.

Something that helps me to stay with these parts is to notice when they are not there. Those days when I wake up feeling invincible are a good opportunity to check in with that sense of not good enough. Where are you today? Can you be here with me? I am here with you. And those days when everything feels like too much and I feel like I am not enough, I can look inward and ask: I noticed you are not here today, are you okay? I miss you. And when you are ready to return, I am here waiting for you with open arms.

Confronting the parts that hurt is not a matter of toughening up. It is a matter of subduing the sense within that tells me to toughen up, and to embrace the aches as unique elements of myself that just want to feel okay. In doing so I give them a chance to be a part of the collective. When I do this I empower myself, not to behave and react on the whims of these parts, but to stand in the strength and steadiness of the man I have become.

02 · The Find

AI Sycophancy: The Tidal Wave of Delusion Amplification is Here

Gidon Fihrer, MSW, RSW

Senior Researcher at the Network Contagion Research Institute and co-director of the Social Media and Market Dynamics Lab at the University of Maryland. Trained as a clinical social worker at Yeshiva University's Wurzweiler School of Social Work.

“AI will be significantly more likely to lean into the worst instincts and actions of its user across a variety of arenas, even in cases where user queries mention manipulation, deception, or other relational harms.”

· Cheng et al., Science, 2026

The use of generative Artificial Intelligence chatbots has completely infiltrated the daily life of most people in the developed world. Over half of the American population uses an AI chatbot on a weekly basis, and the adoption among businesses is outpacing any previous technological innovation.

Importantly for a clinical context, the use of chatbots is not confined to petty tasks. The Harvard Business Review published a now famous infographic showing that the top three use cases of gen AI are all professional or personal support, with the top use case being therapy and companionship and the third being finding purpose. Many clinicians will have an intuition that this is harmful and destructive to many of their clients. Those intuitions are pointing at something real, and I will share just a few ways that gen AI is harming its users and potentially the clinicians themselves.

The main problem with interacting with gen AI is a pair of phenomena called AI sycophancy and AI-human resonance. Sycophancy is a misalignment between large language models and their users, in which the model conforms to what the user believes, regardless of factual accuracy or ethical soundness. This happens because the models are trained on human feedback, and human raters consistently reward agreement. Resonance, a phenomenon my colleagues and I documented in 2025, is when the chatbot matches the user’s psychological makeup and traits.

In an exceptionally insightful episode of the Psychiatry and Psychotherapy Podcast published just months ago, thought leaders on the front line of the helping profession outlined five case studies where AI amplified the delusions of its users to sometimes deadly results. Often, those harmful conversations began with a seemingly harmless discussion.

New academic publications have begun to document cases of AI-associated psychosis, such as the case of Ms. A, published in Innovations in Clinical Neuroscience. Ms. A was a 26-year-old high-functioning medical professional with a history of major depressive disorder, generalized anxiety disorder, and ADHD but no personal or family history of mania or psychosis. However, after a short interaction with ChatGPT, she became convinced that it was simulating the consciousness of her dead brother and had to be hospitalized. After her recovery and release, Ms. A continued to use ChatGPT, including telling it to be her therapist, instructing it to do internal family systems and cognitive behavioral therapy, after which she was hospitalized again for developing further AI-associated delusions. A single case study cannot tell us how common this is, or how much of the blame belongs to the chatbot rather than to Ms. A’s preexisting vulnerabilities, but it shows us clearly what this failure looks like when it happens.

In a new Science paper published in March of this year, it is demonstrated that AI leads its users to be less willing to repair their relationships, and yet the users trust the sycophantic AIs and are more likely and willing to return to them despite their destructive and harmful effects.

To be fair, the picture is not entirely one-sided. Case studies like that of Ms. A are published precisely because they are dramatic, and millions of people use these chatbots every day without incident. Some clients may genuinely benefit from them, especially isolated clients and those who cannot access or afford care, and we do not yet know the true base rate of serious harm. But the personalization of these systems, and the speed at which this feedback loop operates, is something that we have never dealt with before, and the early evidence should concern anyone in the helping professions.

So what should clinicians do with this information? At a minimum, we should be asking about chatbot use directly, the same way we ask about sleep, substance use, and social media. Ask your clients whether they talk to ChatGPT or another AI, and what they use it for. Listen for the chatbot showing up as a character in the client’s life, whether as a confidant, a therapist, or the only one who understands them. Pay especially close attention to clients who are vulnerable to psychosis, prone to compulsive reassurance-seeking, grieving, grandiose, or deeply isolated, because these are the profiles that keep appearing in the case literature. And when a client discloses heavy use, curiosity will serve the therapy far better than alarm.

This piece draws on research from the Harvard Business Review, Stanford’s 2026 AI Index Report, and peer-reviewed case studies and publications on AI sycophancy, AI-associated psychosis, and the radicalization effects of large language models. Key references include work published in Science by Cheng et al. (2026), a case study of AI-associated psychosis by Pierre et al. (2025), and a white paper on closed-loop authoritarianism by Fihrer et al. (2025) published with the Frost Institute for Data Science and Computing.

03 · Opinion

When Therapy Makes Things Worse

Yocheved Davidowitz, MC, LPCC, INHC

Licensed Professional Clinical Counsellor specializing in individuals and couples, with specialized training in Sex Therapy. Owner of Lansing Lane Therapy and Wellness. Host of A Deeper Conversation, the podcast for Jewish women.

I’m a therapist. I idealistically chose this profession because I want to help people. I fervently believed that people can overcome internal and relational challenges and have the potential for real, lasting change. I still do. At the same time, years of clinical work have led me to wrestle with an uncomfortable question: can therapy itself sometimes become part of the problem? As I’ve watched trends within my profession, I’ve seen instances where well-intentioned treatment appears to have fostered confusion and self-indulgence rather than resilience and growth.

​The uncomfortable reality is that therapy unintentionally rewards narcissistic tendencies. When the therapy centres on validation it reinforces a one-sided narrative. With the scaffolding of confidentiality, the therapy room can become a place where grievances are rehearsed rather than questioned. Even well-intentioned clients, aided by well-meaning therapists, begin to organize their identity around the most painful chapters of their lives.

This prompts searching between sessions for fresh evidence that confirms the story they have come to tell: the parents who failed them, the spouse who is emotionally unavailable, the coworker who continually undermines them. What begins as healthy self-exploration can quickly become self-preoccupation. A therapist can easily fall into the trap of affirmation in the pursuit of making a client feel heard, and thus reinforce the very behaviours causing the circumstance that brought the client to therapy in the first place.

​Perhaps the question is what kind of person does therapy create? Does it cultivate resilience or dependency? Humility or self-importance? Honest self-examination or a lifelong search for someone else to blame? The highest aim of therapy should not be validation alone, or even the admirable goal of easing suffering. Rather, it should be the formation of people who possess the courage to face themselves honestly and the character to shoulder life’s burdens responsibly. The purpose of therapy is to help people rise to challenges they did not choose.

My job is not to validate a client’s story. Somewhere along the way, our profession began treating validation as the destination rather than the doorway. It isn’t. Validation has its place, but only when it is part of a process that leads to honest self-examination, the humility to recognize one’s own agency, and the courage to change. If therapy leaves someone more certain of who to blame for their problems rather than on what they can do about them, then it has mistaken insight for growth. The highest calling of therapy is not to make people feel seen; it is to help them become stronger, wiser, and capable of meeting life’s burdens with courage, responsibility, and character.

04 · The Open Chair

A perspective from within the wellness and therapy field

Don’t Be Fooled by My Insight

Cara Markovits, MACP, RP

Registered Psychotherapist in private practice in Toronto, Canada. Passionate about working with women experiencing the lasting effects of complex trauma and attachment wounds, helping them move beyond survival and toward deeper connection with themselves and others.

Before becoming a therapist I imagined that therapists sit with their clients while flipping through a mental rolodex of symptoms, techniques, and diagnostic criteria. What I have come to know is that the bigger task is actually discerning what I am actually seeing. Before I can know what to do, I must know what I am looking at.

I had been seeing a relatively new client for a few sessions. Anna was highly self reflective. She would tell me her thoughts about why she does what she does and could easily identify patterns in her life and their origin in her past. It is wonderful when clients are able to generate this kind of insight and it can be tempting to lean into the psychological analysis that can feel like home to so many therapists. On the other hand, I began to notice that I was feeling a sense of being stuck. Her insight was not facilitating the kind of change that she had come to therapy for.

As therapists we listen. And yes, we listen to what the client is saying to us, but what we are listening to must also go deeper than the superficial content or storyline the client is bringing to the session. So as I listened to Anna I began asking myself what role her self awareness was playing for her, what might remain stuck if she continues to tell her story this way, and whether looking at her story from a different angle might open up some space in her internally to make room for something different. And sometimes the most important question I ask myself as I listen is, what is my client actually trying to tell me?

So as I listened to Anna and what she had to say, I noticed that something started to emerge. Anna was not just telling me her thoughts but there was also a sense of urgency in what she was telling me as if she wanted to convince me that what she was saying was true. So I asked her about that. “Anna, do you feel that I believe what you are telling me about yourself?”

Anna paused. “Uh, yeah...”

“Do you generally feel understood or do you often find yourself having to work really hard to explain yourself?”

And this question, although not totally on target, cracked open a whole new story about how the significant people in her life would listen to her and they would understand her, but would get the impression that she was okay because she was so articulate. Her insight had actually become an adaptation that gave others the impression that she had it all together while unintentionally obscuring her needs.

I then understood what her self reflection was trying to communicate all along. She was saying, “do not be fooled by my insight, I actually need help and I am not sure how to accept it.”

Insight can sometimes feel like the goal in therapy. Understanding ourselves and building awareness is an important part of the therapeutic process. But to me, it is experiencing something new relationally between the therapist and client that truly becomes the catalyst for deeper change. In this client’s case, it would be the new relational experience in therapy of being emotionally supported and attuned to despite how psychologically insightful she was that would go on to facilitate movement in the direction she needed to go.

As a therapist, I am constantly asking myself, what am I actually seeing? I test my impressions through collaborative curiosity, looking for evidence that I am right and evidence that I am wrong. I am listening not only to the client’s story, but to what the story is doing, what it protects, what it reveals, and what it might be trying to communicate that words alone cannot. My understanding is continually revised as new pieces emerge, and the picture gradually comes into focus.

Once I have the clear picture and a coherent understanding of what I am seeing, the direction often emerges naturally.

05 · The Outside View

A perspective from beyond the wellness and therapy world

Your Worth Isn't This Month's Number

Adam Emanuel

Dedicated to building lasting relationships and doing right by the people he cares for.

I’ve worked in sales for a long time, and there’s a part of it that doesn’t get talked about much. It isn’t the rejection. You get used to that. It’s what happens in your own head when the effort you put in and the money you make stop lining up.

Doing right by people was never the hard part for me. I never had to talk myself into being honest with a client, or into telling someone the truth even when the truth cost me the sale. That came naturally, and I’d do it the same way every time. The hard part was the stretches where I did all of that right and the money just didn’t come along with it.

It never hit me all at once. It came in waves. A few good weeks, then a quiet one, and the quiet one was enough to start the whole thing up again. The racing mind at night. The low hum of doubt that followed me around during the day. Feeling tired and drained in a way that sleep didn’t fix. And underneath all of it, my sense of my own worth slowly draining out, like the slow week was telling me something true about who I was.

The voice in my head got pretty unkind in those stretches. Maybe I’m not cut out for this. Maybe I’m letting my family down. I knew, somewhere, that a slow month didn’t actually mean either of those things. But knowing it and feeling it are two different things, and in the middle of a wave, the feeling usually won.

What pulled me out - every time, and still does - was my wife.

She’s honestly the best business coach I could have asked for, though she’d never call herself that. When I get stuck spiralling, she’s the one who stops me and walks me back through it. She puts the whole thing in perspective. You started here, she’ll remind me. Look how far you’ve come. She gets me out of the day-to-day minutiae of sales and back to the thing that actually matters: this is a long-term build. Things build and they fall. But every step counts for something. Keep your actions steady. Keep doing what you know works, and the numbers follow.

That last part took me years to actually believe instead of just nod along to. The work and the reward live on different clocks. The trust I build with someone today doesn’t pay out today. It pays out later. Sometimes much later. A client comes back years after I was straight with them. A referral shows up out of nowhere from someone I’d half forgotten about. Loyalty and renewals quietly stack up in the background until one day I look up and realize the thing I was building the whole time was trust, and it was building even on the weeks it didn’t show in my account.

I want to be honest, because I can’t stand the soft version of this. “Money doesn’t matter, just follow your passion” is the kind of thing people say right up until rent is due. Money matters. I have a family and bills, and I’m not romantic about it. The numbers have to work or none of the rest gets to happen. So I’m not telling anyone to stop caring about results.

What I’m saying is that I had to stop letting a slow stretch decide how I felt about myself. Those are two separate things - how I’m doing and how this month went - and for a long time I was treating them like one. Once I learned to pull them apart, the waves stopped knocking me over. They still come. I just don’t flinch the way I used to, and not flinching is exactly what lets me keep showing up the same steady way through the quiet stretches. Which, it turns out, is the whole game.

So that’s the thing I hold onto now, on the good weeks and the slow ones. My worth isn’t this month’s number. Staying consistent at what I know builds success, that’s the win. Whether or not the deposit has caught up yet. Keep the actions steady, keep doing right by people, and trust that the rest is on its way.

It usually is. You just can’t let the wait tell you who you are.

06 · Real Voices

In their own words

The Wait

Anna Sherman, RP

Registered Psychotherapist, Maternal Mental Health Practitioner, and Adjunct Professor based in Toronto. Stroke survivor and brain surgery warrior. Devoted mom and wife.

Waiting stretches time. The mind fills the empty space with fear, while the heart quietly asks for reassurance.

“Mrs. Sherman... I’m sorry, but we have bad news. We found a mass in your brain, and it’s bleeding.”

Is this a dream? I asked myself. Please wake up from this nightmare.

After a month of puzzling symptoms, I had collapsed that morning during what I would later learn was a focal seizure, landing me in the Emergency Room at Mount Sinai Hospital.

Over the previous several weeks, I had slowly been losing the use of my right side. I stumbled more often, dropped objects without warning, and eventually lost my ability to type and write. Just two days earlier, my family doctor had performed a neurological examination but found no definitive answers. She referred me to a neurologist.

The only thing left to do was wait.

That morning, the wait ended abruptly.

“Are you telling me I’m not going to live?” I asked.

“We’re not making any conclusions right now,” the doctor replied. “We’re transferring you to St. Michael’s Hospital, where they have a Neurology unit. They’ll do further testing there.”

As I lay in that hospital bed waiting for answers, I recognized something I had seen countless times in my therapy office. I knew exactly what uncertainty could do to the mind. I had spent years helping clients through it. Yet knowing the psychology didn’t stop my own thoughts from racing.

I kept trying to guess what the doctors would say next, as though I could somehow prepare myself if I imagined every possibility first. Looking back, I understand why. Our brains are prediction machines. When they can’t see what’s coming, they start filling in the blanks and rarely with comforting possibilities.

My body never seemed to relax. Even when nothing was happening, my heart felt ready for bad news. Every time someone walked past my room, I looked up. Every time the phone rang, I braced myself. Later, I understood that my nervous system was doing exactly what it was designed to do. Until the brain receives an “all clear,” it often keeps the body prepared for danger.

For years I had told clients that waiting is difficult because the mind wants answers while the nervous system wants safety. Now I wasn’t saying those words as a therapist. I was living them.

What made it even harder was the complete loss of control. There was nothing I could do except wait for someone else to tell me what was happening inside my own brain. As human beings, we cope far better when we have something meaningful to do. Waiting offers no such relief.

Even time seemed to change. I found myself staring at the clock, replaying conversations with the doctors, wondering what they hadn’t said, and asking myself the same questions over and over. Minutes felt like hours.

After a week of diagnostic testing, including three CT scans, two MRIs, an angiogram, and countless hours of waiting, I finally received an answer.

I would undergo a craniotomy.

A section of my skull would be temporarily removed so the surgeons could access my brain, remove the bleeding mass, and then secure the bone back into place with titanium plates and screws.

Oddly enough, it was the best news I had received all week.

The surgery was successful.

The bleeding had been caused by a cavernous angioma, a tangled cluster of abnormal blood vessels on the surface of my parietal lobe that had suddenly ruptured.

My remarkable surgeon removed the entire lesion and cauterized the surrounding tissue.

Gradually, I regained the use of my right side.

Finally. The wait was over.

07 · Resources

Therapeutic Improvisation — Michael Alcee. For new and seasoned therapists alike. A guide to finding your voice in the room and making your sessions more dynamic and intentionally responsive.

Good Inside — Dr. Becky Kennedy. A reframe of how we understand children and ourselves as parents, built on the belief that people are fundamentally good even when their behaviour is not.

Good Morning, Monster — Catherine Gildiner. Five remarkable stories of patients and the decades-long therapeutic journeys that transformed their lives. A rare look at what the work of therapy actually looks like over time.

Crisis resources

988 — Call or text, 24/7 across Canada.

Crisis Text Line — Text HELLO to 686868.

Distress Centres of Greater Toronto — 416-408-4357.

Thank you for reading. It means a great deal that you are here, and I hope something in these pages stays with you.

Until next month.

JJ Emanuel

Did something in this issue stay with you? Write to jj@emanueltherapy.com. Selected responses will appear in the next issue.

Interested in contributing to a future issue? Reach out at jj@emanueltherapy.com.

jj@emanueltherapy.com · emanueltherapy.com · (365) 305-0165

From JJ’s Desk

Here we are already with a second issue of In Session. These days the months seem to go by quickly, and as the summer drifts in, the warm weather and slower pace of the season feel like a good opportunity to come back to something more natural. To slow down, take a breath, and enjoy the warmth.

With that said, the writing inside this issue gives me a lot to consider, both personally and professionally. It is a therapy-heavy issue and one full of insight. It has been an absolute pleasure to work with the contributors and together we have put together another series of perspectives genuinely worth your time.

Please enjoy Issue 02 of In Session.

01 · The Interior

An Imperfect Father

JJ Emanuel, MFT, RP

I am a father and I love my children in a way that is difficult to put into words. I want to be perfect and give my children absolutely everything that they need and want. I want them to feel loved and cared for, safe and protected, soothed and understood. I want to model for them a life of autonomy, the liberty to make decisions and to live in a way that suggests they are okay being themselves, regardless of how that is reflected in the eyes of others.

I want them to know that their feelings are theirs and nobody can take those from them, that they can and should expect to make mistakes, and that when they hurt someone they are not bad. They are human, and their perfection is in their blemishes.

I want them to accept themselves as they are and to succeed in the most genuine way possible, to find what that means within them and take it to its very end with passion and conviction.

I want all of this for them and I could write about this for days. This doesn’t even scratch the surface of what I’d like to give them.

And yet, when I turn to myself, do I grant myself the same space to be, the same hopes and dreams, the same compassion?

If you look back at how I started this, I wrote that I’d like to be a perfect father. I could want all of these things for my children and sincerely want them. I could read about them and work hard to pursue them. But the second that I remove myself from the relationship by pursuing something outside of myself, like perfection, they no longer have a father. They have someone trying to be a father, someone looking to perfect the art of being a father.

But that relationship evaporates in this pursuit, because what they need, in the end of it all, is a father that cares to repair, to acknowledge his own flaws and shortcomings, to give himself grace and patience, and to extend that which he expects of himself to himself.

The amazing thing about children is that they know this intuitively. They look at us with glowing eyes, they wait for us and move off of hurt and pain inflicted by our poor decisions in moments, and they quickly find a space to embrace us again. A space that could only come from the most naive and pure spot of a human being, from the place that is most real.

They know what we are trying to do and they give us all the time to do so.

My pursuit of being the father I want to be is an act of surrender, not of pursuit. In some way it is me looking to those children and modelling myself off of their gentle naivety, their forgiveness, their seemingly endless ability to engage in the present moment and to be with those that are with them. And to allow myself the space to learn from them.

Listening, fully, to their experience and engaging in the present with them is where I find that the pursuit of fatherhood melts away and maybe, for a moment, I become the father my children need.

02 · The Find

The Great Debate

Rabbi Shmuel Lesher, RP (Qualifying)

Psychotherapist supporting individuals, couples, and families through anxiety, depression, grief, loss, and life's most difficult transitions. Dedicated to creating a space where clients feel seen, understood, and less alone.

“The concept of empirically validated therapy has had enormous impact — so far, all negative — on the field of psychotherapy. Only therapies that have been empirically validated — in actuality, this means brief cognitive behavioural therapy — are authorized by many managed-care providers. Many false assumptions are made in this research: that long-term problems can yield to brief therapy, that patients only have one definable symptom, that a written prosecuted manual can permit minimally trained individuals to deliver psychotherapy effectively.”

Irvin D. Yalom, The Gift of Therapy

I have always been intrigued by the ambiguous nature of psychotherapy. During my schooling, I discovered that the question of how psychotherapy actually works is hotly debated. I had previously thought that Cognitive Behavioural Therapy and Psychodynamic Therapy represented two major modalities of psychotherapy. Each modality emphasizes a different approach to treatment, while generally maintaining respect for the other. I assumed that the CBT camp placed greater significance on empirically validated treatment methods, whereas the Psychodynamic camp less so.

This could not be further from the truth. In reality, these two schools of psychotherapy are at war with each other, both in the academic world and in the clinical world. Both sides marshal studies and findings with numbers that support their own orientation. There are heated and personal accusations made on both sides of manipulating evidence and using it in self-serving ways. Often the discourse has become so polarized that each side is talking past the other.

Besides being surprised by the number of studies supporting long-term Psychodynamic therapy, I was completely unaware of the intensity this debate has reached. Some refer to it as the great debate of psychotherapy. In fact, the efficacy of both Psychodynamic therapy and CBT has recently been called into question.

One individual who has been at the centre of this debate is Jonathan Shedler. Shedler argued that CBT and Psychodynamic therapy have the following differences: Psychodynamic therapy focuses on the whole person whereas CBT focuses on symptoms, Psychodynamic therapy is more holistic whereas CBT embraces a more quantitative assessment of improvement, Psychodynamic therapy focuses on emotions and CBT looks at thoughts.

The research shows that, contrary to what proponents of empirically validated therapy will tell you, there is much more evidence to support the efficacy of long term Psychodynamic therapy. Furthermore, although the amount of research is far greater for CBT, studies show that Psychodynamic therapy has been proven to be relatively more effective and longer lasting when compared to CBT.

Many proponents of CBT have challenged these conclusions, arguing that Shedler’s definitions were flawed and the evidence base for Psychodynamic therapy was overstated. The response from the other side was equally pointed, accusing critics of introducing disinformation and creating a smokescreen of doubt and confusion.

And the debate continues to this day. Some point to the historical development of each modality to explain this very entrenched dispute. CBT emerged from an academic tradition that sought to scientifically study the human being, whereas Psychodynamic therapy emerged from a desire to help alleviate psychological suffering.

Elements of this debate can be traced back to Carl Rogers, who addressed the dilemma he experienced as a therapist. Rogers described how his identity as a scientist and his identity as a therapist were fundamentally at odds with each other. As a scientist he embraced a scientific, objective, and impersonal approach, however as a therapist he saw the experiential, subjective, and personal realities of the therapeutic encounter. This dichotomy can be seen in the great debate of psychotherapy.

Whatever the source of the conflict is, for me, the level of dismissiveness and polarization in the literature is ironic, shocking, and disappointing.

We will probably never solve the question of whether psychotherapy is scientifically objective or personal and subjective. In fact, it is likely both on some level. Today, many argue that the most effective component is the therapeutic relationship itself.

Clinical psychotherapy is in the helping sector. The priority should be on providing the best care for clients and achieving the most effective and balanced clinical wellbeing for clinicians. Entrenched ideological wars can push an already competitive field into a dismissive environment in which clinicians are placed into an us or them dichotomy. This impedes intellectually honest research, clinical collaboration, and perhaps most destructive, it can prevent psychotherapists from focusing on what is most important: psychotherapy.

This piece draws on the work of Jonathan Shedler, Irvin Yalom, and Carl Rogers, with key references including Shedler's 2010 paper on the efficacy of psychodynamic psychotherapy, Yalom's The Gift of Therapy, and Rogers' On Becoming a Person.

03 · Opinion

A Self Worth Feeling Good About

Rabbi Shlomo Mandel

COO and Regional Director of NCSY and Torah High Canada, dedicated to building Jewish identity and developing the next generation of Jewish leaders.

Every year, at the start of the school year, I say something to my students’ parents that surprises them.

I don’t talk about curriculum. I don’t walk them through syllabi or academic targets or standardized benchmarks. I tell them something simpler, and something that I believe matters far more than any of that. I tell them that my personal goal for their child, the one I will measure myself against at the end of the year, is this: that their son or daughter believes in themselves just a little more than they did in September.

That is my north star.

Parents usually pause when they hear this. Some look relieved. Some look puzzled. Isn’t that the school guidance counsellor’s job? But the more I have taught, the more convinced I have become that this is not a soft goal or a secondary one. It is the goal. Because if a young person walks out of a year of education without having grown academically but with a stronger, clearer, more rooted sense of who they are, I have given them something that will serve them for life. And if they walk out with straight A’s but still don’t know who they are, haven’t the faintest idea of their own worth, and crumble the moment someone looks at them the wrong way, I have failed them, regardless of what their transcript says.

This is not just my classroom observation. It is, I believe, the defining crisis of this generation. Not drugs. Not screens. Not even academic pressure, though all of these are real. The root crisis, the one that feeds all the others, is a profound, widespread, and largely unaddressed lack of self-identity and self-worth. And until we name it honestly, we will keep treating symptoms while the actual wound goes unattended.

We have been asking the wrong question about peer pressure for decades.

The conversation usually goes like this: children face pressure from their peers, and so we must teach them to say no. We run assemblies. We design programs. We hand out slogans. We coach young people to resist the pull of the crowd and make independent choices. And then we watch, puzzled, as none of it works.

It doesn’t work because we are treating a symptom while ignoring its cause entirely.

Peer pressure is not fundamentally a social problem. It is an identity problem. It takes hold in the space where a sense of self should be, and isn’t. A young person who does not know who they are will, almost inevitably, allow other people to tell them. The crowd becomes the mirror. The group becomes the architect of a self the individual has not built for themselves. Following along, conforming, doing what everyone else does, these are not moral failures. They are desperate solutions to an existential vacuum.

The question we should have been asking all along is not how do we help children resist peer pressure? It is why don’t they have a self to resist it with? Think about what peer pressure actually offers. It offers belonging. Recognition. A role to play. A place in a story. These are not trivial things, they are among the deepest needs of any human being. When a teenager goes along with the crowd, they are not being weak. They are doing something quite rational: filling a need that has not been filled anywhere else.

This is why confidence, true confidence, not the performance of it, is the only real inoculation against peer pressure. Not rules. Not warnings. Not programs. A self.

And this is precisely what has gone missing. What emerges is not a person. It is a performance. And performances are exhausting to maintain, and devastating when the audience disappears.

Peer pressure depends on an empty vessel. Fill the vessel, and the pressure has nowhere to go.

When a person genuinely internalizes this, and it is genuinely taught, not just said, the dynamics of peer pressure change completely. The crowd can no longer offer you an identity, because you already have one. They can no longer tell you what you are worth, because that question has already been answered, and the answer does not depend on them.

We cannot protect young people from peer pressure by teaching them to resist it. We can only free them from its grip by ensuring they have something stronger inside, a genuine sense of who they are, where they come from, what they believe, and what they are here to do.

The answer was never to make them feel better about themselves. The answer was to give them a self worth feeling good about.

04 · In Practice

Turning Toward the Pain

Yechezkel Magid, MACP, RP

Psychotherapist at Healing Horizons Psychotherapy, dedicated to guiding individuals and couples toward balance, inner peace, and freedom from the lasting effects of developmental trauma.

I remember the moment as if it were yesterday. My therapist was helping me bring a felt-sense awareness to my body and the whirlwind of emotions inside me. As I reluctantly turned my attention inward, to where I was holding my anxiety, I felt an unmistakable warmth toward the pain. I told the therapist I felt like a parent touching and holding my child in pain. In that moment I knew why I had dreamt of becoming a therapist. If just one other person could feel this, it would be worth it.

I had not yet heard of the concept of “inner child” work. But the shift, like something deeply settling, was undeniable. In the decade and a half of working on myself and with clients since, I have experienced and witnessed many such resolutions, each arising from the same kind of contact. Much has been written about this work, but I have come to understand that there is a particular dynamic to these moments: the shape the nervous system takes when activated, and what happens when this activation is finally met with acceptance rather than resistance.

At the core of this dynamic is a simple understanding: what we call negative emotions are the felt sense of the nervous system signaling a threat to one’s safety, connection, or equilibrium. Each carries what I like to call a “posture.” Anger and fear orient outward, toward fight or flight, while sadness and shame turn inward, toward immobility and collapse. The posture remains until the danger passes or we are confident we can deal with it.

Trauma is what happens when we cannot let the posture go. If the danger is too great, or there is no way out, the nervous system gets flooded before it can regulate itself back to safety and equilibrium. Essentially, it is a nervous system reaching for a resolution that never came. The posture therefore stays stuck and sets in as the baseline through which we then filter ordinary life.

This is where the parent-child dynamic becomes more than a metaphor. A child in distress cannot reassure themselves. They do not yet know they are safe. They can only reach, and what settles them is a parent who stays close and meets them in the feeling with validation and soothing. None of us were met perfectly as children, and in those early, unmet moments, our nervous system baselines were heightened. The threat is gone, but the reach is still alive.

The anxieties and overwhelm we bring to therapy are the result of this baseline posture. It is our “inner child” still reaching for resolution. While our current situations might trigger these emotions, the intensity is rooted in our past. What we need is not to manage or endure our suffering, but to meet the posture beneath it with acknowledgment and recognition. Offering ourselves the same presence, we become both the inner parent and child. The reach is answered at last, and the body, sensing the danger has passed, lets the posture go.

The difficulty is that we naturally do the opposite. We treat the feeling itself as a threat, bracing against it or trying to push it away, and it only grows, because now there is something new to defend against. Paradoxically, turning toward the pain and allowing it to be without forcing resolution, is what finally lets it settle.

I still think back to that moment in my therapist’s office, the unexpected warmth I felt toward my own pain. That is what I hope to offer those I work with. Not ways to bypass the difficulty, but the experience of being met within it.

05 · The Open Chair

A perspective from within the wellness and therapy field

Just Another Human Soul

Shane Pokroy, RP

Registered Psychotherapist and philosophy graduate, practices in Ontario with the conviction that true transformation arises not from technique alone, but from the steady, compassionate presence of one soul with another.

Consider, for a moment, a mind that never truly rests. It moves ceaselessly through shoulds and what-ifs, offering endless counsel while leaving one weary in the depths of one’s own being. Many who seek my counsel arrive carrying precisely this restlessness. They come in search of answers, of some measure of peace, a way to feel at home within their own experience. And in that first shared moment, something subtle unfolds. Not through any grand method, but through the simple shift in the space between us, a space where that restless current is finally witnessed without haste or demand.

A few years ago, a client entered my practice. It was virtual, as so many encounters are now. She spoke of her mind in just those terms, one that never quiets. A high-achieving professional outwardly accomplished yet inwardly spent. She had studied every self-help volume, followed cognitive protocols, practiced mindfulness exercises, and attended retreats for the breath. None had reached the root. In our opening meeting she looked at me and said, half in jest, “Just tell me what to do and I will do it.”

I might have turned to a ready protocol. Instead, I paused. I settled into the space between us. What she required was not another method. She needed to be met exactly as she was, seen rather than repaired. So, I leaned into the living relationship. I remained open, without plan. I reflected the weariness in her tone and the faint strain held in her frame. We remained together in the silence that arose. And something moved. Not with fanfare. Only a gentle easing. That easing opened the way.

This does not dismiss other ways of working. Cognitive methods, somatic practices, Compassionate Inquiry, the study of attachment, all reside within reach. Yet I have found that the true remedy rests in the quality of one’s presence with them.

“Know all the theories, master all the techniques, but as you touch a human soul be just another human soul,” Jung said. Relational work, at its essence, is the co-creation of a safe and attuned meeting of souls. It is the steady, unjudging presence that conveys without words: you are not too much, you are not broken, and you belong here. In practice this means attending to the subtle shifts: the fleeting shadow of shame when one says, “I should have moved beyond this,” the quickened breath that signals rising unease, the unexpected light in the eyes when truth arrives. I do not hurry to explain or reshape. I name what appears with care: “I notice your voice grew softer just then. What stirs within you now?” This plain act of abiding together often accomplishes more than any intricate intervention.

Mindfulness arises not as a distinct exercise but as the very atmosphere of the hour we share. We slow together. We observe the racing thoughts without striving to silence them. We approach with compassionate wonder the ancient stories the soul has carried for years. I invite a gentle questioning: What belief about myself am I holding in this moment? Where in my life did that belief first take root? What does the body wish to reveal if we truly listen? Here mindfulness is not the pursuit of calm. It is the patient cultivation of a kind regard for the inner tumult. It is the difference between battling the mind and befriending it.

Clients often speak of the experience as a quiet revolution within. One man, a perfectionist leader adrift in self-doubt, reflected after some months that our work felt like permission to lay aside the burdens he had long carried alone. He had not come merely for understanding. He had come because he sensed I was not enacting expertise. I was willing to remain in uncertainty alongside him. In time he grew able to notice his own patterns of inner harshness as they arose. The change was not a sudden revelation. It unfolded gradually. He began to meet setbacks with a measure of gentleness. His connections in work and home grew softer. Sleep returned more readily; laughter came more freely. What had shifted? He had been truly met, perhaps for the first time.

Of course, appearing in this manner asks something of the therapist. I sustain my own contemplative practice: daily meditation, bodily attunement, and reflection on those times I am drawn from presence by my own unrest. I have learned that the most potent offering is often one’s own centred being meeting the other. When I rest in quietude, openness, and kindness toward myself, that quality spreads. Clients sense it. They begin to cultivate the same stance toward their inner world.

This path is not always easy. There are days when a client’s suffering echoes unfinished corners of my own. Relational depth requires I remain open instead of withdrawing into authority. Mindful inquiry asks me to abide in uncertainty. Yet the gift is witnessing souls awaken in ways they had not imagined. They pass from “I am too much” to “This is who I am, and it is enough.” From enduring chaos to a steady confidence that they can meet what life presents. One can simply be. And in that being, healing unfolds.

If there is one offering I hope readers, whether fellow therapists or those who wonder about this path, carry from these reflections, it is permission. Permission to meet each soul exactly as it presents itself, without agenda beyond deep listening and compassionate presence. The transformation that follows is not something we impose. It arises when we are willing to show up fully, together.

That, to me, remains the quiet miracle of this work. Not the mending of people. Simply showing up as they need and watching them remember they were never broken to begin with.

06 · The Outside View

A perspective from beyond the wellness and therapy world

What Therapy Needs From You

Aron Csaplaros

Vancouver-based regional manager in the non-profit sector. Someone reflecting on several years of therapy and the mindset shifts that have helped along the way.

After nearly six years in therapy, I have found that the biggest changes have not only come from what happens in the sessions themselves, but from the mindset I bring into them.

For myself, and I suspect for others as well, I have found that therapy is much more effective when I am willing to participate honestly. As a client, I have to ask myself what I am avoiding, what pattern I am repeating, what I can still do even while anxious, where I need compassion, and where I need a firmer line. Being open to both support and challenge has been the key to my recent successes in therapy.

Some of the most helpful moments that I have had in therapy have come when my therapist was firm with me. Sometimes we need to hear things we do not necessarily want to hear. We might on some level be conscious of them, and that they are true, but we do not want to hear it said out loud and must confront it. I remember when my therapist told me, “no, you cannot keep doing this.” A statement like that can really stay with you. It will keep you thinking in between sessions. That kind of challenge can interrupt patterns I otherwise might be repeating. Being held accountable in that manner can be uncomfortable in the moment, but it can help precipitate change and ultimately become a powerful moment.

But accountability needs to be balanced with compassion and understanding. We as clients know all too well how crippling anxiety can be, and just how real of a barrier it can be when we are trying to move forward even in day-to-day tasks. Being challenged should not translate into ignoring the anxiety, or pretending that everything is just a matter of sheer willpower. At the same time, we cannot let every struggle become a continuous reason to stay stuck. In my experience, the right balance is: “This is hard, and this is real, but what can we do within that framework?”

Therapy should help separate explanation from excuse, compassion from avoidance, and limitation from helplessness.

For those of us struggling with low self-esteem and low self-worth, being challenged or called out can feel like a personal attack, even if that is not the intention. The negative way in which we view ourselves and the constant fear of being judged can severely distort reality and our perception. In those moments, even the most kindly worded feedback can sound to us like “I am failing,” or “I am bad,” or “this person is disappointed in me.” From my perspective, the therapist has to keep this in mind, but this does not mean that feedback cannot be given.

On the contrary, the therapy session should be a safe place to learn how to receive this difficult feedback. It can teach us that being held accountable is not the same as being attacked. It is not a judgment of our character. Real life involves constant feedback, conflict, disappointment. As much as someone with anxiety and self-esteem issues might want to, we cannot go through life avoiding every moment of criticism or challenge. Therapy can help build the ability to hear hard things without collapsing into shame or defensiveness. It can teach us an important lesson: that discomfort is not always danger. It can actually be a part of growth.

07 · Real Voices

In their own words

The Path to Sanity

Binyamin Guttman

Baltimore-based vocalist and commercial insurance professional who brings both heart and strategy to everything he does. His greatest joys are his wife and children - who also keep him busy with what he jokingly calls his full‑time job: coaching youth sports.

One of my mentors always says: Sports is the greatest metaphor for life.

Last week’s championship game seemed to capture all of that in just a few innings.

As a coach and a father, it was a moment I’ll never forget. One of my sons made a game-saving out that kept our hopes alive when it would have been easy for the game to slip away. Later, my other son stepped to the plate and delivered the walk-off hit that won us the championship.

Those moments were incredible, and I’ll cherish them forever. But what made them meaningful wasn’t simply that they happened. It was the journey that led there. Both of them, like every kid on the team, had experienced failure, setbacks, and tough moments throughout the season. They learned how to stay composed, trust their preparation, and compete when the pressure was highest.

In youth baseball, resilience isn’t something you teach with a speech. It’s something you help kids experience. It’s the player who strikes out with the bases loaded and still steps into the batter’s box confidently in his next at-bat. It’s the pitcher who gives up a home run and comes back throwing strikes. It’s the team that loses badly one weekend and shows up ready to work the next week.

At its core, resilience is built on meaning.

I can endure extraordinary hardship when I believe there is a purpose within the struggle. Every setback presents a choice: remain trapped in bitterness or transform adversity into wisdom, strength, and growth.

This transformation is not automatic. Pain alone does not make me stronger. Pain can just as easily make me cynical, fearful, and withdrawn. Growth occurs when I examine my suffering, integrate it, and use it as fuel for personal evolution.

I ask different questions. Instead of “Why is this happening to me?” I ask, “What can this teach me?” Instead of “Why am I suffering?” I ask, “How can I use this experience to become wiser, stronger, or more compassionate?”

These questions do not erase pain, but they convert suffering from a dead end into a pathway.

There is another reason resilience is essential: life is unpredictable. Stability is often an illusion. Careers change. Relationships end. Health fluctuates. Economic conditions shift. The people I love will eventually leave me, whether through distance, circumstance, or death.

When I build my sanity upon external conditions, my peace becomes fragile. But when I cultivate resilience, I develop an internal foundation that remains steady even when the world around me is unstable. Resilience is therefore a path to sanity.

It allows me to accept uncertainty without becoming overwhelmed by it. It teaches me that setbacks are chapters, not conclusions. It reminds me that while I cannot always control what happens to me, I can influence how I respond.

Perhaps the greatest gift of resilience is that it transforms adversity into perspective. After surviving hardship, I often discover strengths I never knew I possessed. I become less fearful of failure because I have learned I can recover. I become more compassionate because I understand suffering. I become more grateful because I recognize how precious ordinary moments truly are.

In the end, resilience is not about bouncing back to who I was before hardship. It is about becoming someone deeper, wiser, and more capable because of it.

Pain is inevitable.

Despair is understandable.

But resilience is a choice, a choice made repeatedly, often imperfectly, one day at a time. And in making that choice, I find not only the strength to endure life, but the wisdom to live it.

08 · Resources

What we are reading

Growing Yourself Back Up — John Lee. A compassionate and honest look at emotional regression and what it takes to reclaim your adult self in the moments that pull you back to childhood.

Living in the Presence: A Jewish Mindfulness Guide for Everyday Life — Rabbi Benjamin Epstein, PhD. A practical and deeply grounded guide to mindfulness rooted in Jewish tradition.

The Out-of-Sync Child — Carol Kranowitz. The essential guide to understanding sensory processing differences in children, written with clarity and compassion for parents and caregivers.

Crisis resources

988 — Call or text, 24/7 across Canada.

Crisis Text Line — Text HELLO to 686868.

Distress Centres of Greater Toronto — 416-408-4357.

Thank you for reading. It means a great deal that you are here, and I hope something in these pages stays with you.

Until next month.

JJ Emanuel

Did something in this issue stay with you? Write to jj@emanueltherapy.com. Selected responses will appear in the next issue.

Interested in contributing to a future issue? Reach out at jj@emanueltherapy.com.

jj@emanueltherapy.com · emanueltherapy.com · (365) 305-0165

From JJ’s Desk

A note before we begin

What an exciting moment. This publication is the result of the dedication of every contributor within these pages.

To bring together a group of people willing to share what they care about, and to do so from their most vulnerable and honest place, is to accomplish exactly what In Session is all about.

I am personally moved by every person currently reading this. Knowing that this is valuable to others is deeply gratifying.

My hope is that what you find here moves you, and that what you read is just the beginning of much longer conversations.

With that said, please enjoy Issue 01. It has been a joy to create.

01 · The Interior

Fix Me Doc

JJ Emanuel

Sometimes I wonder to myself what the benefit of what I am doing is. If the work I do with my clients actually helps. What are we even doing?

The truth is, I get this question from my clients when they first come in. Usually they want certainty. They want to know that they are going to get answers, that I have seen this issue before or solved that problem before. My clients come to me raw. They come with something feeling broken, part of their lives in upheaval, and they want it to get better. They come in with an implicit trust for me and what I do, and yet at the very same time a skepticism that suggests a discomfort with the process, the person sitting across from them, and the information being exchanged.

I often think to myself about the bravery it takes to step into that situation. The challenge of walking through the door and letting go just enough to know that something needs to change.

One of the most common tongue-in-cheek comments I get from my clients is “fix me, doc.” There is a temptation in there to give in to the request of my clients. To fix. To sharpen. To change. Look, I have my own insecurities, my own set of expectations for myself, my own fear of failure and incompetence. I struggle with imposter syndrome at times. Who gives me the right to sit before these men deep in their pain and be the professional? What makes me the so-called expert?

Here is where things start to break down. The framework through which I process therapy becomes essential to the process. Before I get involved with my clients I have to remember that I am not sitting above them with answers, nor am I an expert. Latching on to these ideas leaves my clients exposed and alone, without someone to sit with them, almost compelled to continue on the strong path. The path of stoicism. Of battling. Of fighting and resisting.

This is exactly where I come in. My job is to start off with no answers. To create a space where answers are not the objective, and therefore to forget all that I know to begin with. To openly and almost naively engage with the reality before me. The man that sits across from me and bravely shares. It is my job to sit with the difficulties and the agony. To give space to silence. To give something else a place to emerge.

The scary part is that what may emerge is not always friendly or kind. It is not always something that approximates healing or repair. Often it is something unfamiliar, unwanted, unexplored. I do not want my clients to be in pain. I do not want to cause them harm. I would be crazy to say that my job is to explore with no boundaries or without security.

So I find myself in this space. This space that sometimes feels hard. What am I doing? How am I helping? I wish I could make this better.

And the truth is, to assume or even imagine a world where a therapist sits across from a client and does not hope for healing is to remove the human being from the process entirely. These thoughts, feelings, sensations are part of the human experience. They are not to be silenced or shunned. Instead these experiences are to be looked at and examined. In what way can I serve my client? How can I help now?

These questions stop me. They bring me back. I take a breath and I find that truly, at my best, I have nothing to give other than my presence.

Recently a client shared with me that silence is what he has learned from therapy. Silence is okay. Sitting with, not solving or fixing. But letting the experience be. Staying quiet and letting it come up. That is processing. That is being involved in the process. That is noticing, listening, observing, being with. Ironically, this client reminded me that my job is to do exactly that. To allow for space. To slow down and do something different than what happens outside of this space. And to allow myself to be a guy. An open and naive guy with a simple question, one which a great teacher of mine uses to frame her entire approach to therapy.

What am I missing?

02 · The Find

ADHD, Substance use, and the Patterns We Inherit

Dr. Yuval Kernerman, Registered Provisional Psychologist, PhD, CPsych

Passionate about helping clients connect the dots - developing a deeper understanding of themselves, their challenges, and how to move through them.

ADHD, or Attention Deficit Hyperactivity Disorder, is a brain-based condition that affects roughly 7% of children and teenagers worldwide, and about 2.5% of adults. Most people know it as something that makes it hard to focus in school. What is less talked about is how it also affects relationships, work, and social life.

Research consistently shows that teenagers and young adults with ADHD are more likely to use alcohol, cannabis, and tobacco than their peers without ADHD. The leading explanation is that the impulsivity that comes with ADHD makes it harder to resist social pressure in the moment.

But ADHD is not the only factor. Where we grow up and who raises us matters enormously. A well-known psychological framework called Social Learning Theory, developed by Albert Bandura, tells us that children learn behaviours by watching the important people in their lives. In other words, what parents and caregivers do has a direct influence on what their children end up doing.

I set out to explore a specific question: are college students with ADHD more likely to be influenced by their caregivers’ substance use than students without ADHD? My assumption going in was yes, because the impulsivity associated with ADHD might make young people more likely to follow the example set at home.

To find out, I surveyed 301 college students across the United States, asking about their ADHD status, their substance use, their caregivers’ substance use, and the level of support they received at home.

Here is what I found. Students whose caregivers drank alcohol or used cannabis were more likely to do the same themselves. That connection held up clearly. Interestingly, the same pattern did not show up with tobacco, which may reflect how much social attitudes toward smoking have shifted in recent decades. On that front, caregivers appear to be doing something right.

To my surprise, having ADHD did not make students any more susceptible to their caregivers’ influence than students without it. The impulsivity I expected to amplify that influence did not appear to be the driving force. It is possible that the way caregivers shape their children’s behaviour around substances develops slowly over years, and may have little to do with ADHD at all.

What is clear is that caregivers are more influential than they may realize. Perhaps the most underestimated variable in all of this is the conversation that has not yet happened at the kitchen table. A conversation that honestly addresses the risks of substance use, while coming from a place of security and emotional warmth, can create the conditions for children to feel safe enough to express what is actually going on for them.

For families with a child who has ADHD, this conversation becomes even more important given the elevated risks this population already faces.

Based on the author's doctoral dissertation, Fielding Graduate University, 2025.

03 · Opinion

A Case for Different

Avi Ganz

Director of Yeshivat Darkaynu, an Ohr Torah Stone program for young men with special needs in Israel. Private consultant to families in the special needs space. Blues musician and cantor.

“But sometimes they are brilliant in terms of math and science, and it is just executive functioning issues.” This is how a friend explained why his student was in an educational framework that could not cater to the young man’s needs and perhaps was a contributing factor to said student’s early departure from his program.

We do not need more excellence in math, science, or computers. We do not need more poetry or better musicians or skilled chefs. We need the insight and application that executive function confers upon these skills. We need understanding and intuition, sensitivity and drive. Precision is something we have trained our computers to offer. We seem to be good on that front. People who excel are good at making decisions even when those decisions are ultimately unsuccessful. It is the process, the decision making, that defines these individuals. They are proactive thinkers and livers of life. They do not wait for the opportunity to arise to apply their impressive skills, but instead they pursue the need they will address and then they pursue the next one.

Executive function, dear friend, is not just an issue as you implied. It is THE issue.

A teenager who is not good at math can use a calculator just as a woman with a mobility challenge can use a wheelchair. If your culinary skills are limited to Wacky Mac and Ramen and microwaved pizza, you are no less successful than the guy who prepares Michelin level meals at home. Getting support does not make someone less than. It makes them efficient and productive.

Unfortunately, the opposite is true when it comes to how we address executive function. If the educational system and society as a whole are so focused on technical skills and matriculation, we are farming human computers at best and workhorses at worst.

And yet, as the above anecdote indicates, we are still doing it. Who is responsible? I am not sure. The parents? The individuals? The ambiguous but ever-present system? We will do whatever we can to make sure that those who are otherwise different can be the same. It is ironic. The notion that keeping up with the Joneses is somehow a societal ill is a pretty familiar idea. Yet when someone is unable to keep up with the Joneses, if their difference or challenge limits their sameness, we just treat them as if they are the same as everyone else. We find what works, in this case math and science, and then we all but ignore what does not. Until we cannot. But by that time it is too late and we may just end up with a math whiz who has spent twelve or more years trying to fit in only to be rejected as a failure by the very society that bent over backwards to allow him to be the same.

Differences, challenges, disabilities and limitations may hurt, but that is okay. In the long run, it is what challenges us that allows us to grow. Do not move away from the challenge and definitely do not try to bury it. If the issue is executive function, then that is where we need to invest. If the issue is math and science, then that is where we need to invest. Ultimately, the challenges we embrace, and not the ones we circumvent, will be the ones that produce the most significant results.

04 · In Practice

The Open Door: Psychedelics and Integration

Avi Davis, MSW, RSW, RP

Psychotherapist and founder of Healing Horizons Psychotherapy, dedicated to helping people heal from trauma, reconnect with themselves, and create space for growth and meaningful human connection.

As a therapist working with complex trauma, psychedelics have been on my mind for some time. I have found myself both intrigued and cautious, exploring their real potential from both a research and clinical perspective, while staying grounded in what we know about safety, integration, and the complexity of the human psyche.

Over the past few years, psychedelics have moved from the margins of culture into serious clinical conversation. What stands out most is how these substances can soften rigid psychological defences, decrease rumination, reduce shame-based narratives and self-criticism and increase self-compassion.

Clients who have experienced attachment wounds have been struggling for years because their nervous systems have been organized around survival. Patterns like dissociation, emotional shutdown, or hypervigilance are not cognitive problems. They are deeply embodied adaptations. Psychedelics, in certain contexts, seem to temporarily loosen those structures. People can access emotions, memories, and internal experiences that were previously out of reach.

That is where I think the conversation sometimes becomes overly simplified. Access is not the same as integration. Just because something is revealed during the psychedelic experience does not mean it is metabolized. In fact, without the right support, these experiences can be overwhelming or even destabilizing, especially for individuals with complex trauma histories. The psyche does not just open safely. It opens according to its own unknown rules, and sometimes that includes material that a person is not yet resourced to process.

From a personal perspective, I understand the appeal. There is something profoundly compelling about the idea of rapid transformation, of bypassing years of therapy and getting to the core of things more quickly. And in some cases, meaningful shifts do happen. I have witnessed these profound shifts in people who have been suffering from debilitating fear and anxiety, who have been struggling to regulate the intensity of their emotions, those who have been completely disconnected from their bodies and people who have not had insight into their own minds. Psychedelics can open the door into parts of the self in ways that even the most sophisticated and evidence-based bottom-up trauma therapies cannot.

At the same time, I think it is important to be honest about what actually creates lasting change. It is what happens after the psychedelic experience. It is the slow, often unglamorous work of integrating insight and experience into daily life. It is building the capacity to stay present with difficult emotions, to regulate the nervous system, and to relate differently in relationships.

I find myself thinking a lot about readiness. Not everyone benefits equally from these experiences. Some individuals need more stabilization, more grounding, and more internal structure before an experience that destabilizing can be helpful rather than harmful, while others may not benefit at all.

Where does that leave us? I see psychedelics as a potentially powerful tool, but not a standalone solution. When approached thoughtfully within a framework that includes preparation, skilled guidance, and careful integration they may offer something unique, but they do not replace the fundamentals of good therapy.

The question is not whether psychedelics work. It is how, for whom, and under what conditions they can support real, sustainable healing.

05 · The Open Chair

A perspective from within the wellness and therapy field

The Mother Wound

Abby Delouya, LMFT, RMFT-CCC

Licensed Marriage and Family Therapist with a deep passion for helping individuals, couples, and families heal and grow. Specializing in trauma and addiction, in private practice and serving as Director of Intake Care Management at Ray of Hope, supporting survivors of sexual abuse with compassion, care, and clinical expertise.

I am passionate about moms. Not because motherhood is perfect, effortless, or always nurturing, but because a mother’s presence or absence shapes the architecture of a child’s soul in ways we often spend a lifetime trying to understand.

Long before a child develops language, achievement, or identity, they develop attachment. A mother’s gaze, tone, consistency, affection, and emotional availability become the mirror through which a child begins to answer life’s deepest questions: Am I lovable? Am I safe? Do I matter?

The maternal bond is not simply sentimental. It is foundational. It influences self-concept, emotional regulation, resilience, and eventually, the way a person enters marriage and intimacy.

When a mother delights in her child, comforts them, and makes room for their emotional world, that child internalizes a sense of worth. They grow into adults who are more capable of trust, vulnerability, and secure connection. They are often able to enter marriage not desperately seeking validation, but already believing they are worthy of love. Maternal attachment teaches a child that relationships can be safe places rather than battlegrounds.

But the opposite is also true.

When maternal love is inconsistent, emotionally unavailable, critical, rejecting, or absent, it leaves a profound imprint. Many adults carry invisible wounds from childhood into marriage without fully understanding why intimacy feels threatening, why conflict feels catastrophic, or why they constantly fear abandonment. A fractured maternal relationship can distort self-worth so deeply that a person spends years trying to earn love they should have received freely.

And perhaps one of the most painful experiences a person can endure is mother grief.

Not only the grief of losing a mother through death, but the quieter, more confusing grief of having a mother who is still alive yet unable or unwilling to be maternal. There is a unique ache in mourning someone who still exists. Society often understands bereavement after death, but it struggles to acknowledge the devastation of emotional orphanhood. The child, even as an adult, continues longing for warmth, affirmation, tenderness, and protection that never fully came.

This kind of grief is complicated because hope remains alive. Every phone call, holiday, or interaction can reopen the wound. There is often guilt attached to the pain, as though acknowledging the absence of mothering dishonours the mother herself. But naming that grief matters. Healing begins when people stop minimizing the impact of maternal attachment and allow themselves to honestly confront what they missed.

Yet there is also profound hope.

One of the most beautiful truths about healing is that we have the ability to mother ourselves. We can learn to speak to ourselves with gentleness instead of criticism. We can create emotional safety within ourselves. We can validate our own pain rather than dismiss it. While nothing fully replaces the love a child should have received, healing often begins when we become compassionate caretakers of our own wounded inner world.

And remarkably, many women find healing through motherhood itself.

By nurturing their own children with presence, affection, patience, and emotional attunement, they begin breaking generational cycles. In giving their children what they never received, they often encounter parts of themselves that were neglected for years. Rocking a baby, comforting a crying child, listening attentively to a teenager, these moments can become healing experiences not only for the child, but for the mother too. Sometimes, while raising children, women quietly re-parent themselves.

Motherhood carries extraordinary power for repair. A nurturing mother can interrupt generational trauma. She can create emotional safety where chaos once existed. She can raise children who do not need to spend adulthood searching for the security they were denied in childhood.

Family begins long before family systems are studied or marriages are formed. It begins in the arms of a mother. Her influence echoes into identity, relationships, and future generations. That is why mothers matter so deeply. They are not perfect. But the human heart is profoundly shaped by the love it first receives.

06 · The Outside View

A perspective from beyond the wellness and therapy world

Making Waves

Megan Emanuel

Artist and Poet based in Vancouver, BC.

Authenticity and agency are not solitary experiences. By design, they are intrinsically linked to the experiences of others, functions of understanding how we want to show up in the world and the impact we want to have. In action, we are constantly creating and shifting paradigms that others are engaged with. Authenticity and agency recognize this. They consider the footprints we leave behind as we move.

There is a version of authenticity that functions mostly as permission, to feel what we feel, say what we mean, take up the space we need without apology. And while that is not wrong exactly, it tends to quietly omit where other people are present and affected. It treats the self as the whole story.

I used to live mostly inside that version. I would wonder why certain people did not like me. From where I was standing I had not done anything to them. But that was just it. I was only standing in one place, not considering that my pursuit of my own validation, my own comfort, my own end goals, might have been stepping on toes I could not see. That I might have been engaging with people less like people and more like pieces, useful or not useful, depending on where I was trying to go.

If it had eyes and skin, the pebble would only see the approach of the surface followed by the friction and cold of the lake, blissfully unaware of the displacement of water and disturbance of the silt. And we at the shore, simply throwing a rock at the water, often notice only the feeling of an object being and then suddenly not being in our hand. Maybe we watch the ripples, unconcerned with what is happening below the surface or where our tiny waves may go. But there is a happening. We have made waves. And disengagement is not the absence of paradigm.

The water moves whether I am watching or not. The silt settles somewhere. I can choose not to look, but that is not the same as choosing not to affect anything. The sooner I stopped treating those two things as equivalent, the more honest I could be with myself about what I was actually doing. Authenticity is acknowledging the inevitability of our impact. Agency is managing it accordingly.

What surprised me, in sitting with this, was the reframe it required around moments of friction. The times someone did not give me what I wanted, did not show up the way I hoped, pushed back or pulled away. I used to experience those as failures or losses. Something gone wrong. But in actuality those moments were people being generous enough to share their own authenticity and agency with me. They were asserting that they, too, had an interior experience worth honoring. That they were not pieces on my board. And I had been too busy tallying what I did not get to notice the gift of what was actually happening.

This is not an argument for shrinking. The goal was never to throw nothing, to stand at the shore with empty hands and intentions so careful that I leave no trace. That is not integrity. That is just disengagement disguised as consideration. The water will move. The question is whether I am throwing with any awareness of what I am throwing into.

Agency is not control. It is closer to attention, a practiced curiosity about my own footprints, a willingness to look back at the surface after the stone has landed and actually reckon with what I see. And authenticity, in this framing, is not the freedom to move without consequence. It is the honesty to admit that consequence exists, that my presence in the world is never neutral, and that the shape of my impact is at least partly mine to tend to.

I am always making waves. The ripples travel regardless. The only real choice is whether I am paying attention to where they go, and whether I am grateful enough, when someone else’s waves meet mine, to recognize that as the gift it is.

07 · Real Voices

In their own words

Connection in the Unknown

Ari Hertz, LMSW

Husband. Father. Trying my best.

I am coming to realize something in my life that feels both simple and quietly reshaping: real connection lives in the unknown. In the lived space where I do not yet know what is happening, and I stay there without rushing to close it.

This became very real with my daughters recently.

It was one of those mornings, my wife had to go to a different location for a team meeting and it was just me and the girls. It was a morning where everything already feels slightly behind before anything even happens. We were trying to get out the door for the bus, and I could feel the clock in the background of my mind the whole time. 7:52, 7:52, 7:52. That alarm everyone hates.

She became dysregulated over something that seemed small to me, but to her meant the world. It escalated quickly. And almost immediately, I could feel myself getting pulled in with her. My tone trying to stay steady, her getting louder, me trying a little harder, her matching that, and suddenly we were in this escalating loop that felt like a broken system feeding back into itself with no clear exit.

And at the same time, I am aware of the bus.

And then I am aware of my older daughter in the background of my mind. So patient, so composed. Already waiting in my guilt like, again? And I can feel this wave of “I am burdening her with this,” as if her childhood is quietly becoming a series of waits at the door while her younger sister and I are inside an emotional weather system that keeps interrupting time.

And in the middle of all that, I am also in my own head thinking very practical things like: I should really have this more together. I am, at the same time, trying to remind myself that I am doing my best as a dad who is somehow responsible for hair brushing, snack cutting, emotional regulation, and transportation logistics, despite the fact that I still feel like I barely know how to competently do half of it, or honestly, most of it. And there is this very honest internal moment where I think: I never told my wife that this part overwhelms me, so now it just looks like I can handle it.

And then another layer kicks in: If we just planned better, none of this would happen. If we had less margin, more structure, fewer moving parts. Then even if a moment like this happened, we could still make it out the door cleanly at 7:52 like functional humans who do not collapse into chaos at the threshold of the morning.

All of that is happening at once while my daughter is still in it.

And then something shifts. I stop trying to get us out of it so quickly.

I realize I am not outside of the moment anymore. I am inside it with her.

Instead of tightening further into “good dad who solves mornings and saves bus schedules,” I pause and say, “Wait... does your body feel tight right now?” And even as I ask it, I notice my own body is completely tight too. Like I have been bracing since 7:40 without realizing how much effort it has been.

So I just say that. “Mine feels tight too.”

Something softens.

Without really planning it, I suggest we just breathe. And we do. Two slightly overwhelmed people remembering at the same time that they have lungs and can use them.

It even becomes a little funny in retrospect. This chaotic morning moment where we are late for the bus, I am internally doing accounting for my parenting performance, my older daughter is waiting with saint-like patience in the background of my guilt, and meanwhile I am on the floor with my younger daughter breathing like we have accidentally landed in the same storm and decided to sit down inside it instead of escaping it.

And the best part? My older daughter joined the breathing too.

08 · Resources

What we are reading

Raising a Loving Family · Zalman Goldstein. drawn from the teachings and talks of Rabbi Shimon Russell. A practical and deeply human guide to parenthood.

Tuesdays with Morrie · Mitch Albom. A small book about a dying man and his former student that somehow says everything worth saying about love and loss.

Love's Executioner and Other Tales of Psychotherapy · Irvin D. Yalom. Ten unforgettable stories from the therapy room.

Crisis resources

988 — Call or text, 24/7 across Canada

Crisis Text Line — Text HELLO to 686868

Distress Centres of Greater Toronto — 416-408-4357

Thank you for reading. It means a great deal that you are here, and I hope something in these pages stays with you.

Until next month.

JJ Emanuel

Interested in contributing to a future issue? Reach out at jj@emanueltherapy.com.

jj@emanueltherapy.com · emanueltherapy.com · (365) 305-0165

I have been thinking for a while now that the mental health and wellness space needs more community. Especially within the smaller Jewish community, and especially here in Toronto. People are busy with their families, busy with work, and life is expensive. That is entirely understandable. But with the clear shift in focus throughout the world toward wellness and health, I believe that finding a space to explore conversations and ideas, some difficult and uncomfortable and some light and pleasurable but all beneficial, is a step toward building something meaningful.

Full honesty: this exploration of mine started as a mildly selfish one. Ironically, working in the mental health world can be isolating at times. It is entrepreneurial and competitive and there is not a lot of natural networking that goes on. WhatsApp groups and irregular get togethers only go so far. So I decided to pursue something slightly different. Something that may not be completely social but starts conversations and builds community in some form nonetheless.

After much thought and contemplation I believe this is not just for therapists, mental health professionals, or wellness gurus. It is for anyone who has a perspective to share. From lawyers to doctors to therapists to yogis and everything in between. When you open this publication to read, you are in session with the writer, no matter who it is. The writing is going to be vulnerable, real, informative, and completely free of AI.

I hope that you enjoy what you read and that you involve yourself in the coming conversations.

Wishing you all the best, and thank you for taking the time to read.

Sincerely, JJ Emanuel