Lisa Boniferro Psychotherapy & Consultation

Lisa Boniferro Psychotherapy & Consultation I am a social worker providing CBT psychotherapy and supervision. I believe that psychotherapy has the power to change lives.

Rooted in evidence based practice, the support I provide is tailored to the individual and aimed at promoting confidence in one’s ability to continue to progress - long after therapy is complete. I have worked in the mental health field for over a decade. My primary focus is working with individuals experiencing body image or eating concerns, trauma responses, depression, and anxiety. I am also passionate about supporting others to provide excellent care to those living with easting disorders. With over 10-years of training and supervision experience, I am pleased to offer teams and individuals consultation, intensive training, and ongoing supervision. I specialize in the area of Cognitive Behaviour Therapy for Eating Disorders (CBT-ED).

Exciting news! I will be co-facilitating 2-day CBT-T training with Dr. Madeleine Tatham, coauthor of the manual. This mo...
08/31/2023

Exciting news! I will be co-facilitating 2-day CBT-T training with Dr. Madeleine Tatham, coauthor of the manual. This model of care has a solid evidence base and is suitable for those with non-underweight eating disorders. As it is a 10-session model, it is more accessible for those with limited income and benefits.

What is CBT-T?
CBT-T is a protocol for those with non-underweight eating disorders and includes nutritional change, collaborative in-session weighing, exposure based on inhibitory learning principles, cognitive restructuring, behavioural experiments, addressing emotional triggers, body image work, and relapse prevention.

What you will learn:
-the active ingredients of CBT-T (what we include and what we don't)
-how to implement the model in a person centered, flexible manner

How you will learn:
-the small group, immersive format allows for discussion, role play, activities, and q&a time
-the spacing of training sessions allows for reflection and integration of new knowledge
-you will receive the side deck, handouts, and links to important tools and information

Who will benefit?
-those with experience in CBT who want to learn how to apply these tools to eating disorders
-those who already practice CBT for eating disorders but would benefit from offering a briefer and cost effective model for clients who are not underweight
-those who would like a refresh to sharpen their skills
-learners and those new to working with eating disorders

Contact & Information
-Please reach out to contact@lisaboniferro.ca if you have any questions or would like to reserve your space!
-Visit www.lisaboniferro.ca to learn more about me and my background

I am excited announce the dates for this year’s CBT for eating disorders 2-day intensive training. As many of us can att...
10/21/2022

I am excited announce the dates for this year’s CBT for eating disorders 2-day intensive training. As many of us can attest to, two days of virtual training can be quite taxing. As such, I’ve moved the dates to 1-week apart. This allows for better integration of the information presented and more meaningful engagement. The intent behind this training is to provide you with practical skills and strategies so that you leave feeling prepared to implement them in your practice. This immersive training will be limited to a relatively small number of participants to increase participation and make sure that everyone can engage in the learning exercises and demonstrations.

I look forward to sharing the theory, skills, and strategies of CBT-ED alongside acquired practice wisdom and information that is not typically covered in the manuals.

Please reach out to contact@lisaboniferro.ca with any questions or if you’d like to reserve a spot. If you would like to learn more about me and my background, visit www.lisaboniferro.ca or schedule a phone call to discuss your learning objectives and how this training may fit your needs.

Take good care of yourself and each other.

First off, the term clean eating is problematic. It suggests that to be good or pure, you must eat according to a highly...
10/19/2022

First off, the term clean eating is problematic. It suggests that to be good or pure, you must eat according to a highly specific set of rules. The alternative is to be “dirty” or “bad.” Food gets confused with morality. Clean eating limits comfort with social situations (what will be served?!); increases preoccupation with food that damages our connection to others and our bodies; leads to failure when we inevitably break the rules; and frequently vilifies cultural foods, which has an outsized impact on the wellbeing of POC communities (follow .nutritionist to learn more).

Those of us who work with eating disorders saw a significant shift over time from people presenting to therapy having tried more conventional diets (think Weight Watchers) to those who said they were not following any diet at all! – they are just “eating clean.” Practically speaking, this movement is more insidious than the traditional diets of yester-year. Word was spreading that diets don’t work in the long run and linking them to a host of concerns, including increased risk for eating disorders, other mental health concerns, metabolic changes, etc. But clean eating isn’t a diet! It’s a “lifestyle.”

While it is true that many people have a difficult relationship with food, these difficulties are systemic – not individual. Groceries are not equally accessible to all. The cost of food is increasing over time. Companies make money off both sides of the dieting spectrum: providing low fat/low sugar/”whole food” alternatives while also producing the foods that you’ve been trying to avoid but then end up eating more of because you’re So. Hungry. Human bodies need energy (i.e., calories!). The more we limit ourselves, the more we crave. Food has become an industry and not a right. This industry is happy to capitalize on both sides.

It's time to just eat. Eat regularly and honour your hunger. Eat for fuel and eat for pleasure. Eat your cultural foods – as they were meant to be prepared. Food security is a real problem –so advocate to address this problem. Clean eating is not the answer.

If you are contemplating change, free consultations are available at contact@lisaboniferro.ca

Here is a simple change of wording that can open opportunities and reduce stress over time. We often talk about “in cont...
10/19/2022

Here is a simple change of wording that can open opportunities and reduce stress over time.

We often talk about “in control” or “out of control” in our daily lives. Control tends to be interpreted as an all or nothing concept: we have it, or we don’t. A shift towards determining our influence, rather than our control, can actually increase our sense of control over time!

There are very few things in our life that we have complete control over. We can try and try to predict potential outcomes in order to increase our sense of control, but ultimately, it does not lead to perfect outcomes. There are simply too many variables to account for in our day to day lives. These attempts to gain perfect control lead to exhaustion, a sense of failure, and throwing up hands up, exclaiming “why bother trying?” If instead we focus on influence, we may realize we can usually do a lot to shift the probabilities of things happening or going well for us. Note the word probability – not certainty.

When we shift our attention to what we can influence, we may find that we start to feel positively about the actions we took that day, rather than just focusing on the outcome. For example, if you wish to improve the quality of your interactions with a colleague, you can start to brainstorm what areas you can influence. You make sure to say “hello” when you see the person in the morning. You enquire about their weekend with genuine interest. You communicate appreciation for their contributions to a project. Regardless of whether these actions lead to the person liking or growing closer to you, you can feel good about how you behaved in the situation. Looking at what you are able to influence, and the other things that are influencing outcomes, can also help to put the result into a broader context rather than shifting to blaming yourself for everything that happens that is not desirable.

The two take-aways here are to shift language from “control” to “influence” and to start to consider the other things that influence an outcome (pie charts can be helpful here)!

If you are contemplating change, free consultations are available at contact@lisaboniferro.ca

Partial recovery from an eating disorder (ED) is improvement in some or all behaviours (bingeing, restriction, purging, ...
10/19/2022

Partial recovery from an eating disorder (ED) is improvement in some or all behaviours (bingeing, restriction, purging, etc.) while continuing to have psychological impairment related to the disorder. People often describe lingering food and body image concerns or experience symptoms at a low frequency. Full remission is the disappearance of the symptoms and suffering from the disorder. When people achieved partial recovery but are not getting the relief that comes from full remission, the ED can start to feel like a permanent state of being. Something lived with forever. Research and the lived experience of those who have had EDs tells us this does need to be the case for everyone!

Think of an ED like a fire. It grows if there is nothing to contain it. Partial recovery from the ED means we’ve put out the fire, but the embers of what hasn’t been dealt with is left behind. While embers take less effort to manage than a full-fledged fire, if we turn our backs (e.g., during increased stress, illness), there is a good chance that the embers catch fire and grow out of control again. Full remission means taking steps to put out the fire so that it no longer requires your constant attention. Embers are put out so that the fire is unlikely to restart again. Of course, if a fire started once, we want to ensure that measures are put in place to reduce the chance that it comes back. Remission is relief. This said, we can’t do the things that fueled the fire in the first place (e.g., dieting, problem solving with food/body; etc.)!

While we know EDs can be long term and that no treatment will work for everyone, I urge people to aim for full remission in therapy. Fire out. Embers out. Safety measures put in place. Clinicians are not great at predicting who will achieve remission in treatment, so the best option we have is to give every person the benefit of aiming for this goal. For those struggling over long periods with their concerns, partial recovery may be a great medium-term goal. And, it is always good to revisit whether now is the time to see if remission is possible.

If you are contemplating change, free consultations are available at contact@lisaboniferro.ca

For this post, vulnerability means that we open ourselves up to uncertainty, risk, and emotional exposure. Life experien...
10/14/2022

For this post, vulnerability means that we open ourselves up to uncertainty, risk, and emotional exposure. Life experiences, temperament, current environment, and other factors contribute to our openness to vulnerability. Our willingness to be vulnerable is likely to change depending on who we are around and the emotional resources we are bringing to a situation.

When you have an aversion to vulnerability, it is like wearing heavy, battle-ready armour around all the time. There have likely been situations in your life where this armour was helpful and protective. It made a lot of sense to wear it. When it becomes habitual, the armour can become more impairing than the potential for harm. In this case, the armour may protect you from some stubbed toes and stumbles, but it also sets you apart from others, prevents you from engaging in activities, makes it hard to connect with others, and may cause it’s own long term injuries due to the weight of carrying it around.

One way to start to work with vulnerability is to first contextualize when your armour helped to keep you safe and fit the situation. Validate that you weren’t born with the armour but that it was likely adaptive at a time. Then start to look at whether your current environment requires this level of protection or whether there are spaces and people where you can start to experiment with taking it off. Just because a space or a person is generally safe, it does not mean that there will be no risk for bumps and bruises. We take the risk because the benefits of connection with others and taking chances outweighs these risks.

We cannot avoid hurt when living a life that embraces vulnerability. This said, we ensure hurt and harm when we reject it. When we lean into vulnerability, we tend to take chances that open new opportunities for growth and connection. Vulnerability is associated with intimacy – a strong human drive. When we allow ourselves to be seen, we develop deeper connections and a sense of belonging and being understood.

If you are contemplating change, free consultations are available by contacting: contact@lisaboniferro.ca

Take good care of yourself and each other ❤️

We all have a scheme for how we determine whether we’re doing okay in the world (i.e., our self-evaluation). We can thin...
10/14/2022

We all have a scheme for how we determine whether we’re doing okay in the world (i.e., our self-evaluation). We can think of this in the form of a pie chart: bigger slices tend to have more of an impact when they are going well or going poorly, and smaller slices don’t shift how we feel about ourselves very much. When working to improve your quality of life or recover from mental health concerns, it can be useful to look at your self-evaluation pie chart to see if it 1) reflects your goals and values and 2) is balanced enough to have stability when things inevitably go wrong in one or more of the areas.

When something takes up a lot of room (i.e., we over-value it), we tend to be perfectionistic and sensitive to perceived failure. It also takes over other areas of our life, so they get smaller and smaller over time. We end up with all our eggs in one fragile basket. One wrong move and everything goes wrong. For example, if work takes up 80% of your pie chart and the rest is made up of relationships and interests, there is a good chance that when something goes even slightly wrong at work, you feel very distressed. If something happens that is out of your control (e.g., a layoff), it is difficult to get to problem solving how to secure a new job. Unfortunately, the other pieces of your pie chart are so small that even if they’re going well, they don’t provide much solace.

While we may value something very much (e.g., our role as a parent, our work, our creativity, or a relationship), it is important to be able to lean on other things in your life to be able to sustain your investment in what you care about. Overevaluation of specific things can lead to poor mood, burn out, increased perfectionism, and is usually not sustainable in the long run.

This concept is especially useful when working with eating and body image concerns. It is common for shape, weight, and appearance to take on an outsized roll in how one evaluates oneself. Creating a more sustainable, balanced pie chart is a necessary step to long-term wellness.

If you are contemplating change, free consultations are available by contacting: contact@lisaboniferro.ca

It is important to untangle the thought process of “worry” from the emotional response of “anxiety.” Anxiety can be unco...
10/14/2022

It is important to untangle the thought process of “worry” from the emotional response of “anxiety.” Anxiety can be uncomfortable if it is excessive. Because of this, our natural response is to try to get rid of anxiety, when the real problem may be excessive worry!

Worry is normal. It leads to anxiety, an emotion that can increase preparation for events and helps us do what is necessary to keep ourselves and others safe. The Yerkes-Dodson Law explains this well: there's an optimal level of arousal that increases performance when tackling day to day situations. Too little or too much arousal can lead to poor performance.

We’re going to focus on the latter: too much anxiety leading to avoidance, poor problem-solving, exhaustion, and demoralization. This is often the case for people living with Generalized Anxiety Disorder. However, rather than tackling the anxiety directly, CBT addresses excessive worry first. We don’t want to get rid of ALL worry (because it’s helpful!) – but help to get worry to a place where it is adaptive rather than impairing.

How is this done? Education about worry’s connection to anxiety and the role that “intolerance of uncertainty” plays in excessive worry. Most of us dislike uncertainty but this can tip into an almost allergic response to uncertainty: even a tiny amount leads to a very big response. Given that our lives are full of uncertainty, you can see how this can be exceptionally difficult to live with. Next, we focus on worry awareness training to see what your particular “Hallmarks” are. You will then intentionally set up exposures to uncertain situations to increase your tolerance and learn new things about the world. You are also encouraged to re-evaluate your beliefs about the usefulness of worry. Because people with high levels of worry tend to have difficulty with problem solving, these skills are built into the model. For the remaining worries that are about future events and not things that are happening right now, something called “imaginal exposure” is used before moving to relapse prevention.

If you’re experiencing excessive worry, change is possible! Book a free consultation at contact@lisaboniferro.ca

Emotional eating causes stress for many people and can lead to loss-of-control or binge eating over time. So where do we...
10/05/2022

Emotional eating causes stress for many people and can lead to loss-of-control or binge eating over time. So where do we start? It may not be where you’d guess.

Many, if not most, eating episodes that feel out of control are preceded by one or more of the following: not eating enough the day; going too long between eating episodes; inadequate carbohydrate intake, or not maintaining a minimally healthy body weight that is right for you.

So why does it seem like emotions are the culprit?

You may have beliefs about food that are rooted in diet culture. This can lead you to think you’re eating well throughout the day when you are not getting enough energy to maintain control over your eating.

There is a narrative that overeating is about emotions and the way to fix this is through targeting your emotions. While this can work for some, if your food intake is off, you’re unlikely to be successful with this in the long run. Consider that eating enough, especially carbohydrates, helps to regulate mood by boosting certain neurotransmitters. We are better at responding to emotional “pushes” when we’re eating well.

Think about it like this: You are holding on to a monkey bar. You’ve been practicing this so you’re pretty good at it. The more you distract from your body, the longer you can go. Whether you’re paying attention or not, your arms are getting tired. Then someone comes along and pushes you hard. You fall down.

You would have fell eventually, but it seems you only fell because of that push. This is the same with emotions and eating: when your energy balance is off, it is likely that your body would have pushed you to eat more than you planned eventually but a strong emotion came along and gave you the push first. If your feet were on solid ground to begin with (in this case, eating enough and eating regularly), a push won’t usually lead to a fall.

Therefore, CBT treatment for eating concerns starts with eating first and emotions and body image second. For many, the boost to their mood and sense of control around food comes quickly and helps to motivate future change!

Free consultations can be scheduled at: contact@lisaboniferro.ca

When seeking out therapy for something you have been challenged by, the treatment tasks can initially seem simple. We of...
10/05/2022

When seeking out therapy for something you have been challenged by, the treatment tasks can initially seem simple. We often begin treating depression with a morning routine of waking up with your alarm and brushing your teeth. Anxiety work can include targeting activities, such as picking up the phone, that you have been avoiding.

It is common for people to think that these are things for which they should not require problem-solving or assistance. This can lead to a sense of shame and not putting in the effort to follow-through.

It is important to consider your context when determining if something should be easy or difficult. When we are caring for someone experiencing a serious illness, we don’t assume that they will continue to perform at the level they did before the illness. Certain tasks become more difficult, and others are not possible. If we expect them to do everything for themselves, it’s likely to lead to prolonged struggle and more impairment. When we respond to the person’s needs and meet them where they are at, they can focus on getting well and building up their strength and capacity over time.

If you are reluctant to seek help because you don’t think you should need it or are reluctant to implement skills and strategies that you think should be easy, consider your current context. Are there things (environmental, social, physiological, psychological) that mean you need a bit more help than you'd expect? If so, bring these to mind when you are engaging in self-criticism. While going to school may be easy for some, when you have anxiety, it can be very difficult. Responding to your body’s need for food may be natural for some, but it can be more complicated with you’re struggling with an eating disorder. The better you understand your current state and work to accept it, the more opportunities there are to work on the areas that cause you distress. Acceptance does not mean that you don’t work to change things!

If you are contemplating change, free consultations are available through the website or by contacting me at contact@lisaboniferro.ca

Take good care of yourself and each other ❤️

Exposure is used in CBT for many mental health concerns, particularly anxiety, trauma, and eating disorders. Exposure is...
10/05/2022

Exposure is used in CBT for many mental health concerns, particularly anxiety, trauma, and eating disorders. Exposure is great tool to address anxiety that gets in the way of doing things that are important to you or things that are negatively impacting your quality of life.

A simple example of when we’d use exposure is with phobias. When you are afraid of dogs, we develop strategies to increase your contact with dogs so that you have neutral or positive experiences with the animal and learn that maybe not all dogs are dangerous. We then build on more unpredictable encounters with dogs so that you learn how to recognize signs that the animal is safe or not, and how to respond accordingly.

One thing that can undermine exposures is when we engage in something called “safety behaviours.” Safety behaviours make you feel better in the moment but get in the way of learning. In the above example, you may close your eyes when approaching the dog, or seek reassurance several times from the owner that he does not bite. While this reduces your anxiety in the moment, you don’t get the benefit of learning something new. We can usually tell if safety behaviours are being used when you have done something several times and feel just as distressed as you did in the beginning.

Once safety behaviours are addressed, we want to optimize exposures by doing things like:

- Combine exposures to different feared things. If you previously had anxiety about a specific food and social eating and have been practicing exposure for both of them, start to pair these events.
- Mix it up. We want to learn that the feared outcome will not happen/isn’t so bad in ALL situations. Conduct the exposures in different settings and with different people.
- Describe it. Make note of and label your emotional experience without attempting to change or escape from it.
- Pay attention. Be sure you are attending to the aspect that makes you anxious and not turning your mind to something less distressing.

As a CBT therapist, I can help you to identify if exposures would be helpful and how to structure them in a way that will be most useful.

Free consultations available: contact@lisaboniferro.ca

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London, ON

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Tuesday 9am - 5pm
Wednesday 9am - 5pm
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Friday 9am - 12pm

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