When someone learns that I’m a psychotherapist, I’m often told that they think they should “talk to someone”, but that the whole idea is overwhelming and scary. I understand their fear and hesitation. Talking to someone that you don’t know about personal things is really difficult…and that’s after you’ve gone through the process of finding someone. The goal of this post is to answer some of the frequently asked questions that I get, in the hope that contacting a therapist will be less intimidating and you will be able to find the right therapist for you.
Why would I want to talk to a therapist?
People usually decide to talk to a therapist when the pain of what they are trying to cope with becomes too big for them to handle on their own and they recognize they need help. For more ideas, this previous blog post gives 10 reasons why you may want to see a therapist.
How can I find a therapist?
Once you’ve decided that you would like to speak to a therapist, here are a few different ways to find one:
Referral from a friend or family member. While seeing a therapist is not something we often share with others, in our close relationships we may know of someone who is. If you feel comfortable disclosing to this person, you can ask if they are happy with their therapist and ask for their contact information.
Web Searches. You can search on-line for a therapist in your area. Psychology Today and Theravive are two sites that provide listings of local therapists. Professionals on both sites have been vetted for their credentials. There is detailed information about their specialties and links to the therapists’ website if they have one.
Health Professional Referrals. Medical professionals (doctors, chiropractors, massage therapists, naturopaths) often have a referral list for therapists. There is a connection between physical and mental health. Sometimes health professionals will suggest counselling and provide a list of potential therapists. If not, and you want a referral, all you need to do is ask.
What should I be looking for?
There are lots of very good therapists out there–doing all types of therapy. However, studies show that more important than the type of therapy, the biggest indicator of client success is the therapeutic relationship that develops between the therapist and client. In other words…there needs to be a ‘good fit’.
If possible, have a phone or email conversation when you first make contact with a potential therapist. Ask if this person has experience in helping people to deal with your area of concern. If that goes well, then book a first meeting. You will have to pay for the first session, but it’s money well-spent if you decide that this isn’t the therapist for you. Trust your instincts. Your friend may feel comfortable with their therapist, but that doesn’t mean she’s ‘your’ therapist.
What happens in a therapy session? Do I have to lie on a couch?
Lying on a couch is no longer required! Instead, clients come into an office (that’s usually quite comfortable) and talk to the therapist. Sometimes the therapist will have a plan for what to talk about during that session; at other times, the client drives the conversation.
I’ve found it helps clients to have an idea of what will happen in a session, so I have a basic structure. The session starts with the client telling me about what has been happening for them since our last meeting. We check in on any homework that was suggested. I ask the client if there is anything they want to talk about. Normally the client has outlined goals for therapy (what they would like to be different when therapy is finished) and that always provides areas for conversations.
This is your therapy, so again you get to choose!
How long will I be in therapy? Do I have to go forever?
While therapists learn various types of therapies (Cognitive Behaviour Therapy, Emotionally Focused Therapy, etc.), therapy is also an art. Every client is different, with different needs for the amount of time they will be seeing a therapist.
Personally, I operate from the perspective of ‘this is your therapy’ and you get to choose. If a client is in crisis, then I suggest meeting weekly until things become more stable. Once the crisis is past, we move to bi-weekly or even monthly. It depends on what the client chooses as well as what is in their best interest therapeutically. Ethically, a therapist shouldn’t want a client to have to come forever. The overall goal is that people feel better and go back to their lives.
Once clients ‘graduate’ from seeing their therapist, many treat their therapist as one more tool in their health toolbox–checking in when necessary.
How does confidentiality work?
Basically, whatever you say in therapy, stays in therapy. However, there are times when a therapist is legally obligated to break confidentiality:
- Harm to self or others. If a therapist believes that you are in imminent danger of hurting yourself or someone else, a family member, police or ambulance will be called to ensure safety.
- A child under the age of 16 or older adult in care is in danger. In these cases Family and Children’s Services or the police will be called.
- Your files are subpoenaed by the court or by the College of Registered Psychotherapists.
- A client experienced a health emergency during a session. In this case, medical staff would be provided only with necessary information. No information about why a client is in therapy will be shared.
Some therapists (myself included) carry confidentiality into the community. I inform clients that if I see them in the community I will not say hello. I don’t want to put anyone is a situation where they have to explain how they know me. I am always open to speaking to clients outside of the office, but they get to make first contact.
My benefits plan covers services provided by a psychiatrist, psychologist, psychotherapist or social worker. What’s the difference?
Since each of these professionals can provide mental health services, it can be confusing to figure out which one is right for you. The best way to explain it is by breaking down the services they provide.
Psychiatrist: A psychiatrist is a medical doctor (MD) who has done extra training in psychiatry. Psychiatrists are able to diagnose a mental health issue, such as schizophrenia, and prescribe any necessary medication. Some psychiatrists provide therapy to their patients, but due to the shortage of psychiatrists, in my experience they usually provide diagnosis and medication management. Psychiatrists may refer their patients to counsellors for therapy.
Psychologist: Psychologists hold at least a Masters degree in psychology. They are qualified to diagnose mental health issues, but not prescribe medication. Some will do counselling.
Social Worker: Social workers can be put broadly into two camps…clinical (do counselling) and community. Community social workers do such activities as working for Family and Children’s Services providing case support and assessments, helping governments or local agencies with social policy, etc. Social workers can either have a Bachelors degree (BSW) or Masters degree (MSW). All social workers must belong to the College of Social Workers in order to practice.
Psychotherapists: Psychotherapists are counsellors. That is our speciality. We hold a Masters degree (or equivalent) in psychotherapy and must be registered with the College of Registered Psychotherapists of Ontario (CRPO). If I have a suspicion that a client may be dealing with a specific issue that would benefit from a diagnosis or an exploration of the use of medication, I will suggest that the client talk to their family doctor.
I don’t have benefits, and can’t afford to pay out of pocket. Is there anywhere I can go?
Seeing a therapist is expensive and not everyone is covered under benefits. Some therapists provide a sliding scale or see different groups of clients at a discounted rate. Many agencies (KW Counselling, Carizon, etc.) have a sliding scale based on income. As well, agencies such as KW Counselling offer free weekly drop in counselling services.
Making the decision to talk to a therapist takes courage…and studies show that counselling works!
And now…Bob Newhart shows us the type of therapist we may not want to see. Enjoy!