Psychotherapy is a general term used to describe a form of treatment that is based on "talking work" done with a therapist. The aim is to relieve distress by discussing and expressing feelings; to help change attitudes, behaviour and habits that may be unhelpful; and to promote more constructive and adaptive ways of coping.
Successful psychotherapy depends on a supportive, comfortable relationship with a trusted therapist.
Types of psychotherapy
Psychotherapy can be short-term (up to 16 sessions) dealing with immediate issues or long-term dealing with more longstanding complex issues.
Psychotherapy models include:
Whether you choose to see a therapist alone, with a partner or family member, or as part of a group (with other participants you don't know) will depend on the kind of problem you want help with. Individual sessions generally last between 20 to 50 minutes. Group sessions or family appointments can last longer.
Family therapy is focused on changing the way families interact. It aims to increase understanding and improve communication among family members. It does so without placing blame on any one person. Family therapy is generally used when the family system is seen as contributing to one family member's difficulties (such as a child or adolescent's).
It can be used when one family member's difficulties are influencing other family members, and help them cope and adjust to the situation. Both the "identified client" (the person identified as having the problem) and the other family member(s) can benefit from this kind of therapy.
Couple therapy helps couples to resolve problems and conflicts that they're unable to find solutions to on their own. Both partners sit down with the therapist and discuss their thoughts and feelings. This kind of therapy aims to help couples get to know themselves and each other better. If the couple wants to make changes, the therapist can help them do so.
Group therapy brings together eight to 12 people who are struggling with similar issues. It can help to reduce a person's sense of isolation.
Groups are usually led by one or two mental health care providers who guide the group process and offer structure and direction where needed. Groups may focus on the issues the come up each week (process-oriented) or may follow a set structure.
Family doctors, or general practitioners (GPs), are often the first health care professionals someone will turn to when they have a mental health problem. A family doctor may prescribe medication, talk briefly to you about your concerns or refer you to a mental health specialist. Some general practitioners offer psychotherapy as a full-time practice.
Psychiatrists have a medical degree and five years of psychiatric training. Because psychiatrists are medical doctors, they are licensed to prescribe medication and provide psychotherapy. As medical doctors, they are more likely to identify connections between psychiatric and physical health problems. Some clients report that psychiatrists tend to be more focused on medication than on talking therapy—perhaps because of their medical training. However, some psychiatrists put emphasis on psychotherapy in their practice.
It is often very difficult to find a psychiatrist who is available to see you without a long wait, particularly if you live outside a large city. In fact, in some under-serviced communities, there may not be a psychiatrist on staff at the nearest hospital. These hospitals instead rely on visiting psychiatrists from larger cities or videoconferencing. Through videoconferencing, psychiatrists are able to assess and follow up with clients even though they are in different locations.
Psychologists have at least nine years of university education. They also have at least one year of supervised practice. They have a lot of training in doing assessments, which includes making diagnoses and providing therapy. Psychologists have a PhD or PsyD, but their fees are not covered by most provincial health plans, and they cannot prescribe medication. However, the services they provide through hospitals, community agencies, or private clinics or offices may be available without charge.
Professionals from a variety of other fields (e.g., social work, nursing, occupational therapy) may also provide therapy. Depending on the field, their training may range from a diploma to a PhD. Many of these professionals supplement their education by taking extra courses and counselling training from universities or hospitals. Some take advantage of community-based workshops, training programs, seminars and conferences.
Social workers and nurses are particularly common in a psychiatric setting. They also tend to be available more often than doctors. Social workers are trained to focus on how a person's social environment affects his or her health. (By social environment, we're referring to a person's housing, family, work, financial situations, social supports, education, gender, etc.)
Information about how to find health care professionals who offer psychotherapy is available online.
People go to psychotherapists to discuss the problems they have identified. They may get therapy one-on-one or as part of a couple, family or group. There is scientific research proving the effectiveness of both medication and psychotherapy to treat mental health problems, as well as proof of their effectiveness when used together.
Generally, people seek professional help when their problem is really interfering with their lives (e.g., relationships, work, school) and their ability to function and enjoy themselves.
If you're looking for a therapist, you can ask:
Often the best way to find a therapist is to get a recommendation from a friend, family member or a health care provider whose opinion you respect. When you do get referrals, try to get more than one at a time, and get on several waiting lists, if necessary.
Don't be afraid to ask therapists questions to find out if you are comfortable with their style and approach. Some sample questions:
You may want to consider whether you want a therapist of the same gender, sexual orientation or ethnic background as you. There may also be other characteristics that you want your therapist to have in common with you, or to at least be sensitive to (e.g., issues of race, culture, age), or other factors that you see as important to your identity and way of viewing the world. As well, it's a good idea to find out how many sessions the therapist will provide and how much the therapy will cost.
How often you will need to go to therapy depends on the nature of your problems. You may have a concern that can be addressed in a few sessions. Or you may have more complicated issues that require about 20 sessions. Some people get therapy off and on throughout their lives.
Psychotherapy from a psychiatrist or any other medical doctor is covered by provincial health plans and will thus not cost you anything. Services obtained from other health care professionals (e.g., psychologists, social workers) may also be free if they are offered in government-funded hospitals, clinics or agencies. If psychotherapists work in a private practice, their services will not be covered and you will be charged a fee. The fee will vary depending on the therapist's experience and training and the type of therapy (group therapy may be less expensive.) Some therapists offer a sliding scale, which means that they can offer a reduced fee based on your income.
Fees may also be covered through an extended health care plan or private insurance (you may have a benefits plan through your work.) Some of these plans may only cover services up to a certain amount and for certain types of therapists (e.g., psychologists but not social workers).
If you are working in a large organization, you may have access to an employee assistance program (EAP)—sometimes referred to as an employee and family assistance program (EFAP).
If you are a student, counselling services will most likely be provided by your high school, college or university. Some communities also have free clinics, support groups and drop-in centres that offer counselling.
Good treatment is often based on a proper assessment. It also involves following clear goals you have discussed and decided on with your therapist. To reach your treatment goals, you need a therapist who has education and experience with your kinds of issues, and is someone whom you can trust and respect.
Most likely when you start therapy, you'll have certain goals or ideas of what you'd like to be different. If you find that you are meeting these goals over time, chances are the therapy is making a difference. It's important to understand that results don't necessarily happen overnight. In fact, sometimes you'll feel worse at the start as issues are brought to the surface.
If you don't know if you are making progress in therapy, you should discuss this with your therapist. You may want to schedule times to evaluate how things are going in the sessions.
Studies indicate that only 15 per cent of successful therapies happen because of the model or technique a therapist uses. The most important factor for successful therapy is the quality of the relationship between the therapist and client.
A trusting relationship between you and the therapist is key to successful therapy. If you are feeling uncomfortable with your therapist, it's possible that your personalities may not be the right fit. Or the therapist may be offering a form of therapy that is not useful to you. However, it's equally possible that your discomfort could be related to bringing a difficult issue out into the open or the anxiety of speaking to someone new.
To determine the source of your discomfort, it's important to discuss your concerns with your therapist. If you have had therapy before, it's also useful to tell your therapist what worked and what didn't work with other therapists. This will give your new therapist an idea of what you want from the therapy and if he or she can provide it.
But don't stick around in therapy if it's not working. You can fire your therapist! But if you do, make sure that there is someone else who will be able to see you. Your therapist may be able to refer you to another therapist.
Therapists must keep your information confidential. However, there are a few exceptions to the rule. If they suspect that you may seriously harm yourself or someone else, or in some court proceedings, they are obliged to report their suspicions. If, for instance, a health practitioner suspects that you have abused a child, they must contact the Children's Aid Society. If the client has a condition, including a mental health problem, that would make it dangerous for him or her to operate a motor vehicle, then a physician must report this to the Ministry of Transportation.
The courts can also subpoena your therapy records and your therapist's testimony under certain conditions, such as a sexual assault case. So it's a good idea to discuss with your therapist what he or she will include in your records and how they will be kept.
Your therapist should explain confidentiality (privacy) issues with you at the beginning of the therapy.
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