Psychotherapy 101: Finding A Therapist
Not all psychotherapists are created equal! In the last Psychosocial we dove into types of psychotherapy modalities. Once you have done some research on the types of psychotherapy that may be a good fit for you, it’s time to find a therapist.
In Canada, there are several professional designations that practice psychotherapy from psychiatrists, psychologists, Gestalt therapists to social workers. Here is what you need to know and look for.
Psychiatrists
Psychiatrists are medical doctors that specialize in psychiatric illnesses and mental health. They may work in private practice but more likely these days are affiliated with the psychiatric department of a hospital, program or institution. They are governed by the provincial college of physicians and surgeons and bound by the Hippocratic principals of medicine.
Pros
Psychiatrists have the capacity to prescribe medication which can be a more fulsome approach to treating a mental health issue beyond psychotherapy. In the words of late Rethinker Melanie, they have more tools in their toolbox. Psychiatrists are often front line in a diagnosis and can treat moderate to severe psychiatric disorders. Many of them specialize in specific areas which can be helpful if you are dealing with a specific issue like trauma or addiction. Because they are medical doctors, psychiatrists are usually covered by provincial healthcare plans even on an outpatient basis or in private practice.
Cons
It is very rare these days to find a psychiatrist who also practices psychotherapy. When they do offer psychotherapy, it is often for a short finite period of sessions. This can be problematic for people who need to develop trust with a therapist before being able to disclose aspects of their life or problems that they want to address.
The other challenge is that psychiatrists are big believers in medication, which for some people feels invasive and unnecessary. They don’t often do any type of couples counselling or family counselling unless it is for children and youth. Also, sometimes you will have to go to a hospital for your sessions which can be a source of stress for some people.
Referral
In order to see a psychiatrist, you will need a referral from your doctor or a visit to the ER for a mental health issue.
Psychologists
Psychologists hold doctorate degrees but are not physicians, and they cannot prescribe medication. Rather, they solely provide psychotherapy, which often involves cognitive and behavioural interventions.
Like psychiatrists, psychologists utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose people who are experiencing symptoms of psychological illness. They often use psychological tests such as personality tests, clinical interviews, behavioural assessments, and IQ tests in order to get a better idea of how a client is functioning.
Pros
Psychologists are skilled in both assessment and intervention, so it is a one-stop shop for healing. They offer long-term therapy and will see couples, families and children. Like psychiatrists, they may have a specialization in an area such as anxiety. They work in hospitals, clinics, schools, community organizations and private practice. Psychologists are regulated by their provincial college to ensure quality assurance and ethical practice.
Cons
Psychologists who work in private practice are not covered by provincial insurance plans. This means you may pay out of pocket unless you have health coverage through your employer. Psychologists in private practice range from $200 – $300 hour which is costly for ongoing psychotherapy!
If you are referred to a mental health program, these services may be covered but usually for a finite period of sessions and there may be a long waiting list.
Referral
Psychologists in private practice often take self-referrals. However, if you are interested in a specific program through a hospital or organization, you will often need a referral from a physician or in the case of children, from the school.
Social Workers/Psychotherapists/Counsellors
Some of the most skilled, accessible, affordable and dynamic psychotherapists are social workers or counsellors.
In Canada, the regulation of trades and professions is done at the provincial level. The typical model for professions is self-regulation. Self-regulation refers to an approach or system where regulatory powers are delegated (in the case of the CRPO, through the Regulated Health Professions Act by the Ministry of Health and Long-Term Care) to a body that is comprised of members of the profession and that has the responsibility of protecting the public’s right to safe, effective and ethical health care.
Currently, the only provinces in Canada where counselling and/or psychotherapy are regulated are Quebec, Ontario, Nova Scotia and New-Brunswick. Alberta has recently passed legislation to create a College of Counselling Therapy.
Looking for certified counsellors/psychotherapists in the above provinces are a good idea since they demonstrate that they are professionals that are ruled by a code of ethics, a standard of practice, a disciplinary procedure and that they will have to update their skills regularly to maintain their certification.
Psychotherapists and counsellors work in hospitals, organizations, schools, government programs, institutions and private practice. They work with individuals, groups, couples, children and youth. Many have their own therapeutic modalities and offer a variety of psychotherapy interventions.
Pros
A good psychotherapist is someone you can build trust and repour with. They often engage in long-term counselling and can adapt to whatever situation is happening in your life. This means you could see them several times a week or twice a year. Since they do not come from a science background like psychiatrists and psychologists, they are more focused on relationships, compassion and connection which can be very nurturing, while at the same time being driven by evidence-based practice.
Cons
Psychotherapists who have a private practice are only covered by private health insurance plans. The exception is government-funded programs or organizations that offer counselling services. The average cost of a seasoned psychotherapist is $130 – $250 an hour which is cost prohibitive for many people. Many urban cities offer organizations or practice collectives which try to make psychotherapy more affordable like Hard Feelings or Family Service Toronto. Also, if you are a university student you may have access to counselling on campus and similarly, if you work in an office with an EAP (Employee Assistance Program) you will also have access to psychotherapy services.
Referral
You can self-refer to a psychotherapist, although some of them will have full practices and may not take new patients. Keep in mind that some may specialize in a specific type of psychotherapy (CBT), a specific population (women in crisis) or a specific model (couples counselling or family therapy).
For a complete guide to finding the “right” psychotherapist for you, check out our next installment of Psychotherapy 101.