Psychotherapy FAQ

Usually new clients start with one session per week. This serves multiple purposes not the least of which is establishing a set schedule that the client can depend on when organising their own calendar. Also important is the time this gives a client to consider what has happened during each session and still have it relatively fresh in their mind when they return. This helps to develop a comfortable rapport between the client and therapist. It maintains continuity in the conversation.

Some practitioners are so busy that they do not have time to see individual clients more than once or twice a month. Only the client can decide whether this situation is suitable to address their needs.

Some types of psychotherapy, usually more oriented towards the cognitive behavioural schools of thought, follow a set program regardless of who the client is. There are procedures that will be followed in a pre-determined framework. With that type of relatively short-term work, it may not be necessary to see the client as often but it does not invite or encourage a deep understanding of one’s self as the goal is usually immediate symptom relief.

This really depends on the nature of the presenting issue that has brought you into therapy. Situational concerns may not require the same depth of commitment. This usually ends up falling more into the realm of counselling than true psychotherapy. Achieving something deeper naturally requires a deeper level of commitment. Less frequency can still accomplish much but it will usually take longer.

The quick and concise answer: it maintains a sense of momentum in the work allowing the therapeutic relationship to develop and the work to progress consistently. Sometimes, if the sessions are too far apart, each session can feel like starting over.

That is determined by the client, usually in consultation with the therapist. Quite simply, you determine when you have had enough.

A psychiatrist is a medical doctor with specialisation in the field of psychiatry. Of the three main categories of mental health practitioner, they are the only ones who can prescribe drugs for treatment. A psychologist generally holds a non-medical doctorate degree in psychology. That degree can be either clinical or research oriented, sometimes both.

A psychotherapist generally has a graduate degree in the specific field of psychotherapy they practice. Like psychologists, they cannot prescribe drugs although both should have some familiarity with the available medications clients may be using or may have been prescribed in the past.

That depends on who you ask.

Since COVID-19, many therapists have moved their practices to an online only format.

Personally, I am not fond of it. There are too many distractions for both client and therapist. It is often difficult for the client to speak openly when they really want or need to. Quite frankly, I have caught myself examining my toenails while working with a client online and I doubt I am alone in that regard.

I do online work occasionally but normally only when absolutely necessary. With established clients whom I know well, we may switch to online sessions for convenience if the client requests it. Sometimes a client may move to a different location that makes it difficult to continue in person. A scheduling issue may make an online session the only option occasionally. Someone from a rural area where services are not readily available may reach out. These are good reasons but, whenever possible, I prefer to work with my clients in the same room.

This is discussed on a case-by-case basis only.

And here is why: I have negotiated much lower rates with clients who described a level of need in consultation only to have them show up at my office in late-model high (very) end vehicles. This sets a tone lacking honesty or a sense of fairness and is no way to begin to build a trusting environment.

My hourly rate is already quite competitive and, in appropriate circumstances, we can discuss individual needs but we won’t be bartering on the phone.

How do I know if my therapist is any good?

There are presently over 10,000 registered psychotherapists in the Province of Ontario alone; plenty of us to choose from. It really is important to sit down and have a conversation with any therapist you are considering working with and most will offer at least a phone consult at no cost to help you decide.

Trust me on this: you will know within the first 2-3 sessions at most if you have found a therapist you can work with. If it doesn’t feel like a good fit, it probably isn’t. Move on to another therapist and try again.

A registered psychotherapist in Ontario can not bind you to a contract or request several sessions payment in advance (this does not necessarily apply to some group work). The right professional for you is out there and you are not obligated in any way to stick with someone that just doesn’t feel right.

Should I stop wasting my money? Should I get a better therapist?

Long term and lasting change is incremental. There are rarely “Aha” moments such as Hollywood might lead us to believe. When working with a client over medium or long term, I believe it is important to look for momentum. If I don’t feel a sense of movement in the work, I do a check-in with my client. I will ask three questions:

• Do you feel like you’re getting what you need from our work?
• Is there anything you would like to talk about that you are finding difficult?
• Is there somewhere we should be going with the conversation that we just aren’t getting to?

The answers to these questions often help us to get back on track.

You should say exactly that. Everybody drifts occasionally and your therapist is only human. That said, if you don’t feel comfortable letting them know when you feel unheard or unseen, there’s a more important issue of trust that also needs to be discussed. Think about what it is that keeps you from telling your therapist how you feel in this regard. That can, and probably should, be part of the work.

I don’t think my therapist knows or understands much about me or my life. We seem to come from very different worlds. Should I look for a therapist who is more like me?

We are all individuals regardless of race, colour, creed, orientation or any other parameter you have in mind. Your therapist is no more and, more importantly, no less “like you” than any other human being sharing the planet.

There is always a certain amount of flying blind in a psychodynamic therapy and, given time and information, your therapist should be able to adapt to where and how you are without losing sight of their own authentic self in the work you do together.

There are times when you may encounter a therapist who just doesn’t seem to “get you” and that is, arguably, the time to think about another therapist but be sure of who is passing judgement on who before you make the switch.

Maybe this is something worth discussing in the work. The interpersonal space of the therapeutic setting is, or, ideally, should become, akin to a microcosm of the world at large. How many situations of this kind come up in life every day? Maybe part of the work will revolve around developing a better understanding of how we often cope.

How long will it take for me to "get better"?

That is completely dependent on what it is that has brought you into therapy. I’ve had clients feel satisfied with the work they have done in a few months. I have other clients still wishing to continue the work after more than a decade. It depends on what you, the client, define as “better” or “finished.”

One thing many clients find advantageous is that the door is always open. Every client I have ever had knows that if, after we have finished our work, the client should decide that they wish to re-connect, they will always be welcome to return: Even if just for a “check-in.”

Sometimes just knowing that support has not gone away is enough.

Should I try something other than psychotherapy?

There are aspects of who we are that are genetic and there are aspects of who we are that constitute learned behaviour and social survival techniques. There is great debate over which ones are which and whether or not certain character traits can actually be changed permanently. Psychotherapy goes one step further and will often (but not always) ask whether or not they should be changed at all.

Sometimes the biggest change required is a move towards self-acceptance. Ultimately, we are individuals trying to feel connected in a world of individuals. We don’t want to feel different in spite of the simple truth that all of us are.

Often the challenge is two-fold; to accept that your own individuality is not your biggest flaw but your greatest asset and, from there, find a way to feel secure in expressing your authentic self in a way that is acceptable and even attractive to the social arena you wish to be a part of.

Is it a good / bad idea to see a psychotherapist and a psychiatrist / counsellor / other therapist at the same time?

I’m a big advocate of building a health care team. It’s not a requirement but, in many cases, it is prudent. Many of my clients have done this and the reasons vary. Often a client will come to me on the recommendation of their treating psychiatrist or family physician simply because that treating physician is of the opinion that regular weekly sessions which they cannot provide will be of benefit.

Sometimes I get so overwhelmed by my anger / anxiety / fear / jealousy / emotional state that I can hardly breathe/function, let alone think/predict/decide what to do. Can psychotherapy help me with these strong physical symptoms, or does it only help me "understand" myself?

One of the benefits and, in fact, main purposes, of psychotherapy is that it can give the client somewhere to put raw emotions in a safe and non-judgemental place. Part of the reason these emotional states build up is that they are not acceptable or “allowed” in our outside environment.

But emotions, all emotions, need space. Withholding strong emotion can lead to anxiety. Letting the pressure off can likewise reduce that anxiety and put us in a place where we can rationally determine what is at the root of that emotion; potentially giving us better strategies for managing going forward.

Or do you just discuss the "problem" clients?

In a way, it could be said that every client is discussed if for no other reason but to ensure colleagues are aware of our caseload. No identifying information is shared.

Oddly enough, sometimes the clients we don’t see as “problem clients” are the problem clients. This is explained by the concept of “counter-transference.”

It is often much easier for a colleague to identify this at work than for the therapist to see it in themselves.

Or is it enough to meet every other week, or even less frequently?

As the client, that is ultimately your decision regardless of the reason.

I'm not a student, and I don't have health coverage, but I don't think I can afford $125 an hour. Can I request a reduced rate?

This can be discussed at your first session.

Counselling can generally be described as falling into the advice giving space although that is not all it is. True psychotherapy is based on certain principles of being and behaviour that have been studied in the clinical setting for generations. Although the conversation may seem random, your therapist is looking for subtle indications in language, posture and tone that will help to identify important directions in the work.