Often, people make the decision to come to therapy when they have tried on their own to manage their difficulties or problems but with limited success. If your difficulties are producing a lot of distress or discomfort or are getting in the way of your ability to live your life as you would like or need to, engaging in therapy is recommended.
Sometimes there is an event in your past that is coming back in the present and causing difficulty or distress. Sometimes a change in your life circumstances has made it so that your old ways of coping are no longer working, or there are new challenges in your life that you don’t feel you are able to deal with. At times it can be as simple as a new awareness that you have been putting others’ needs before your own, or you are missing certain skills (communication, assertiveness, etc.) that are holding you back from reaching your full potential. You may also have been encouraged by a loved one or a medical professional, or given a new diagnosis that you need help with.
There are different approaches to therapy that emphasize different goals. In general, however, the purpose of therapy is to produce increased awareness and understanding of the nature and sources of your difficulties as well as of yourself in order to make positive changes that will improve how you are coping and increase your quality of life, both emotionally and functionally. The goals of therapy are typically jointly determined by client and therapist collaboratively.
There are several therapeutic approaches that can be used on their own or in combination depending on your therapist.
- Cognitive behavioural therapy (CBT): a form of psychotherapy based on learning theory that focuses on how a person’s thoughts, beliefs and attitudes affect their feelings and behaviours. Tends to focus more on current challenges than on the past; often goal-oriented and skills-based. May also address the core beliefs and fears that are influencing current problems.
- Psychodynamic therapy: this form of therapy emphasizes the significance of our early childhood experiences and how they continue to affect us in adulthood. It argues that human behavior arises from both conscious and unconscious motives that need to be uncovered and explored through the therapeutic relationship that develops between therapist and client.
- Dialectical Behaviour therapy (DBT): Originally developed to treat clients with Borderline Personality Disorder, DBT is now broadly applied to many clients who are struggling to manage overwhelming emotions. It is a model of therapy that helps clients learn new skills to manage painful emotions and decrease conflict in relationships.
- Acceptance and Commitment Therapy (ACT): is a form of psychotherapy that uses acceptance and mindfulness strategies with commitment and behaviour change strategies to increase psychological flexibility. Its focus is not to eliminate difficult feelings but to be present with what life brings us and engage in behaviours consistent with our personal values.
- Systemic family therapy: is a form of therapy that focuses on helping members of a family understand each other better, change negative behaviours and resolve conflicts. It views families as an emotional unit, where all individual members affect the family as a whole.
This is very difficult to accurately predict as it depends on many factors, including the nature of the difficulties or problems that you are seeking help for as well as how long they have been present for, your motivation, frequency of sessions etc.
A good trial of therapy is considered to be between 20 to 25 sessions, with sessions being weekly to maximize the potential benefit. Some problems can be improved in as little as 5 to 10 sessions, while others can take more time. Please ask your therapist for an estimate of how long they think it will take once they know your situation better.
A standard therapy session is 50 minutes in length, though this can vary at times depending on the plan agreed between you and your therapist. For example, sometimes therapists will suggest 80‑minute sessions if you are doing exposure and response-prevention (E/RP) as part of treatment for Obsessive‑Compulsive Disorder (OCD) or Post‑Traumatic Stress Disorder (PTSD).
A first therapy session typically involves a full assessment of the issues that are bringing you into therapy as well as questions about your history (social, family, health, work/school) and past experience with therapy or counselling. It is an opportunity to get to know you and agree on what you will be working on together
All information discussed in a therapy session is private and confidential for anyone ages 14 and over. The content of your sessions can only be shared with others with your explicit and written permission.
Signed consent is required for communication with another professional involved in your care (e.g. your GP, Psychiatrist, academic institution, insurance etc.). Confidentiality must be broken if there is a serious and immediate concern about your safety, or the safety of others as in the case of suicidal risk or risk of seriously harming others. Please ask your therapist about more details of how confidentiality works, and the situations where it would not apply.
Therapy ranges in cost depending on the experience level and discipline area of the therapist. The average psychologist charges $120/session with a range between $90 and $250/session.
It depends on the specific therapist that you work with. You need to ask before starting therapy to determine if this is an available option.
Most therapists require 24 hours notice of cancellation without charging a fee. Many therapists will make exceptions in the case of illness or other circumstances beyond your control (e.g unfavourable weather conditions etc.). It is a good idea to ask your therapist about their cancellation policy at the first session.
Therapy is meant to be once a week until you start to feel better or there is some level of improvement/progress that you and your therapist agree upon at which point it is usually slowed down until the point of discharge.
After therapy is complete and the goals have been met, it is possible to have occasional “booster sessions” in the months following the end of therapy if needed to sustain gains or review.
Every therapist has their own unique style and way of working even if using standard therapeutic approaches and techniques. Feeling comfortable with your therapist and being able to build a relationship of trust is key in knowing if you are a good fit with your therapist in addition to the ability to make the desired progress.
Licensed psychologists are covered by insurance companies for therapy services, though the exact percentage of coverage varies depending on your insurance plan. Psychotherapists (who can be social workers, nurses, couple and family therapists) who have their license with the OPQ (Ordre des psychologues du Québec) may or may not be covered, so it is a good idea to ask your insurance company directly about their coverage for psychotherapists who are not psychologists.
You can certainly do some looking around and help to facilitate the process by giving the person you are looking for some information. However, unless the person you are looking for is a child, most therapists will want to have some direct contact with the person who will be receiving the services before booking a first appointment.
This is partially due to the nature of confidentiality, but also because a large portion of the success of any therapy is the motivation and participation of the person receiving the services. People who are forced or coerced into therapy against their will, or who don’t believe that they have a problem, usually do not do well in therapy until they can see the benefit for themselves.