Dr. Oren Amitay, Ph.D., C. Psych
Registered Psychologist
Key Features of a Good Psychotherapist
| Finding the Right Therapist for Yourself
| Very Different Types of Psychotherapists
| Beginning Therapy & Cost
| Duration of Therapy
There is no doubt that the most important element of therapy—aside from the client's willingness and ability to engage fully in the process—is the relationship between the client and therapist. So it is important that you feel comfortable with whomever you may be working. Never think, "Well, I don't quite like my therapist and I don't always feel comfortable with him/her, but they're an expert so I'm sure they know what they're doing." Because the fact is, therapists are only human and even the most "technically sound" therapist (i.e., they know how to employ certain techniques) might lack in many other important skills. Or, they have their own problems they haven't really resolved and those problems seep into therapy. Or maybe the two of you just don't "click."
Whatever the reason, if you don't feel comfortable with your therapist, your chances of positive outcomes in therapy are significantly reduced. And research indicates that, on average, you should know if your therapist is right for you by the second or third session. However, this is only an average. Depending on your personality, interpersonal style, and past experiences, it may take longer for you to determine if you and your therapist are a good match. Don't make any decisions in haste. But also don't assume that all therapists are equal and that you're necessarily going to do well with any particular therapist.
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I've had many clients complain to me that the therapist never did anything and never seemed interested in them. They just sat there listening, refusing to give advice, offer their opinions, etc. On the one hand, the therapist may have been performing a certain type of therapy that, in fact, probably leads to the most beneficial and genuine change in the client. On the other hand, if you're not aware of what's going on or the rationale behind the treatment approach, it's very easy for you to feel uncomfortable and to perhaps infer things about the therapist or therapy that may not be true.
Similarly, if the therapist lacks certain key traits/skills such as empathy and "people skills," does not really "know" him/herself that well, and does not really feel that comfortable in his/her own skin, you're most likely going to pick up on that. You may not quite be able to put your finger on it, but you will probably have a sense that something's not quite right. Some therapists try to hide their own insecurities and personal/professional shortcomings by retreating behind the therapy's supposed techniques or mechanisms. This can be done in many different ways and take many different forms, sometimes intentionally, often unconsciously.
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However, you should know that there are important differences among these different practitioners, including whether or not the client is protected in therapy. For instance, in Ontario, literally ANYBODY can call themselves a “psychotherapist.” ANYBODY. If the person does not belong to a College, you have no recourse should they do something wrong.
Doctors (GPs, family doctors and other MDs) are licensed but many of them have no formal training in psychotherapy. Maybe they've read a few books or attended a workshop or two. They might be very nice and you may enjoy talking to them. But just because they are doctors, please don't automatically assume that they are skilled in the practice of psychotherapy. Even many psychiatrists--who are MDs, whose specialty has to do with "the brain," and who have studied psychotherapy--know a lot about medications but are not very good practitioners and lack "people skills."
Returning to the issue of unlicensed psychotherapists, recently, after years of lobbying and after the passing of the Psychotherapy Act in August of 2007, Ontario is closer to establishing the College of Psychotherapists and Registered Mental Health for those who wish to practise psychotherapy but who are not registered Psychologists, Psychiatrists (or other MDs), or Nurses.
Here is a link to one organization that would probably benefit from the creation of such a College (I am in no way affiliated with this organization and cannot say anything about it, other than that it was at the top of the page when I googled certain terms regarding this new College): http://www.oaccpp.ca/news/bill171.html.
Here is another link to the Ontario Association of Social Workers, many of whose members conduct psychotherapy themselves, describing this new Bill 171 six months before it was passed:
http://www.oasw.org/en/communitysite/news/news.asp?id=81
This page provides a good description of psychologists vs psychological associates:
http://www.cpo.on.ca/members-of-the-public/index.aspx?id=88&ekmensel=10_submenu_0_link_2
And this page describes psychologists vs psychiatrists: http://ottawa-psychologists.com/faq1.htm
The point is, you should educate yourself as much as possible about the process of psychotherapy and finding a therapist who is best for you.
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Unfortunately, unless you have private insurance coverage, psychotherapy can be very expensive because it is not covered by OHIP unless the therapist is a psychiatrist or other MD such as a family doctor/GP. But because they are the only ones covered by OHIP, it can be very hard to find such a therapist who is accepting clients or who even has a wait list. If you dial 211, which is a free, confidential service that provides information on various services available, you may be able to find psychologists or other therapists who offer rates on a "sliding scale," if cost is a factor as it is for most people.
Speaking of cost, psychologists are recommended to charge $205/session (usually 40-45 minutes), although many psychologists offer somewhat reduced rates if they want their clients who have no insurance coverage to remain in therapy long enough to make a difference. Many psychotherapists with no real credentials charge $100/session or even $150/session. Some psychiatrists or GPs who have OHIP coverage charge fees above and beyond OHIP, sometimes $25/session, sometimes more.
Although I follow the $205/session recommendation, I do also work on a sliding scale basis based on the client's need. I also offer a free initial consultation so that clients can discuss all of these issues without any sense of obligation.
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The therapist can probably not give an exact answer and the answer may change as therapy progresses. But it’s important to get a sense of these things. It’s also important for the therapist to periodically check in with you about such matters.
I've had numerous clients who said they wanted to work on one issue, which we did in the agreed upon period of time. But as we worked on that issue, the clients realized that there were far more issues than they had realized or had previously been willing or able to acknowledge. We then began heading in different directions and often took different approaches for these "new" issues. But we always do this in a collaborative manner. As I say to my clients, “We both have our hand on the steering wheel. I have my foot on the gas but so do you. And you also have your foot on the brake.” In short, we work together to help the client deal with issues that are most important to him/her, either in their current life or something in the past (which usually finds its way into their present life, both consciously and unconsciously).
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KEY FEATURES OF A GOOD PSYCHOTHERAPIST:
As I say to my clients, "there are many different ways to get to the same place in therapy." Having been trained in and having taught many different types of therapies, I am familiar with their philosophical, historic and practical differences. But I also look at what the literature, research, and my own professional experiences tell me about the similar features of the many different therapies out there.There is no doubt that the most important element of therapy—aside from the client's willingness and ability to engage fully in the process—is the relationship between the client and therapist. So it is important that you feel comfortable with whomever you may be working. Never think, "Well, I don't quite like my therapist and I don't always feel comfortable with him/her, but they're an expert so I'm sure they know what they're doing." Because the fact is, therapists are only human and even the most "technically sound" therapist (i.e., they know how to employ certain techniques) might lack in many other important skills. Or, they have their own problems they haven't really resolved and those problems seep into therapy. Or maybe the two of you just don't "click."
Whatever the reason, if you don't feel comfortable with your therapist, your chances of positive outcomes in therapy are significantly reduced. And research indicates that, on average, you should know if your therapist is right for you by the second or third session. However, this is only an average. Depending on your personality, interpersonal style, and past experiences, it may take longer for you to determine if you and your therapist are a good match. Don't make any decisions in haste. But also don't assume that all therapists are equal and that you're necessarily going to do well with any particular therapist.
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FINDING THE RIGHT THERAPIST FOR YOURSELF:
Make sure to ask your potential therapist about his/her orientation. Do they get defensive when you ask such questions? Can they explain things to you in clear, "plain English" without falling back on jargon or other means of expressing themselves that confuse you? If they say they are "eclectic," you might want to ask further about that: what exactly are the different orientations and/or techniques they incorporate into their therapy?I've had many clients complain to me that the therapist never did anything and never seemed interested in them. They just sat there listening, refusing to give advice, offer their opinions, etc. On the one hand, the therapist may have been performing a certain type of therapy that, in fact, probably leads to the most beneficial and genuine change in the client. On the other hand, if you're not aware of what's going on or the rationale behind the treatment approach, it's very easy for you to feel uncomfortable and to perhaps infer things about the therapist or therapy that may not be true.
Similarly, if the therapist lacks certain key traits/skills such as empathy and "people skills," does not really "know" him/herself that well, and does not really feel that comfortable in his/her own skin, you're most likely going to pick up on that. You may not quite be able to put your finger on it, but you will probably have a sense that something's not quite right. Some therapists try to hide their own insecurities and personal/professional shortcomings by retreating behind the therapy's supposed techniques or mechanisms. This can be done in many different ways and take many different forms, sometimes intentionally, often unconsciously.
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VERY DIFFERENT TYPES OF PSYCHOTHERAPISTS:
The preceding section's focus on personal and professional limitations of psychotherapists brings up another important issue: These are all different factors and you should never assume that there’s a correlation among all of them. For instance, many people do not realize that there are significant differences among psychologists, psychiatrists, and “psychotherapists” who are either not registered/certified or belong to a different College such as Social Work or Nursing. I am not a “registration/certification snob,” that is, I know there are many incompetent, unempathic, and/or unethical registered psychologists. I also know that some of the best “therapists” come from Colleges other than Psychology or even have had no formal training whatsoever.However, you should know that there are important differences among these different practitioners, including whether or not the client is protected in therapy. For instance, in Ontario, literally ANYBODY can call themselves a “psychotherapist.” ANYBODY. If the person does not belong to a College, you have no recourse should they do something wrong.
Doctors (GPs, family doctors and other MDs) are licensed but many of them have no formal training in psychotherapy. Maybe they've read a few books or attended a workshop or two. They might be very nice and you may enjoy talking to them. But just because they are doctors, please don't automatically assume that they are skilled in the practice of psychotherapy. Even many psychiatrists--who are MDs, whose specialty has to do with "the brain," and who have studied psychotherapy--know a lot about medications but are not very good practitioners and lack "people skills."
Returning to the issue of unlicensed psychotherapists, recently, after years of lobbying and after the passing of the Psychotherapy Act in August of 2007, Ontario is closer to establishing the College of Psychotherapists and Registered Mental Health for those who wish to practise psychotherapy but who are not registered Psychologists, Psychiatrists (or other MDs), or Nurses.
Here is a link to one organization that would probably benefit from the creation of such a College (I am in no way affiliated with this organization and cannot say anything about it, other than that it was at the top of the page when I googled certain terms regarding this new College): http://www.oaccpp.ca/news/bill171.html.
Here is another link to the Ontario Association of Social Workers, many of whose members conduct psychotherapy themselves, describing this new Bill 171 six months before it was passed:
http://www.oasw.org/en/communitysite/news/news.asp?id=81
This page provides a good description of psychologists vs psychological associates:
http://www.cpo.on.ca/members-of-the-public/index.aspx?id=88&ekmensel=10_submenu_0_link_2
And this page describes psychologists vs psychiatrists: http://ottawa-psychologists.com/faq1.htm
The point is, you should educate yourself as much as possible about the process of psychotherapy and finding a therapist who is best for you.
[top]BEGINNING THERAPY & COST
Unfortunately, unless you have private insurance coverage, psychotherapy can be very expensive because it is not covered by OHIP unless the therapist is a psychiatrist or other MD such as a family doctor/GP. But because they are the only ones covered by OHIP, it can be very hard to find such a therapist who is accepting clients or who even has a wait list. If you dial 211, which is a free, confidential service that provides information on various services available, you may be able to find psychologists or other therapists who offer rates on a "sliding scale," if cost is a factor as it is for most people.
Speaking of cost, psychologists are recommended to charge $205/session (usually 40-45 minutes), although many psychologists offer somewhat reduced rates if they want their clients who have no insurance coverage to remain in therapy long enough to make a difference. Many psychotherapists with no real credentials charge $100/session or even $150/session. Some psychiatrists or GPs who have OHIP coverage charge fees above and beyond OHIP, sometimes $25/session, sometimes more.
Although I follow the $205/session recommendation, I do also work on a sliding scale basis based on the client's need. I also offer a free initial consultation so that clients can discuss all of these issues without any sense of obligation.
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DURATION OF THERAPY:
Since cost is an important factor for most people, time/duration of therapy is also something to consider. You should thus also ask how long the therapist envisions therapy lasting and why that is. For some issues such as certain phobias, treatment can be effective in relatively short periods of time (e.g., 4-12 sessions). For many other issues, you may be able to make certain changes in your behaviour and perhaps modify your manner of thinking somewhat in 12-20 sessions. But real, “deeper,” more “meaningful” and long-lasting change can take far longer because you’re dealing with issues that you may have been harbouring for a lifetime.The therapist can probably not give an exact answer and the answer may change as therapy progresses. But it’s important to get a sense of these things. It’s also important for the therapist to periodically check in with you about such matters.
I've had numerous clients who said they wanted to work on one issue, which we did in the agreed upon period of time. But as we worked on that issue, the clients realized that there were far more issues than they had realized or had previously been willing or able to acknowledge. We then began heading in different directions and often took different approaches for these "new" issues. But we always do this in a collaborative manner. As I say to my clients, “We both have our hand on the steering wheel. I have my foot on the gas but so do you. And you also have your foot on the brake.” In short, we work together to help the client deal with issues that are most important to him/her, either in their current life or something in the past (which usually finds its way into their present life, both consciously and unconsciously).
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