EVERYTHING YOU EVER WANTED TO KNOW ABOUT THERAPY & COUNSELLING

No. This belief creates a certain stigma around seeking support and can get in the way of people accessing therapy. Feeling stuck or distressed are good reasons to seek therapy, therapy can also be very useful for other reasons including:  

• Gaining new insight into specific problems

• Clarifying life or relationship goals

• Accessing motivation to make change and to pursue important dreams

• Developing better communication, conflict resolution, and overall relationship skills

They also take your money! ;) There are many different styles of therapy and different therapist approaches, but all therapists do more than simply listen and nod their heads. Even therapists who operate from a more traditional psychoanalytic framework (think Freud and how therapy is often portrayed in the movies - clients lying back on a couch while a very serious and silent doctor makes notes) are doing a lot more than simply listening and nodding their heads, even if they have a less active approach than therapists who operate from other therapy models.

Today most therapists sit in chairs across from you and engage with you in setting goals and finding solutions in a more conversational manner. However, there is still a big range in how active therapists are in terms of asking questions, directing the sessions, and making suggestions.

Although there are individual differences between our therapists at Couple Therapy Toronto, in general, we tend to lean in the direction of being more active and engaged in the therapy process.  We have found that most clients want therapists to take charge, direct the session and offer feedback and suggestions.

While therapy goals are ultimately determined by clients, it is important for therapists to create structure and ensure the focus of the sessions is relevant to the therapeutic goals. This means that the therapist may guide the conversations, make suggestions, interrupt conflicts or cyclical patterns that occur in relational therapy, ask a lot of questions, and offer paraphrases and reflections of what is being heard and understood. Therapists may also brainstorm with clients to find new possibilities and solutions to problems and suggest homework when they think that it will be helpful. 

Some do and some don't. We tend to offer advice and suggest solutions when it seems appropriate, but will usually brainstorm with the client and attempt to elicit the client's own insights into the best course of action. It is a collaborative effort. For more information on this topic, see the discussion on this page of "Do therapists really do anything other listen and nod their heads?" 

Yes. Therapy can be about whatever you need it to be about. Social skills or public speaking skills require knowledge, practice, and some degree of confidence in your ability to engage in these activities with some effectiveness. Many people become anxious when interacting in large groups, regardless of whether it is a professional or social environment. These skills can be worked on and practiced in the context of therapy and the anxiety and fear that arise are perfect opportunities to learn more about the kinds of core beliefs, self-appraisals, and assumptions that we hold. 

Absolutely. Deciding if you want to make changes, getting clarity on what your goals really are, and determining what it is going to take to make these changes, are all important parts of the therapy process.

While many of us struggle at times in our lives with unhelpful or even destructive habits, these habits have developed for a reason at some point in our lives, often as ways of coping with painful emotions. It is understandable that we would want to have a better sense of the big picture and what change would look like before making these changes.

Therapists, especially when working in the field of addictions, will often speak of different stages in the process of making change. We move from an initial flash of insight that we may need to make changes, to a deeper contemplation of our habits and the changes we may need to make, and eventually to action. There are additional stages that involve maintaining these changes and preventing relapse.

Regardless of where a client is in this process, there is therapeutic work that can be done. It is up to you, as the client, to decide when you are ready to move from contemplation to action. A therapist can help you explore the consequences of making these changes or not making these changes.

The answer is usually yes. There is a lot of research that suggests that therapy can be effective for many of the challenges that may be considered "mental illness". In many cases therapy is more effective than medications for treating mental illness, and in other cases it may be helpful in combination with prescribed medications. However, when someone is having an acute mental health crisis they may require other types of assistance and stabilization before starting therapy.

For more information on "mental illness" and why we keep putting "mental illness" in quotation marks, see our article "How do I know if I have a mental illness?"

It depends on a number of factors including the goals, the current state of the problem, life circumstances, and the amount of work and effort clients are willing to put into the therapy process and the strategies to create change in between sessions. According to a substantial body of therapy research, the most dramatic effects from therapy often happen within approximately 8 sessions, however, people tend to benefit from further work to deepen their understanding, prevent relapse, and possibly work on other related issues.

For clients with histories of complex trauma (a series of traumatic events over time), it tends to take longer to create sustainable change, as there can be more work to do to establish sufficient emotional safety in the therapeutic relationship  and to build up the external circumstances in their lives to be able to continue to grow and thrive. 

Couple and family therapy tends to take longer as there is more complexity and more people, sometimes with differing goals. Similar research on couple therapy suggests that it usually takes between 10 - 30 sessions to fully meet clients' therapy goals.  The ideal frequency for therapy depends on the above identified factors, as well as client finances and schedules. When possible it can be quite helpful to come in more frequently during the initial sessions and then to spread them out more as progress is being made, if it isn't possible to maintain the original frequency. Starting out weekly is often a good idea to begin.

OHIP does cover the cost of some therapy programs that occur within medical facilities – like hospital-run group therapy programs, or some short-term therapy that is offered within Family Health teams. Outside of those specific contexts OHIP will only cover the cost of therapy if the therapist is also a medical doctor, and the vast majority of therapists are not. 

Private insurance providers will often cover some of the cost of psychotherapy but the degree of this coverage and what type of mental health providers they will cover varies depending on the insurance company and plan. To ensure that you are covered, check with your insurance provider and the therapist that you are considering working with. Most often you will be required to pay up front and get reimbursed from your insurance provider directly. 

There are a number of factors that influence what therapists charge and many of these factors are the same as with any business, such as supply and demand, overhead costs, skill and experience, and the perceived value of the service to clients.

Fees may also be influenced by reimbursement limits that are set by insurance providers and Employee Assistance Programs as well as fee scale recommendations from professional bodies.

A more expensive therapist doesn't always make for a better therapist, as higher fees can have more to do with market factors and credentials.

Yes, many therapists do offer a sliding scale as most of us enter this field out of a genuine desire to support others in difficult times and want to make sure that people with less income and those who are out of work or with greater financial constraints still have access to support.

Unfortunately, financial constraints are still a real barrier for many clients, even though lots of therapists offer a percentage of their therapy spots for clients who need a lower rate. Each therapist who decides to offer reduced rate spots will decide the percentage of their client load that they can afford to offer reduced fees to. This can sometimes result in waiting lists...

There are some free services but they can be hard to find and often have waiting lists. Usually these services are offered through the hospitals or the Centre for Addiction and Mental Health (CAMH) in Toronto and similar organizations in other communities. There are, however, agencies that work with lower income clients and families that receive funding from The United Way and sometimes from governmental bodies. In Toronto, these include Family Services of Toronto, Skylark Children, Youth & Families or Catholic Family Services.

There are also psychotherapy training programs that offer lower cost therapy with clinical interns such as The Centre for Training in Psychotherapy and The Gestalt Institute. You can always check with Universities as well, as some of them train therapists in house and may have clinics that are open to the community at lower rates. The University of Guelph Couple and Family Therapy Centre is an example of this type of resource that serves the community at reduced rates while also providing a training ground for clinical interns.

Although it is not a substitute for seeking in person support, you will find many helpful videos, book recommendations, and web resources on Mental Health and Wellness in the Additional Resources section of this website.

There are great therapists and not so great therapists and everything in between. And, as mentioned in our article on finding the right therapist, sometimes a bad therapist experience may have more to do with the fit between the therapist and client rather than a "bad therapist". Unfortunately, it is not uncommon to hear from clients about experiences with therapists that didn't work for them.  If your bad experiences result from inappropriate or unethical actions by a therapist, you likely have recourse and may want to do something to prevent others from experiencing what you experienced.

Therapy needs to be safe and therapists need to maintain appropriate boundaries for therapy to be safe. For more information related to inappropriate behaviour by therapists, see "What can I do if I'm concerned about things my therapist is saying or doing?" on this page.  If the bad experience is simply a bad experience, rather than something abusive or unethical, you may be able to use this experience as valuable information to gain new clarity about what it is that you want from a therapist and from the therapeutic relationship.

You may want to use this experience to help you generate questions to interview future therapists to ensure that you get what you are needing. We ask clients about previous therapy experiences in our intake process in order to help understand what the clients are wanting and not wanting from therapy. This information is very important.   Even if you have a great therapist and a great therapeutic relationship, you can still have painful experiences, leaving you feeling misunderstood, frustrated, or angry. If you have an overall sense of trust and respect in the therapeutic relationship, it may be helpful for both of you to have a conversation about how you are feeling. Doing so may lead to powerful new insights about dynamics that show up in other areas of your life as well. It may also lead to a renewed sense of trust in the therapeutic relationship, and be important feedback for the therapist in terms of working with you and other clients more effectively and respectfully.

Research on therapy effectiveness shows that working through misunderstandings or frustrations with a therapist can lead to better therapy outcomes than if these misunderstandings did not occur in the first place. Trust is built through care and responsiveness to difficulties that arise in relationships, not through perfection and the absence of problems. 

First off, it is often a a good idea to start by raising your concerns with your therapist. A therapist should be open to receiving concerns and feedback about their behaviour, and if they are not, this may be a sign that this is not someone that you would want to work with. Many issues can be resolved through a thoughtful conversation with your therapist as they may result from misunderstandings or actions that were taken without knowledge of how they would impact you as a unique individual.

However, If your therapist is engaged in behaviours that seem unethical or like a violation of your boundaries, rights, or privacy you may want to file a complaint with their professional or regulatory bodies to ensure that this is not part of an ongoing pattern that could be impacting others now and in the future as well. Most therapists adhere to codes of conduct laid out by their professional colleges and associations and these colleges and associations tend to take complaints against their members quite seriously. Your therapist can provide you with information about their professional memberships and regulatory bodies, and you may also be able to find out for yourself simply by their credentials (e.g. Psychologists in Ontario are regulated by the College of Psychologists of Ontario, Psychotherapists are regulated by the College of Registered Psychotherapists of Ontario).

People seeking therapy often come to therapy at times of vulnerability and it very important that you are treated with respect and dignity. This includes answering your questions, responding to your concerns, respecting confidentiality, respecting physical boundaries, and not doing anything that could be experienced as an abuse of the therapist's power and privilege (e.g. making sexual advances, making offensive jokes, asking to borrow money). If you have any concerns at all, you have a right to speak up.

Most therapists cannot prescribe medications. Only medical doctors can prescribe medications in Canada and most medical doctors who prescribe medications for mental health related concerns are not therapists. Some GP psychotherapists and psychiatrists may conduct therapy and also prescribe medications.

No therapist will force you talk about anything that you don't want to talk about, however, some therapy traditions do inquire more about your childhood experiences and how they have come to shape your sense of self, your rules and values for relationships, and any potential traumas that may impact your current functioning and wellbeing.

It can be helpful to understand where these beliefs and coping strategies come from in order to make sense of your experience and feel a sense of self-compassion, however, it is not always necessary to know the origins of our coping strategies and habits in order to recognize that they need to change.

Simply recognizing that these coping strategies are not serving us anymore, is all that is needed to start exploring how we might change them. If you are clear that you do or do not want to talk about your childhood in therapy, it would be good to share this information when you are shopping around for a therapist.

That is a difficult question. Like typical therapists we'll attempt to answer this question with a series of other questions.

• Why do these other individuals think that you would benefit from therapy?

• Do their reasons make sense to you?

• Are there ways that you have acted that have given others a reason to be concerned?

• Are your friends or family seeing patterns of behaviour that you may not be aware of?

• Are you open to or willing to try therapy?

It is important to trust yourself and your own intuition about what you need, but at the same time, sometimes we are unable to see our own choices as clearly as other people see them. The idea of "needing therapy" may get in the way of making the right choice for you. Instead of need, what about the question - "Could I benefit from developing more insight into who I am and the choices that I make?"

Another possibility is doing therapy with whoever it is that is telling you that "you need to do therapy!" The person who is telling you this may be experiencing pain in their relationship with you and the two of you may benefit more from some form of relational therapy, even if it is a friend. It is not uncommon when a client arrives after being "sent" by a family member or partner, that we discover that relational sessions would be more helpful than individual sessions.

Read our article "Why You May Not Be the Real Problem" for more discussion of this topic.

Often this question comes up around gender (e.g. Should I work with a female therapist if I’m female?), however, it also comes up around race, ethnicity, sexual orientation, religion, family structure etc. The answer to this question depends on a number of factors. The most important is - what you think. If you would feel more comfortable speaking with a therapist who has some shared life experience with your, listen to your own preferences.

It is important to have a therapist that you feel comfortable speaking with, and having some similarity in life experiences can create comfort, insight, and may allow for a deeper sense of being understood. It can also make a difference if you have had particularly bad experiences with someone from a particular gender or social location (culture, gender, sexual orientation, race, class, etc).

There are times, however, where it may be more therapeutic to work with someone either very different than you in background and life experience, or even to work with a therapist who triggers some pain for you because of the characteristics that they share with the person or people who you have had these bad experiences with.

A sad reality is that most sexual abuse and serious physical violence that occurs in the world, is committed by men. This means that there are many people of all genders who have understandable issues of trust around any close relationships with men, even if they have healthy relationships with some men in their lives.

Some clients have found the opportunity to work through some of their painful histories involving men, with a man, to be particularly healing.

What will work best for you will depend on your own life history, what you are looking for, and where you are at in your healing journey.

While common experiences or shared culture will matter for some people and some problems, it is likely to be less important for good therapy than the personal connection and "fit" with the therapist that results from individual personality factors and a therapist’s ability to provide a compassionate non-judgmental atmosphere during sessions. But that is for you to decide.

Yes, therapy is confidential and therapists have both ethical and legal obligations to maintain client confidentiality, however there are some exceptions to this rule. Below are some of the specific circumstances where breaking confidentiality may be required by a therapist:

• In response to a court order or as otherwise required by law;

• To report a child in need of protection in accordance with the Child, Youth and Family Services Act (2017);

• To eliminate or reduce a significant risk of serious bodily harm to a person or group of persons;

• For the provision of emergency healthcare in circumstances where it is not possible to obtain the client’s consent in a timely manner and the client has not prohibited such a disclosure; or

• To report a client who is a member of a regulated health profession and where mandatory reporting under the Regulated Health Professions Act (1991) applies.

• With the client's consent, or where disclosure is otherwise permitted under applicable privacy legislation for purposes related to their care.

No. You decide what you are comfortable talking about and any respectful therapist should appreciate your boundaries in this regard. However, the more you are able to share about the challenges you are facing, the more the therapist will be able to help you.

Just like any other relationship, it may take time to feel emotionally open enough to disclose things that are embarrassing or that we fear that we will be judged about. It is up to you to decide if you trust the therapist and their ability to be understanding and non-judgmental about your concerns. If you don't trust that you can disclose these important matters, it may be helpful to look for a new therapist, someone that you feel more comfortable being open with. 

Confidentiality is of the utmost importance in the therapeutic relationship and clients have a right to this confidentiality. However, there are certain types of illegal activities that might need to be reported because of the risk that they pose to others. Most types of illegal activities that are disclosed in therapy do not need to be reported. If every illegal activity had to be reported, then people who are engaged in, or who have ever engaged in criminal activity, would never be able to get help.

Getting support may be essential in moving toward making different choices that lead to better and safer outcomes for everyone. It is essential that clients can talk freely about their experiences and explore the consequences of their choices without fearing that they will be arrested or publicly shamed for doing so.

Typically the only time that the police would be contacted would be if a client informs a therapist that someone is at imminent risk of being physically harmed and there is no way to prevent this from happening without the involvement of the police.

If a client threatens to end their own life, or physically harm someone else, and the client has a clear intention to do so, a plan, and means to carry it out, then the police might need to be involved. In all situations, a therapist would work with the client first to try to find alternatives that are safer for everyone without needing to involve the police.

In addition to the imminent risk of serious harm, reports of recent, current or potential future neglect or abuse of a child may need to be reported to the Children's Aid Society (CAS). Therapists, like all residents of Ontario, are legally required to report reasonable grounds to suspect that a child may be in need of protection. In Ontario, mandatory reporting obligations primarily apply to children under the age of 16, though some protections and services may also apply to youth aged 16 and 17.

Whenever possible we will work with clients to ensure that these reports are fair, accurate and that the clients are involved in making these disclosures. CAS is a resource to help families in keeping kids safe. CAS will work hard to keep families together, whenever possible.

Note taking and record keeping are additional considerations when discussing illegal activities with your therapist. In some legal proceedings, a court may order the disclosure of therapy records if it determines that the information is sufficiently relevant and that disclosure is justified. Courts generally balance the importance of privacy and confidentiality against the needs of the legal process. A subpoena alone does not automatically mean records are released. Therapists often challenge subpoenas, and courts frequently balance privacy interests against the need for disclosure.

It is extremely rare in most clinical environments for files to be subpoenaed. Regardless, if this is a concern to you then it might be a good idea to discuss with your therapist how notes are taken and what kind of information is contained in those notes.

No. Fears and fantasies are not illegal and are completely welcome in therapy. Fantasies often contain inappropriate content that we would never consider really acting out.

Fantasies can be ways of channelling experiences, impulses, and desires that we cannot make conscious room for in other aspects of our lives. Fantasies can be healthy ways of channeling emotions, fears, and desires that would be unhelpful or destructive in reality.

For example, If we have been taught that it is terrible to be angry with people, or have been made to feel powerless in particular circumstances, we may harbour secret fantasies of expressing power and anger (e.g. pushing someone, acting vindictively, or making someone's life more difficult).

If we have strong taboos around sexuality, we may become aroused by the "risk taking" of fantasizing about the very things that we deplore. It can be frightening to have thoughts and fantasies that conflict with our values, but so long as they are purely fantasies and there is a clear distinction between fantasy and reality, there is absolutely nothing to be worried about and they pose no risk to anyone.

Exploring fears and fantasies that conflict with our values, or that are considered socially inappropriate, can be very illuminating and liberating as part of a therapeutic process. In addition to the benefit of reducing shame and fear, it can help us get clearer on our guiding values and ethical frameworks.

This is a really important question. In moments of pain and distress many people have thoughts about hurting themselves or others and sometimes these thoughts are simply that - thoughts, rather than indicators of plans or actions. However, if you are feeling afraid that you might hurt yourself of somebody else, take this fear seriously and find someone to talk with about this as soon as possible. 

Being afraid in these moments is a good thing. It means that there is a part of you that deeply cares about your own well-being and the well-being of others. Honour this fear and reach out for support. If you have a friend or family member that you can talk with, do so. If you have a therapist or other health care professional that you see, let them know.  When working with clients who have hurt themselves or others in moments of distress, it has broken my heart to see the shame, sadness, regret, and real life consequences that often come with these choices (e.g. damaged bodies, lost relationships, broken families, criminal records, jail, lost opportunities).

When we are in a state of distress, regardless of who we are, it is much harder to make good decisions for our lives. In these moments we need to borrow the insight and care of someone else. It is through the support of others in difficult times that we develop the internal resources to be able to effectively cope with our emotional pain and make better choices. We don't have to do it alone.   

If you are having these concerns right now, and live in Toronto, you can call 416-408-4357 to reach the 24/7 crisis line. The crisis line is a free confidential phone service with people who you can talk to about whatever is going on. You can also visit their website: www.torontodistresscentre.com. To find a distress or crisis line in other parts of Canada, please visit the www.suicideprevention.ca website.  

If you are a kid or a teenager, you are welcome to call the crisis line above but you may find it even more helpful to call the Kids Help Phone, where phone counsellors have more experience talking about the kinds of problems that are unique to kids and teens. Kids Help Phone can be reached at 1-800-668-6868. They also have a lot of information on their website and provide e-counselling/live chat as well: www.kidshelpphone.ca

If you are questioning your ability to keep yourself safe, or prevent yourself from harming another person, and it doesn't seem realistic right now to reach out to friends, family or the above resources, you can always call 911 or go to the emergency department of a local hospital. Better to be too cautious than not cautious enough. If you do decide to call 911, make sure to let them know that you are not armed, that you are not a danger to any police officer or first responder, that you are simply afraid and struggling with emotional distress and are worried about what you could do if you don't get help.

I recommend writing down the numbers for the Distress Centre or the Kids Help Phone and carrying it in your wallet or bag. That way, you have it when you need it. There is no need to be alone when you are in pain and experiencing these kinds of concerns. 

See Videos, Book Recommendations, and Web Resources on Self-harm and Suicide, and Violence & Abuse in the Additional Resources section of this website.

That depends. Family Therapy can be very helpful for teenagers who are struggling but there are times when it may be more helpful for them to do individual therapy, especially when they are unlikely to share what is going on with them in front of other family members. For more information on therapy options for teenagers read about therapy for Kids & Teens and also Family Therapy.

There are a number of ways in which a therapist can help when a kid is being bullied. First off, since bullying can have serious effects on a child's well being, it is important to brainstorm about strategies and solutions to ensure that the bullying stops - if this hasn't already happened. Schools are increasingly responsive to concerns about bullying but it may require some advocacy to develop a plan with the school that will work in your circumstances.

In addition to safety planning with you and those who are involved in the care of your child, we would want to understand what impact this bullying has had on your child and your family, help support your child's coping mechanisms, work to prevent your child from internalizing (taking on) the negativity of the bullying, and collaborate with you and your child to draw out strengths and opportunities for learning from this painful circumstance.

Understanding why kids act differently than we want them to can be difficult. It isn't always as simple as figuring out what is "wrong" with your child as it may be more what is wrong around your child or in relation to your child. Younger kids are limited in their verbal communication and limited in the power that they possess to create the changes they would like to see in their relationships.

These limitations, either in verbal expression or the power to influence, can lead kids to make choices that can appear as "misbehaving" or "acting out" but that are fundamentally attempts to communicate or attempts to meet important needs (e.g. attention, care, respect).

Before trying to figure out "what is wrong" or what needs to change, we typically try to understand what your child may be communicating through this behaviour. We are interested in knowing about the context that their behaviour is occurring within - for example - how you and the rest of your family interact with your child, what is happening for them in school, in their friend groups.

If we understand the context, as well as the strengths and coping strategies of your child and your family as a whole, we can work collaboratively with you and your child to help find new solutions to meet those important needs.

Kids are particularly sensitive to being blamed for family problems and will often feel responsible even when parents are telling them otherwise. Because of this tendency it is all the more important to get to know kids and demonstrate an understanding of their strengths before getting them engaged in any behaviour change project. Often the most powerful interventions for kids are changes that parents make. This is why our preference is often to work with kids within the context of their families.

There are times where the challenges that your child faces may require other attention in addition to a strength-based and relational approach to therapy. Child Psychologists and Psychiatrists will often conduct different types of assessments and treatment plans, including diagnoses of mental disorders when relevant.