• What does it mean to be a regulated health professional? Why should I pay more to see a mental health provider who's regulated?

 

Regulated health professionals in Ontario are members of professional colleges that have the responsibility to protect the public by (a) setting rigorous standards to enter the various health professions, such as the minimum education, training, and competence required to call yourself a psychologist, social worker, and so on; (b) prescribing standards, guidelines, and ethical principles that the health professional must adhere to while registered with the College; (c) ensuring that professionals participate in quality assurance activities to update and improve their knowledge and skill; and (d) investigating and disciplining any complaints that the public may have about the behaviour of a regulated professional. 

 

Regulated professionals that provide mental health services in Ontario include those registered with the College of Psychologists of Ontario, the College of Physicians and Surgeons of Ontario, the College of Nurses of Ontario, the College of Registered Psychotherapists of Ontario, the College of Occupational Therapists of Ontario, and the Ontario College of Social Workers and Social Service Workers. These various Colleges, in essence, hold regulated providers accountable for the services they provide. In comparison, there’s no means of ensuring quality of care and accountability if you receive care from a mental health service provider who’s not registered with one of the above Colleges. All regulated professionals are required to show you their registration certificate upon request, and you are able to review their registration status on the respective College website.

 

• What is psychotherapy? Is it the same thing as counselling and therapy?

 

Psychotherapy, in the broad sense, refers to the various activities and discussions that take place in a therapeutic relationship between a mental health professional and a client with the goal of improving the client’s mental well-being. These wellness goals of psychotherapy could include helping individuals process grief and loss, adjust to stressful life events, achieve valued goals, or prevent a mental illness from developing. Some psychotherapy goes beyond promoting wellness in that it’s used to treat serious mental disorders that are causing significant impairment in some aspect of the client’s functioning, such as their decision-making, behaviour, communication, or relationships. In Ontario, this branch of psychotherapy that treats mental disorders is considered a “controlled act,” meaning that only certain healthcare professionals are authorized to practise it. This restriction is in place to protect the public because, when someone tries to treat an underlying mental illness that is already causing serious impairment, more harm than good can be done if the psychotherapeutic techniques are applied incorrectly by someone who does not have the necessary training. The only professionals who are authorized to provide the controlled act of psychotherapy in Ontario are psychologists, physicians (including psychiatrists), social workers, nurses, occupational therapists, and registered psychotherapists.

 

In contrast, the terms therapy and counselling are not regulated, meaning that anyone can call themselves a therapist or a counsellor, regardless of their level of training. As a result, these terms are harder to define. Counselling can be thought of as overlapping with psychotherapy in that it too is a talk-based service intended to promote wellness. However, the counselling term typically refers more narrowly to the provision of information, advice, or encouragement to help a client cope with a specific dilemma or navigate a certain area of life, such as in career or vocational counselling, financial counselling, addictions counselling, or spiritual counselling. Counsellors do not perform the controlled act of psychotherapy of treating mental illness, although people with mental illness who attend counselling may learn to cope with their symptoms more effectively. Therapy is a broader term than psychotherapy or counselling because it includes any activity that is meant to have a health benefit, including a range of medical interventions (such as chemotherapy or pharmacotherapy), holistic practices (such as aromatherapy or Reiki), or lifestyle activities (such as horticultural therapy or animal-assisted therapy). However, used as a standalone term, therapy most typically refers to some combination of psychotherapy and counselling. 

 

• What is “evidence-based practice” anyways?

 

Put simply, evidence-based practice refers to healthcare delivery that is explicitly guided by an integration of the best available research and the clinician’s understanding of the client’s personal characteristics and preferences. In other words, evidence-based practices include approaches that have been proven to be effective in research and that have been tailored to individual clients’ unique needs. Clinicians who use evidence-based practice will save you time, money, and energy because they’ll have the expertise to avoid approaches that are of questionable effectiveness or that are potentially harmful. 

 

• What’s the difference between a psychologist, psychiatrist, psychotherapist, and social worker? 

 

If you’re unsure of the differences between these professions, you’re not alone, and to be fair, there are some similarities between them. Importantly, they are all regulated by a professional college to ensure a minimum level of qualifications and standard of care, and they are all authorized to provide the controlled act of psychotherapy. However, there are some key differences. 

 

Psychotherapists have the narrowest scope of practice. They’re required to have completed a program of education and training in psychotherapy (typically a Master’s degree involving at least 360 hours), as well as at least 1000 hours of experience providing psychotherapy under the supervision of another regulated psychotherapist with at least 5 years’ experience. Psychotherapists do not diagnose mental illnesses or prescribe medication.

 

Social workers can have either a bachelor’s, master’s, or doctoral degree in social work. Their training prepares them to help individuals, groups, or communities by recognizing the broader social and economic factors that contribute to well-being, such as their access to education, food, housing, education, and healthcare; their freedom from discrimination and violence; and their broader sense of social inclusion. Given this focus on the social context, many social workers provide information, resources, and advocacy-based counselling services to assist people in navigating the system to gain access to various health and social services. Although social workers are authorized to perform the controlled act of psychotherapy, they are not required to have the necessary training in psychotherapy to provide this service as soon as they enter the profession. In other words, after becoming registered, social workers are responsible for assessing themselves to determine whether they are competent to perform the controlled act of psychotherapy. Typically, social workers will assess themselves as competent to provide psychotherapy if they have received additional formal training in psychotherapy, as well as 2-3 years of supervision while providing psychotherapy. Social workers do not diagnose mental illnesses or prescribe medication.

 

Psychiatrists are medical doctors who completed a five-year post-graduate residency program in psychiatry after completing the requirements to become a physician. Psychiatrists assess and diagnose mental illnesses, and their medical background uniquely allows them to prescribe medication to treat mental illness. Although psychiatrists are authorized to provide psychotherapy, like social workers, not all have received extensive training and supervision in psychotherapy. In Ontario, psychiatrists’ services are publically funded through the Ontario Health Insurance Plan (OHIP), meaning that you do not pay directly for psychiatric services, even if you see one in a private practice setting. However, typically you must be referred to a psychiatrist’s specialized services by a physician, and wait times can be quite lengthy. As a result of their training backgrounds and the wait times for their services, most psychiatrists provide relatively little psychotherapy and instead focus their practice on the prescription of medication to treat mental illness.

 

Psychologists in Ontario have completed 4 to 6 years of graduate school to earn a doctoral degree. During this training, they receive extensive training in the assessment of mental illnesses using interviews, questionnaires, and standardized testing; the theory and strategies involved in various approaches to psychotherapy; and the statistics and research methods that are used to advance the profession’s understanding of clinical issues. This training also includes completing various practica, where psychologists-to-be work in different mental health settings to provide assessment and psychotherapy under the supervision of registered psychologists. They are also required to complete their own original research project. Finally, psychologists are required to complete a 1-year pre-doctoral residency involving full-time clinical practice under supervision, as well as another year of supervised practice after their graduation. Given the amount of formal training and supervision that psychologists have in assessment, psychotherapy, and research, psychologists’ services are more consistently covered by extended health plans than those of social workers or psychotherapists. Psychologists do not prescribe medication.

 

To help you compare the qualifications and scopes of practice of the different mental health professionals in Ontario, check out this comparison chart made available by the Ontario Psychological Association. 

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• How do I know if a certain therapist is right for me?

 

Before starting therapy, it can be helpful to find out whether the therapist you’re considering is a regulated health professional, how much experience they have working with people who have similar difficulties as you, what they see as the active ingredients in their therapeutic approach, and what evidence there is that their approach to therapy works for problems like the ones you’re experiencing. At ThinkWell CBT, we have tried to take as much of the guesswork out of starting therapy as possible by laying out everything you could want to know about our approach on our website. We encourage you to read through the information we’ve provided about CBT, what to expect in your first appointment, and the rest of these FAQs. You are also invited to take advantage of your free consultation to get any of your remaining questions answered. 

 

That said, nothing will help you know whether a therapist is right for you like that first few sessions. That’s where you’ll get to find out whether a service is as advertised, how well your feedback from one session is integrated into the next, and how much of what you’re doing in your therapy sessions is translating into improvements in your quality of life between sessions. You’ll also get a feel for whether your therapist’s personal style—the stuff that’s harder to describe on a website but just shows up in the room—works for you. The great news is that at ThinkWell CBT, we’ll be just as focused on the quality of our therapeutic relationship as you will be because we know how important the relationship is for positive treatment outcomes. If for whatever reason you find that ThinkWell CBT isn’t a good fit for you, keep in mind that you can take a copy of the information we keep on your file with you to another mental health professional, which means you’ll be able to keep building from where you left off with your new therapist. 

 

• Is now the time to make an investment in therapy? 

 

Although the decision of when to seek therapy is highly personal, now may be the time to seek professional help if you’ve noticed that you’re experiencing more frequent or distressing thoughts or emotions that aren’t subsiding on their own and that are starting to interfere with your quality of life. But you don’t have to be at your lowest to benefit from therapy. For example, you might choose to invest in therapy sooner to prevent a problem from developing or worsening. Alternatively, you might decide that now is the time for therapy when you’re fairly satisfied in life but want some dedicated time to work towards a meaningful goal that would further improve your wellness. These types of preventative, early intervention, and health promotion measures can mean that fewer sessions are needed to achieve your goals. 

 

To benefit most from CBT, you’ll want to be able to commit to spending regular time between sessions carrying out the action plans you set with your therapist. That said, it’s quite normal for your motivation to fluctuate over the course of therapy, so your therapist will be ready to help you work through any motivational barriers that arise so that you can keep progressing towards your goals. 

 

• Should I participate in individual or group services?

 

In general, research comparing individual and group therapy suggests that both formats are similarly effective for a range of presenting issues. However, there are other factors to consider to guide your decision. Individual therapy affords greater flexibility because treatment plans and schedules can be revised in an ongoing fashion to accommodate new needs, goals, or priorities that arise unexpectedly.  Group services, in contrast, have pre-established agendas that generally can’t be tailored to an individual’s changing needs, and the predetermined schedule means that there’s usually no way for a client to make up the material if they miss a session. Some people find that this additional structure in group services is to their advantage because the group agenda carries them forward in building new skills despite any life events that may otherwise create detours in individual treatment, and the fixed schedule has a way of ensuring that they don’t find reasons to postpone their next session. 

 

The time and financial commitments for group and individual services also differ. Individual sessions tend to be shorter than group sessions—usually 50 minutes as compared to 1.5 to 3 hours­—because your session time doesn’t include hearing about how other clients are applying or responding to the material. Despite being longer, group sessions are less expensive than individual sessions because the costs are shared across the clients. The specific cost savings of group services depends on the type of group and number of participants in the group. Fees for ThinkWell CBT’s groups are available here. 

 

The advantages and disadvantages of group dynamics may also influence your choice. Many people feel more self-conscious in a group, sometimes to the point that they find themselves unwilling to share the amount of personal information in group sessions that would be necessary to benefit from services. These people may prefer to meet individually to reduce the barriers to engaging actively with the material and therapeutic process. On the flip side, many people who are initially hesitant to participate in a group find that hearing about how other people have struggled with or worked through similar problems can help to decrease any shame they may be experiencing and provide a sense of hope for the changes they can achieve. The group context can also offer new ideas and perspectives that you wouldn’t hear in the individualized format. For example, other group members might ask questions you didn’t know you had yet, they might offer creative solutions to barriers you’re encountering, or they might have helpful ways to think about something the therapist said to make it ‘click’ for you. 

 

A final consideration is the availability of individual versus group services at different times. Depending on your needs and when you seek services, there may be a difference in how long you have to wait to begin individual versus group services. Although we strive to keep this website updated on service availability, please contact us for the most accurate information about any waitlists.