About the therapeutic process
- Getting started in therapy – what should I expect in the first appointment?
- How can I prepare for my first therapy appointment?
- How often should I come to therapy?
- When will I start to feel better?
- How do I get the most out of therapy?
- Will the therapist just agree with me to make me feel better?
- What happens if I don’t like something that the therapist has said or done?
- When will therapy end?
About accessing psychotherapy in Ontario
- Is there a difference between psychotherapy and counselling?
- What’s the difference between a Psychotherapist, a Counsellor, a Social Worker, a Psychiatrist and a Psychologist in Ontario?
- What is covered under my extended medical insurance?
- Therapy is so expensive and I don’t have extended benefits. Where can I get free counselling?
About mindfulness-based therapy
About the therapeutic process
1. Get started in therapy: what to expect in the first appointment
It’s normal to feel a bit nervous when meeting a new therapist. Just like any relationship it takes a little time to settle in.
In the first appointment, after you go over an agreement about confidentiality and consent to counselling with your therapist, they will likely ask you about:
- what brings you to counselling
- what you’re hoping for
- what’s worked well or not so well if you’ve seen a counsellor or psychotherapist before
- relevant history and context to your situation
Your therapist will likely give some ideas of what they think might be helpful in terms of an approach to start with. You’ll make a bit of a plan together.
The feeling of “fit” with a counsellor is important. It’s important that you start to feel at ease and have a sense that your therapist “gets you”. If this doesn’t happen in the first couple appointments, it’s okay to either ask for a referral or search again for another therapist.
Essentially you and the therapist are building a relationship, a therapeutic relationship. It differs from other relationships you might have since the conversation focuses uniquely on you, with a goal of supporting you in the direction you’d like to move towards in life. The quality of the relationship is important to allowing those changes to happen.
You will have space to explore what’s going on in your life that brings you to counselling. Your therapist will listen and ask questions so that they really understand your experience. From there your therapist will likely suggest ways of working together and where to start. This is a collaborative process though so your input matters too.
2. How should I prepare for my first counselling appointment?
Your therapist will ask some questions to get oriented to you and your concerns in the first few appointments. You may feel a bit nervous in the first appointment as it’s all new, so it’s useful to start thinking and taking notes in the weeks before your appointment. It also helps you start to own the shifts that you want to see happen in your life.
- What brings you to therapy?
- What do you hope to accomplish? What would be different afterwards in your life if this was the best therapy experience ever?
- Do you have ideas of what might help or not help about a therapy experience, do you have hopes for a particular kind of therapy or relationship?
- Keep track of any symptoms or patterns your are interested in addressing in the weeks before so you can let your therapist know.
- Note down any questions you have.
3. How often should I come to therapy?
To develop the therapeutic relationship and get rolling with the explorations and shifts you’d like to see, in the beginning once a week is typical. If you are in a crisis, more often may be useful until you stabilise. Once you have some traction with your therapist and you start feeling shifts, spacing sessions out to every 2 weeks can make sense. Once positive shifts are established, some clients book in when they feel the need, some come monthly. Check in with your therapist and determine what feels appropriate.
4. When will I start feeling better?
Most people find they feel better after the 1st session just in terms of starting to take action on something that’s not working in their lives. It can help a lot simply to have someone really listen, and to get stuff off your chest.
Research actually shows people feel better after making the first call and booking an appointment!
Generally it takes a couple sessions to do some intake and build the beginnings of a therapeutic relationship. Often from the 3rd appointment the work tends to deepen. Often by session 6 or so clients have new tools to use or new insight and report positive change.
All this said, therapists are not magicians! There are things you as the client can do to make the most of therapy.
5. How do I get the most out of therapy?
Find a therapist who you feel aligned with. Get clear about what you are hoping to get out of the process. Go regularly enough to engage with your process and get on a role with your therapist. Then, engage with your process, get curious about yourself, journal, ask for homework.
If you leave a therapy appointment and don’t consider, reflect or do anything different until the next appointment, 1 hr a week may not change very much in your life! The more you engage in the process, the more you will get out of it:
- Write in a journal. Take time after each session to write about what stood out. What are you taking away? What further wonderings do you have? Can you make up some journalling questions for yourself to deepen the themes that came up?
- Try out the homework tasks your therapist offers, or find your own. Homework builds on what you are working on in session. Often you can co-create this with the therapist or the therapist may ask for your own ideas.
- Check in with yourself before each session. What happened during the week that feels relevant to our process? What’s been working? Where have I got stuck? What’s most important today?
6. Do therapists just agree with you to make you feel better?
While active listening is often a part of therapy and involves reflective statements that validate your experience, a good therapist won’t simply agree with everything you say! A therapist should take time and ask questions to understand your perspective and experience, but should also be able to challenge you, deepen your experience and help develop your insight.
While individual therapy is limited in a way, the therapist can use their experience of you, and other tools to help make this a richer experience than simple nodding and agreeing.
6. What happens if I don’t like something that the therapist has said or done?
As you build a solid therapeutic relationship with your therapist, bumps may occur, just as in any human relationship. Therapist typically welcome feedback! Interpersonal bumps in this setting actually give you and your therapist a lot to work with as long as you feel safe.
Check in with your therapist regularly about how you feel the process of counselling is going.
If for whatever reason you don’t feel safe to talk to your therapist, you can always contact the College of Psychotherapists of Ontario.
7. When will therapy end?
Keep an active dialogue going with your therapist about your goals and progress. If it seems like you are doing well in the areas you specified in the beginning, you can discuss if there’s still a role for counselling. Maybe the goals have shifted, or maybe it’s time for a break , or maybe spacing sessions out further helps you build towards closure.
Accessing psychotherapy in Ontario
1. Is there a difference between psychotherapy and counselling?
Generally speaking counselling is more skills-based and short-term. counselling focuses more “on the provision of information, advice-giving, encouragement and instruction” (CRPO)
Psychotherapy is more in depth, looking at the family in which you grew up, and bringing in the unconscious. In psychotherapy the relationship between the client and counsellor is particularly important, providing the basis for healing. That said the terms have (until recently in Ontario) been used fairly interchangeably, the difference resting in individual practioners.
In Ontario there is a College of Psychotherapy, so anyone practicing the “act of psychotherapy” now needs to be a member of that college. Members of that college are now called Registered Psychotherapists.
2. What’s the difference between a Psychotherapist, a Counsellor, a Social Worker, a Psychiatrist and a Psychologist in Ontario?
Generally speaking, the difference is in training and approach to mental wellness. Some of these practitioners will work in community-based agencies, some in private practices.
| Title | Training | Regulating Body | Typical skill area/orientation |
| Psychologist | PhD or other Doctoral level degree (often research-based) | College of Psychologists of Ontario
· Registered Psychologist |
Psychologists can do more assessment (e.g. they can diagnose mental illnesses). Psychologists can work in agencies or in research environments, or in private practice. The therapy-focused work they do is similar to that of psychotherapists.
· private fees are often in the $230-250/hr-range · fees typically covered by extended medical insurance |
| Psychotherapist | Masters level (MA – Masters of Arts, MSW – Masters Social Work, MEd. – Master of Education) usually. | College of Psychotherapists of Ontario (formed in 2015).
· Registered Psychotherapist |
Psychotherapists and Counsellors can either work in private practice or in agency settings.
· a 50-60 minute talk/listening-based appointment. · an orientation to your goals. · often an encouragement to do homework between sessions and build your own skills, so if you are self-motivated you will get more out of this. (This applies to most counselling or psychotherapy). · private fees are typically around $160-200/hr-range, but there is no guidelines for fee range set externally. · fees are often covered by extended medical. Ask your employer. · if agency-based, appointments may be limited in number and/or include fees (sometimes income-based). |
| Counsellor | none specified though often counsellors have an Masters degree | Counselling is not a regulated profession in Ontario, so there’s no regulating body.
|
Counselling is now a more general term applicable to many areas, e.g. volunteer post-partum counselling, credit counselling etc. Counselling used to be ubiquitous with psychotherapy but since the College of Psychotherapists came into effect it has changed.
· Counsellors typically focus on short-term brief therapy or support. · Private fees maybe covered under “Mental Health” but this is less common · Counsellors can work in private or agency settings. |
| Psychiatrist | MD (Medical Doc) with specialisation in mental health | College of Physicians and Surgeons of Ontario | Psychiatrists are part of the medical system and covered by OHIP.
You need a referral from a GP to see a Psychiatrist typically. The Psychiatrist could be linked to the Doctors office (as in the case of the Hamilton Family Health Team approach) or through a department at St Josephs or another hospital. Typically psychiatrists use diagnosis and medication when treating mental health challenges. · intake process likely with a nurse · short appointments typically |
| Coach | May have a coaching certificate | None as such. Similar to counsellors (above). | · Short-term, solution-based, proactive, goal-oriented, practical. (e.g. I want to figure out how to build my own business, or loose weight etc)
· Focus on here and now rather than exploring past · Not recommended for people struggling with mental health concerns necessarily – more for people who are highly functioning and have a sense of a goal and want to move forward. · Fees range, but often include paying per month or for several sessions as a package. · Online or phone coaching is common so being local isn’t necessary. |
| MD Psychotherapist | A Medical Doctor (MD) degree plus additional training in psychotherapy | College of Physicians and Surgeons | · Covered by OHIP if under their MD licence.
· Can be challenging to get an appointment since this is a popular avenue and there aren’t that many practicing. |
| Social Worker | BSW – Bachelor of Social Work, or a MSW -Masters of Social Work | Ontario College of Social Workers and Social Service Workers
· Registered Social Worker (RSW) |
Can work in a private practice, an agency, a hospital, and other settings. Varied roles including psychotherapy, case management, resource finding, advocacy.
· In a private practice setting where psychotherapy is offered, fees are usually $160-200/hour. · Fees often covered by insurance. |
| Art Therapist | Registered Art Therapist (ATR). Masters-level degree. | Not a regulated profession in Ontario. Many are members of the College of Psychotherapists. | Art therapists can work in private practice and in agencies. Many work with children and many offer services in group format.
· Fees for private practice are similar to Psychotherapists. · Fees less likely to be covered by insurance typically unless supervised by a Psychologist, or the therapist is also part of the CRPO. |
3. What is covered under my extended health insurance?
Insurance plans differ a lot. Even if you have the same provider as your neighbour, your employer has it’s own arrangement with the insurer. So check your coverage with your employer.
Specifically check:
- how much is covered
- what providers (see above list) are covered
- when your coverage roles over each year
Since the College of Psychotherapists is fairly new still, it is also worth directly asking your employer if psychotherapists are now covered. It’s only if there is demand from employees to the employers that insurance companies will start to cover RP’s services.
It’s often “Psychological Services” that are covered, which can mean Psychologists or include Psychotherapists.
Some psychotherapists receive supervision through a psychologist and can therefore bill through them. If your insurance company only covers psychologists, but you want to work with a psychotherapist who is supervised by a psychologist, check with your insurance company to ask if they cover “supervised practice”.
4. Therapy is so expensive and I don’t have extended benefits. Where can I get free counselling?
If you are in Hamilton, Ontario, and want to talk to someone and you can’t afford the fees or don’t have extended benefits, here are some ideas:
- If your doctor is with the Hamilton Family Health Team(HFHT) or the McMaster Family Health Team you may be able to access counselling through the Mental Health worker at your doctors office. The HFHT team offer psycho-educational group support as well that are open to the public.
- For LGBTQ+ related resourcescheck out my Pride blog post
- Call Coast Mental Healthfor emergency support.
- Mental Health services at St Joesoffer group or individual counselling.
- Interval Houseoffers some counselling and programming for women leaving abuse.
- Try accessing resources linked to your need (e.g. addiction, trauma, post-partum etc) or your sexual identity or culture or religious affiliation (e.g. queer, Muslim etc) and tap in to local supports that way.
- The Red Book lists all sorts of community supports that may be appropriate to your needs.
1. What is mindfulness-based therapy?
Mindfulness-based approaches refer to therapeutic approaches that encourage noticing and engagement with present-moment experience.
Working in this way creates a different tone to the therapeutic experience, so that it becomes less about you talking and the therapist listening, and more about you listening and relating to yourself in a different way, with the therapists’ guidance.
Here are some examples from the therapy room:
> Tuning in
As you talk about a topic or experience, the therapist will help guide you into mindful awareness, which means helping you slow down and turn your attention inside. This way you can better notice your experience. If you’re talking about something that feels stuck for you, they may invite you to notice what’s happening inside as you talk. For example “Take a moment to sense in: sense that stuckness on the inside.”
> Experiments
If during an exploration of what’s keeping you stuck, you and the therapist find that there’s something in there around setting boundaries, the therapist may set up an experiment so that you can evoke present-moment experience to learn more about how your system has become organised. This could involve physicalising the internal dynamic or externalising it.
> Grounding
Mindfulness can help build your grounding and relaxation skills. This is useful to help settle an experience that starts to get too intense to be therapeutically useful, and help you feel more in control.
> Particular methods
There are a wide range of somatic or mindfulness-based therapies. EMDR, Sensorimotor psychotherapy, Somatic Experiencing are some. Personally I use Hakomi techniques and Focusing to guide this work along with my own intuitive sense and awareness and curiosity. Another way of describing the work is body psychotherapy.
Check out these articles describing sessions with clients and also this therapist’s own process using embodied practices!
2. Is mindfulness-based therapy like meditation?
In a way yes, because you are using your observer mind to notice your experience. The therapist will guide you into your inner experience and your ability to pay attention on purpose, inwardly, will develop.
In a way no, because meditation is a specific practice you do to develop your mindfulness skills, e.g. a 20 min breath meditation. A mindfulness-based therapist rarely spends a lot of time teaching meditation in sessions. For straight up meditation groups try Mindfulness Hamilton or online resources.
3. How does mindfulness help in therapy?
Mindfulness yields information that comes direct from your body, your being, rather than just your mind. It deepens the work and pulls it out of story and into experience, where real shifts are possible. Along the way the therapist helps your cognitive mind understand your “inside” experience.
Mindfulness-based therapy helps you as a client relate internally that is different from what you can typically do alone through thinking, meditating or talking with friends. By practicing these mindful approaches in session, you start to develop a different language for working with your inner experience. With a little practice this becomes a language you can use on your own. No need for ongoing expensive therapy. Win!
Mindfulness helps you experience big feelings whilst staying safe. It helps you understand them, relate kindly to them, and express them. Feelings can be understood as energy wanting to move. Our job is to help them move safely, without overwhelming the system, or other “protector” parts that might be scared of big emotion. Metaphorically we can see feelings as a flag being waved from inside saying “pay attention to me”.
If feelings are overwhelming, mindfulness-based approaches help you develop grounding skills to help you get back in the drivers seat.
With mindfulness you and the therapist get real-time information about your experience and how you are organising your experience. You then work with the therapist to heal the hurt parts and help you get unstuck. You actually feel the difference.
Longer term benefits to the client include:
- Increased emotional regulation
- Decreased reactivity and increased response flexibility
- Decreased stress and anxiety
- Offers a new language to communicate with your inner world
All that said, your therapist should always work with you to find approaches that fit, and use them with your consent. Therapists can of course draw on other approaches should you prefer them or if they are more appropriate for the situation.
4. Is “mindfulness-based” often used interchangeably with “body-psychotherapy” or “somatic pschotherapy”?
Yes.
5. What do previous clients appreciate about working with me?
“In my first session with Stephanie I knew that I was in a safe and compassionate place. Stephanie’s mind-body approaches were extremely helpful and allowed me to heal some dark places.”
“Working with you has been an enormously valuable experience. You encouraged me to express myself in ways that were quite different from my regular talking and thinking modes and that started a new way of engaging with my emotions and my body, while making me feel totally safe.”
“Perhaps most of all, I am thankful that you were fully there with me, that your gentle presence guided me to the gentle softening in me.”
“You were compassionate, but what i enjoyed was also when necessary and when you felt that i was ready, you went deeper and cut through some bullshit along the way.”
“Because our work is based in ‘felt sense’ and imagery, I can take the work home and out into the world to help me strengthen my self awareness as well as work though difficult times.”
“It is very nice to work with someone that truly cares.”