What to expect from therapy?

Most people at some time or another need some help. Psychotherapy is for anyone who is unhappy with the way he or she thinks, acts, or feels and wants to change.

In general terms, psychotherapy is a relationship in which one person enlists the professional assistance of another person for the purpose of bringing about changes in their feelings, thoughts, and/or behaviours. The task of the psychotherapist is to help individuals make the changes they wish to make. Often the person entering therapy knows that changes are needed, but does not know how to go about making them. Other times, the person knows they are unhappy with some aspect of their life, but does not know what changes to make in order to improve.

How the psychotherapist goes about helping the client depends upon the therapist's training and theoretical orientation. There are many schools of thought and theories from which therapy styles and techniques have been derived. We call these "therapeutic orientations." The therapeutic orientation will affect the therapist's style and focus, as well as the methods and techniques used in therapy. Dr. Cebulski practices Cognitive Behaviour Therapy.

Therapy has three phases: Assessment & Feedback, Treatment, and Follow Up

Assessment

Therapy begins with an assessment, which usually takes one or two sessions. Dr. Cebulski begins by talking in detail about the circumstances that led you to seek therapy. Common questions include: When did the problem start? Under what circumstances does it occur or not occur? How long does it last? How intense is it? Has it occurred before, etc.? The therapist usually asks many specific questions in order to get a thorough personal and family background, perhaps to determine a diagnosis, and to obtain a clear understanding of why you are coming to therapy and what you hope to achieve. You may be asked to complete a psychological test, designed to get a more in depth understanding of the presenting problem or of your personality. Assessment is followed by feedback from the therapist and the establishment of a treatment plan that you are comfortable with. Initial assessments are used to get therapy started. However, the assessment of a client's problems is an ongoing process throughout therapy. Sometimes therapy goals and treatment plans are renegotiated during therapy as things change.

Treatment

After the initial assessment, the rest of therapy is devoted to helping you feel better and solve your current problems. The goals you bring to therapy are the focus of the sessions, but how these goals are addressed depends on the therapist's approach and individual client characteristics, to which the therapist tailors his or her approach. Some therapists take a more directive role in how therapy proceeds, whereas other therapists let clients direct the course of therapy. In CBT, therapists usually take a collaborative approach with their clients, providing structure and direction but respecting a client's preferences regarding pacing and therapy direction.

Couples' therapy differs from individual therapy in that it takes into account the needs of both people in the relationship. In couples' therapy, the focus of intervention is the relationship. However, the basic principles and theoretical orientation of the therapy remain the same.

Follow Up

Once you feel you have made some or all of the changes desired, it is often advisable to begin spacing out the sessions from weekly to bi-weekly or monthly, so that you have more space to implement new ways of thinking and behaving, but still can receive help and support. After a period of time you and your therapist may agree that therapy has been successful in helping you achieve your goals, so therapy is no longer needed. (You can end therapy at any time, though it is often advisable to discuss this decision with your therapist.) Once therapy has ended, it may be useful to return after a reasonable period of time has elapsed for one or more follow-up or "booster sessions" to troubleshoot problems and consolidate treatment gains. If problems do reappear or if you encounter a new problem, you can come back to therapy at any time.

Sessions are generally 50 minutes in length, and occur at intervals determined by you and your therapist. Weekly and biweekly intervals are common, but other time periods between appointments may suit particular client needs. The therapy schedule takes into account your degree of discomfort or distress, your financial or insurance situation, your personal schedule, and your preferences.

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What to expect from your first appointment?

The first session is a time for you to determine whether you feel comfortable, confident, and motivated to work with your therapist. You should feel that your therapist understands your situation and that he or she is a good match for you. If you do not feel comfortable working with your therapist, you should ask to be referred to someone else. Health care professionals understand the importance of the therapeutic relationship and are not (or should not be) offended by a request to be referred to someone else.

While you are deciding whether or not you feel comfortable with your therapist, he or she uses the first session to begin conducting the initial assessment. It is useful in preparation for your first meeting to think about what brings you to therapy and what you hope to get out of therapy.

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What is your approach to therapy?

Drs. Cebulski practices Cognitive Behaviour Therapy.

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Do I need a referral?

You do not need a referral to obtain services. You may be self-referred. Some extended health insurance companies, however, require a written referral from a physician before they will reimburse you for psychological services.

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Are these services covered by OHIP?

Psychological services are not covered by OHIP. Most extended health insurance providers reimburse some, if not all, fees for assessment and treatment that are provided by a registered psychologist.

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Why see a regulated health professional?

To use the title "Psychologist", a doctoral degree (Ph.D., an Ed.D., or a Psy.D.) in Psychology from an accredited university program is required. In addition, a psychologist must pass a series of licensure examinations and complete one year of supervised practice before he or she can be registered (i.e., licensed) as a psychologist by the College of Psychologists of Ontario (CPO). The role of a regulatory body such as the College of Psychologists of Ontario is to protect the public by ensuring that its members are properly trained and adhere to the standards of the profession. Only qualified members of a Health Regulatory College in Ontario are regulated in this way. Members must adhere to a code of conduct and a series of regulatory standards and guidelines in order to maintain licensure. A member who fails to adhere to the code of conduct and standards of professional practice is subject to disciplinary action by his or her respective college. Only clients of health care practitioners regulated by a Health Regulatory College are subjected to the protection provided by the Regulated Health Professional Act. To determine if a psychologist is registered and in good standing, you can contact the regulatory body by phone or e mail, or check the College's website (www.cpo.on.ca)

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What is the difference between a Psychologist and a Psychiatrist?

In Canada, psychologists and psychiatrists are regulated health care professionals, licensed to provide a specific range of health care services by the various provincial governments. Psychologists and psychiatrists have approximately the same number of years of formal training and are entitled to use the designation "Doctor" in the context of providing health care services.

A psychologist is qualified to provide health care in Ontario has a doctoral degree (Ph. D., Ed.D, Psy.D.) in psychology, after obtaining Honours Bachelor and Masters degrees, also in psychology. This educational program usually requires approximately 10 years of university training, specializing in the understanding of human emotion, thought, and behaviour and in the assessment and treatment of psychological problems and illnesses. Psychologists have advanced training in psychotherapy and the science of behaviour change. Psychologists must also demonstrate proficiency in conducting research in these areas. Some psychologists have training in the use of medication to treat mental illness. However, in Ontario psychologists are not licensed to prescribe medication. Psychologists are extensively trained in the development and use of psychological tests to assess intelligence, emotional and behavioural problems, and neuropsychological dysfunction. Psychologists' fees can be covered by extended health care plans, employee assistance programs, and through government agencies or other special programs. Psychologists are licensed and legally regulated by the College of Psychologists of Ontario.

Psychiatrists have a 4 year degree in medicine (MD) like your family physician, and then take specialized training in the diagnosis and treatment of emotional and behavioural problems in the form of a residency in psychiatry (usually lasting 4+ years). Psychiatric training involves the study of biological aspects of mental health disorders as well as psychological factors, with a focus that is more biologically oriented than is usually the care for psychologists. Psychiatrists are trained and licensed to prescribe medication as well as to conduct other biological treatments such as electroconvulsive therapy, and their fees are covered by the Ontario Health Insurance Plan. Psychiatrists are also qualified to conduct psychotherapy, although the degree to which psychiatric residency programs provide specific psychotherapy training varies. In Ontario, psychiatrists, along with all other physicians, are licensed and legally regulated by the College of Physicians and Surgeons of Ontario.

Because of the differences in training and focus, psychologists and psychiatrists provide compatible health care services, and work well in collaboration.

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What are psychotherapists and counsellors?

The terms “psychotherapist, psychotherapy, counsellor, and counselling” are usually used to refer to a broad range of providers and mental health services. Psychotherapy refers to the treatment given to someone with a psychological illness, or with a psychological problem that has a significantly negative impact on one or more important areas of his or her life. Counselling refers to the help given to those with non-illness related problems, and tends to be more advice oriented. Practically, however, the terms “psychotherapy” and “counselling” are often used interchangeably, adding to the confusion about what the terms actually mean.

Regardless of whether or not the person you are seeing describes him/herself as a psychotherapist or a counsellor or uses some other label, the most important consideration is whether or not this person is a member of a regulated health profession in that province or state. Please see the section above that discusses the benefits of receiving help from a regulated health professional. In Ontario, those using the title “Psychotherapist” must now be registered with the College of Registered Psychotherapists of Ontario. Those using the title “Psychologist” must be registered with the College of Psychologists of Ontario. A person using the title “Counsellor” may or may not be registered with one or more of the various regulatory colleges, as the use of this title does not require regulatory college membership.

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Can psychologists prescribe medications?

The brief answer is no. Psychologists are not medical doctors and are not currently licensed to prescribe in Canada. (There are however some states in the US that do allow psychologists with extra training to prescribe medications.) Their training focuses on the study of human behaviour, and assessment and treatment for those with psychological problems and disorders. When medications are required to assist in the treatment of psychological problems, psychologists encourage their clients to consult with their family physician or psychiatrist, refer their clients to the family physician or psychiatrist, and provide consultation as required.

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Will you work with my doctor?

Absolutely. Many mental health issues impact overall health. With the client's consent, psychologists routinely consult with the family physician in order to best meet the client's health needs.

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Confidentiality / Privacy

Information disclosed to a psychologist is confidential and by law cannot be shared with anyone else without the client's consent, except under certain specific conditions. These conditions are referred to as the "limits of confidentiality". These limits typically involve situations where the client gives the psychologist information that leads him or her to suspect that harm might come to the client or someone else. If a psychologist suspects that a client is going to harm him/herself or someone else, that a child is being abused or neglected, or that another regulated health care practitioner has sexually abused a client in some way, then the psychologist is legally required to report this information to the appropriate authority (the police, children's aid society, professional regulatory body are examples). The courts also have the power to subpoena a psychologist's files. The College of Psychologists of Ontario has the right to examine a psychologist's files in the context of a complaint investigation or as part of the continuing education process. In the case of the College accessing a client's clinical record, the information in the record is subject to strict confidentiality conditions.

Youth who are old enough to consent to treatment are old enough to consent to release of information from their psychological file. Therefore, they have a choice as to what information is shared with their parents. Some youth give consent to share all information from their sessions and some youth do not. In some circumstances it is good practice to encourage young clients who meet the criteria for capacity to share general information with their parents or guardians regarding diagnosis, treatment, prognosis, etc., while keeping specifics confidential. However, whether or not there is disclosure and how much is entirely their choice. It should also be noted that there is no specific legal age for consent to health care services in Ontario. The law requires that a youth have the capacity to understand the nature of his/her problem and the services that are being offered, and the capacity to appreciate the potential consequences of accepting health care services or not. If a youth meets these "understand and appreciate" criteria, then he/she is able to consent or withhold consent for his/her own health care, and is able consent or withhold consent to the release personal information.

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