Frequently Asked Questions
Who are the regulated health professionals that may provide psychotherapy services?
There are six regulated health colleges in Ontario whose members can provide psychotherapy services. These are:
- College of Nurses of Ontario (C.N.O.)
- College of Occupational Therapists of Ontario (C.O.T.O.)
- College of Physicians and Surgeons of Ontario (C.P.S.O.)
- College of Psychologists of Ontario (C.P.O.)
- College of Registered Psychotherapists of Ontario (C.R.P.O.)
- Ontario College of Social Workers and Social Service Workers (O.C.S.W.S.S.W.)
Is there a set number of sessions required?
Each person is different and has unique needs so there is no magic number of sessions for a particular issue. The number of individual psychotherapy sessions are mutually decided when psychotherapy is started.
Everything discussed between the person receiving psychotherapy services and a psychotherapist is confidential, however there are ethical, practical, and legal limits and exceptions to this which will be discussed at our first session. These limits are determined by the regulating professional college (in my case the College of Registered Psychotherapists of Ontario) and applicable Federal and Provincial legislation. These limits are subject to change, please check the relevant websites, Acts, or government legislation for any changes. The limits and exceptions include:
- Circle of care – this means that health record files will be kept confidential however, other office staff may review your file as it applies to their job function. Confidentiality restrictions will apply to all staff.
- To comply with professional regulation means the sharing of psychotherapy information with the College of Registered Psychotherapists of Ontario (CRPO) for supervision, quality assurance, and auditing purposes.
- When a court order/subpoena is made for a client file.
- When child abuse is suspected, or a child is need of protection then a psychotherapist has a duty to report to the local Children’s Aid Society in accordance with the Ontario’s Child and Family Services Act, section 72. A child needing protection includes (refer to the act for more information):
- A child at risk for or has suffered physical or sexual abuse or exploitation
- Emotional abuse including children witnessing domestic violence
- Where there is a risk of harm to a child
- To inform an appropriate family member, health care professional, or police if necessary; of a client’s intention to end his or her life.
- If there is a significant imminent risk of serious bodily harm to any specific person, then there is a duty to warn the intended victim or to contact relevant authorities.
- To report sexual abuse of a client by a health care professional to the health care professional’s regulatory college.
- During an emergency, where a client is incapacitated or unable to give consent and the psychotherapist is unable to contact a substitute decision maker or emergency contact.
Openness and honesty
To make the most of the psychotherapy time is it best to be open and honest. This will help in achieving your goals. I also encourage you to be active in your therapy, to ask questions about your therapy, to express your feelings and concerns. In this way we can address any conflicts or issues that may arise in therapy, so they can be resolved. Conflicts that do arise in therapy, while often challenging, can allow for deeper understanding and aid in therapy success.
Are your services covered by insurance plans?
Services I provide are not cover by the Ontario Health Insurance Plan (O.H.I.P.). Please check with your health care insurance provider before your first session to verify your health insurance coverage and limitations. I am a Registered Psychotherapist practitioner providing psychotherapy services. All services provided are subject to H.S.T. and psychotherapy services in Ontario are eligible for the medical expense tax credit by Canada Revenue Agency – see CRA website page “Authorized medical practitioners for the purposes of the medical expense tax credit”
What does it mean to be an active partner in therapy?
Therapy is a collaborative partnership between the person receiving the therapy and the psychotherapist. This relationship between a client and a therapist is known as the therapeutic alliance. This alliance is a two-way street where each partner invests a significant amount of time and energy. A good therapeutic alliance is a critical factor in successful therapeutic outcomes, but there are other factors which influence outcomes as well. For psychotherapy to be most effective it requires that a client be active, committed, and engaged in their therapy. Research has shown that a client’s level of motivation, personality characteristics, and symptomology all impact therapeutic outcomes of psychotherapy (Lynch, 2012). When a patient is an active partner in their therapy it means that a client is not just informed of their therapy, but is involved in their therapy taking part in therapy plans and goals. It means working together with your therapist on a therapy plan that is acceptable to both and making your preferences for therapy known. This includes having an open relationship between the client and therapist where questions and concerns are addressed in an open, honest, and non-judgmental manner. I encourage each client to be active and engaged in their therapy.
Taking the initiative to become informed and aware of the various options that are available for psychotherapy will help you to become more involved in your recovery. There are, however, many different sources of information with varying degrees of reputability and it is wise to talk with your therapist about any concerns you have. Another way to be active is to visit your primary care provider prior to seeking psychotherapy, such as a family physician or a nurse practitioner to discuss with them your concerns.
What is the relationship between mental Illness & chronic conditions?
There is a relationship between mental health, mental illness and chronic physical conditions such as breast cancer, colon cancer, C.O.P.D., diabetes, heart disease, lung cancer, and stroke (C.M.H.A. Ontario, 2008). Medical illnesses may also effect your mental health. The prevalence of psychiatric symptoms and disorders such as depression and anxiety in Multiple Sclerosis, for instance, is much greater than in the general population (Chwastiak & Ehde, 2007). Other conditions such as brain tumors may affect a person’s mood swings and other cognitive changes (American Brain Tumor Association, 2015). Drugs can be a factor that may negatively impact your mental health. To learn more about medications and herbal supplements including the adverse side effects of various medications and herbal supplements visit the MedlinePlus website (MedlinePlus, 2015a, MedlinePlus, 2015b). A primary care professional may be able to determine any physical conditions which may impact your present mental health condition. There are many conditions that have been shown to be factors in mental health. For example, a primary care practitioner can rule out factors such as; having an undiscovered physical condition, illness, or an adverse reaction to a medication which could impact a client’s mental health. This is something that a primary care practitioner can do, but please be aware that a physician, or psychiatrist may make a mental health diagnosis as well. A diagnosis made may be a relief to some clients or may be something a client may not want.
How can a medical check-up help?
Although it is not necessary to visit your primary healthcare practitioner for a check-up or examination prior to engaging in psychotherapy it is prudent to do so. A check up with a primary care practitioner can help to uncover medical conditions that may be factors affecting your mental health prior to seeking psychotherapy. A primary care practitioner can rule out factors that can adversely affect a person’s mental health that may not be obvious or apparent. These factors can be biological, environmental, genetic, chemical, or physical.
The following are examples highlighting the importance of having a primary care practitioner checkup or exam prior to seeking psychotherapy:
1. Depression or psychosis could be as a result of a medication side effect. For example, Isotretinoin, prescribed for treating acne, “…may cause changes in your thoughts, behavior, or mental health.” (MEDLine Plus, 2015c)
2. A concussion or Traumatic Brain Injury (TBI) increases an adolescent’s risk of suicide, partaking in high risk behaviors, and poor mental health (Ilie, Mann, Boak, Adlaf, Hamilton, Ashbridge, Rehm, & Cusimano, 2014)
3. There is an established link between thyroid disorders and depression (Hage & Azar, 2012).
4. There is a strong association between a major illness and mood problems. For example; having Multiple Sclerosis increases the risk of having depression or anxiety (Chwastiak & Ehde, 2007)
Can I use email and texting?
Email and texting are not secure methods of communication for the communication of personal and private information. Please use these applications for basic information only such as; making an appointment, canceling an appointment, asking for general information. Please do not send personal and private information using texting or email. There are applications that increase the security of communications when using email, texting, faxing, and phone calling, however before using these applications please make sure to understand their strengths and weaknesses. Some of these applications are:
- Signal – for texting communication security (https://signal.org/).
- Protonmail – for email security (https://protonmail.com/)
- Hushmail – for email security (https://www.hushmail.com/). This is a fee-based application service
American Brain Tumor Association. (2015). Mood swings and cognitive changes. Retrieved, April 16, 2015, from http://www.abta.org/brain-tumor-information/symptoms/mood-swings.html
Chwastiak, L. A. & Ehde, D. M. (2007). Psychiatric issues in multiple sclerosis. Psychiatric Clinics of North America, 30(4), 803-817. Doi:10.1016/j.psc.2007.07.003
CMHA Ontario. (2008). Backgrounder: The relationship between mental health, mental illness and chronic physical conditions. Retrieved April 16, 2015 from http://ontario.cmha.ca/public_policy/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/
Hage, M. P. & Azar, S. T. (2012). The link between thyroid function and depression. Journal of Thyroid Research, vol. 2012, Article ID 590648, 8 pages, 2012. doi:10.1155/2012/590648 Retrieved June 15, 2015 Retrieved from http://www.hindawi.com/journals/jtr/2012/590648/cta/
Ilie G, Mann RE, Boak A, Adlaf EM, Hamilton H, Asbridge M, Rehm, & Cusimano. (2014) Suicidality, bullying and other conduct and mental health correlates of Traumatic Brain Injury in adolescents. PLoS ONE 9(4) 1-6: e94936. doi:10.1371/journal.pone.0094936
Lynch, M., M. (2012). Factors influencing successful psychotherapy outcomes. Retrieved from http://sophia.stkate.edu/cgi/viewcontent.cgi?article=1057&context=msw_papers
MedlinePlus. (2015a). Drugs, supplements, and herbal information. Retrieved, April 16, 2015, from http://www.nlm.nih.gov/medlineplus/druginformation.html
MedlinePlus. (2015b). Drug reactions: Also called side effects. Retrieved April 16, 2015, from http://www.nlm.nih.gov/medlineplus/drugreactions.html
MedlinePlus. (2015c). Isotretinoin. Retrieved June 18, 2015, from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681043.html