Some of the challenges that you may be facing in your personal life or at work may seem too big to handle on your own. You may feel overwhelmed by everyday demands or find it hard to enjoy life. Maybe you're having trouble sleeping or concentrating at work. Perhaps you and your partner are arguing more or your child is having problems at school or seems "down." There are many different reasons that you or a family member may seek professional counselling.
What is counselling?
The words counselling, therapy, and psychotherapy are often used to describe the same process. Whatever term you use, counselling usually involves a series of appointments with a trained behavioural health professional who can help you identify your issues, talk about them, and learn coping strategies and possible solutions that work for you.
Through counselling, you may discover patterns of thinking and behaving that you may need to change in order to feel better and live a healthier, more positive life. Counselling can help you understand more about who you are; the time you spend with a trained professional who can help you identify your strengths and make positive changes in yourself or your life is an investment in your future emotional well-being.
Counselling and therapy can occur individually, with another person, with a family, in a group, or in a combination of these. Therapists working with couples often see the individuals separately as well as together; and, when working with families, they may see the whole family together, individual family members, or various combinations of family members.
Counselling is private and confidential, and protected by the health information privacy law which governs the jurisdiction in which you live (some are federal laws and some are provincial/territorial). With few exceptions, your counsellor cannot share information about your situation without your consent and written permission. There are two exceptions in which the law would require a counsellor to share information with the appropriate authorities. The two exceptions are:
- If your counsellor receives a court order or subpoena to release the information.
- In situations of imminent danger to you, to someone else, or to a child (including domestic violence where there are children in the home.)
The different kinds of counsellors and therapists
In Canada, practitioners refer to themselves by a number of titles, including Social Workers, Marriage and Family Therapists, Certified Pastoral Counsellors, Psychologists, and Psychiatrists.
In some provinces such as Ontario, Quebec, or Nova Scotia, counselling and psychotherapy are regulated through Provincial Health Regulatory Bodies. In other provinces, there are many persons who provide counselling who are not regulated, except possibly through voluntary self-regulation. Any counsellor you choose should have a minimum of a Master's degree and be registered or licensed to practice with a professional association in their province/territory of residence.
- Social Workers may have a Bachelor's or Master's degree in clinical social work. Social workers have special training in understanding how the home, social, and work environments affect people. Social workers are able to provide individual, family, and group counselling. They assist in helping individuals deal with a variety of issues such as grief, anxiety, posttraumatic stress, and other issues, and aim to help people develop their skills and abilities to use their own resources and those of their community to resolve problems.
- Marriage and Family Therapists have a minimum of a Master's degree in counselling, psychology, education, or social work, with a postgraduate certification in marriage counselling or family therapy, or both. They usually focus on practical counselling that deals with personal relationships, family dynamics, and couples' conflicts. This type of therapist may be a Registered Marital & Family Therapist (RMFT) or have a Masters in Marital and Family Therapy (MMFT), registered with the Canadian Registry of Marital & Family Therapists.
- Counsellors. It is important to understand that "counsellor" is a general term that can refer to many different types of people offering many different types of emotional and practical support. A counsellor may be registered with the Canadian Professional Counsellors Association, a not-for-profit association whose members have received designations upon meeting competency-based criterion for membership. Or, a counsellor may be a member of the Canadian College of Professional Counsellors and Psychotherapists (CCPCP). Other counsellors specialize in supporting individuals with addictions, and may be certified by the Canadian Addiction Counsellors Certification Federation (CACCF).
- Certified Pastoral Counsellors are members of the clergy who have specialized training in counselling individuals, couples, and families on a variety of issues utilizing a faith-based orientation. They must hold a minimum of a Master's degree.
- Psychologists must be licensed by the regulatory body in their provincial/territorial jurisdiction to practice in Canada. According to the Canadian Psychological Association, requirements for licensure vary, with some jurisdictions requiring a doctorate degree (PhD), and others, a Master's degree. Psychologists have training in using psychological and educational testing to identify and resolve problems. Psychologists work in many settings, including mental health centres, hospitals and clinics, schools, employee assistance programs (EAPs), and in private practice.
- Psychiatrists are licensed medical doctors (MD) trained to diagnose and treat a patient's mental and physical condition. Referrals to Psychiatrists are typically obtained through a family doctor. In Canada, psychiatrists are the only mental health professionals who can prescribe medications, and they are able to evaluate individuals for appropriate psychotropic medications, such as antidepressants. They can also hospitalize patients who are in crisis or in need of a higher level of care. They generally work within a group practice with other behavioural health professionals or in a hospital setting, and work as a team with other professionals, referring clients to social workers, psychologists, and other professionals for therapy.
Choosing a counsellor or therapist
Counselling is a highly personal process, and the match between a counsellor or therapist and a client is highly personal, too.
Some therapists may specialize in treating women, men, children and adolescents, the elderly, couples, or families. Others may be specialists who focus on issues such as posttraumatic stress, eating disorders, sexual identity, or substance abuse.
There are many kinds of counselling and psychotherapy treatment modalities. Some involve exploring past experiences and their ongoing effects on the present. Others focus on the present and ways to understand and change thoughts and feelings that result in behaviours that are of concern to you. This is especially true of Cognitive Behavioural Therapy (CBT), which has become one of the most widely prescribed forms of therapy. CBT is often short-term and focuses on changing a specific behaviour or group of behaviours. A good therapist should know when to select a particular approach to treat a specific problem.
Even more important is the way you feel about a therapist or counsellor. You need to find someone who seems genuine, really listens, is caring, and is interested in helping you. Here are some things to keep in mind when choosing a counsellor:
- Choose someone you like and feel that you will be able to trust. Research shows that the relationship and rapport between the counsellor and client are more important than the therapist's training and approach. So when you're choosing a counsellor or therapist, ask yourself these questions: Do I like this person? Is he easy to talk with? Does she understand what I am trying to say? Does the match feel like a good fit?
- Advocate for yourself. Ask questions that will help you decide whether you and the therapist share a similar sense of values. Think about whether you'd be comfortable discussing your problems and concerns with this person.
- Be prepared to tell the therapist something about yourself and your life, and then decide how you feel about the response. While it's important to honestly explain the situation you are trying to deal with, remember that it is okay not to reveal every detail in your first meeting. Trust is built upon experience with another person.
Where to look for a counsellor or therapist
- Your EAP may be able to assess your needs and provide a referral. EAPs are designed to address short-term issues and to identify resources and referrals for emergency and long-term issues. An EAP consultant is generally available via toll-free number that is available to you from your employer. An EAP consultant will be able to discuss your particular concerns and help you find the resources you need.
- Your primary care physician or your children's pediatrician, clergy, or school guidance counsellors may be familiar with counsellors and other treatment professionals in your local community.
- Trusted family and friends may be able to recommend someone.
- An extended health care plan. Find out whether your health benefits provider has a list of clinical professionals. Often, there is a toll-free number on the back of the health benefits card or information you receive from your employer.
- Refer to the resource list of professional associations at the end of this article.
Questions to ask the counsellor or therapist
Once you have some recommendations, you might ask a therapist or counsellor:
- Do you specialize in treating people with concerns like mine?
- How much experience do you have treating people with problems like mine? What particular training do you have in this area?
- What are your credentials?
- What therapeutic approaches and techniques do you use?
- Who will participate in the therapy (my child, my spouse, the whole family, only me)?
- How frequent will the sessions be?
- What are your hours? Are you available evenings, weekends, or for extra sessions?
- Do I have to pay for sessions I miss due to illness or other emergencies?
- What happens if I decide I want to stop?
- Have you treated people of my age, religion, or ethnic background?
- Would you be comfortable providing a referral if, after a reasonable period of time, I do not feel as though we have made progress?
- In an emergency, is there a procedure for reaching you?
- How long do you expect counselling to last?
When talking with the counsellor or therapist, ask yourself these questions:
- Is this someone with whom I feel comfortable?
- Do I think the therapist understands my situation?
- Does the therapist or counsellor seem optimistic about my ability to make progress?
What about children?
Some children need counselling or an evaluation to help with behaviour problems, depression, school problems, or family conflicts. Counselling also can be helpful for children who are dealing with illness, death, or divorce.
Therapists who work with children often use play and toys to help younger children express their feelings. A child might meet with a counsellor or therapist individually, in a group with other children or siblings, or with a whole family. Parents (especially parents of preschool children) are often involved in counselling to help children deal more effectively with the situation.
When choosing a counsellor for your child:
- Always consult your pediatrician before entering a young child into counselling. He or she will want to rule out the possibility of any developmental or medical problems that your child may be experiencing that require specialized treatment.
- Offer an older child a choice about what kind of therapist he or she would like to see (man or woman, young or old). Involving your child in the decision can help if your child is uncertain or hesitant about seeing a counsellor or therapist.
- Ask the counsellor or therapist who in your family will be involved in the therapy.
When deciding on a counsellor, you may also wish to consider the following with respect to fees:
- Do you have access to an employee assistance program (EAP) that provides counselling services?
- Do you have extended health benefits through your employer that may cover the cost of counselling? If so, how much will it cover? Is there a deductible? Is there a limit to the number of sessions? Is coverage limited to a certain dollar amount or number of appointments by professional provider each year? What type of counsellor is acceptable? Does it cover treatment for substance abuse?
- If you have to pay for all or some of the counselling costs, does the counsellor you're considering offer a payment plan?
- Are you seeing a psychiatrist or psychologist? It's important to note that in Canada, in order to see a psychiatrist, you typically need a referral from your family doctor. Provincial/territorial health plans typically cover psychiatrists' fees. If you're seeing a psychologist employed by a public institution like a hospital, school, or correctional facility, his or her services will be covered by the public health system. If the psychologist practices privately in the community, provincial/territorial health plans typically do not cover the cost of these services. However, be sure to look into any extended health benefits available through your employer as these may cover fees you incur, depending on your coverage.
The amount of counselling you will need depends on your concerns. Many people complete therapy in a few months or less, especially when they seek counselling about a specific behaviour. In general, the more serious the problem, the longer people need to remain in therapy. Therapists often prescribe short-term therapy for a specific concern.
Beware of counsellors or therapists who promise that they have all the answers. Good therapists know that the solutions to your personal life challenges lie within you. They believe that their role is to help you discover your own answers in an environment of trust.
These reputable groups can help you find a counsellor or therapist, as well as other supportive resources in your community:
Canadian Mental Health Association (CMHA)
Canada Psychological Association (CPA)
To find a psychologist: http://www.cpa.ca/public/findingapsychologist/
Canadian Counselling and Psychotherapy Association (CCPA)
Canadian Association of Social Workers (CASW)
Canadian Association for Marriage & Family Therapy (CAMFT)
Canadian Addiction Counsellors Certification Federation (CACCF)
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