Therapy

FREQUENTLY ASKED QUESTIONS

1. What is the difference between a Psychotherapist, Psychologist, and Psychiatrist? 

This is a question I get a lot. Basically, in Canada, a psychiatrist is the only mental health professional that can prescribe medications, and typically provide diagnoses for mental health disorders (e.g. anxiety, depression, biopolar, etc.). Sometimes, a GP can prescribe anti-depressants, but they typically only do this for patients they are familiar with. Psychologists work with a wide range of clients, and are sometimes responsible for assessments, treatments and research in their specialized area. Psychotherapists typically provide 'talk therapy' as their treatment, and they might use some experiential exercises, based on their training and expertise. 

 

​All three types of mental health professionals can do psychotherapy. Psychotherapy is basically 'talk therapy' and if you have a good rapport and trust with your psychiatrist, they might also engage in therapy with you. The main difference usually is cost. 

​One note from the CRPO website about psychotherapy and counselling: 

“The practice of psychotherapy is distinct from both counselling, where the focus is on the provision of information, advice-giving, encouragement and instruction, and spiritual counselling, which is counselling related to religion or faith-based beliefs.” HPRAC: New Directions, 2006; Chapter 7, Regulation of Psychotherapy, p. 208.

CRPO does not regulate counsellors or counselling. However, psychotherapy and counselling can be highly interrelated.

2. What credentials should I look for in a mental health therapist? 

In Canada, mental health regulation is done at the Provincial level. The following information is specific for clients who are in Ontario. Registered Psychotherapists (RP) are therapists that are in good standing with the College of Registered Psychotherapists in Ontario. Only those registered with the College are allowed to use that title, and must abide by the levels of competency, ethical code, standards of best practice and quality care as outlined by the College, as well as the Regulated Health Professions Act (RHPA). The College is there to protect clients, first and foremost. When looking for a mental health therapist, whether it is a psychotherapist, counsellor, social worker, psychologist or psychiatrist, always ensure they are registered with their designating College. For the CRPO, you can do that by looking up their name on the Public Registry: https://www.crpo.ca/find-a-registered-psychotherapist/

 

In Ontario,  only those who belong to the follow colleges can perform psychotherapy (taking into consideration their training and additional qualifications to guide their expertise/scope of practice): College of Registered Psychotherapists, College of Nurses of Ontario, College of Occupational Therapists of Ontario, College of Physicians and Surgeons of Ontario, College of Psychologists of Ontario, Ontario College of Social Workers and Social Service Workers.

3. How confidential are my sessions? 

Confidentiality is an important part of our relationship, and I typically review this with you during our first session. This applies to scheduling and attendance, and everything we talk about in the session, including the records kept about your session. You must know that I will do everything I can to protect your confidentiality from any inappropriate disclosure. You can request your records to be shown to another person at any point using our written consent form.

In a majority of cases, your written and signed approval will be required prior to giving anyone information about these therapy sessions. This includes your parents, partners, friends, colleagues or bosses. There are some cases that do not require your signed authorization, which can be 1) if there is clear and immediate danger to yourself, the client, or any others, 2) if there is a legal requirement to release information, or 3) if a child needs to be protected (CCPA, 2015).

Below you will find some examples of when communication between us can or may be disclosed, or are required to be disclosed by law:

·       If you are going to harm someone else, or put them/their life in danger (this can include if you tell me that you want to physically/sexually harm or neglect someone else (e.g. homicide), or if you will put someone at risk with any diseases, e.g. HIV, as per CCPA Standards of Practice, Sec. B2, CRPO Limits of Confidentiality, OACCPP Standards of Practice Sec. 2.6), I have a duty to warn them,

·       If you are going to commit suicide, or put yourself in imminent (i.e. immediate) danger (this can include serious physical hurt or threats to kill yourself; as per CCPA Standards of Practice, Sec. B2, CRPO Limits of Confidentiality, OACCPP Standards of Practice Sec. 2.6), I have a duty to call your emergency contact, and call Emergency Services,

·       If you tell me about any abuse/neglect to a child (which is anyone who is actually, or appears to be, aged 16 or under; as per Child and Family Services Act, R.S.O. 1990, Chapter C.11), I have a duty to call Children's Aid Society,

·       If the court issues a court order (it is mandated by law and I would get in touch with you as soon as I could to let you know about it), 

·       If there is any provincial/federal warrant issued for an investigation (e.g. a criminal investigation against myself, or if you issue a formal complaint against me, or want to bring me to court through a lawsuit), 

·       If you are in trouble (e.g. injured, or ill) and cannot give consent for help, I might need to access and get information to contact your emergency contact, relatives, or friends (i.e. a decision-maker),

·       If you disclose any sexual encounters with a health care practitioner or professional (as per Regulated Health Professions Act, sections 85.1, 85.3, and 85.4.), I have a duty to report it (in this case, I do not usually have to provide your name, but we do have to fill in a report), or

·       If you formally request information to be released (either to a third party, or for your own records).

 

In cases that you disclose intention to cause imminent harm to someone else, you must understand that we, as practitioners in Ontario, have a duty or obligation to warn not only the police, but the person/people (who is/are in danger) as well.

During the duration of time that I spend as a qualifying registered psychotherapist, I will continue to obtain supervision, and will discuss all my clients with my supervisor, so that I can learn and grow as a professional. In some cases, if I’m unsure of the best course of action, in order to provide you with the most useful information or resources, I might contact fellow colleagues in the mental health profession. In these scenarios, I will not disclose your personal information or anything that will identify you, and any disclosure of information will be for professional uses only.

Lastly, if you are using insurance or another party to pay for these therapy sessions, you must know that some information may be released, such as the date of our sessions, and whether or not you attended the session. No personal information is disclosed, nor details of our session are ever disclosed without your written consent. If these sessions are court-ordered, confidentiality is limited, and the court can request information from me that I would be required to disclose.

4. Where do I go if I'm in crisis or need immediate help? 

This is a working list of emergency numbers to have on hand, or services within the City of Toronto to support those around you, or if you ever need. This list is not exhaustive/comprehensive, and I welcome any suggestions/updates. One of the resources I really appreciate and refer/check myself is https://www.211toronto.ca (there is a 211 website for Ontario as well, if you are looking for resources outside the GTA).

 

I would like to share that I cannot personally attest for all of the resources below. I completely empathize that there are flaws in our system (in terms of wait lists) and it can be really hard to navigate (I've experienced it myself, and heard a range of experiences from clients/colleagues/friends). At the same time, there are wonderful, supportive, and helpful services out there. This list is meant to help support your search. 

 

To begin, in case of an emergency please call 9-1-1 or go to your local hospital. If you or someone you know needs street outreach, please call 311. If you are looking for services not found here, call 211.

 

24-hour crisis lines and support: 

  • Toronto Distress Centre 24 hour crisis line 416-408-4357 (408-HELP) 

  • ONTX Ontario Online & Text Crisis ServiceCrisis Text (2pm-2am ET): 741-741

  • Gerstein Centre 24 hr crisis line 416-929-5200

  • Kids Help Phone 24 hour crisis line 1-800-668-6868 | Text Services: Text "CONNECT" to 686868 (also serving adults) 

  • Youthspace.ca (NEED2 Suicide Prevention, Education & Support) Youth Text (6pm-12am PT): (778) 783-0177

  • (For post-secondary students) Good-to-talk 1-866-925-5454 

  • Assaulted Women’s Helpline (24 hrs) 1-866-863-0511

  • Toronto Rape Crisis Centre crisis support 416-597-8808

  • Women’s College Hospital 24hr Sex Assault/DV care: 76 Grenville St. rm 1305, 416-323-6885

  • Gerstein Centre mobile crisis team 416-929-5200

  • St. Elizabeth mobile crisis team 416-4980043

  • St. Mike’s and St. Joe’s mobile crisis teams call 911 and ask for mobile crisis team

  • Location of CAMH emergency: 250 College St.

 

Taxi/Transportation Phone Numbers:

  • Beck 416-751-5555

  • Toronto Citi Taxi 416 740-2222

  • Co-Op Cabs 416 504-2667

  • Uber/Lyft apps

 

To consult or report if you suspect child abuse:

  • CAS Toronto 416-924-4640

  • CCAS Toronto 416-395-1500

  • Jewish Family & Child Toronto 416-638-7800

  • Native Family & Child Toronto 416-969-8510

 

Support for Shelters and/or a warm meal or in need of drop-in centres

Call 311 or Central Intake at 416-338-4766, 1-877-338-3398 for emergency shelter.

  • Toronto Shelters Central Intake 1-877-338-3398

  • Daily Bread Food Bank 416-203-0050

 

Free/Low-Cost Counselling Services

5. Are therapy fees covered by OHIP? Or by my insurance? 

​Unfortunately, in Ontario, OHIP does not cover psychotherapy. Many private extended health care policies do cover psychotherapy. It is worth checking your specific plan or coverage with your workplace employee assistance plan for the details of your coverage. It should say "Registered Psychotherapist" in order to obtain coverage for my services.

 

You can also download a form to ask that an RP be added to your workplace's policy (typically the decision is made by an HR professional, brokers, group sales team or decision-maker in the company). After members from the OACCPP have been advocating, many insurance companies are open to including it (i.e. they met, & presented to members of the Canadian Life and Health Insurance Association, consisting of 100+ insurance companies, they are open to including RPs), they determined it is possible and a good news story for decision makers of benefit plans because including RPs can be done at no additional cost.

 

 

Please feel free to contact me for more information. 

6. Can we connect on social media? 

In today's world, it is a reality and inevitable that you might come across your therapist on social media. I've put together my policy for social media so you know what to expect from me. If you have any questions, I am happy to discuss this with you in our first session. 

Friending: I do not add current or former clients as friends on Facebook or Linked In. This is to ensure your own confidentiality, as well as respect my personal privacy. 

Following/Liking/Commenting: Anything I post through Choose Gratitude's or Ohana Wellness' pages are open for individuals for follow/like/comment from their own interest or willingness. I will never request that you do so, nor will I put any pressure to be active on these pages. I am the first to acknowledge that 'gratitude' and positive psychology as a practice has many different impacts on individuals, and I do not think it is helpful to shame, or put pressure on anyone to take part in something if it is not genuine. 

Other considerations re: technology & other concerns: 

1.     Please note that if you connect with me via social media for an appointment, releasing any personal information, or if you are in crisis, I am not guaranteed to respond within a timely manner, nor are these sites always secure. It is not advised to connect with me via social media sites. The best way to contact me is through e-mail.

2.     Additionally, if you are using location services, they might register at certain offices, and is something to be mindful about if you hope to maintain your privacy about your therapy services.

3.     Lastly, if there is any reviews online about Choose Gratitude, the services might not be related to psychotherapy services. I would never ask any psychotherapy clients for a testimonial (it is against our Code of Ethics to do so), nor will I respond to any testimonials posted in order to respect the privacy of my clients. You may choose to post or share with anyone that you wish that you are my client, and tell them about your experience in any public forum, but note that you will be sharing your personal information and I recommend using a pseudonym or something you are comfortable with. 

4.     Sometimes, I will run workshops through Choose Gratitude. These are not mandatory, nor are current or former clients required to attend or promote them. They are psycho-educational in nature; however, are not a form of therapy, nor would there be any formal processing of mental health challenges. While there might be individuals who attend that live with various mental health challenges, each person is advised only to share what they are comfortable with, and as facilitator, I would strive to make each workshop a safe space. There is a disclaimer at each event that participants can sign with more information. Contact me if you have any questions or would like to see the waiver.  

7. How do I choose a therapist? 

This is a great question, and let me start by saying I've been there too. It is so hard to narrow down the options, so I hope to provide you with considerations that will be helpful in your decision-making process.

 

1.     Rapport, trust, and plain old good connection - this is so important. Research shows that the therapeutic relationship is one of the key factors impacting therapy. This makes sense, as it is important to have someone you can truly feel comfortable with, and someone you trust to hold space for your truth. 

2.     Registration, training- see above (#2) for the importance of having a professional who is regulated within your province. 

3.     Fees - let's be honest, money is important today, so this is definitely a consideration. It was for me, and I'm sure it will be for you. It is an investment into your inner peace, and it can bring healing, but there are also some low-cost or free resources available if you really cannot afford to pay. Contact me if you'd like to learn more about resources in Toronto. 

4.     Types of therapies/ expertise - some therapies have more evidence supporting them (e.g. cognitive behavioural therapy); however, it is important that you are on board with the type of therapy. 

 

In addition to these, I would urge you to consider your openness and readiness to change, and where you are on your journey. Psychotherapy is a beautiful process of reflection, introspection, exploration, and healing, and it can also be terrifying, can open up wounds that you worked so hard to cover up, and things might seem like they get worse before they get better. You might realize you aren't fully ready to delve fully into some things. You might go for some sessions, take a break as you allow some of the insights to incubate, and then return when you are ready. There is no normal -- you decide your path. 

1. What can I expect in my first counselling session? 

An intake session of 65-minutes can be booked. Typically, each therapy session lasts 50 minutes. I review any paperwork that is required, and share with you the limits of confidentiality, as well as my cancellation policy. If you have any questions, I also allow time for this, as I want you to be fully informed along the process. I typically give you a head's up 10 minutes before we finish in case there is anything you wanted to discuss that we haven't had a chance to.

During our first session (or even first few sessions), it is an opportunity to learn more about you (i.e. about your life, people in your life, any relevant information pertaining to your mental health, informed by a biopsychosocial assessment). I like to hear a bit more about why you are interested in counselling, and to share a bit about my approach. It is a chance for both of us to gauge our rapport, our trust in each other, and our connection. Having a good relationship with your therapist is so important to the work you'll do in therapy, so the first few sessions, I like to get to know who you are outside just your mental health.  

Sometimes, we might collaboratively decide on one thing you might try to do differently, or something you'd like to try before our next session. Other times, it might be just an experiment or challenge we decide on together in order to gauge its usefulness for you. So, towards the end of the session, you might have a take-away from the first session, other times, it might be a few sessions before we decide on any action item. 

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My cancellation policy requires at least 24 hours to cancel your session. If it is later than that, I do require full payment for the session. Payments, scheduling and reminders are all done through an online software called Jane, and abides by the Canadian privacy laws (i.e. PHIPA). All servers are in Canada.

Contact me to get a copy of the Informed Consent Form if you would like to read it. If you can print, sign and bring a copy to your first appointment, that is greatly appreciated. 

© 2020 Diviya Lewis, RP