Psychotherapy: Asking the right questions

Since June 2012, in Quebec, the practice of psychotherapy has been a reserved activity by law. This means that only authorized professionals—psychologists, medical doctors, and professionals holding a psychotherapist’s permit—are allowed to practice it. People practicing or claiming to practice psychotherapy without this authorization can be prosecuted for illegal practice. Psychotherapy is scientifically recognized as an effective treatment.

In passing the law governing this activity, the government’s aim was to better protect the public against persons who do not have the necessary qualifications and who can, unfortunately, cause a great deal of harm. For simplicity, professionals authorized to practice psychotherapy (psychologists, medical doctors, and holders of psychotherapist’s permits) will be referred to as “psychotherapists” in this booklet. By law, psychotherapists cannot refer to themselves with that title alone: they must use a double title such as “nurse psychotherapist”. However, psychologists and medical doctors can practice psychotherapy without using the title psychotherapist.

* Information about the law governing the practice of psychotherapy can be found on the website of the Ordre des psychologues du Québec (OPQ), at www.ordrepsy.qc.ca

WHAT IS PSYCHOTHERAPY?

Psychotherapy is a treatment intended to ease psychological suffering or difficulty. It can be used by anyone—a child, an adolescent, or an adult—who wants to make significant changes in his or her life in order to feel better. It can involve helping the person to make changes in behaviour, emotions, or habits, find answers to his or her questions, make difficult choices, or better understand or cope with a difficult situation.

WHEN SHOULD I CONSULT A PSYCHOTHERAPIST?

Like everyone, you can experience difficult periods or challenges in your life. Often, the support you receive from those close to you—your family, friends, or colleagues—will be enough to help you cope with these difficulties. However, sometimes the situation is complicated enough that their support may not be sufficient. When your feelings of distress do not improve, when you don’t have enough resources in your life to cope, or when your challenges are preventing you from doing your work or living your life, professional help might be necessary.

However, sometimes the situation is complicated enough that their support may not be sufficient. When your feelings of distress do not improve, when you don’t have enough resources in your life to cope, or when your challenges are preventing you from doing your work or living your life, professional help might be necessary.

WHY DO PEOPLE BEGIN PSYCHOTHERAPY?

People begin psychotherapy for many reasons. For example:

• bereavement

• depression

• addictions

• anxiety problems

• a difficult break-up

• a failure at work

• difficulties in their relationships with others

It’s all right not to know exactly why you feel the need to consult a psychotherapist. Your psychologist or psychotherapist will evaluate your situation and your needs before helping you to figure out the most appropriate course to take.

WHAT STATE OF MIND SHOULD I BE IN WHEN STARTING PSYCHOTHERAPY?

Psychotherapy is an active process. You will need to be fairly open to talking about yourself. The psychotherapist is not there to judge you, but to help you understand yourself and find solutions to your difficulties. In psychotherapy, no subject is off limits.

It is very important for you to be at ease with your psychotherapist and to be able to trust him or her. This relationship, which is built up over time, is crucial to getting the most out of your psychotherapy. For this reason, choosing the right psychotherapist is a very important part of the process.

WHO CAN PRACTICE PSYCHOTHERAPY?

Since June 2012, psychotherapy is regulated by law. Only psychologists and medical doctors with the required skills, as well as holders of psychotherapist’s permits, are legally permitted to practice psychotherapy. The psychotherapist’s permit is granted by the Ordre des psychologues du Québec. It is only available to professionals whose training and skills meet stringent requirements established by law. Psychotherapists include members of certain professional orders (psychologists, medical doctors, nurses, social workers, marriage and family therapists, guidance counsellors, psychoeducators, and occupational therapists), and others who were already practicing psychotherapy when the law came into force and whose skills have been recognized.

No one may use the title of psychotherapist alone; the law requires a double title made up of the person’s professional title followed by “psychotherapist”. For example, a person could be a “social worker-psychotherapist” or a “guidance counsellor psychotherapist”.

To find out whether a person is authorized to practice psychotherapy, please consult the Directory – Psychotherapy on the website of the Ordre des psychologues du Québec.

WHAT HAPPENS IN PSYCHOTHERAPY?

INITIAL ASSESSMENT The first step in the process is the initial assessment, a very important step which allows you and the psychotherapist to identify: • your needs • your expectations regarding psychotherapy • your strengths and difficulties • the nature and origin of the problem • what has happened in your life to lead you to consult • your goals for psychotherapy The assessment meeting will also allow you to find out more about the psychotherapist’s approach and to make sure you feel comfortable with both the psychotherapist and his or her approach. Do not hesitate to ask the psychotherapist any and all questions you may have.

This is the time to ask the psychotherapist about his or her:

• training

• theoretical approach and preferred strategies for intervention

• way of working with clients

• availability

• fees

IN-DEPTH EVALUATION

After this assessment meeting, the psychotherapist may decide that the nature of the problem requires a more in-depth evaluation or a psychological diagnosis. In that case, he or she may refer you to an appropriate professional for this purpose.

CONSULTATION SESSIONS

Treatment involves interview-style meetings between you and your psychotherapist. These sessions, which may last 45 to 50 minutes, happen on a schedule agreed on by your psychotherapist and you—most often on a weekly basis.

WHAT ARE THE THEORETICAL APPROACHES AND WHICH ONE SHOULD I CHOOSE?

There are several theoretical approaches—also called theoretical orientations or models—in psychotherapy. Most psychotherapists use more than one approach, or techniques drawn from different approaches. Do not hesitate to ask psychotherapists about the way they work with clients and make sure that it suits you. During the initial assessment, the psychotherapist may refer you to a colleague who uses a different theoretical approach, if this is more in line with what you are looking for. To illustrate the various approaches, we’ll use an example case and review four of the main modalities.

Julie is depressed. She has been suffering from insomnia for more than a month. She argues with her boyfriend every day. She hasn’t felt like seeing her friends and has lost interest in her usual activities. Julie is tired of feeling this way and has decided to begin psychotherapy.

COGNITIVE-BEHAVIOURAL APPROACH

In this approach, psychological difficulties are related to unhelpful thoughts and behaviours. In psychotherapy, cognitive-behavioural psychotherapists use various techniques and strategies to help their clients to modify their behaviours, thoughts, and emotions.

What behaviours and thoughts is Julie finding troublesome? What is making her feel bad? A cognitive-behavioural psychotherapist will work with her on her behaviours, habits, and thoughts, and will suggest strategies to help her live a more happy life.

EXISTENTIAL-HUMANIST APPROACH

According to the existential-humanist approach, human beings have within themselves what they need to realize their potential. Humanist psychotherapists work on the present moment, on their clients’ ability to take stock of their current difficulties, understand them, and change their ways of being or acting. They help their clients believe in their own potential and make changes in their own lives.

How does Julie feel today, right now? What does Julie think is the reason she is having these feelings? How can she cope with them? An existential-humanist psychotherapist will help Julie find meaning in her emotions and develop her own solutions.

PSYCHODYNAMIC-ANALYTICAL APPROACH

Strongly influenced by psychoanalysis and the concept of the unconscious, this approach draws connections between clients’ present difficulties, their past experiences, and repressed and unresolved conflicts in their personal histories. Clients are led over time to become aware of the influence of these conflicts on their current functioning, in order to understand them and gradually break free of their influence.

What is disturbing Julie so much? Has a recent event brought up painful memories? A psychodynamic- analytical psychotherapist will try to understand Julie’s life story, her past conflicts, her fears and traumas, and how they have shaped her perception of herself and her life. By becoming aware of her past, Julie will be able to gain some distance from the situation, to better understand it and be able to make choices.

SYSTEMIC-INTERACTIONAL APPROACH

In this approach, personal problems are thought of as arising and continuing as a result of the interactions between people and those around them (family, friends, colleagues, etc.). The goal of systemic-interactional therapy is to modify the relationships between clients and those in their lives. Often, this will involve meetings between the psychotherapist and important people in the client’s life.

Among the people in Julie’s life, who is influencing her so much? How might Julie’s relationships with others be harmful for her? A systemic-interactional psychotherapist will analyze Julie’s relationships and the methods of communication and systems that have arisen between her and the people in her life.

HOW LONG DOES PSYCHOTHERAPY TAKE?

The length of a psychotherapeutic treatment can vary depending, among others, on the nature of the problem you are consulting for and the goals that you and your psychotherapist have set together. It is important to remember that making major changes in your life can take time. The psychotherapeutic treatment might last anywhere from a few weeks to several months.

CAN PSYCHOTHERAPY BE ACCOMPANIED BY MEDICATION?

Psychotherapy is a treatment in itself. In certain cases, it can be advisable to use more than one treatment at once. In such situations, your psychotherapist may recommend that you undergo a medical examination. It will be your doctor who decides with you whether to supplement your psychotherapy with medication. If you are having psychotherapy and using medication at the same time, it would be in your best interests for your psychotherapist and doctor to work together.

HOW MUCH DOES PSYCHOTHERAPY COST?

The cost of psychotherapy varies from one psychotherapist to another. Each authorized professional practicing in a private office is responsible for setting his or her own fees. These are generally charged per 45- or 50-minute session, and you should expect to pay about $180 to $220 per session in and around greater areas of Montreal. Ask your professional about his or her fees and feel free to ask any questions you may have about fees or other modalities.

CAN PSYCHOTHERAPY SERVICES BE COVERED BY INSURANCE?

Certain private or group insurance policies reimburse the cost of psychotherapy in whole or in part. To find out whether your insurance policy covers these fees, contact your insurance provider. In many cases, fees for psychotherapy may be tax deductible, as they are considered fees for health services.

FREE PSYCHOTHERAPY SERVICES AVAILABLE?

It is possible to see a psychotherapist in the public health or education system, in particular through CLSCs, hospitals, and primary or secondary schools. These services are free of charge. However, the public system’s resources are in heavy demand, and as a result, there is usually a long waiting list. There are also community resources that can offer free or low-cost psychotherapy services for low-income people. Your local CLSC can give you more information.

WHEN AND HOW CAN I FILE A COMPLAINT?

Psychotherapy is regulated by law, and professionals licensed to practice it have a code of ethics that they are required to comply with. If you are dissatisfied with the behaviour or services of your psychotherapist, or if you believe you have suffered inappropriate conduct on his or her part, you can report it to his or her professional order. If your psychotherapist is not a member of another professional order, you should contact the Syndic’s Office of the Ordre des psychologues du Québec.

The Syndic’s Office is also in charge of investigating cases of illegal practice of psychotherapy. For more information about psychotherapy, please see the Ordre des psychologues du Québec website at www.ordrepsy.qc.ca.

HOW TO CHOOSE A PSYCHOTHERAPIST?

If a particular psychotherapist is recommended to you, start by checking that he or she is authorized to practice by consulting the Directory – Psychotherapists on the Ordre des psychologues du Québec website.

At all times, you can contact the Ordre des psychologues to check whether a psychotherapist has been disciplined by the disciplinary council of his or her professional order. If you want to consult a psychotherapist in private practice, you can use the Ordre des psychologues’ referral service to search by region and other criteria such as the reason for consultation, theoretical approach, and the psychotherapist’s gender.

Visit Trouver de l'aide - Ordre des psychologues du Québec or phone 514-738 -1881 or 1-800-561 -1881 toll-free.

Do not hesitate to contact multiple psychotherapists in order to choose one you feel comfortable with.

Reference article: get_file