What is the difference between a psychotherapist, a psychologist and a psychiatrist?
A Psychiatrist is a medical doctor (MD) specializing in psychiatry (the study of abnormal behaviour and mental illness) who is licensed to prescribe medication (psychopharmacology therapies) for medical disorders of varying magnitudes. As medical doctors first and foremost, it is understandable that the majority of psychiatrists will closely adhere to the medical model that proposes the usefulness of thinking in terms of abnormal behaviour as a disease, which is a significant progress from pre-18th century conceptions that were based on superstition - possession, demons, witches and punishments from God.
In recent decades, some critics have suggested that the medical model may have outlived it’s usefulness, since strictly speaking, disease or illness can affect only the body, hence minds can only be sick in the way that some jokes are “sick” or economies are “sick”. Abnormal behaviour may be considered as a deviation from social or cultural norms rather than an illness, and therefore “problems with living” rather than medical problems, are more aligned to psychotherapy than medical treatments.
With the increased emphasis on the treatment or psychological disorders using drug therapies, fewer and fewer psychiatrists are providing psychotherapy services as a “talking” alternative, but they are covered under OHIP, so you might find a very high demand for their services and you may possibly experience quite a long wait. They are unlikely to be available outside of regular office hours and you will need to be referred to a psychiatrist accepting new patients by your family doctor or have your name on a waiting list with a psychiatry association for a referral to one of their available members.
A Psychologist is someone that applies psychological research, theories and techniques to mental health issues, psychology being the study of human behaviour. Psychologists are not licensed to prescribe medication as an alternative to psychoanalytical cures, but they are licensed to administer psychological assessments and diagnose various psychological conditions. Because of the strong emphasis on the medical model in psychology studies, you may find a great number of psychologists have a tendency to work and think in terms of diagnostic labels and treatment plans, but certainly not all psychologists, particularly those with a relational bias to their training and client work. Many do engage in insight therapies which involve verbal interactions or talking cures.
You may need a medical referral to justify the services to your health provider, but you are free to seek out a psychologist that provides the services you need, be it family therapy, couples counselling or individual “talk” therapy. Psychologists also operate during regular office hours but are covered by most health plans. Depending on your extended health plan, you may be limited in how much money you can spend on seeing a psychologist, which may limit the number of times that you are able to afford psychotherapy from a psychologist.
A Psychotherapist specializes in providing psychotherapy services, psychotherapy meaning the treatment of the “psyche” or mind. Psychotherapists do not typically take the stance that they have all the answers as to what is “wrong with you”, but are more likely to help you explore your thoughts and feelings about your life and your situation. The training to conduct psychotherapy is distinctly different than the academic study of psychological research methods. Psychotherapy training typically requires psychotherapy students to serve an internship or practicum placement in order to learn and hone the necessary skills of a therapist, whilst under the direct supervision of a qualified psychotherapist, trained to supervise trainees.
You do not need a referral to schedule an appointment with any psychotherapist you choose, simply make the call and take it from there. Psychotherapists are covered by some health plans, but even if your plan only covers psychologists for psychotherapy you will find psychotherapists generally more cost effective for therapy lasting more than 4 or 5 sessions. The reason that most psychotherapists are more affordable is due to their lower fee structure as the provider of psychotherapy rather than the prescriber of psychotherapy. Dedicated psychotherapists are far more likely to offer appointments outside of regular office hours because they work directly for you and not for OHIP, some even work on weekends.
Who uses the services of a Psychotherapist?
People from every culture and all walks of life are increasingly seeking the services of psychotherapists these days for many different reasons. A great many psychotherapy clients are generally fairly well functioning individuals and couples looking to work through everyday issues or come to terms with events from their past, sometimes referred to as the “worried well”. We can all benefit from someone to talk to about what troubles us, however, talking to even your closest friend cannot be expected to achieve the same outcome as engaging in a therapeutic relationship with a trained professional.
Psychotherapist are often trained to work with a wide spectrum of human issues, ranging from general dissatisfaction with their life experience and mild anxiety to more significant depression, existential issues and suicidal thoughts. You might just want to explore your life experience and engage in a personal growth process of self-reflection that can lead to increased self-knowledge, self-competency and self-esteem, all hallmarks of a well rounded individual and all well worth pursuing. The bottom line is, if you are thinking about beginning therapy, you do not need to justify your reasons to a health plan official or a government health system representative. You just need to want to benefit from therapy.
How will the upcoming legislation of psychotherapy impact choosing a therapist?
There has been a global trend in the last decade, to recognize the practice of psychotherapy as a distinct profession. The Ontario College of Registered Psychotherapists and Mental Health Therapists is currently under formation and will soon be responsible for the legislation of our industry, which will raise public awareness of the various options available and make it much easier for people to find registered health professionals (we will be listed on the college’s database for all to access). Just like other legislated services such as massage therapy, the use of recognized designations (registered massage therapists are known as RMT’s, registered psychotherapist will be designated RP’s) will make it much easier for everyone to find a qualified therapist that meets industry standards of training, experience and competency.
Psychotherapy regulation will ensure ethical practice, and also provide a great deal of protection and comfort for anyone seeking legitimate therapeutic services. Until our regulatory body is fully functional, as a consumer of professional mental health services, I firmly believe that you have the right to verify whether anyone that you are considering as a therapist or couples therapist, was, during their professional training, required to participate in their own personal therapeutic process with a suitable psychotherapist, psychologist, psychoanalyst or psychiatrist, and also, whether they currently participate in ongoing supervision of their work.
The best advice that I can give you is to choose someone with good standing and current membership in a professional psychotherapy association (like CAPT, IASP, OSP etc) that you feel comfortable developing a therapeutic relationship with. If your therapist is certified in their field, they will be able to gain entry to a professional association that requires ongoing development. This usually ensures that they will have a reasonable amount of experience to drawer upon and are able to create a safe environment for you. Chances are, if you feel challenged by the depth of therapy you are engaged in, you are probably being provided with enough of a challenge for true personal growth.
How do I find the right therapist for me?
Unless money is not an issue for you, it does not make sense to pay a professional engineer to add a little air to your tires or to enlist the services of a jet engine designer to adjust your spark plugs. The point is, you may not need an expert psychological evaluation to know if you are feeling a little deflated lately, or to understand that you could benefit from more vitality and energy. The first step is to simply recognize that you want to benefit from therapy. The next step is to seek the level of help that makes sense to you.
The therapeutic triad of therapist, method of treatment and you are all factors that will determine the magnitude of any “successful” therapy, or at the very least, have a significant impact over the likelihood of a beneficial outcome from therapy. With each of these factors having such a large influence, choosing a therapy and a therapist that would help make you as comfortable as possible, to engage as effectively as possible, would be a wise way to cater to your third of the equation, while at the same time exercising as much control as you can over the other two thirds of the triad.
Unlike psychiatrists and many other doctors who may practice psychotherapy, I don’t diagnose what is “wrong” with you and I do not prescribe pharmaceutical “solutions”. You may find that a trained ear and attentive, empathic engagement in your process, can make all the difference between expert medical advice and authentic caring understanding.
I cannot guarantee that I am the right therapist for you or your relationship, but I invite you to make that decision for yourself during a free introductory meeting.
Do all psychotherapists provide the same psychotherapy services?
There are many different forms of psychotherapy available from graduates of a variety of psychotherapy schools. Each school of psychotherapy (e.g., Relational, Gestalt, Cognitive Behavioural, Freudian to name just a few), has their own theories, practice and expertise, ranging from short-term cognitive behavioural modification to longer-term insight or emotionally oriented psychoanalytic therapy.
There truly is a therapy to suit everyone, whether that be insight based, outcome based, energy based or art based, whatever interests you to pursue, with a little research you will be able to locate a competent therapist who can provide you with exactly what you are looking for. If you are not sure what type of therapy would best suit you, your family doctor may be able to advise you, but your best bet will probably be to have a chat with a few therapists that stand out for you and simply get a feel for what it might be like to meet them each week in therapy.
How does psychotherapy help?
That is such a difficult question to answer since what works for one person may not work for another. There are literally hundreds of psychotherapeutic treatment approaches, that can be loosely categorized into one of 3 main categories:
- Biomedical therapies (medication, clinical procedures)
- Behavioural therapies (CBT, hypnotherapy)
- Insight therapies (psychodynamic, psychoanalysis)
Broadly speaking, the most important factor in any successful therapy has always been shown to be the emotional climate in which therapy takes place. Critical elements being the genuineness, regard and empathy of the therapist. As a relationally trained therapist, these are the most important areas of my training, over and above assessment and diagnosis. I do utilize two of the three therapeutic methods of “treatment” (insight and behaviour) although for me, the person is always at the forefront in therapy, not a psychological label or medical condition.
Insight oriented therapies can be used to benefit people for a variety of purposes but are especially useful in addressing 3 main areas of concern:
- Problems rooted in unconscious conflicts left over from childhood
- Problems rooted in inaccurate self-concept and excessive concern about pleasing others
- Problems rooted in inadequate attention paid to one’s strengths, blessings and positive experiences
Behavioural oriented therapies (like hypnosis and stress counselling) can be used to benefit those looking to modify their behaviour. Hypnosis is often used as a behaviour therapy, utilizing the application of learning principles in or out of a trance state to change maladaptive behaviour. It is particularly useful in the desensitizing of fears and phobias as well as the treatment of various other habits, through conditioning new habits of behaviour and counterconditioning (or habit breaking) of maladaptive habits like smoking or over-eating.
For certain situations, I believe in a multi-modal approach, covering all bases. The combination of all 3 therapeutic treatments I’m sure has it’s place, however, you will need to see your psychopharmacologists if you feel that the use of medication would assist you in managing symptoms while you are working to resolve the source of those symptoms, as I am qualified to help you achieve insight and assist you to make behavioural changes, not to prescribe medication.
How effective is psychodynamic / insight therapy?
Psychodynamic therapies repeatedly prove to be as effective as drug therapies, although they work on different timelines. Drugs may have a more immediate impact, by reducing or masking symptoms considerably and quickly, however they are mainly intended to be used as short-term coping strategies since, they do very little to resolve the origins of symptoms (unless your depression is a purely a chemical anomaly rather than the result of some life experiences that have resulted in a reduction in the production of seretonin). Psychodynamic therapies offer the possibility of working more effectively on the roots of your dissatisfaction, something far more long lasting and far reaching.
A major Canadian clinical research program broadly studying the effectiveness of therapies that has been widely publicized, performed a meta-analysis of the 3 main therapy types and has successfully compared them using statistical data gleaned from a great number of therapy participants. The analysis of each type of therapy when used for depression and anxiety, resulted in a number indicating its’s effectiveness. Results to the magnitude of 0.2 being small effectivity, 0.5 = moderate and 0.8 = large effectivity. The effectivity magnitudes showed 0.31 for biomedical therapies, 0.68 for cognitive-behavioural therapies and 0.97 for insight therapies. The results for the effectivity of insight therapies continued to improve after treatment, with results in the magnitude of 1.51 nine months after treatment end! There have been many similar studies conducted, each showing similar effectivity ratios between modalities.
How long does therapy last?
Another incredibly difficult question to answer with any accuracy, since everyone is so unique, the reasons that people seek therapy are so specific, every therapist is also unique and each therapeutic relationship is individually flavoured by all these ingredients and more. The benefits of therapy can last a lifetime.
A rule of thumb (if such a thing exists) is to consider the reason that you are considering entering therapy - how long has this reason existed, to what degree has it impacted your life, what else have you tried, has anything else helped? To avoid disappointment and discouragement, it may be a good idea not to expect miracles or drastic improvements immediately, though not to rule out the possibility of either!
Many people begin therapy, focusing on a specific area of their life, often finding it so useful that they soon turn their attention to other areas of their lives that could also benefit from the trust, safety and understanding already developed with their therapist. Building a real relationship with your therapist is really the first step in any therapy. If the foundational therapeutic relationship is secure, you will be able to trust me to provide a familiar reference point for many of your life experiences and come to consider our time together as a safe base from which to explore and continue to grow.
Some people experience profound changes almost immediately that they find someone who will really listen to them and work hard to understand every nuance of the way they feel. A few people enter therapy with somewhat unrealistic expectations of how quickly they will begin to feel the benefits of therapy or find that the process is not immediate enough to meet the urgency of their situation. Sometimes they may not have found the right therapist for them, other times the type of therapy they are engaged in might not be the best fit for them. Often it is just a matter of time before being able to settle into therapy and begin the therapeutic process.
Statistically speaking, a clinical study correlating the treatment and recovery of over 6000 patients, found that 50% of patients experienced significant improvements after only 20 sessions of therapy. 70% felt improvements after 45 sessions and a good 30% improved in less than 10 sessions. Obviously, with a research population of 6000 people, they would all have experienced varying differences between therapy methods, their chosen therapist, their motivation to fully engage in the therapeutic process and a myriad host of other unique qualities that cannot be identically cloned or duplicated and “administered” 6000 times.
If you have found a qualified therapist that you like, you may find it useful to commit to a certain number of sessions (10 for example) and assess your degree of satisfaction and the usefulness of their modality of psychotherapy when you have given the therapeutic relationship a chance to deepen a little. Once you are truly “swimming” in therapy, you may look back to realize that any hesitations you had whilst “paddling” in those first sessions, were simply understandable self-protective measures aimed at avoiding the unknown or getting in too deep before you felt held securely enough to let the safety of the beach out of your sights for an hour.
What is relational therapy?
Relational therapy evolved from the scientific discipline of insight therapy, once practiced only by an elite stream of medical experts. This modern form of psychodynamic therapy has dispensed with much of the formality once associated with cold, blank analysts, almost devoid of personalities. Relational therapists are real people who genuinely care about the work they do, and in particular, the people that they choose to work with.
Relational Psychotherapy has its focus softly placed on the relational field that is shared in any interactive exchange, in particular the relationships that are influencing your thoughts and feelings about yourself today. Interpersonal experiences are at the core of real life and an interpersonal interaction is at the foundation of real therapy, not an impersonal observation or a dehumanizing diagnosis, but maybe that is just my subjective opinion.
Your life thus far has been moulded through interpersonal situations. Based on the feedback that you begin receiving as a baby, your self-image, self-esteem and self-worth is heavily influenced throughout life by others. Things work out pretty well when people grow up in ideal homes, are loved unconditionally and learn repeatedly that they are wonderful. Unfortunately, this ideal occurs to only a minority of human beings, with many who grow up to inflict their bad self image on others, possibly you.
The way you feel is often distorted by the only sense that you are able to make of the way that you experience relational interactions. So if you are repeatedly told that you are worthless or that you do not deserve to be treated any better, chances are, without a great support system, you are going to end up believing that. How you see yourself in relation to others in the world we share, is sadly open to the only interpretation that you are able to make, which may often be distorted by the relational “mirrors” that are available to you.
As a relational therapist, I am attentive to influences that others may have had on your self-image and can help you uncover the many ways that you have taken on the projected images of others. Just because others think it, doesn’t make it right, after all, it is what you believe that really counts in your life.
How is therapy psychodynamic?
Psychodynamic therapy is based on the theory that the human mind is an active agent, not locked into knowing and not knowing, but open to transforming within relationships or being changed through experiences. To illustrate this, consider for a moment the first phone number you once had in your life, the name of the child that sat next to you in grade one, or maybe the name of your grade one teacher? If you are drawing a blank to any of these once important pieces of information, does that mean that it is not possible to realize or retrieve them? Sometimes it takes an event or a discussion to trigger a memory of this nature, for example, bumping into the brother or sister of that child from first grade, stumbling across a similar number that suddenly reminds you of your first phone number, or being inspired or scolded by someone that brings about a familiar sensation in your body that brings that teacher’s name flooding back to you without even trying.
Your unconscious mind surfaces in your dreams, often in bizarre and confusing ways. You may have no idea what your dreams mean all the time, or ever, however, they are your dreams and you dreamt them. Freud referred to dreams as the “Royal Road to the Unconscious” since they are literally littered with clues that can frequently be followed to profound understandings of your deeply held beliefs and unguarded feelings about your past present and future. With a little help, even conflicting, confusing thoughts and feelings you might experience while you are awake, can be explored for deeper meanings and possible understanding.
One understanding opening a doorway to another, deeper understanding, each in turn opening up deeper and deeper levels of unconscious knowing, previously kept from you by many levels of cognitive defence. Since you unconsciously disguise meanings in your own dreams, insight work is not something that is typically open to self-reflection, to do this work, you are going to need the help of a qualified, psychodynamic psychotherapist.