Ellie, I feel weighed down by personal problems. When do I know I need professional help and where do I turn
When you're feeling beyond the usual January blues, get to work on yourself. Sending a question to an advice column can be the kickstart. It helps you define the problems when you write them down. After that, you may need to probe deeper. I recommend this when a person feels overwhelmed by ongoing stress, has difficulty functioning normally or is floundering in a troubled relationship. That's when skilled professionals can provide guidance and experience. Yet, just when your head is muddled, wading through a sea of names and specialties becomes a complicated, confusing ordeal.
Fear not: You're not alone. People need help getting help. The following is a guide to getting past the therapy mystique - how to shop, select/reject, and graduate from professional help.
HOW TO SHOP: Yes, you're the consumer here. Apply those same savvy strategies you use when scouting out a suitable car, a school for your kids, even clothing that matches your style and needs. Once you have a therapist's name in mind from a recommendation or selected from a list:
- Ask about specific training; years of experience; specialty areas such as stress management, marital problems, eating disorders and sexual difficulties; whether therapy is short or long-term; and the fee.
- Anyone can hang out a "counsellor" shingle. But there are differences. Physicians and psychologists are regulated by legislation that also provides for a complaints procedure. Social workers are regulated by their college, other therapists by professional associations. (More details below.)
THE CLICK FACTOR: Chemistry matters, as it does in any relationship. It's especially important in establishing trust with a therapist. After a couple of sessions, if there's no rapport developing, step back to question why. Consider what you are bringing to the table. Are you being open and honest? Therapy isn't a guessing game; no one can help if you don't supply enough information. If you still think the therapist doesn't "get" you, you haven't clicked. You're free to move on.
HOW TO REJECT: Breaking up isn't hard to do ... just say it isn't working. There are many possible reasons:
- Someone may be well-trained, but not be skilled in dealing with your problem. People seeking help for themselves as individuals may also need couples counselling, or a combination of both. If there's no progress or increase in insight over a reasonable time, say so and look elsewhere.
- Right person, wrong approach: Short-term therapy helps in problem-solving with a specific goal in mind. If that's what you want, and all that you can handle in time or cost for now, be upfront about it. Long-term therapy, on the other hand, seeks insights into behaviour patterns that often go back to childhood, and this method can trigger lasting personal change. The choice is yours. Don't stick with a style and goals that feel uncomfortable or don't fit your needs.
HOW TO GRADUATE: There's no diploma marked "cured," no magic formula. At some point, the therapy has given you enough tools and awareness.
- If you've opted for short-term, the therapist helps define your goal at the start and monitors how you're achieving it. The immediate problem either gets solved or you know how to handle it better.
- For personal change, the process can take years - but that doesn't mean you'll need continuous therapy. Even with a long-term approach, you may want or need break periods, or choose to switch to a different therapist at another stage.
- You call it quits when you've changed enough and/or improved your life.
HOW TO FIND: A professional therapist can be referred by your family physician (some do counselling themselves). That's a good entry point, since seeing a doctor first clarifies whether there's a medical problem and medication might be needed. Or seek recommendations from the confidential employee-assistance program at your job, or through community agencies or trusted friends. Yellow Pages listings are under Marriage, Family and Individual Therapists.
- Clinical psychologists hold a doctorate and are certified by their college. See the Ontario Psychological Association, www.psych.on.ca, for confidential referrals, or call 416-961-0069; 1-800-268-0069.
- Psychiatrists hold a general medical degree and specialized training in psychiatry, licensed by the College of Physicians and Surgeons. They can prescribe drugs. They're covered by OHIP and require referral from a family physician. Their waiting lists tend to be very long. See www.cpso.on.ca for a doctor search; call 416-967-2626; 1-800-268-7096, ext.626.
- Practising members of the Ontario Association for Marriage and Family Therapy must have a master's degree plus two years post-master's clinical experience, a minimum of 1,000 supervised counselling hours. See www.oamft.on.ca; 416-364-2627; 1-800-267-2638.
- The Ontario Association of Social Workers has professional members with university degrees in the field; the group offers referrals to therapists/counsellors in your area. See http://www.oasw.org; call 416-923-4848.
- Psychotherapists aren't regulated in Ontario. Members of the Ontario Society of Psychotherapists normally hold a graduate degree and/or have 3,000 hours of clinical experience. See www.psychotherapyontario.com; referral service, 416-923-4050. Psychotherapy involves generating insights through various specialized approaches (ask about these).
- The Ontario Association of Consultants, Counsellors, Psychometrists and Psychotherapists is an umbrella organization including counsellors who are not psychologists or social workers. They must have a graduate degree in a related field and/or specialized training and practical experience under supervision. See http://www.oaccpp.on.ca, call 1-888-622-2779.
- Note: Community agencies also refer to therapists, many of whom charge on a sliding scale geared to affordability.