Online therapist and ACoA counsellor answers FAQ

Beth Mares Registered Psychotherapist (Ontario) serves English Canada.

Adult children of alcoholics counselling--young woman who lives in Northern Ontario is doing her online therapy session.

 

Does distance therapy work well for adult children of alcoholics issues? In my experience, yes. There are some contraindications for online therapy, though, whether for ACA issues or something else. See online therapy.



Is it true that some people do their therapy in half a dozen sessions? If so, why do people do long term psychotherapy? Some people can indeed do what they need and want to do in six sessions or less. In most cases this is a matter of solving a specific problem and/or getting back on track. Usually a long-standing problem takes longer than that, but in some cases it can still be settled in short term psychotherapy (under 20 sessions). Some people solve their initial problem in a few sessions but then decide to spend more time to resolve some others, or come back for another problem at another time.
Some people decide to do long term psychotherapy. Some of these are overcoming chronic depression and/or the effects of childhood trauma so that they can lead a normal life. Others, typically highly educated and relatively privileged, are investing in personal growth and wisdom for the sake of a richer and more fulfilling life, and/or to enable them to cope with a very challenging leadership role. For many people long term therapy produces a substantial net financial gain, most often by increasing earning power, improving physical health, or making a functioning marriage possible.

Is it O.K. to pick a therapist out of the phone book, or are some much better than others? Some are much better than others. Also, some might be great for some issues or some types of clients but not necessarily for you.

How do I know whether I should be looking for a psychotherapist, a psychiatrist, a psychologist, a social worker, or what? If schizophrenia or brain damage is suspected, the person needs to be diagnosed by a psychiatrist. It might be best to go to a psychiatric facility such as the Centre for Addiction and Mental Health (Clarke Institute of Psychiatry). A condition requiring medication that is too complicated for the family doctor also requires a psychiatrist, but in most cases the psychiatrist will not do the psychotherapy. For psychotherapy a psychotherapist is often the best choice, though a psychiatrist might do great psychotherapy, if you can find one, and so might a psychologist, if you can afford one. If you need to do deep work your best bet is someone with an analytical training, which you are most likely to find in a psychotherapist. (In Toronto there are some psychiatrists who are analysts, but of course the demand vastly exceeds the supply.) A social worker with an MSW in counseling is an option if you require counselling only, and is the professional of choice when what you mainly need is information about resources to help with non-psychological problems that are causing stress (e.g., caring for a chronically ill family member). Some social workers are also trained in psychotherapy.


Is it true that long term therapy can make the problem worse by making the person dependent?
Good psychotherapy is empowering, though it might initially disconcert a Rock of Gibraltar type by getting him in touch with his need for emotional support. Long term therapy may also pass through a stage in which the client develops a dependent transference, which he subsequently works through. This is a difficult procedure that should only be attempted by a therapist who has an in-depth training for it. Needless to say, the client also needs to be prepared to stay till the transference is worked through. Some ineffective "therapy" or "counselling" can create and perpetuate dependency. Eric Berne, author of Games People Play, commented (some years ago) that some social work schools seemed to be teaching their students how to "play" a "game" that kept the clients stuck and disempowered. Sometimes also an inadequately trained therapist will unconsciously foster dependency for his own gratification. Someone who has doubts about whether his long term therapy is working should seek a second opinion from a suitably qualified therapist.


Is it O.K. to use a referral service? I have heard that they are pyramid franchises in which counsellors get referrals by paying money.  Some are, even though accepting money for referrals (even indirectly) is generally considered unethical among health professionals, and is banned by colleges such as the College of Physicians and Surgeons of Ontario. Referrals ought to be made because the referrer believes that the therapist is the best for the client. Referral services operated by professional organizations for their members or by psychotherapy schools for their graduates should be fine. However, a website can be designed to give the impression that it belongs to an organization when it is really a commercial enterprise that therapists pay to be on; so check carefully that it is a real professional organization.


Do you get what you pay for? I have heard that therapists in the private sector are better.
There are excellent people in the public sector, but there is heavy demand for them; thus it is much easier to get an excellent therapist in the private sector.


I have tried everything, and nothing has worked. I wonder if you have tried everything except staying with something long enough for it to work. For some people it can take quite a long time to see a big improvement, so for those people it can be hard to tell if they or on the right track. I suggest you get a detailed assessment.


Is it best to work with a psychotherapist who specializes in the particular problem you have?
 It depends. You want a therapist who works successfully with your presenting problem and who is also likely to be able to work with whatever else turns up. Psychological and life problems come in all combinations, which is why the more experienced therapists can cover a wider range. I started off my private practice specializing in depression, childhood trauma, and adult children of alcoholics issues. Before long I found myself dealing with a wide range of issues. Problems that look similar can have very different causes and underlying dynamics. A counsellor who can only do one thing is likely to be working by formula at a superficial level. Few people fit a formula. However if, as sometimes happens with psychiatrists, the practitioner is a competent psychotherapist and then chooses a specialty, that is fine, and could be better for rare problems that generalists might not have experience with.


In your experience, have you found that depression can be overcome through psychotherapy without medication?
Often, though medication may sometimes reduce suffering and speed up the process. However, if the person is manic or has severe vegetative symptoms of depression he will probably not be in a fit state to do psychotherapy without medication. It is also worth noting, especially for older people, that depression can be caused by the effects of some medications and some illnesses on the body chemistry. Lack of physical activity or low levels of light in Canadian winters can also cause or contribute to depression. Physical problems like these need to be corrected by physical methods.


Why do psychotherapists charge for the session when the client is unable to give 24 hours notice?
 
This is to provide an adequate income for the therapist while keeping the basic cost of sessions to a minimum. Twenty-four hours gives the therapist an opportunity to offer the appointment to someone else. This system is traditional among health care professionals, though some massage therapists and others who are not very busy accept shorter cancellations, and some family doctors handle the matter by overbooking--not an option when appointments are for an hour.

It is important for a psychotherapist to be consistent and objective in carrying out his cancellation policy. If he gets involved in judging how good the client's reason is etc. he could make himself into an Authority Figure, which may upset the balance of power in the relationship and disrupt the therapy. (The client may imagine the therapist to be larger than life, but that is different from the therapist buying into it.) Furthermore, it is best if the client feels free to base his attendance on his own needs and does not confuse the issue with feeling guilty or worrying about the therapist's income.



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Beth Mares Counselling