This section contains important information about my practice, as well as my professional services and business policies, including limits of confidentiality. Please read carefully.
What is psychodynamic psychotherapy?
People often come to therapy with concerns about one or more aspects of their lives, or with feelings of unhappiness or dissatisfaction. Psychotherapists are trained to work with you on a variety of difficulties, including depression, anxiety, low self-esteem, substance abuse, trauma, existential issues, grief and loss, problems in your relationships, family troubles, to name a few.
Psychodynamic therapy, also known as insight-oriented or talk-therapy, helps people understand how their present behaviours and mood are affected by unresolved issues and unconscious feelings. Therapy is a way to explore such thoughts, sensations, feelings and ways of relating that might be outside of our awareness, and that contribute to the difficulties we currently face. One of the main goals of psychodynamic therapy is to build self-awareness.
The initial consultation.
The first meeting is an opportunity to get to know one another, discuss how we might work together and to answer any questions you might have. I will be asking personal questions about you for the purpose of identifying areas for therapeutic growth. Don’t worry if you don’t have a concise answer, part of the work in therapy is to explore this very question. Try not to censor yourself for fear of judgment or appearing impolite. There is no right or wrong way to do therapy. Being a ‘good client’ doesn’t mean being on your very best behaviour, it means being the most genuine version of yourself.
Psychotherapy requires you to be comfortable with your therapist. Finding a “good fit” in therapy is essential. Choose to work with a therapist who you feel ‘gets you’, is working alongside you, and you feel a sense of ease with. The level of comfort you feel is important at the initial consultation. If you don’t feel comfortable, it’s perfectly fine to seek out another professional.
Therapy is the forming of an alliance to bring about change in your life. A good therapeutic alliance tends to be fostered by the therapist being warm, understanding and empathetic. It also helps if they have experience, confidence, training and qualifications, and trustworthiness. Without this connection, you may not feel comfortable talking openly about difficult issues.
How does therapy work?
We work together over a series of one-on-one sessions. You are encouraged to speak freely about anything that comes to mind, including current issues, fears, desires, dreams and fantasies. Through a psychodynamic approach we begin to examine unresolved conflicts or symptoms that arise from past relationships and how they manifest themselves in the present. I listen with the intent to understand and explore your concerns by using one or a combination of therapeutic approaches. These approaches will vary depending on your needs.
When it comes to your symptoms, setting realistic goals and objectives, specific to your needs can make psychotherapy a positive experience. Change does not happen overnight. Nor does the development of self awareness and insight. Hardest of all is replacing old behaviours with new ones. As time progresses, we review these targeted goals and redefine them if necessary.
Therapy is not about advice giving. We explore issues together so you can make the most informed decision yourself. The job of a psychotherapist is to help you help yourself. Advice-giving creates dependency, whereas helping you discover your patterns that keep you stuck or undermine your well-being creates self-awareness.
The goal of psychotherapy is to empower you with ways to deal with life issues, learn the triggers, and build resiliency, so you can find well-being. Overtime, new perspectives can emerge, leading to the opportunity for long-term change, building one’s self-awareness and understanding of the influence of the past on present behaviour.
The most important aspect of effective therapy requires the client and the therapist to work collaboratively. The felt bond between therapist and client, or “alliance”, means that the therapist is not more powerful or privileged, and that it takes work on both sides to make progress. It’s important that you do the work outside your sessions. Keep a journal, reflect on your last session, prepare for your next one, and pay attention to your thoughts and feelings throughout the week. You’ll have much more material for your sessions, and you’ll find that you are applying the work to your everyday life.
It is a privilege to share this journey with you. Therapy is like taking a course where you are the topic. Therapy can be an amazing, transformative process toward living a conscious life.
I work from a feedback Informed approach.
Feel free to give feedback, express your needs, and ask questions. For instance, this may involve telling me what you’d like to discuss during a session, informing me that a certain appointment time doesn’t work for you or asking me for clarification. Talk about any issues you have with me, your therapist. Gaining feedback will help us to engage in the collaborative process together and keeps the therapy moving forward in a meaningful way.
Guidelines for moving towards termination.
The appropriate length of the termination depends on the length and intensity of the treatment and when the problems for which you entered into therapy have become more manageable or are resolved. As the client you have the right to terminate therapy at your discretion. Ending relationships can be a difficult process. It is important to discuss termination in order to achieve some closure, this may be done at least 2-3 sessions prior to the final session.
You will likely have many emotions to work through and time should be spent acknowledging and processing them. The final stage of psychotherapy can be characterized by a sense of accomplishment, pride, calmness, and health for both psychotherapist and client. It may also bring up feelings of unresolved loss or resistance about having to end the relationship you have worked so hard to establish. Open discussions about your reactions to termination and your feelings about the therapeutic relationship are an important stage. This also provides us with an opportunity to review the progress that we have made and to review the tools and skills that you have acquired during our sessions. These tools will be critical in helping you be self-sufficient in handling problems that might have previously brought you to therapy.
If therapy is terminated for any reason or you request another therapist, I will provide you with a list of qualified psychotherapists. You may also choose someone on your own or from another referral source.
If I determine that the psychotherapy is not being effectively used or if you are in default on payment I may terminate treatment after appropriate discussion with you. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. Should you fail to schedule an appointment for four consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.
What are the risks and benefits of therapy?
“Risk - the possibility of failure or loss - cannot be avoided if the possibility of success is to have any meaning. There are risks of emotion that involve honestly and spontaneously expressing feelings, admitting fear, or professing love. There are risks of growth in giving up control, in being yourself, or in trying something that has never been attempted before. There are risks of intimacy in working through vulnerability, jealousy and trust. There are risks of autonomy in cutting off dependencies and being more responsible. And there are risks of change that involve breaking old rules, patterns, habits, and moving into the work of the unknown.”
- Jeffrey A. Kottler, Professor Emeritus, Psychotherapist, Educator and Author
Participating in therapy can result in a number of benefits to you, including a deeper understanding of yourself and your personal goals, reduction of distress and symptoms, improved relationships with others, and/or resolution of the specific issues. Therapy can have risks as well as benefits. Improvements and any “cures” cannot be guaranteed for any condition due to the many variables that affect these therapy sessions.
While the primary goal of therapy may be to improve your well-being, it can also result in considerable emotional discomfort and distress. Recalling memories and experiences, or changing a behavioral style, can be trying, upsetting—even overwhelming. Experiencing uncomfortable feelings, sadness, guilt, anger, shame, frustration, loneliness, and helplessness, discussing unpleasant situations and/or aspects of your life are considered risks of therapy sessions.
For psychotherapy to be a productive, you have to desire change, possess a curiosity of your inner world and an interest in understanding what motivates you, and be able to tolerate a moderate degree of frustration. Therapy cannot be successful unless you want to be there. It’s essential that you not feel trapped into making an appointment. If you feel coerced into going to therapy, please express your discomfort to me. There are also many reasonable alternatives to psychotherapy like Psychiatric care, and other therapeutic interventions, such as Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, etc., self help, through self-help books, or doing nothing.
Should you have any concerns regarding your progress in therapy, it is important to let me know.
How long does psychotherapy last?
Weekly or bi-weekly spots are available. For some, short-term session is all that’s needed perhaps to help problem-solve a situation or talk about a personal concern. Although short-term therapy may be sufficient for some clients, long-term therapy that lasts over a course of years may be desired for others to gain lasting benefits.
Do you have a sliding scale?
Yes, I offer a sliding scale, or reduced fee, to help offset the cost of therapy for those that have a limited income or are experiencing a financial burden and cannot afford the standard rate. It is a case-by case situation based on an honour system. Sliding scale fees are renegotiated on a six month basis to determine if adjustments are possible. Please do not hesitate to inquire if you are in financial difficulty before confirming or during a consultation session.
What is your cancellation policy?
Implementing some penalty for late cancellations and no-shows is standard practice and is an important part of the broader scope of the therapeutic work. If you must change or cancel an appointment time that has been set aside for you, please notify me as soon as possible so that I can provide that time to another individual. If you cancel your scheduled therapy appointment late, and have not notified me (by telephone, email, or text) at least 24-hours in advance, payment will be required for the full cost of the session. Additionally, if you arrive late or do not show to a session you will be charged the full session fee. An invoice for the session will be sent and fees must be paid by you before the beginning of the following session. A total of two missed appointments without prior notification may lead to ending the therapy relationship in which case you will be provided with at least 2 weeks notice and alternate referrals. I appreciate your help in keeping the office schedule running timely and efficiently.
What are your payment policies?
I accept payments by cash or cheque at the end of each session. Alternatively, payment may be made by electronic transfer (e-transfer) prior to the start of the session.
I issue receipts and account summaries at the client’s preferred frequency; after each session, monthly, or annually.
All fees include any applicable HST.
Late payments may be subject to an additional $35 after a week period.
Returned cheques may incur an additional fee of $50 which is payable at the following session.
All balances owing must be paid for the previous session before commencing a new session, unless previous arrangements have been made.
What am I am I paying for?
Yes, therapy is a big financial investment. If you find the right therapeutic relationship and environment it can be just what you need to make the changes in your life you're looking for.
Often times paying out of pocket for a therapist can feel expensive. I understand. Therapy is a collaborative journey. It involves a therapist and participant working together to overcome obstacles, which in turn, leads to a healthier and more productive life. The return on investment is there, but why is it expensive.
As a client, you are hiring someone with years of schooling on the subject in which they have invested in. Remember, you are not paying to chat with a friend. You are hiring a mental health professional. Here are some other training and certification maintenance expenses:
Therapists use liability insurance which helps maintain certification and registration fees.
Fees for professional association memberships such as, The Canadian Association for Psychodynamic Therapy or CAPT, The Canadian Psychotherapy and Counselling Association (CCPA) and The College of Registered Psychotherapist of Ontario or CRPO.
Investing in annual training such as continuing education fees or professional development courses. Therapists need to keep up with advances in their field.
Office rent, supplies and utilities.
Therapy-related books for self-study or homework for clients.
Payments to an assistant or online billing specialist such as Owl Practice.
Then there are the cancellations or no shows.
Therapists also pay for their own therapists.
And a Supervisor and/or group supervision. Most therapists have a supervisor who helps them treat clients, address ethical issues and ensure they follow the rules of the bodies that regulate them. This supervisor is often a more experienced therapist.
Therapists can only bill for the time they see clients and after the hour they have to organize their clients’ information, market themselves and perform administrative duties, such as; writing case notes, treatment plans and research.
Therapist’s availability and emergencies.
I provide ten minute "check in" calls to clients during times of crisis. Please do not hesitate to reach out. Although, I will make every effort to return calls within 24 hours (or by the next business day), I cannot guarantee your call will be returned immediately. During peak periods it may take up to 24 hours to receive a response. If you are experiencing a crisis please phone Crisis Services Canada at 1-833-456-4566, or the Distress Centre Helpline at 1-416-408-HELP (4357) or text 741-741. In the case of an emergency, if you are feeling unsafe or require immediate medical or psychiatric assistance, please call 911, or proceed to the nearest local emergency room department.
Please note that this practice is not designed to provide ongoing crisis management for issues such as psychosis, ongoing violence, or active suicidality. Please discuss these issues with your doctor if at any time you believe you need a higher level of care for these types of issues and we will assist you in locating an appropriate referral. ALWAYS call 911 and/or report to the nearest emergency room for immediate care during a psychiatric emergency.
Email is the electronic equivalent of a postcard. I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. Protecting personal health information is vital, please do not send confidential information through email unless it is encrypted. This will help to ensure that you take appropriate care both in the content of the email and any attachments. Threats to confidentiality include, but are not limited to: 1) the transmission may be intercepted; 2) the transmission may be sent to the wrong recipient; and 3) the e-mail or text message may be accessed by an unauthorized person. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
Will my insurance benefits cover psychotherapy?
Please note you may be able to submit your receipts to insurance providers for reimbursements. Some clients have access to extended health benefits though employee and private health insurance plans, which provide full or partial coverage for counselling or psychotherapy services provided by a Registered Psychotherapist who are members of the College of Registered Psychotherapists of Ontario (CRPO).
You are encouraged to check with your insurer prior to the initial consultation regarding coverage and wether or not your plan requires a physician referral. Psychotherapy services provided by private practitioners are not covered by OHIP. Please check your coverage carefully by asking the following questions to your insurance providers:
• Do I have mental health insurance benefits?
• Is a Registered Psychotherapist covered by my plan?
• How many sessions per year does my health insurance cover?
• What is the coverage amount per therapy session?
If your insurance plan provides reimbursement for out-of-network providers, I can provide you with a statement summary, which you can submit to your insurance company to receive some insurance reimbursement, depending upon your benefits.
What are your limits of confidentiality?
The information disclosed by you in therapy is generally confidential and will not be released to others without your written consent. However, in law, there are a few exceptions where disclosure of personal health information is required without consent.
Exceptions to confidentiality, include:
Supervision relationships (used for mentorship and only on a first name basis).
If you threaten to commit serious bodily harm to yourself or another person. Where I believe on reasonable grounds that disclosure is necessary to eliminate or reduce significant, imminent risk of serious bodily harm (includes physical or psychological harm) to you or anyone else, e.g. suicide, homicide.If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in insuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
If there is reason to believe a child, elderly person, or dependent adult is or has been abused. Where disclosure is required under the Child and Family Services Act, for example, where I have reasonable grounds to suspect that a child is in need of protection due to physical harm, neglect or sexual abuse by a person having charge of the child. I must notify the police and inform the intended victim.
If I am presented with a subpoena or court order that has been signed by a judge. Where it is necessary for particular legal proceedings (e.g. when I am subpoenaed).
To facilitate an investigation or inspection if authorized by warrant or by any provincial or federal law.
For the purpose of contacting a relative, friend or potential substitute decision-maker of the individual, if the individual is injured, incapacitated or ill and unable to give consent personally.
To a College for the purpose of administration or enforcement of the Regulated Health Professions Act, 1991 (RHPA) (e.g. assessment of my practice is part of the quality assurance program; mandatory reporting where you are a regulated health professional and I have reasonable grounds to believe that you have sexually abused your client).
In any of the above circumstances, I will only reveal the minimum information that is necessary, and I will do my best to inform you of the information being disclosed and to whom it will be provided before I do so. Anybody who receives any of this confidential information is required by law to maintain the confidentiality of this information. Please let me know if you have any questions or concerns.