Finding the right psychologist or psychotherapist can be difficult.
We've put this page together to assist you.
When should I seek psychotherapy?
You should consider psychotherapy when:
- You feel an overwhelming and prolonged sense of helplessness and/or sadness, and your problems do not seem to get better despite your efforts and help from family and friends.
- You are anxious or have rituals, worries or fears that get in the way of your daily routine.
- You find it difficult to carry out everyday activities. For example, you are unable to concentrate on assignments at work or school, and your performance is suffering as a result.
- You worry excessively or are constantly on edge.
- You have been the victim of or have witnessed something traumatic.
- Your actions are harmful to yourself or to others (for example, drinking too much alcohol, abusing drugs or becoming overly argumentative and aggressive).
- You have sexual difficulties or have questions or worries about your sexual life or sexual orientation.
- You need help dealing with major changes or transitions in your life (for example, retirement, divorce, change in profession, etc.).
Does psychotherapy work?
Psychotherapy is without doubt one of the interventions that has been researched the most. The evidence is overwhelming: psychotherapy does work.However, like for any other treatment, this does not mean that it works for all conditions and under all circumstances. For example, in some cases, it may be more appropriate to recommend medication or a combination of medication and psychotherapy, or the best course of action might be to implement supervised self-care (e.g. computer assisted therapy or bibliotherapy) or other forms of low intensity interventions according to a stepped care model of intervention.
Your psychotherapist, psychologist or physician should be aware of these models and explain what intervention is most likely to produce the results you are looking for.
Who can deliver psychotherapy services in Quebec?
In Quebec, psychotherapy is regulated under Bill 21 which states that only psychologists and physicians can offer psychotherapy. Other professionals such as social workers, family therapists, guidance counsellors, nurses, and occupational therapists may also offer psychotherapy if they hold a valid license from their regulatory body and have a psychotherapy permit delivered by the Order of Psychologists of Quebec. Other provinces have other regulations. For example, in Ontario, psychotherapy is an activity that falls within the scope of practice of members of the College of Psychologists and of the College of Registered Psychotherapists of Ontario.
What professional should I choose?
If you are looking for psychotherapy, keep in mind that scientific research is important. Doctoral-level practitioners have extensive training in research. Since 2006, Quebec has harmonized with other provinces in requiring a doctorate to be a psychologist. Doctoral level psychologists have completed anywhere between 8 and 11 years of university training, depending on their specialty (as compared to Master level psychologists who completed no more than 5). Only doctoral level psychologists can be full members of the American Psychological Association, and the Canadian Psychological Association (CPA) states that the doctoral degree should be the entry to practice degree for registered psychologists everywhere in Canada. The CPA also states that in Canada, a doctoral degree (Ph.D.) is considered the basic degree for a profession in psychology and endorses the doctoral degree as providing the best preparation for professional work.
According to the Society for Clinical Psychology of the American Psychological Association, if you are seeking therapy for a particular disorder, you should interview potential therapists until you find one who offers one of the treatments that has scientific support. If you have had an unsuccessful psychotherapy experience, we recommend you consider a research-supported approach. You should always choose a clinician with whom you feel comfortable and at ease.
If you are seeking help for sexual difficulties, your best bet is generally a licensed sexologist, as this professional has received 5 years of training entirely dedicated to treating sexual difficulties.
If you are looking for a professional to conduct an assessment or testing (e.g., I.Q., cognitive assessment, dyslexia, ADD/ADHD), we recommend seeking the services of a doctoral level psychologist who specializes in assessments. Simple, easy to read information about psychological tests and neuropsychological tests can be found on this website.
If you need a formal diagnosis for a mental disorder (e.g., major depression, anxiety), you should see a physician (family physician, psychiatrist or pediatrician) or a doctoral level psychologist, as such assessments are reserved by law to certain groups of professionals.
How can I avoid problems?
If you are looking to begin a psychotherapy, first make sure you are dealing with someone who has a professional license or permit issued by a regulatory body. If you are receiving services in Quebec and the person you are receiving psychotherapy services from is not a member of a recognized regulatory bodies or does not have an authorization to practice psychotherapy delivered by the Order of psychologists of Quebec, you are not protected and will not have any recourse if anything goes wrong (unless of course you initiate procedures, on your own and at your own expense, in civil court). You can find a list of the recognized regulatory bodies on the Office des Professions du Quebec website.
Many titles are used and advertised in the mental health field and in the different fields of human relations. Many of these titles are unregulated in Quebec, including for example psychosociologist, coach, therapist (and related or similar titles such as psychoanalyst, therapist in helping relationships, art therapist, hypnotherapist, drama therapist, cognitive therapist, etc.), to name but a few. In some cases, these non-regulated titles refer to activities that are not considered psychotherapy under Bill 21. For example, a coach may help you improve your potential and have an important effect on how you manage your various responsibilities at work (often referred to as executive coaching), or an art-therapist may offer art-therapy to a child with a developmental disability in order to help him express himself in a new or more helpful way. Bill 21 does not apply in these situations, as such services are not considered to be psychotherapy. A list of some of the activities that may be confused with psychotherapy, but that are not considered to be psychotherapy as per Bill 21 can be found on the OPQ website.
Other times, however, these non-regulated titles are used to indicate an area of specialization in psychotherapy (for instance, a psychologist may advertise that he or she is also a cognitive-behavioral therapist, which would let potential clients know that he is a licensed psychologist and that the therapeutic modality he uses is cognitive-behavioral therapy). This is sometimes done for marketing purposes, for example. If what you want or need is psychotherapy as defined in Quebec's Bill 21 and the person you are seeing advertises using a non-regulated title, make sure they also have a recognized professional title such as physician or psychologist, or a valid psychotherapy permit delivered by the Order of psychologists. According to the law, the title of “psychotherapist” cannot be used alone. A psychotherapist who uses the title “psychotherapist” is required to first use his professional title (e.g.: nurse, psychotherapist); psychotherapists who acquired a right to practice via the Bill 21 grand-father clause and who are not eligible for licensing with a regulatory body must indicate their degree and the area in which they graduated, followed by the “psychotherapist” title (e.g., M.A. in Art Therapy, psychotherapist; or M.A. Philosophy, psychotherapist).
Always be wary of titles as they can sometimes be misleading. When in doubt contact the Order of psychologists of Quebec. Before meeting with a professional, call the regulatory body and ask if that person has a valid license and if they have been subjected to any sanctions or have been the object of complaints. If the professional is not a psychologist or physician, you should call both their regulatory body and the Order of psychologists of Quebec to make sure they also have a valid permit for the practice of psychotherapy.
Not all professionals, even those who have a valid license, use best practices. Ask your mental health professional if there is scientific evidence supporting their work. You can also ask about the methods and techniques that the therapist is proposing (see What should I ask my mental health professional when we first meet? below). There are still quack therapies that are offered out there!
What should I ask my mental health professional when we first meet?
Remember: you have a right to ask!
- What are your areas of expertise (e.g., children, adults, etc.)? It may be wise to stay away from a professional who claims an expertise in everything. Many clinicians are able to offer excellent services to different age groups, or for a variety of problems. However, if the professional you are seeing claims to have an expertise in psychotherapy, executive coaching, crisis intervention, organisational consulting, etc., you should be vigilant and ask him what his primary area of expertise is.
- I have been feeling (anxious, tense, depressed, etc.) and I'm having problems (with my job, my marriage, eating, sleeping, etc.). What experience do you have helping people with these types of problems?A key factor to develop true expertise is clinical exposure. In order to develop an expertise in an area, a clinician had to have the opportunity to work in that area. Ask your therapist how many cases like yours he or she has seen and treated, how he knows if an outcome is successful (see below).
- What about diagnosis? There are situations when a diagnosis will not be needed or helpful. Your clinician should be able to explain this to you in simple, straight forward terms. However, some insurance companies will require a formal diagnosis for the reimbursement of psychotherapy services. In Quebec, only psychologists and physicians can diagnose mental disorders. Other professionals, for example licensed guidance counsellors, may also diagnose mental disorders if they have a special permit to do so. Make sure you ask your professional if he or she is legally allowed to diagnose such conditions. The easiest is to choose a clinician who can both diagnose and treat, like a doctoral level psychologist or physician.
- Why about scientific evidence? Many clinicians will offer a specific type of therapy simply because that is what they know and can offer. Others may claim that all that matters is the therapeutic alliance (the relationship they establish with you). Research has indeed shown that the alliance is a robust predictor of treatment outcome; however, it is not the only thing that matters – the alliance is a necessary factor, but not a sufficient factor for positive treatment outcome. Claiming that all that matters is the alliance is no excuse to offer any type of psychotherapy. If you are seeking therapy for a specific condition, ask your psychotherapist what evidence exists in support of the therapy he or she offers, and ask where you can find that evidence yourself.
- What about best practice guidelines? It is not unusual for clinicians to make decisions and recommendations solely based on their gut feeling. Guidelines in psychology are relatively new and unfortunately, few clinicians are familiar with them. Despite this, you as a client should ask your psychotherapist what guidelines apply to your situation. Institutions that develop guidelines (e.g., NICE) sometimes have a version of a guideline written specifically for patients. Ask your psychotherapist if that is the case for you, and where you can find those guidelines.
- What are the advantages and disadvantages of the therapy you are considering? Some possible disadvantages may include duration, cost, lack of scientific support, or low success rates. These are things your psychotherapist should be able to explain to you in a way that makes sense to you.
- How long will the therapy take and how much will it cost? It is very difficult to determine ahead of time how many sessions will be needed for a given person so you will need to be flexible here. That said, ask your psychotherapist if studies have examined the course of treatment he is offering for your condition. He should be aware of the research and be able to give you a sense of what studies indicate in terms of treatment duration as compared to the natural course of the illness when left untreated.
- How will we know if the therapy is working to help me with my problem? Studies suggest that clinical judgment alone is not enough to detect current problems with a therapy or to predict the outcome of therapy. Studies show that clinicians most often fail to detect when a patient is not on course to recovery and fail to recognize treatment failures. Your psychotherapist should use valid progress tracking measures to document changes in your functioning. Ask your therapist what progress and outcome tracking measure he uses and if it is a valid and reliable method.
How is psychotherapy paid for?
Psychotherapy is generally not covered under Quebec’s Medicare. However, there are exceptions to this. For example, in some situations, the costs of therapy may be covered by the SAAQ if you were involved in a car accident, by the CSST if you had a work related accident, or by IVAC if you were the victim of a criminal act. Individuals with a First Nations or Inuit background may also have access to psychotherapy free of charge via federal health benefits. Many insurance companies also provide coverage for mental health services, including for psychotherapy. Call your insurance company to see if psychotherapy is covered and, if so, how you may obtain these benefits. Also ask how many sessions are covered and/or what the maximum amount of reimbursement is for a given year. Finally, make sure to ask what professionals are covered under your insurance plan. For example, most insurance companies will cover the cost of services delivered by a psychologist, but not by a psychotherapist or counsellor.
If money is an issue, you can also choose to see a psychotherapy intern. These interns are typically advanced doctoral students in psychology who have a restricted permit for the practice of psychotherapy delivered by the Order of psychologists of Quebec and who practice under supervision.
Access to psychotherapy remains a major challenge for those who do not have the financial resources that are needed. It is for this reason that different groups such as Medipsy and the CAP, to name but a few, have been promoting greater access for those in need.
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Click here for an overview of the different clinical services offered by Medipsy Psychological Services. Medipsy is located at 4610 Ste. Catherine Ouest, in Wesmount. You may also want to visit the website of the Montreal ADHD Clinic for Children and Adults, or here for the the Montreal Phobia Clinic.