How do I get started in therapy? What are the steps?


At All of You Wellness Centre, your initial enquiry by phone or e-mail will result in booking a free 15 – 20 minute telephone interview (usually at a later time) during which you will be asked to give a rough outline of your reasons for seeking help. In addition during that call, the parameters of treatment will be discussed (confidentiality, fees, insurance coverage, office locations, appointment time preferences, 24 hour cancellation, policy, missed appointment fees, etc.). If the intake coordinator feels that an All of You therapist can help you, and you accept the terms of service, an initial face-to-face appointment will be booked. You may be requested to complete a personal history form and complete some online questionnaires prior to this first appointment.


Is therapy ever complete? Does it just go on forever?


The stereotype of psychoanalysis is that you lie on a couch forever as you talk to yourself endlessly in the presence of the analyst who tries his/her best to be nothing more to you than a blank screen for your projections. Today this is as untrue of psychoanalysis as it is of other forms of therapy, many of which are designed to be brief, targeted and mindful of the economic cost involved.

The duration of therapy cannot be separated from the manner in which a client integrates the changes that arise from therapy. In practice, clients achieve a plateau in their development which must be explored before they are ready to move on to the next stage. During these stages of exploration of new ways of being in the world, therapy may continue and appear to “idle” as the therapist provides only support while the client gathers their forces to move forward again. At this stage, apparent relapses may occur, but usually are quickly overcome as the client's newly acquired coping mechanisms are brought to bear. Sometimes, is may be desirable to interrupt therapy when things plateau if the experience of being self-supporting without the therapist is part of the therapy. We are speaking here of what might be termed “strategic therapies” aimed at personal growth and correction of problems with deep, old roots. Other therapies are tactical: crisis, goal or results-oriented. These types of therapy typically have a short course and may be the entrée to longer term strategic therapy. In practice, most courses of therapy begin with a crisis of some sort –the “presenting problem” that causes the client to seek therapy. With the therapist's help, a new perspective, recognition by the client of existing strengths they can apply and provision by the therapist of information about other supports available within the client's environment, help shift the initial problem from crisis toward being a manageable symptom and it begins to become apparent that the initial reason for seeking therapy is underlain by a more strategic long-standing perhaps pervasive issue.

In principle, therapy is never finished because we are continually in the process of evolving and growing. However, if you have gotten what you wanted from a course of therapy, then, for the time being, you are finished. It is time now to live what you have learned and the feeling that you need help to make your life better may never come up again. If at some time in the future you have a sense that you are getting stuck again, it may be time to do more therapy.


I'm mad at my therapist. Should I quit therapy?


While it is possible that a panel of experts might also disapprove of whatever action of your therapist has upset you, it is far more likely that your therapist has hit upon a core issue that brought you to therapy. One of the most common patterns is to seek approval from people we look up to. Likely you look up to your therapist; otherwise you would have chosen a different one. If you therapist shines a light on something uncomfortable to you, it feels like disapproval. And the most common defensive responses to perceived disapproval and criticism are anger and flight. Why not tolerate your discomfort and hang around for the discovery that will change you? Wasn't that the result you were seeking?


What role do transference and counter-transference play in psychotherapy?


As definitions and lengthy discussions of these terms are available from many sources, we will not repeat them here other than to say that it is perhaps more profitable to look at transference as a naturally occurring process in all relationships, not just in therapy, rather than pathologizing it as Freud did in describing transference as a infantile neurotic pattern. Phenomenologically, we understand new experiences as a function of past ones –it cannot be otherwise –and thus the projective aspect of perception is pervasive. In that sense, transference is just one of the mechanisms by which we find our way in relationships. By learning about ourselves, we may become mindful of our transference, but it is debatable that we can be cured of it or operate without it.

Transference is what makes the therapeutic relationship non-hypothetical. When transference arises (whether the client is aware of it or not), the energy tied up in the patterns that trouble the client is being brought online. This creates an opportunity for new awareness and growth.

Counter-transference is rooted in your therapist's own life experience and is partly what enables him/her to be of assistance to you, to relate to your problems non-hypothetically, provided that your therapist is able to remain mindfully self-aware, recognizing that their own emotional response to your story implicates their own unresolved issues.


I want to end my therapy but can't face my therapist with my decision. Should I just make excuses and disappear?


At the risk of sounding redundant, your relationship with your therapist is just like any other relationship you have: it's a relationship. And such, it deserves a proper ending. It is more than a commercial transaction that ends with a cash register tape in your pocket.

One of the disservices we do ourselves is neglecting endings everywhere in our lives. Like most errors of omission, they go unnoticed. We break off with people without ever having an open discussion that goes beyond the anger of the breakup; we don't say good-bye to people who are dying; we leave jobs/ parties/community groups without saying good-bye, because we say “it doesn't matter,” but the real reason we do it is that we are not courageous enough to be open about our decision. Ending therapy has a impact on both you and your therapist. The (silent) damage occurs on both sides: you may feel the hollow weight of a lack of integrity; your therapist is confused about your disappearance; and both of you lose out on the opportunity for growth that having closure could bring. By disappearing, you miss yet one more opportunity to become comfortable with bringing about closure without which the accumulated unresolved experiences of life create an emotional backdrop of inauthenticity tinged with a bit of shame. Disappearing isn't a crime.   It's just a lost chance to grow as a person.

People terminate therapy for many reasons. They don't like their therapist; they tell themselves can't afford it; the stress and discomfort of change is too much, at least for now; the change that has been achieved suffices for what they think they want out of life, at least for now. Therapy seldom ends with a mutual realization that the client has arrived at perfection, both client and therapist being exceedingly glad and a grand graduation takes place. In most therapeutic relationships, the client and the therapist do as much as they can within the time and other resources that are available. Movement occurs, hopefully, but perfection remains “out there.” Despite such limitations, one of the things that makes the therapeutic relationship relatively unique is that it is a forum where nothing is outside the relationship: we should be able to tell our therapist anything, including good-bye. When we quit therapy without closure, we are putting that decision outside the relationship, and thereby violating one of the premises of that highly unique relationship.


How do I know if my therapist isn't doing a good job? Sometimes I feel worse after therapy. That can't be right.


There is no comprehensive list of signs against which to check. Egregious misdoings by your therapist are identified in professional codes of ethics and conduct. If you think your therapist is failing you, the best approach is to confront your therapist –which is different from complaining to a friend –knowing that you will grow from the experience even if you are have been mistaken—e.g., you discover your are getting upset because your therapist is doing his/her job in challenging your resistances –or your therapist takes a position where you have to agree to disagree. In any event, if you don't like the answer you get, at least the issue is out in the open and any decision you make is based less on assumption and more on fact.


Is it OK to see more than one therapist at a time?


In principle, different therapeutic approaches should not conflict, but in practice might e.g., a cognitive approach which encourages you to mentalize thereby focusing your awareness away from bodily sensations versus a somatically focused approach which encourages you to “get out of your head.” Some clients might find two simultaneous therapies overwhelming. Even if you can encompass different approaches concurrently, you are adding stress to the stress that brought you to therapy in the first place, not to mention potentially unnecessary expense and perhaps reducing the benefit of each approach. At All of You Wellness Centre, our policy is not to begin therapy with clients who are still receiving psychotherapy elsewhere, with the exception of clients who are being seen by a prescribing psychiatrist or family physician who monitors the client's psychological well-being as a necessary part of psycho-active drug therapy but are not actively engaged in psychotherapy with the client.


Am I getting value from my sessions? Is my therapist doing enough? It seems to me that I am doing all the work.


The real question is would you do this work if you were not seeing your therapist or would your life go on in the same familiar patterns you wanted to change by going to therapy? Some people expect that transformations will occur during the therapy hour. Actually at least half of the change that results from therapy takes place later, after each session, and in the six months following the end of a course of therapy. This makes sense: in the therapy room, you are talking about your life. The living of your life takes place outside the therapy room. The second part of this is who does the work in therapeutic change. Some clients, thinking along the lines of medicine, expect that something will be done to or for them in therapy, that some procedure will be applied, when in fact change is the client's response to the therapeutic relationship. Therapy is a relationship and it is through relationship that human beings change.


Why is psychotherapy expensive? It's just talk!


Like any business operation, your therapist has to pay rent, heat, electricity, ongoing profession development costs to stay current, along with other normal business expenses in order to provide you with an appropriate environment –in this case a safe, quiet and comfortable space in which to hold your sessions. In addition your therapist has to make a living in order to be available to you. If your therapist cannot make a living from their work, they will likely have to work at some other profession.


Psychotherapy is health care. Why do I have to pay for it?


Unfortunately public health care dollars are not equitably distributed across the health care system. The necessity to attend to mental health concerns is still an emerging priority in public health care funding.


I have benefits at work. Why aren't psychotherapy services fully covered?


Benefit plans cover psychotherapy in varying ways, sometimes separately with a separate limit per session and per annum, sometimes additionally restricted by being bundled in with a set of supplemental health care services all taken from the same annual total reimbursable sum. In addition psychotherapy may be reimbursable only if provided by particular practitioners. Read your plan details and do the math on the total cost of your therapy when selecting a therapist. For example: suppose your plan reimburses $50 per session for a max of $500 per annum.


CASE I: Suppose the therapists on the approved list on average charge $175/session. In order to collect the full annual limit from the insurance ($500 at $50 per session over 10 sessions), you will be paying $125/session over and above the amount reimbursed by your benefit plan, a total of $1250 for 10 sessions.


CASE II: You select a therapist whose services are not reimbursable by your benefit plan but charges $100 / session. Over the course of the same 10 sessions, your outlay would be $1000, AND you would have the luxury of choosing the therapist you feel is most suited to your concerns and personality.


I can't afford to pay for therapy every week. Can't we do something in one session?


There are two pieces here: 

1. What can be accomplished in one session and what is accomplished in longer courses of therapy?

2. What is therapy worth to you?


2. Let's deal with the second question first. Before starting anything, asking whether you can afford it is one of the first considerations. Are you already spending what therapy would cost on other discretionary purchases? Can you truly not afford therapy or do you just not want to spend the money? Is your reluctance to invest in your well-being and your future happiness really about money? Or is money a front for your resistance to confront issues in your life? Do any of these questions have resonance for you? If you really cannot afford therapy, there may be options like student clinics (lower cost but not likely free), or community agencies offering free counselling provided by volunteers (usually a waiting list). Neither of these options is likely to be highly specialized.

1. Brief therapy or single session/drop-in therapy deals with crises and tactical issues. Deeper issues such as the origins of patterns in your life cannot be addressed in one session and may not even be focal if the first session is devoted to addressing a crisis. The aim of such a session is shift the client's perspective on their presenting issue (reframing), increase the client's awareness of the resources they can draw on both within themselves and in their social circle and community to support them in dealing with their presenting issue, and ascertain whether other agencies or services should be involved. It is helpful to your therapist to know that it is your intention to see them only once.


As a final note, therapy need not be weekly, or may begin at that frequency, later shifting to a longer inter-session interval. The time between sessions is as important as the sessions themselves because change has to be lived, not just talked about. In addition, you are not helped if you become dependent on your therapist. Therapy is intended to support you in your life, not become your life. The frequency of sessions must be based on keeping that perspective as well as on cost and other practical considerations.


Some therapists offer a sliding fee scale. How do I get that?


At All of You Wellness Centre, fee reduction and pro bono consultation is at each Member Therapist's discretion. You may be asked to complete an Application for Reduced Fee. Reduced fees are a made possible by other clients paying the full fee for the services rendered. Therefore, there is a maximum number of clients who can be seen on a reduced fee basis at a given time. Availability and the factors below are weighed in determining reduced fee eligibility. Filing an Application for Reduced Fee does not imply a guarantee that a fee reduction will be approved. Reduced fee eligibility will be reviewed if there is a change in your circumstances. Any personal information you provide is strictly confidential.