Psychotherapy Services Hamilton

What is the difference between psychotherapy and counselling?

Dr. Barbera C. Psych and her associates provide both counselling and psychotherapy services In Hamilton and online to individuals and couples in Ontario. All clinicians are either registered with the College of Psychologists of Ontario, the College of Registered Psychotherapists of Ontario or are completing their post-masters work to register as a psychological associate with the College of Psychologists of Ontario.

What is Psychotherapy?

Psychotherapy is a specialized therapy delivered primarily through talking that is focused on helping a person improve their well-being and ease emotional and psychological concerns. The concerns that psychotherapy addresses can include mood, anxiety, PTSD, low self-worth or low self-confidence, grief, adjustment difficulties, distress tolerance, disruptive behaviours and more.

Psychotherapy can be delivered to individuals, couples, families and groups. 

Dr.  Jennifer  Barbera  C.  Psych  and  her  associates  focus  on  providing  psychotherapy  services  to  individuals  and  couples.  We  do  not  provide  family  therapy  or  work  with  children.

How is psychotherapy different from counselling?

Psychotherapy focuses on assisting individuals who have significant concerns related to their mood, emotions, behaviour, thinking or social functioning. Psychotherapy is a regulated procedure, that only certain regulated health professionals are authorized to perform after meeting a comprehensive list of requirements.

Counselling is not a regulated procedure, used with people who generally have less severe concerns and are not experiencing any disruption to their functioning. For instance, someone might pursue counselling when they want to help overcome a break-up. In contrast, another person might seek psychotherapy when a recent relationship break-up has lead to significant sleep disruption and changes in mood and or an inability to attend work. 

The Controlled Act of 'Psychotherapy'

Psychotherapy is considered a 'controlled act' and is regulated in Ontario by the College of Registered psychotherapists of Ontario. In Ontario, the act of counselling is not regulated. 

Psychotherapy regulation means that there is better protection for people seeking psychotherapy services because:

-registered psychotherapists must demonstrate proof of specific education requirements (e.g. a masters degree).

-registered psychotherapists must complete some exams to be licensed.

-registered psychotherapists must receive and provide evidence of extensive clinical practice and of having received supervision on their cases from a registered  psychologist  or psychotherapist.. 

-registered psychotherapists must complete ongoing continuing education requirements. 

-the College of Registered Psychotherapists of Ontario is available to respond to complaints made by the public and has the authority to investigate and apply sanctions and make decisions regarding continued licensing. 

According the Regulated Health Professional Act, only regulated and approved health professional can perform a controlled act. 

Only the following professionals may apply to become regulated and authorized to perform the controlled act of psychotherapy. These health professional include:

Registered Psychologists, 

Registered Social Workers, 

Registered Social Service Workers,

Registered Nurses, 

Registered Occupational Therapists,

Registered psychotherapists, and

Physicians

To perform  the  act  of  Psychotherapy,  a  clinican  must  be  either  registered  with  one  of  the  above  regulatory  colleges,  or  they  must  be  in  the  process  of  fulfilling  their  requirements  and  working  under  the  direct  supervision  of  a  regulated  health  professional  who  is  permitted  to  provide  psychotherapy.

As defined in the Regulated Health Professions Act, the controlled act of Psychotherapy is defined as:

i)  Treating

ii)  by means of psychotherapy technique

iii)  delivered through a therapeutic relationship

iv)  an individual's serious disorder of thought, cognition, mood, emotional regulation, perception or memory that

v)  may seriously impair the individual's judgement, insight, behaviour, communication, or social functioning (RHPA 1991).

All 5 elements of this definition must be present for an intervention to be considered the controlled act of 'psychotherapy'. 

According to the College of Registered Psychotherapists of Ontario, when you work with a psychotherapist you should expect:

-To have the risks, benefits and expected outcome of the therapeutic intervention explained to you during the initial consent procedures, referred to as 'informed consent'.

-A clear and mutually established set of goals or plan for therapy.

-Each and every session has a clear beginning and end to the session, during which problems or concerns are discussed, and possible solutions or outcomes are explored.

-That the Registered Psychotherapist demonstrates clear and appropriate professional boundaries and provides a safe and confidential environment. 

What are other ways to identify a competent and professional psychotherapist?

When looking  for  psychotherapy  services  we suggest looking for:

-A psychotherapist who works in a professional office with other mental health clinicians, such as other psychotherapists and psychologists. This usually helps to ensure that they have a professional practice established and that they seek out ongoing consultation as opposed to only working out of their home in isolation from other professionals.

-A psychotherapist who has experience and training in the specific area you are seeking services for. In particular, ask how often they assist other individuals with the same concern. Ask what type of training they have. 

Ask what issues they don't assist with. A professional psychotherapist should only work in their areas of competencies and should be able to identify issues they don't assist with and populations that they don't work with. Be cautious about a  therapist who works with any age and any issue.

-A psychotherapist who has a breadth of training is suggested. This means that the clinician is trained in more than one therapeutic modality such as CBT, DBT, ACT, EFT, IFS etc. Be cautious about clinicians who only provide one therapeutic modality because not everyone responds to the same approach, and having a range of options and combining approaches is often beneficial. Ask the clinician what their main theoretical orientation is and why. Also, ask how they became trained in the approaches they use and when.

-A psychotherapist who is continually attending additional clinical training, including clinical practicums or intensives, is recommended. Ask the psychotherapist what trainings they have taken in the last year and look for someone who has taken at least a few trainings in the last year.  

-A psychotherapist who has a professional website and online reviews is recommended. Online reviews can help you gain insights into the experiences that others have had with the particular psychotherapist you are considering. 

Expect that there could be the occasional negative review even with an excellent clinician because sometimes individuals become upset with clinicians when they don't comply with unreasonable requests made of them, such as changing names on receipts or simultaneously providing services to a significant other- both practices are unethical. Individuals may also write negative reviews when an assessment is completed for the WSIB, and inconsistent information was presented. Seek out reviews to have as much information available as possible, but remember to take reviews in balance. 

Aside from explicitly looking for the characteristics mentioned above, it may also help to know what red flags to look for  in  psychotherapy or how to know when a psychotherapist may not be as professional or competent as expected. 

When  looking  for  a  psychotherapist,  we suggest being cautious about the following:

-A psychotherapist who does not establish informed consent and make a point of directly answering any questions you might have before commencing  psychotherapy  services. A reputable psychotherapist should directly address issues such as confidentiality, the costs of services, their cancellation policy, risks and benefits of services etc. Consent forms that cover all key points are lengthy but responsible.

-A psychotherapist who schedules multiple psychotherapy appointments back-to-back or many appointments (e.g., more than 4-5) in one day. Particularly for trauma-related work, a reputable clinician should avoid scheduling back-to-back appointments because its essential to take time to ensure proper grounding and closure before sending people on their way after trauma work. Ask the psychotherapist you are considering whether they schedule back-to-back and how many appointments do they schedule in one day? 

Dr. Jennifer Barbera and her associates do not schedule psychotherapy  appointments back-to-back to ensure that people do not feel rushed out the door and to help make sure people do not wait for their appointment to start. We also usually avoid scheduling more than 4 appointments a day, with occasional exceptions of 5 appointments when needed to accommodate someone's needs. 

Many practices schedule back-to-back, and it's not uncommon for clinicians to schedule 7-8 appointments in one day. This  does  not  allow for  a  buffer  in  case  needed,  or  time  to  review  and  prepare  for  each  session.  Ask  to  help  make  sure  you are  getting  better  quality  services!

-A psychotherapist who talks about themselves during your appointment. Occasionally for the clear purpose of helping to normalize your experience, it may be appropriate to use brief and intentional self-disclosure; however, a reputable psychotherapist should never shift the focus of a session away from you and onto themselves. 

-A psychotherapist who tells you what you should or need to do. A reputable psychotherapist should not pretend to be the expert on your own life or give you direct advice (unless you are at risk of serious harm). A reputable psychotherapist should help you explore and identify what course of action is best for you. They should be able to set aside their own opinions and values so that you do not feel judged. They should be explicit if their own values could at all influence the way they are guiding you or responding to you.

-A psychotherapist who either writes continuously throughout the entire appointment or never writes anything down. A reputable psychotherapist should take some notes to help inform their clinical work and note-taking; however, they should also be attentive and focused on you. 

-A psychotherapist who allows you to talk openly early on about your trauma history, without getting you to pause and check-in about how you are feeling inside before proceeding. Psychotherapists who are not trauma-informed can unknowingly aggravate a person's trauma-related symptoms. 

A reputable trauma-informed therapist is aware that although parts of you certainly want to talk about what happened, there may be other parts of you that feel differently and could feel distressed and more anxious afterwards, which can lead to increased numbing, dissociation, anger and self-harm.

For other suggestions on how to locate a reputable therapist visit our Therapy 101 page.

Resources:

The College of Registered Psychotherapists of Ontario

https://www.crpo.ca

What made you decide to become a Psychotherapist  and offer  psychotherapy  services? 

As with so many things in life, my path to becoming a psychotherapist wasn’t a direct one. I was immersed in a career as a Professor of Medical Radiation Sciences when I decided to go back to school to get a Masters degree. I was seeking to get an education in an area that would give me additional skills, and I thought that Counselling Psychology  and  psychotherapy  would be a great fit because I had been counselling and providing psychosocial support in my professional life for almost 2 decades. 

I’m also very open about my personal experiences with mental health issues (anxiety, panic attacks, depression, trauma) and there is always such a demand for high quality therapists, so I thought that I had a lot to offer as a clinician. I can honestly say that going back to school in my early 40’s and  becoming  a registered  psychotherapist in Hamilton Ontario was one of the best decisions that I’ve made.

Where did you go to school and what kind of schooling did you have to complete  to  become  a  psychotherapist?

I did a Masters degree in Counselling Psychology at the University of Toronto - OISE. I initially started part-time so I could continue working to support my kids, but eventually I took the big leap and finished the program on a full-time basis. The program included a full year counselling  practicum, and then I had to fulfill all of the therapy and supervision requirements to join the regulatory college CRPO  in  order to  become  a  registered  psychotherapist. I don’t think that people realize that these things take years to complete!

What are your strengths as a psychotherapist and what are your areas of continued growth?

The areas that I consistently get good feedback on from my psychotherapy  clients are that I’m a calm presence for them, that I’m easy to talk to and my clients feel comfortable with me, that I work really hard to understand my client’s experience and to find the best way to help them, and that I help my clients to view themselves (and their problem) differently and that gives them hope. 

I strive to be as non-pathologizing as possible, which means that things that we/our medical system labels as “disorders” I see as adaptive behaviours that served a purpose at one point, and I aim to help people to shift to new behaviours that are more helpful. I also bring a systems lens to my sessions, as a way of helping clients to understand how things (such as family of origin, gender, race, patriarchy, etc.) influence their problem or the way they view their problem.  

And finally, I’ve been known to bring a bit of humour into session (when appropriate) because I believe that laughter is so necessary when we’re suffering and it’s a great connector.

I think that confidence is something that I’ll perpetually continue to work on, especially when I have moments where I don’t know that perfect thing to say to a client. 

What is your favourite part about being a psychotherapist?

My favourite part about  being  a  psychotherapist  is that I get to connect with my clients in a very rich and fulfilling way. There is something so rewarding about witnessing the transformation that happens in  psychotherapy when my clients feel seen and heard. It’s also so wonderful to see clients shift and grow in ways that they never thought was possible.

What is your least favourite part about being a psychotherapist?

This is an easy one - the administrative tasks, such as  psychotherapy  notes!

What is something that surprised you when you became a Psychotherapist?

I know that this answer is likely not a popular one, but the more I delved into the medical model of mental illness I was surprised to see what an abysmal failure it is. 

The DSM, long considered the diagnostic standard in mental health, often pathologizes and categorizes people as disordered when very often their symptoms can be considered normal responses to stress and trauma. Drug addiction for example, is almost always rooted in trauma and wanting to escape that pain, and we still tend to classify it as a moral failing.

What should others know about you as a psychotherapist?

I always tell my clients that I’m a human first, psychotherapist second. I’m imperfect and fallible just like everyone else and I’ve been a consumer of therapy services off and on for decades. 

It takes a certain vulnerability to come to therapy and share pieces of our lives and parts of ourselves that may be very difficult to look at, and I want people to know how much I will respect that. At the same time, therapy sometimes involves challenging ourselves and having difficult conversations in the therapy room and I’m not one to shy away from that. Being human is messy and beautiful at the same time, and we’ll celebrate it all in the therapy room together.

What is your favourite kind of psychotherapy?

I love any type of psychotherapy that acknowledges the client’s ability to self-heal and that helps them to integrate really difficult emotions and often unconscious material into growth. So right now I’m loving therapies such as EMDR (Eye Movement Desensitization Reprocessing) and IFS (Internal Family Systems). 

I also think that ACT (Acceptance and Commitment Therapy) is so useful in helping clients to cope with their inner experiences in a way that keeps them connected to what they value and in promoting well-being. 

What is your favourite topic to learn about in the mental health field or topics related to therapy?

For the past few years most of my learning and education has been focused on the management of trauma. As I’ve previously mentioned, I gravitate towards therapy techniques that promote our natural ability to heal and integrate (such as EMDR and IFS) so I’m always looking to build on the skills that I’ve already learned in this area. I’m a HUGE therapy book nerd and also love diving into authors that focus on vulnerability and shame (such as Brené Brown) and more holistic views of mental health.

Is there anything else you would like to let people who are considering contacting a therapist know?

I want people to know that therapy is work, but it’s so rewarding to focus on and discover new things about yourself. So you truly have to be an active participant, be ready to do the work, and have patience that this takes time. I emphasize this because I see how much we all want the “quick fix” especially in today’s world of easy access to information and our consumerist mentality of fast everything. 

We also live in a world that encourages dismissing or repressing certain emotions (like sadness, anger, grief) and I think that we’re all suffering to an extent because of that. So I want people to know that they’re not broken! Therapy can help you to connect to the full spectrum of feelings as you learn ways to accept and manage your emotions in a way that feels healthier.