What is therapy?

Let’s start at the beginning because there is a lot of confusion around what therapy/counselling/psychological treatment is and is not.

First, anyone can set up shop and call themselves a “therapist”. The word therapy is not regulated by any professional body. There are many different schools that train people in psychotherapy: psychologists, psychiatrists, clinical counsellors, social workers, probably others. Each profession tends to have a different approach, and even within professions there are many different philosophies, styles and approaches. Psychiatrists stand out in that they are students of medical schools who have specialized in psychiatry. They are the only mental health professionals in Canada who are able to prescribe psychiatric drugs, although some do provide psychotherapy alongside medications.

Psychologists typically have the most in-depth training in mental health. They are trained in assessment and diagnosis, as well as in treatment for a wide variety of mental health concerns. They are also typically trained in research and can help wade through the confusing literature of what works for who under what circumstances.

While I believe medication can be very helpful for certain types of mental health problems, I think they are very much overused. Most common mental health concerns (periods of anxiety, low mood, relationship problems, low self-esteem, dealing with trauma) respond well to good quality psychotherapy.

Therapy is often misunderstood as just “talking about your problems.” Describing your personal challenges is indeed Step 1, but good therapy should be much more. (In fact, venting often makes things worse). A good therapist should provide a structured, safe space and help you explore, identify, experience and think through your problems. We need to get our problems outside of ourselves in order to look at them and understand what’s going on. A good therapist should help you sort through various layers of emotions, understand how you protect yourself from experiencing emotional pain, and help you experience and make sense of painful emotions. In addition to focusing on emotion, a good therapist will help you identify and challenge assumptions, beliefs and thoughts that perpetuate certain emotional and motivational states and behaviours. This is no simple matter and requires skilled guidance; it is not something we can do on our own with a self-help book or with a friend. Learning new skills is also often part of good therapy; skills can include regulating and expressing our emotions, problem solving, maintaining personal boundaries, relaxation skills, etc.

People often ask me if it is possible to really change? Yes, absolutely. Granted, there are core aspects of ourselves that we can’t change. For example, if you are quiet and introverted you cannot change yourself into a raging extrovert. But we can change the way we experience ourselves and others. We can grow and evolve into more authentic versions of ourself. We can learn to accept and love ourselves, and let go of self-criticism, blame, and feelings of unworthiness. We can learn to be more present in our relationships. Unfortunately, our society does not value this work as much as taking care of our physical body — but it is critical to good mental and physical health.