Many mental health disorders respond very well to pharmacological interventions but for some people they may need additional help. Psychotherapy, also known as “talk therapy” is often used in conjunction with medications or on its own. The goal of therapy is to help a person work through and to understand where their feelings come from and to equip them with strategies to manage them so they can function better. Psychotherapy has been known to help with challenges in daily living, loss of a loved one, the impact of trauma as well as various mental health disorders such as depression, anxiety, personality disorders, etc.
Therapy is provided by trained professionals including Psychiatrists, Psychologists, licensed Social Workers, licensed Professional Counselors, licensed Marriage and Family therapists, Psychiatric Nurses, and others with specialized training in psychotherapy. Psychotherapy in Ontario is governed by the College of Registered Psychotherapists. The college can assist you to find a registered professional via their website.
Different Types of Psychotherapy
There are many different types of psychotherapy, with no one single approach being effective for everyone. While some clinicians may specialize in one particular type of therapy, others may combine elements of different approaches within a single session to meet the needs of their client.
An overview of five commonly practiced forms of therapy is as follows:
Cognitive Behavioural Therapy (CBT)
CBT is an evidence-based therapy that has been clinically proven to be effective in the treatment of depression, chronic pain, disordered eating, anger management, addiction and poor self esteem as well as other mental health disorders.
CBT is a structured, goal oriented therapy offered on a short term basis with a focus on present behaviours. It works on the premise that the way we think and interpret life events will affect how we behave and ultimately how we feel. For example, if a person believes that people don’t like them (thought), they may avoid social situations (behaviour) and will subsequently feel lonely (feeling).
During a session, a therapist will first work to help the client learn how they can recognize persistent negative thoughts or beliefs and then teach them how to respond to those thoughts/beliefs in a more productive way. Clients will learn a range of strategies to help them overcome their negative thoughts, including (but are not limited to): journaling, distraction techniques, role playing, and cognitive reframing.
CBT is offered individually, through group sessions and virtually, online. Clients who participate in a CBT program agree to a homework component. CBT can be done through self help programs or with a therapist. While individual CBT therapy is commonly available through direct one-on-one sessions, Ontario also provides residents with access to free, virtual CBT programs offered via the following websites:
Dialectical Behaviour Therapy (DBT)
DBT is a form of cognitive behaviour therapy that was first developed to treat those suffering with borderline personality disorder. More recently it has been found to be effective in treating other kinds of mental health disorders including disordered eating, ADHD, post traumatic stress disorder and mood disorders.
The goal of DBT is to teach skills that will help a person regulate their emotions and handle stress in a healthy manner by focusing on both acceptance and change. Where it differs from cognitive behaviour therapy is that it teaches a person that their experience and emotions are real (acceptance), and that once one has accepted their reality for what it is, they can then work to change and achieve positive outcomes.
DBT treatment is long term therapy generally lasting 6 months to a year. It consists of 4 components including individual psychotherapy, DBT skills training group, in the moment coaching and a consultation team. Participants work through 4 modules; mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. DBT like CBT has a homework component.
DBT programs are available free and on a fee for service basis, although there are often long wait times and strict admission requirements for funded programs. In order to reduce wait times, mental health agencies often offer DBT informed therapy which is usually shorter in duration and doesn’t require all four modes of treatment to be provided. While less intensive, it provides many of the same benefits of a full DBT program. Short term DBT skills groups are often available to bridge the gap while waiting for DBT programs
Fee-for-Service Providers in the GTA
York Region: Psychological Counselling Services Group
GTA: Broadview Psychology, Dialectical Living, Layla Care, DBT Centre, TPWG
Free (Government Funded) Programs
York Region:
York Region Interagency Dialectical Behaviour Skills (DBS) Group. To register contact glowndes@yssn.ca or call 905-898-1171.
The Centre for Addition and Mental Health (CAMH) – Borderline Personality Disorder Clinic
Ontario Shores – Borderline Personality Self-Regulation Clinic
Psychodynamic Therapy (PT)
Psychodynamic therapy focuses on exploring and understanding a person’s thoughts and feelings on a deeper level than other forms of therapy. It has been found to help individuals who are dealing with general distress, relationship difficulties, depression, anxiety and personality disorders.
The emphasis of PT is on the connection between a person’s present and past experiences and the difficulties they are currently facing. For example, someone who was abandoned by a parent when they were young may find it difficult to develop intimate relationships because of a fear of abandonment. They might find it less painful to intentionally sabotage a relationship, thus avoiding the possibility of being abandoned by someone else. This insight provides the patient with an opportunity to resolve the internal psychological conflicts in order to improve their life experience, self esteem and relationships.
Using a client centered approach, the therapist will work with the patient to explore and uncover deeper thoughts, ideas and feelings and then offer observations about certain themes and patterns that emerge. Psychodynamic therapy can be an effective short-term therapy, but it often takes a year or more to achieve long lasting benefits.
Interpersonal Therapy (IPT)
IPT is a form of psychotherapy that is often used with those who are suffering from major depression. It has also been found helpful to treat anxiety, chronic fatigue syndrome and mood disorders.
IPT is a short-term therapy offered in either one-on-one or group settings. It addresses how a person’s psychological wellbeing is affected by their relationship with others. The strategy is to improve and strengthen the patient’s interpersonal relationships, thus building up their confidence in social situations. These improved relationships will assist in diminishing the negative feelings and symptoms of their mental illness.
Solution Focused Brief Therapy (SFBT)
SFBT therapy as the name implies is a brief, goal oriented form of psychotherapy intended to work towards a specific objective of the patient’s choosing.
Therapists will work with clients to envision what life would be like if the problem was gone or their goal achieved. The therapist will help the patient draw on their own life experiences to discover resources and tactics (e.g., past coping strategies, personal strengths) that are used to construct a solution that is both practical and sustainable.
Approaches to delivering therapy
Psychotherapy can be delivered in a few different ways and for some, treatment may incorporate more than one format. Common approaches to delivering therapy include:
Individual Therapy
Clients work one to one with a therapist with sessions usually usually lasting under an hour on issues that affect them.
Family Therapy
An approach that focuses on family dynamics and attempts to strengthen communication and foster understanding between family members. Family therapy is often beneficial when the family system is contributing to the issues of a person with mental health challenges.
Couples Therapy
Joint sessions where couples work through problems they are unable to solve on their own. The therapist provides a safe space for couples to discuss their feelings, work through problems and work towards changes they wish to make.
Group Therapy
This involves a therapist working with multiple people at the same time. It gives individuals the opportunity to both receive and provide support in a safe, nonjudgmental environment. Group sessions also provide the therapist with a chance to observe their clients in a social environment, and the clients are given the opportunity to practice their interpersonal skills. Compared to individual therapy, group sessions tend to be more cost effective with shorter wait lists.
Psychotherapy does not come in any one form and is usually tailored to meet the needs of each individual client. It can also be delivered in a variety of ways, while some patients prefer face-to-face sessions, others are more comfortable speaking to therapists over the telephone and more recently virtual settings including text/chats and online methods have become more accepted. The key to successful talk therapy is the participation and “buy-in” of the client because it requires work and introspection on their part.