Dear Beth,... I have just found out that my brother is seeing a psychiatrist for therapy for depression. He says she is good. But from what I have heard, including from my girlfriend who has been through three of them, people go to psychiatrists for years without getting better. She says they make you feel like a worm and you get even more depressed.

There are psychotherapists like yourself where he lives, but he said he can't afford it. He makes good money, but I think he does not think he is worth spending it on. So I said look for a psychotherapist under OHIP who is not a psychiatrist, and he said they do not have anywhere near as much training in psychotherapy as psychiatrists. Is that true?

Beth answers: That is true, though I know of one who has obtained a comparable psychotherapy training outside of medical school.

Regarding the things one hears about psychiatrists, it is worth remembering that people usually go to see them when they are depressed, putting themselves down, and imagining that others think they are not good enough. Some people will imagine this even more about a therapist, whom they may see as being able to help by virtue of being "better" than themselves. When the therapist is a psychiatrist, this effect is increased by the power, prestige and authority that Society gives doctors. Also, the psychotherapy method most used by psychiatrists here involves adopting a somewhat distant manner as a way of helping the client to focus on his own inner experience. This takes some getting used to, as in the context of our society's system of signals such a stance can be interpreted to mean indifference or superiority. It is a good method for some clients, but not for others. 

I would not doubt that in any profession there are people who are not very talented, lacking in important interpersonal skills or personal qualities, too overloaded to be effective, or currently unfit for work. I am aware how distressing and damaging a bad experience with a therapist can be, so I understand your concern. However, I have worked alongside a number of psychiatrists over the years, and I have seen some excellent work done by them. On the whole I have been favorably impressed, even though they all had workloads that I would not attempt to handle. It seems to me that the biggest problem with psychiatrists in Canada is that there are not nearly enough of them to handle the demand. People who are unwilling or unable to pay for psychotherapy are going without--which is why many G.P.s have been trying to fill the gap themselves.

It looks to me as though your brother has been exceptionally lucky, and is getting under OHIP what most people have to pay for. I recommend that you trust his judgement on this matter unless you find compelling reasons not to. This will support him in overcoming the negativity and self-doubt which accompany depression and in making the best possible use of his therapist.

For more on supporting someone who is depressed, see Helping a depressed family member. See also Online psychotherapy for depression.