Psychotherapy: Toronto therapist answers FAQ

Online psychotherapist in Ontario, Canada answers FAQ

Ontario forest, soothing and therapeutic

by Toronto-based registered psychotherapist Beth Mares. Beth's Ontario licence covers English Canada.

I have feelings of anxiety that I do not know the reason for. Is hypnotherapy the way to find out? Hypnosis is not used for this purpose these days, as it is generally not very effective for integrating material from the unconscious, and it can create confusion about past history, as you may have heard if you have followed the controversy about recovered memories. I would recommend psychodynamic (insight-oriented) therapy or Acceptance and Commitment Therapy with someone who is qualified to work with childhood trauma in case there is some. Hypnotherapy is best for learning how to relax.

My psychotherapy helped me to cope a bit better, but it reached a point where nothing new was happening. I am still unhappy. Is that as good as it gets? No, it's not. Perhaps you were working with a therapist who does not do sufficiently in-depth work for your particular problem. Whatever the reason, I suggest you get an assessment from an experienced and knowledgeable therapist.

I feel as though something is not right, but I have not gone to see a therapist because I do not know what the problem is or what to ask for. Don't worry. A good therapist will help you figure it out.

There seem to be at least a hundred kinds of psychological therapy. How do you know what type you need? Most of the "brand names" represent various combinations of the main types of psychotherapy. These are behavioral, cognitive, (often combined as cognitive cognitive behavioral therapy or CBT) Neuro-linguistic Programming (including hypnotherapy and guided imagery) and dynamic or insight-oriented (including short term dynamic, process work, Self Psychology, and analytical work based on transference). Group therapy, family systems work, body therapies and expressive arts therapy could also be considered separate categories. The best way to get an idea of what type(s) would be helpful for you is to get an assessment by an experienced psychotherapist who understands them all. If that is not available, any thoroughly trained and experienced therapist should be able to tell you after one or two sessions whether his method can be expected to do what you want.

What is Acceptance and Commitment Therapy (ACT)? It is a "new" extension of cognitive-behavioral therapy designed to overcome some limitations of the method. Negative beliefs and feelings are experienced instead of just being fought against; and the therapy looks at whether the person's lifestyle is consistent with what he or she truly wants out of life. Of course, the better therapists and counsellors have been doing this for decades, under a variety of names.

I tried therapy for a dissociative disorder caused by childhood trauma and my life got totally out of control. Some disruption may be involved when one is working with childhood trauma, and medication and in severe cases short hospitalizations may be required to manage it. However, childhood trauma is not something to play around with, as unfortunately some therapists and body workers who did not know what they were getting into have done. It is essential to have a very responsible, stable psychotherapist who is adequately trained in working with trauma and careful to minimize disruption.

The work needs to proceed in three stages. The first is establishing safety. This includes learning how to manage flashbacks, getting one's life under control, and establishing a therapeutic alliance with the therapist. Only after that should the second stage, processing traumatic memories, be attempted. The third stage consists of reconnecting with the community and establishing a normal life.

Should a therapist be just sitting there saying barely anything? If it is working, fine. There does not have to be a lot of sound and fury for change to take place. However, if the method is unsuited to the client (and in my experience it is unsuited to most clients), or if the therapist does not have the depth of training to use it, it could be a waste of time.

Should a therapist be telling a person how to run their life? Some types of therapy may involve making suggestions about the client's life, and for many clients this is very helpful. However, if the therapist gets into power struggles with the client, feels responsible for running his life, or does not support him in making his own decisions, expect that more harm than good will be done.

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