Monday, April 23, 2018

8 Questions You Might Want to Ask Your Therapist Before Starting Your Sessions



1. “Are you trained in scientific, evidence-based treatments that are proven to be effective?”


Over the past few decades, numerous psychological treatments have undergone intensive, scientific investigation to examine their effectiveness in helping individuals with a wide range of psychological disorders. To-date, many empirically-supported therapies have been identified. It is important that your therapist is well-versed in what treatments are most beneficial for you based on scientific evidence. Application of these treatments alone, or in combination, provide you with optimal treatment options.

The registered psychologists at Centre for Interpersonal Relationships (CFIR) have received 3000-4000 hours of clinical training in evidence-based treatments before graduation, and supervise psychotherapists and social workers in the implementation of these treatments.


2. “Do you only offer one type of treatment (e.g., CBT) or do you provide different types of treatment options? What happens if your preferred approach doesn’t fit well with me?”


Not all approaches work for everyone. Not all treatments will fit your concerns and needs!

Research study after research study demonstrates that, while psychological treatments do work, not all treatments work for everyone.  Some individuals drop out of treatment, some do not fare well, and some don’t achieve any significant change. It’s unclear whether one particular brand of therapy fits better with any specific child, adolescent, adult, couple or family. From a practical viewpoint, however, some clients may want a shorter therapy option that targets their symptoms without going into a lot of depth, while others wish to have an in-depth exploration and understanding of their challenges. Sometimes symptoms are addressed first, and then a closer investigation of underlying self and relational causes are explored to acquire more profound change.

Many psychologists and psychotherapists will combine a variety of strategies to help you achieve your treatment goals. At CFIR, our psychologists, psychotherapists, and counsellors may use a variety of cognitive-behavioural, dialectical-behavioural, or mindfulness-based strategies to help you diminish your emotional distress and symptoms.  They may then turn to various experiential or psychodynamic approaches to help you to become more aware of your self and your self in relationship with others to create change at a more in-depth level. 

It is essential to find a therapist that can respond to your needs and concerns by offering a variety of treatment approaches in both a short and longer-term format. CFIR mental health professionals are skilled in various types of evidence-based treatment models and short and long-term treatment. They can help you reduce your immediate distress and diminish your symptoms, as well as help you to understand and change deeper self or relational issues underlying your difficulties. 


3. Will you provide a comprehensive assessment of my condition (i.e., interview and questionnaires)? 


Assessment is vital to understand the nature of your difficulties and can help guide treatment and inform the direction of your recovery process. A medical doctor might use interviews and ask that you complete a variety of tests (e.g., blood pressure, blood, and urine tests, ultrasounds, and other technologies) to understand the nature of your health issues. Similarly, psychologists conduct extensive interviews and administer questionnaires to help with their understanding of your difficulties. Numerous factors can contribute to your current problems. A combination of clinical interview and scientific, evidence-based measures will assist your mental health practitioner to understand the unique circumstances underlying your present concern. 

A clinical interview and questionnaires can also save you money, hours and treatment sessions since a lot of information is ascertained all at once and used to identify contributing factors to your distress and concerns early on in treatment. Reliable and valid questionnaires can save a lot of in-session time by gathering valuable information about factors underlying your condition promptly.

A thorough assessment can also provide relevant information about what to expect regarding the duration of your treatment. CFIR’s comprehensive assessments help us to identify contributing factors underlying your concerns. Realistic timelines for your recovery from your condition can then be determined based on the assessment outcomes.


4. “Are you well-trained? Are you a provincially registered care provider or supervised by a registered clinical psychologist?”


It’s essential that you seek treatment from a practitioner who has been well-trained and a member of a professional college in Ontario such as (but not limited to) College of Psychologists, College of Psychotherapists or College of Social Workers. Registration with a College denotes that your practitioner has completed education and training that has met the standards of practice for the profession. 

Registered psychologists have the most training in evidence-based psychological treatments. The registered psychologists working at CFIR supervise psychotherapists and social workers in the application of evidence-based therapies in their practice with their clients.


5. “Is there a way for us to connect before starting therapy sessions to ensure you’re a good fit for me?”


The relationship with your therapist is a vital aspect of your treatment and recovery from your symptoms and distress. Research studies suggest that the single most significant factor in whether a client changes during a course of therapy is the nature of his or her relationship with a therapist—whereas the treatment itself accounts for a less amount of your development. Make sure you are comfortable with your therapist and how they will work with you to address your concerns. 

Relationships are significant to us! CFIR offers a free initial 30-minute consultation to help determine if he or she will be a good fit for you! Meeting a therapist in-person will give you a sense of whether you feel comfortable with them or in the physical office surroundings. The 30-minute consultation gives you a chance to learn if the therapist is flexible in providing different treatment options. There’s nothing more frustrating, and costly, for you and your loved ones than to start with one therapist, spend numerous sessions working in one treatment approach, only to find it’s not working or fitting well with you. If your therapist primarily works in one treatment modality (e.g., CBT, or EFT, or Psychodynamic), it’s good to know whether he or she will be able to switch treatment direction if therapy is not working for you. 

Ask whether or not your therapist can provide different types of treatment. If your treatment is not working for you, your clinician should ideally provide you with other options or refer you to someone else who may be able to meet your needs for a different type of treatment. CFIR clinicians are skilled in employing different treatment models and often integrate different treatment approaches to offer you the best treatment possible.

At CFIR, we work collaboratively with you to identify your treatment goals and offer different types of treatment options to ensure that you get the help that you need. We are flexible and can change our treatment approach if you find that significant progress isn’t happening by using one method.


6. “How many sessions are required for treatment of my condition? What constitutes change or ‘recovery’? Are there quick, short-term treatments for conditions like mine?”


Receiving sufficient treatment to recover from your mental health concern is crucial! Your therapist should have some sense of the treatment dosage (i.e., number of sessions required) to reduce your symptoms or to recover from your mental health issue. Typically, 50% of clients feel better after about 7-8 sessions, and 75% report marked improvement after 20 sessions. There is, however, a significant body of research that points to the expected duration of treatment for a wide range of psychological issues (i.e., number of sessions required for symptom reduction or recovery from your condition). Your treatment provider needs to know the research to provide some sense of what you can expect regarding your treatment duration. 

When it comes to creating meaningful and significant change, there are no quick, short-term treatments. If you solely want to acquire information or education on a condition or topic, one or two sessions may suffice. Diminishing symptoms and recovery from your condition will, however, require more sessions and commitment to change. Typically, short-term treatment requires between 8-20 sessions to ensure significant symptom reduction and recovery for most conditions. However, some conditions need upwards of 12-14 months of consistent treatment for recovery.


7. “Is your service covered by my workplace insurance? How do I verify if I can afford the number of required sessions either using my insurance coverage or paying ‘out of pocket’?”


Workplace insurance programs cover not all mental health care practitioners. Clients who don’t review their workplace insurance before receiving psychological services can find themselves very disappointed, and out of a lot of money, when they find out that they're insurance won't cover the duration of their sessions. Research how much coverage you have available and figure out how much ‘out of pocket’ money you’ll need (if necessary) to attend sessions consistently until significant change is realized. 

Registered psychologists tend to be covered by most workplace insurance programs. However, if you are seeing a psychotherapist or social worker, you’ll want to verify whether your plan includes their services. At CFIR,  a registered clinical psychologist supervises psychotherapists and social workers, and receipts are issued under the supervising psychologist as well. Some insurance companies will accept these circumstances, while others will not. It’s up to you to verify with your insurer whether your insurer will cover your sessions.

Since most individuals will require more sessions than their insurance covers, you need to evaluate whether you can afford to pay for sessions ‘out of pocket’ once your insurance has run out. Have this discussion with your therapist to ensure that lack of financial resources does not disrupt your treatment. Based on your insurance, and ability to ‘pay out of pocket,’ your therapist may determine given your presenting concerns, that other treatment options may be better for you (i.e., workshops or group therapy, or seeing a psychotherapist or joining our Reduced Cost Services program). Referral to our counsellors is seamless and ensures continuity of your treatment with minimal disruptions.

If you find yourself out of insurance dollars, and your ability to pay ‘out of pocket’ reduced, you may want to modify the number of your sessions per month or take a break from therapy until which point your workplace insurance coverage is available to access again.


8. “What is your fee? Do you offer a range of fee options (i.e., sliding scales) or services in different formats (i.e., individual, couple, family, group therapy, workshops) to ensure accessibility and affordability of psychological services? 


Your therapist’s fees should be known to you and agreed upon before therapy commences. Also, depending on your payment method, you might also want to ask about whether your therapist has a sliding scale (i.e., able to offer a lower fee to ensure accessibility and affordability).  Services in different formats (i.e., individual, couple, family, group therapy, workshops) may also be an option to ensure accessibility and affordability of psychological services. We'll be happy to answer your question regarding cost for a session through CFIR when booking a Free Consultation.

Friday, April 20, 2018

A Look at Hypersexuality: Treatment and Assessment



The classified advertising site, Backpages.com, was recently shut down by the United States government, thereby making it inaccessible in Canada as well.  The website, which hosted everything from child care to real estate ads, was recently suspended by U.S. law enforcement due to activity stemming from the “adult” sections on the site.

Many essential political and societal discussions have transpired following the decision to close the site, including debates about whether the intention to prevent sex trafficking will benefit from this action. 

Amid these discussions, some of my clients who use the internet to access sex services, and who identify as having problems regulating their sexual behaviour feel a sense of relief.  Some are experiencing an unexpected external control over their response, albeit temporary, now that Backpages.com is no longer accessible.

What is hypersexuality?


Problematic sexual behavior is referred to using a variety of labels – from sex addiction to compulsive or impulsive sexual behaviour to hypersexuality.  Societally, this is commonly labeled as sex addiction, but there remains little scientific evidence to support sex as an addiction.  There is also some suggestion that perceived addiction to pornography can contribute more to psychological distress than pornography use itself (Grubbs, Volk, Exline, & Pargament, 2013). 

Many of my clients seek out therapy for problems managing their sexual behaviours, sexual interests or both. Regardless of the label, many men (and it is mostly men that seek treatment for this in my practice) are struggling with a variety of sexual behaviours, from anonymous sexual encounters to frequent masturbation and pornography use.  Some men also experience distress related to the content of their sexual thoughts, or pornography use (versus the frequency of their sexual behavior).  In other words, they experience a sexual interest that is atypical or less common; the inclination could turn illegal if acted upon and/or it contributes to significant moral distress. 

Assessment


Research has been conducted to identify the characteristics of individuals who seek out help for hypersexuality, along with related treatment targets (Cantor et al., 2013; Sutton, Stratton, Pytyck, Kolla, & Cantor, 2014). The paths leading people to engage in hypersexual behaviour are varied and beyond the scope of this current blog, but there are more common ones I see in my clients.  Clients often use sexual behaviour as a way of procrastinating, avoiding, and escaping stressors.  Many of my clients struggle with identifying, labeling, and expressing their emotional experiences (preferring instead to ignore and suppress). This is even more common with emotions experienced as being more challenging to manage (i.e., frustration, anxiety, anger, disappointment), and they seek out a distraction, and a way of temporary escape, through sexual behaviour. 

Other clients have varied sexual interests that are explored through pornography or sexual activity with another, that they may not feel comfortable talking about or exploring in their partnered relationship.  At times there is a mismatch in sexual drive or interests in a relationship, but what is often apparent is a lack of healthy communication between partners about their needs and experiences in their sexual relationship.

What is essential when seeking support is finding a mental health clinician who will engage in a detailed assessment to understand the nature of the problem and the contributing factors.  It is also essential to determine if there are other mental health concerns (i.e., depression, anxiety, bipolar disorder to name a few) that are influencing the behaviour and also require intervention.  There is no ‘one size fits all’ approach to treating individuals who struggle with sexual behaviour. As a result, an assessment helps to determine the most relevant treatment targets to assist those seeking help to achieve their goals.

Treatment


A therapist assists clients in understanding the origins and development of their behaviour.  Clients are offered support through their journey to develop and refine skills to live a life that is more in line with their values.  This path is often challenging and filled with a range of emotions, and mistakes and a return to old patterns may occur.  With the guidance of a therapist, these challenges can be navigated and explored in a safe and supportive environment. The client can take steps they feel are necessary to define and live a more fulfilling and value driven life.

Often when a man is in a partnered relationship, couples therapy is recommended, mainly when the sexual behaviour of concern involved infidelity.  In these situations, the sexual behaviour that occurred happened in the context, and with all the relevant dynamics, of a relationship.  If the couple desires to remain together, at the very least, the rebuilding of trust occurs again in the context of the couple.  With that in mind, many men still seek out therapy on their own, either at the insistence of their partner or without their partners’ knowledge that there is a problem. 

If you can identify with these struggles, there is help and support.  Individual and couples therapy is available at the Centre for Interpersonal Relationships (CFIR).


References


Cantor, J., Klein, C., Lykins, A., Rullo, J., Thaler, L., & Walling, B. (2013). A treatment-oriented typology of self-identified hypersexuality referrals. Archives of Sexual Behavior. 42. 10.1007/s10508-013-0085-1.

Grubbs, J., Volk, F., & Exline, J., & Pargament, K. (2013). Internet pornography use: Perceived addiction, psychological distress, and the validation of a brief measure. Journal of Sex & Marital Therapy. 41. 10.1080/0092623X.2013.842192.


Sutton, K., Stratton, N., Pytyck, J., Kolla, N., & Cantor, J. (2014). Patient characteristics by type of hypersexuality referral: A quantitative chart review of 115 consecutive male cases. Journal of Sex & Marital Therapy. 41. 10.1080/0092623X.2014.935539.