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By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Recognizing that you are having emotional difficulties can be challenging to admit, but it’s the first step to getting effective treatment. So, good for you for getting there, but figuring out how to get the help you need can be another daunting step as there are so many different types of mental health professionals.
Psychologist vs Psychiatrist Psychologists and psychiatrists are both mental health specialists with expertise in assessing and treating emotional issues. They have approximately the same number of years of formal training. While there are some similarities between psychology and psychiatry, there are also some important differences in their type of training, focus and treatment approaches. We will address each of these topics below. Training
Focus
Treatment and Referral Process
Psychologists and psychiatrists have their own areas of expertise. Some individuals are matched with one or the other and see results, but you may also benefit from seeing both who work together to support you. Speak to your family physician to get some advice and guidance on who can best help you. Your provincial psychological association can also assist with answering questions about how to find a psychologist best suited to your needs. Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Online Counselling Services: Understanding Your Options
Online counselling services are becoming more and more popular as our lives get busier and we become more technologically connected. Online counselling provides a unique opportunity to people with busy schedules or other concerns that prevent them from being able to access in-office treatment. If you’re interested in online counselling it may be difficult to know where to start as there are already many different services available, often at vastly different price points. Types of Online Counselling Services So, what types of online counselling services exist? And how do you know which services are best for you? Here we will talk about the different types of online counselling services and their pros and cons. 1. Apps (standalone use)
2. Apps (community-based support/chat rooms – for example: Healthful Chat)
3. Apps with coaching supports (example: Better help)
4. Online counselling Service
What is continuity of care? Continuity of care is the consistency and effectiveness of treatment over time. With mental health services, this includes the work a person does with their individual practitioner over time, as well as the focus on working with other members of the individuals’ health care team (if/as needed). When services don’t have this continuity, there’s something that’s lost in the therapeutic experience. That’s not to say these types of services don’t have a place. They’re effective in providing crisis management, for example supporting a person through the process of panic attacks. It’s important to understand the differences between these services to determine which is most appropriate based on your goals and financial needs. Are you ready to book your online counselling session? If so, get it touch! We’re also happy to provide more information if you have any questions. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Psychiatric medications are one of the most commonly prescribed classes of medication. Every year, up to 1 out of 5 adults will be prescribed medications for mood and often end up taking them for the long-term. Medications can be helpful when symptoms of anxiety or depression – the most common mental health issues – are acute and severe. However, long-term use is often not required, needed or even recommended. If we are taking medications for mood, and as symptoms improve, it’s wise to consider whether ongoing use is needed – particularly given the unpleasant side effects. Any changes to medications should always be discussed with your physician, but it can be helpful to go into these conversations armed with information.
What causes anxiety and depression? For most people, the emergence of anxiety or depression symptoms is the result of a complex interplay of multiple factors, which include:
The way we think about the world (our thoughts) and the way we cope with stress (our actions and behaviours) also play an important role in whether – and to what degree – we will manifest the emotional state of depression. Although there is little empirical support that anxiety or depression are exclusively caused by a biochemical imbalance, biochemistry does play a role. The efficacy data on the use of antidepressants and anti-anxiety medications are also very clear: they are most effective and recommended when symptoms are moderate to severe – primarily to assist with improving what is called the vegetative (or physiological) symptoms that accompany anxiety and depression – such as sleep or changes in appetite. When symptoms are less intense, non-pharmacological interventions such as cognitive behavioural therapy (CBT) are recommended. Contrary to popular belief, long-term, permanent use of psychiatric medications is not recommended or even needed – and can lead to other side effects and problems. In fact, an extended duration of time during which mood is consistently stable, combined with significant changes in psychosocial circumstances and external stressors is often an indication that psychiatric medication use can be reduced, if not eliminated altogether. Safely reducing or eliminating medications If you feel that you are ready to reduce or eliminate the psychiatric medications that you are taking, here are three things to keep in mind before making any decisions on your own. Enlist the support of a mental health professional who can offer insights into the psychosocial factors that played a contributing or exacerbating role for you. They can also help build a relapse prevention plan – with a heavy focus on preventative strategies that can help you manage symptoms from a non-pharmacological perspective. Any reduction of medications should be done in close consultation with a physician so that the side effects of both the reduction in medication, as well as close monitoring of symptoms can be conducted. Then, if you decide that reducing the medication is the right next step for you, make sure to involve your partner or get the support of a close friend or family member. Having the support of another can help you to identify and manage any symptoms that emerge as a result of the tapering off process. Remember that not everyone is reliant on medications for their lifetime, but there is no shame if they are required. Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
My wife is fundamentally against the idea of counseling – she’s depressed, unsatisfied with life and has serious body image issues. But I think she needs to see an expert. How can I convince her it’s a good idea? The answer: It can frustrating and saddening for any of us to see someone we love being unhappy and struggling with life. We can often feel helpless in not being able to improve our loved one’s emotional state, particularly if we feel we have exhausted the avenues we have available to us. Certainly there can be a number of positive benefits that many people can experience from seeing and receiving treatment from an objective, neutral and trained mental health professional. That being said, the first point I would like to underscore is that it is not your role to “convince” your wife to seek out counseling. Your role as a partner is, first and foremost, to serve as a source of unconditional support. I do not mean at all to convey that she does not need or would not benefit from counseling, but the way that you approach this discussion is key. All too often I see well-meaning partners who will “tell” or “try to convince” their partner to seek out counselling, but this message can be interpreted as critical (rather than supportive). I would suggest that you start by have a genuine, heart-to-heart conversation with her. If possible, be mindful of timing this conversation on a day and time when both of you have dedicated and uninterrupted time to speak, free of other distractions. Convey your love and concern for her. Focus on communicating how you feel, and be specific about what you have noticed (e.g., “I feel saddened when I see you looking upset and tearful…”). Avoid making assumptions about how she is feeling (e.g., “I think you are depressed and need help”) as this may come across as accusatory or judgmental. Ask what you can do to help and support her. Focus on directing the conversation toward what she feels she needs, and what she thinks would be helpful. You say she is “fundamentally against” the idea of counseling, and I would try to understand where this comes from. Has she had negative or unhelpful experiences with mental health professionals in the past? Does she feel shame or stigma about having to seek out help? Is she unclear about what role a professional would play? Does she feel hopeless that treatment would not help? This may provide a better understanding of where she is coming from, and may help guide you towards ways that you can more effectively support her. Finally, offer to go with her to an initial appointment, no-strings attached. Maybe she’s afraid and unsure about the process. Let her know that you see this as a family issue, and that if she is feeling unwell emotionally that impacts you. Emphasize that your goal is to help and support her, in whatever way possible. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  The Benefits of Online Counselling Services: Is Online Therapy Effective?
Online counselling has emerged as a response to a need that people have been expressing: Almost everything these days can be done through our phone or our computer, so why not health services as well? But the question we continue to receive: Is online therapy effective? Not only is online therapy as effective as in-office sessions but there are many added benefits of online counselling that we will outline here. Who is online counselling for? Online counselling is a unique service that allows people to access regular counselling services from the comfort of their own home. It increases the level of accessibility for clients, and the Psychological Health & Safety Clinic is proud to be able to offer these services with the same level of care as would be expected from in-office appointments. Online counselling, however, is not just for people with busy schedules who struggle to make in-office appointments. Online counselling also benefits people who:
What are the benefits of online counselling? Of course the main, and most obvious, benefit of online counselling is convenience. We save both time and money. We’re not required to spend time on hold or call during office hours to make an appointment. We don’t have to spend any extra time or cost travelling to a physical location and are less likely to be required to take time off work to attend appointments. And, of course, we’re able to do therapy from wherever we are able to get access to a computer and an internet connection. That even means we can have an appointment in our pyjamas if we’d like to! Reduced wait times, broader options for appointment times (including evenings and weekends), and increased access to the counsellor of your choice are all additional benefits of online counselling. Not having to force your choice of therapist (which is a very important consideration in therapy) based on where you live is also a fantastic advantage – it allows you to select the therapist who would be the best fit for you, regardless of where you or they live. This is particularly attractive for individuals who live in smaller or more remote communities where options for counsellors are limited. The specific nature of therapy itself (as opposed to other physical/medical treatments) is the added comfort of being able to have the appointment from the privacy and security of your own home. In therapy, it is common to discuss extremely emotional topics and people are often required to be vulnerable. For many, this is easier to do via video conference in comparison to an office setting that one is unfamiliar with. Being in your own home when a therapy session ends can also often facilitate a more conducive way to regroup and settle emotions post-therapy. Benefits of Online Counselling – Removing BarriersAnother major benefit of online counselling services is to help remove barriers for people seeking services. Not having to travel to a physical location is often a preferred choice for many people, particularly for those who:
Are you ready to book your online therapy session? If so, get in touch! We’re also happy to provide more information if you have any questions. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I’ve been seeing a therapist for 8 months. I’m unhappy with my life and feel like I’m not the best mother I could be. The thing is, I don’t feel like therapy is helping at all. My situation and my outlook hasn’t improved. Do I just need to be patient? Or does seeing a psychologist not help some people? The answer: At the risk of sounding biased, I firmly believe that we can all benefit from the support, perspective and guidance of an objective, competent, and specialized professional for various issues at different points in our lives. This is true for any area of life with which we are struggling – physical health (physician), our taxes (accountant), selling a home (realtor), or our emotional health (psychologist/psychiatrist). Although I don’t have enough information on your difficulties and history to provide you with a sense of how long you may need treatment for, I can let you know that the research indicates that individuals with the most common types of psychological concerns (i.e., uncomplicated depression, anxiety, and relationship difficulties) experience significant benefit after an average of 12-16 treatment sessions. Individuals with more complicated histories or concerns (such as childhood history of trauma or chronic suicidality) experience benefit with about 24 sessions. Certainly 8 months is a long enough period of time for you to have started to experience some significant benefits from therapy. It is wise of you to pay attention to the feeling you have that your current therapy is not helping you, as that is giving you an important message that you need to do something different. The beneficial impact of therapy is dependent on a number of important factors. Here are a few considerations: 1. As with any other relationship with a professional, a good fit between you and the service provider is important. I believe this fit is even more important to the success of a psychologist/patient relationship than others, given that patients are having to expose themselves emotionally and are addressing issues such as fears, insecurities, and other core vulnerabilities. Ask yourself whether you feel there is a good fit with the psychologist you are seeing in terms of their approach, style, and personality. 2. You describe feeling unhappy with life in general and with respect to your parenting style. Does the psychologist you are seeing have expertise in dealing with depression and mood issues? Parenting issues? 3. In every single profession, individuals range in terms of their competence levels. Ensure that the psychologist is up to date on advances in treatment approaches, and takes an evidence-based treatment approach (which means providing treatment techniques that research has shown are effective). Ask the psychologist directly about the types of treatment approaches he/she uses and the rationale for such. 4. Finally, have you communicated with the psychologist about how you are feeling about treatment not being effective? A good psychologist will not get defensive, and will openly address your frustration with the lack of progress. He or she should suggest a different treatment approach, or suggest an alternate type of treatment and/or alternate professional. If, after considering the above and after having a candid discussion with your psychologist, you feel that there are still no shifts or improvements, I would suggest seeking out another psychologist. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Online Counselling Security: Is it Secure and Confidential?
Online counselling provides people with a unique opportunity to easily and efficiently access therapy sessions from the comfort of their own home. In some cases, it may encourage people to seek support who may not otherwise – because of a busy life and logistical demands. But here we are addressing the concerns of online counselling security and the big question – is online counselling secure and confidential? Having a therapy session from the comfort of your own couch is appealing to many, it also brings up natural concerns around security. Security and confidentiality are both important aspects of therapy so it’s a good thing to be thinking about when considering virtual sessions. At Dr. Joti Samra, R.Psych. & Associates, security and confidentiality are very important to us and here we will discuss how we approach these topics in our practice. Confidentiality Confidentiality, for anyone who has not previously been to therapy, is a critical aspect of the therapeutic relationship. Best practice and ethical guidelines for psychologists and counsellors are very clear that information between a client and a therapist cannot be shared with anyone, barring any concerns of safety or acute risk. Confidentiality is an important part of therapy as it ensures people are comfortable sharing personal details about their lives without fear of that information being shared elsewhere. Before starting therapy, the therapist ensures the client understands what confidentiality means, as well as what the limits to confidentiality are and an informed consent form is signed. Just because virtual counselling services are conducted online does not mean they cannot be held to the same standards. We are committed to protecting our patients’ privacy and ensuring that our telehealth services meet the standards for psychological health services via telecommunications, as set out by the Canadian Psychological Association. This includes ensuring that information is kept confidential and that clients fully understand and provide informed consent to treatment. Online Counselling Security When it comes to online services it’s impossible to completely mitigate security risk, but it’s important everyone understands the risks before making a choice. We utilize encrypted secure platforms for the storage of all clinical and identifying information (client’s name, personal information, and clinical charts). We are happy to ensure our clients are comfortable with the process and welcome any questions or concerns about how we approach security. Are you ready to book your online therapy session? If so, get it touch! We’re also happy to provide more information if you have any questions. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Most people have heard of CBT therapy, but how many really know what it is? Don’t worry if you don’t, it’s one of those things that’s fairly challenging to describe. So, here I am going to break it down for you. I will discuss cognitive behavioural therapy (CBT therapy), what it is and how it’s techniques can be used in our day to day lives.
So – WHAT IS CBT? CBT is a talk-therapy that works on changing or modifying our emotions – or things that create distress – by focusing on our cognitions or thoughts (C) and our behaviour (B). Emotions are often hard to change in the moment. However, with practice, we can get good at changing our behaviours and thoughts, even when emotions are strong. CBT is not about brainwashing or rewiring our thinking. It’s also not about positive or excessively optimistic thinking. It’s about realistic thinking. When we’re stressed, anxious or depressed we tend to do a number of predictable things in terms of the way we think. Some of these include:
CBT helps us revise and refine our thoughts so they’re more accurate, and helps us draw awareness toward our behaviour so that we aren’t inadvertently reinforcing those thoughts. 3 ways to incorporate CBT techniques into your daily life 1: Increase awareness of thoughts now. Research says we have tens of thousands of thoughts a day – and most are automatic. This works well otherwise we’d be in sensory overload – but not so well if we have unhealthy or unhelpful ways of thinking. If the unhealthy or unhelpful ways of thinking become ingrained, they can have a powerful and negative impact on us. Becoming more aware of the thoughts we are having is the first step in changing them, or at least changing how we feel about or react to them. 2: Engage in the opposite action of what your natural urge is when stressed. This is a behavioural technique that is really helpful for changing our mood states. This is the case because our natural urges point us in the direction of short term coping mechanisms that aren’t necessarily healthy in the long term. How does this work?
3: Focus on things you can control – behaviour and thoughts – and keep in mind emotional changes will lag behind. Final Thoughts There is a very strong evidence base on the benefits of CBT for dealing with a range of psychological health conditions – whether it’s general stress or a condition such as anxiety, depression, addiction, or disordered eating. If you think CBT may be helpful for you, I encourage you to read more about it – we have tons of free resources on our website. Remember: Our thoughts matter. Our perception is our reality. Changing and revising & refining those thoughts can strongly impact how we feel. Considering taking that first step today? Good for you, that’s a big step to take. You can easily start by contacting the Psychological Health & Safety Clinic today. A little more unsure? Or don’t feel like you have enough time? Consider virtual (online) counselling as an alternative to traditional online therapy. All of our associates are trained in cognitive behavioural therapy as well as other therapy methods. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
My boyfriend is in therapy, which I encouraged him to do. But sometimes I worry about the psychologist saying disparaging things about our relationship. Would a professional do this or am I being paranoid? The answer: One of the most important roles for a competent psychologist is to be objective, neutral, and balanced in terms of their perspectives on their patient’s life situations. That said, psychologists – like any other individual in any profession – range in terms of their skills, efficacy and approach. So the answer is that a competent and ethical psychologist should not be making inappropriate judgmental comments to your boyfriend. But, like any other profession, there is always the small chance that a professional may be acting in a non-professional manner. One’s relationship is often a very appropriate area for discussion in a therapeutic relationship, so chances are good that your relationship has been discussed in some capacity. The more important question is what other worries you may be having about your relationship. To me, it sounds like you are concerned that your boyfriend may be bringing up these issues in therapy and that the psychologist may be commenting on them. My best advice would be to have a straightforward and open conversation with your boyfriend. Remain respectful of the fact that your boyfriend may – very appropriately and understandably – not want to talk about any details of his therapy with you. Instead, the goal of putting your concern on the table is to initiate a discussion about any areas of your relationship that you or your boyfriend think could be improved upon. Ask him openly how he thinks things are going in your relationship, and if there are areas that he thinks need to be improved upon. Share your perspective and identify what you see as strengths and weaknesses. Take a positive, problem-solving approach where you work toward thinking about ways that you could both improve any areas that are less than ideal from one or both of your perspectives. Try to not get defensive when you have this conversation. Remember that all relationships have challenges, and that the stronger couples speak openly about areas of weakness and proactively work on them. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. Online (Virtual) Counselling: As Effective as In-Office Sessions?Planning for and traveling to appointments can be such a hassle. Most of us have busy lives and packed schedules, so the time it takes up to book and travel to appointments often discourages us from making them. We know that the appointments are important but we can’t justify the time. You’ve likely seen an explosion of advertisements over recent years for virtually-delivered health services: online, through video, phone, and apps. Did you know that doctors and nurses aren’t the only ones providing these services? Psychologists and clinical counsellors are now also providing virtual counselling services. All you need is a computer (desktop or laptop), a private space, and a good internet connection and you can have your therapy sessions from the comfort of your own home! Sounds easy, doesn’t it? Is it the same experience and as effective as in-office appointments?It’s easy to think there may be a cost that comes with the convenience of telehealth, but that’s not the case. The clinicians you have the opportunity to work with are the same professionals, with the same level of education, that you’d work with if you were participating in in-office sessions. In some cases, the clinicians who are offering telehealth services are also offering in-office sessions depending on individual needs. Furthermore, the research efficacy demonstrates that for the vast majority of presenting issues (e.g., work and relationship stress, anxiety, and mood disorders) the effectiveness of therapy services provided virtually are equal to – and in some cases even better than – traditional in-office delivery. What the Research SaysA large 2016 survey funded by the National Institute of Health (NIH) concluded that between 94 percent and 99 percent were “very satisfied” with virtually-delivered counselling services, and one-third of respondents actually preferred the telehealth experience to in-office.
Another study indicated that people who engaged in telehealth sessions were more likely to want to repeat their experience with a therapist than they were with an in-office care provider. Furthermore, over 60% of millennials indicate they would like telehealth services to fully replace in-office visits, and indicate they would prefer the use of technology to supplement their experience. These results are not surprising considering that millennials (who now make up the greatest portion of the workforce) are a generation that generally grew up with and are comfortable navigating computers and technology – and not only want but expect the convenience technology can afford. |
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