I've always found it puzzling what people chose to spend their money on at the expense of other things. Now that I work in the mental health field, it mystifies me even more. Weekly manicures, $4 lattes, cab rides, cocktails, botox, restaurant meals: No problem. Counselling? No way.
I think in Canada, the reluctance for many people to pay for psychotherapy or counselling goes beyond the widespread stigma of seeking mental health support. First off, we are not used to paying for health care. Aside from dental and vision services, for which some people do not have extended health insurance coverage, our medical expenses are covered by our provincial health insurance plans. While psychiatrists are covered by our health care system, they rarely do psychotherapy any more and are very difficult to access.
Clinical psychologists, clinicians supervised by clinical psychologists, and, sometimes, clinical social workers, can be covered by private insurance plans, but the services of other mental health care providers must be paid for out-of-pocket. Even those with extended health insurance for counselling may only get $500 per year, which will usually only cover a few sessions. And a lot of people it seems, don't want to pay. Anything. Period. After all, most of the time when you go to see a physician, you leave with a tangible outcome: a referral, a prescription, a test result, etc. What do you get from a counsellor?
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Many folks assume that counselling involves nothing more than a dour individual in a corduroy jacket sitting silently while the client (we no longer refer to you as "patients") lays down on a couch and verbalizes his or her stream of consciousness. Yes, that is one approach. But it is only one, and there are many. I've heard people say, "If I want someone to talk to, I talk to my friends." A trained counsellor or therapist provides something different than a friend. We are trained to be as objective as possible. While there is no such thing as complete objectivity, it is easier to be objective when (1) you do not already have a personal relationship with the subject, and (2) when you have been trained to be aware of your own biases and to keep them in check.
A counsellor can also employ a wide variety of therapeutic techniques to help a client address a problem. This goes beyond simply listening. It could be cognitive-behavioural techniques such as keeping though records, it could be narrative or art therapy, it could be psychoeducation about any number of issues, it could be skill building in a variety of areas, and the list goes on and on. While some therapeutic approaches are passive, others are equally interactive or directive.
Counsellors and therapists can have a wide variety of training and credentials and can employ a diverse array of approaches, but what matters most is the relationship that is formed between counsellor and client (what we call "the therapeutic alliance"). All too often I hear someone say he or she once visited a counsellor and it was not a positive experience, so he or she swore off counselling forever. Unfortunately, finding the right counsellor can take time and some trial-and-error. There is no one-size-fits-all. It can be helpful to tell potential therapists exactly what you are looking for. If you aren't sure, do some research ahead of time.
Start by exploring your reasons for seeking a counsellor. Define your goals. What do you want to get out of counselling? What are some of the popular therapeutic approaches out there, and what are they best suited for? Do you want a counsellor to just listen, or do you want a more directive counsellor? Once you've figured this all out, find clinicians in your area and start making some calls. Many are willing to do free phone, or in-person consultations. If you try one and it's not the right fit, try another.
Many people believe that their problems are their problems and they should be able to deal with them themselves. And what the heck do you get from seeing a therapist any way?
We do more than just listen. We are trained to look for psychopathology. We may pick up on symptoms of depression or anxiety that can be addressed through specific counselling strategies, or we may recommend you speak with your family doctor about taking appropriate medication. We can teach you stress management techniques or communication skills that can assist with relationship or workplace problems. We can help with decision-making regarding education, career or health issues. We can facilitate the resolution of marital or family conflict and educate on parenting and discipline. Some counsellors may have special experience and training for dealing with addictions, eating disorders, phobias or trauma.
So while it's true that you may not walk out with a solution to your presenting problem after your first appointment with a counsellor, it may not take biweekly sessions over the course of 10 years to see results. Many counselling approaches are designed to be brief.
So is it worth the money? Do counsellors really offer you more than a friend or your local sympathetic bartender? The answer is yes and yes. We can provide many tangible skills and resources that can help you overcome a wide variety of health or life challenges. You may not get results as instantaneous as botox but they may be longer lasting and far more significant!
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She has way too many people she sees either for one-time consults or for longer who would benefit from a therapist (possibly in combination with medication management through a psychiatrist or the family doctor, with possible backup from a psychiatrist), but money is the huge obstacle for many, many people.
That being said, it's also hard for people to find the right therapist to see, and if you're getting the wrong kind of therapy, or the therapist just isn't good, that's money down the drain. Same thing applies to a crappy doctor of course, but it's often harder to tell, and the money isn't out of your pocket.
If you are surprisd, Ms Berman, you are simply actively demonstrating the degree to which you are steeped in a prevailing institution and unable to see the staggering pitfalls of a deeply tainted system.