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Understanding Theories
Psychotherapy is about helping people grow and change. When clients come for help, therapists gather information and make decisions about how to intervene or proceed to best helping clients to make the changes they seek by using theories to organize and simplify the information clients share. A therapists’ theory is a kind of map and includes knowledge of human development. The theory leads to the type of techniques and tools a therapist may use, though some draw from other theories when it fits. A theory should fit with the way a therapist views mental health, but also fit the client issue and personality, as well as their resources. Overall, the theory is not as important as a good fit with the therapist. Is Therapy Effective? Research consistently suggests the effectiveness of therapy with between 75% and 80% of clients benefitting after 10 to 20 sessions, with lasting benefits. What makes therapy effective? Outcomes depend largely on how effective the therapist is using what is called “Common Factors”. That is, factors common to all therapeutic approaches. It is about their ability to develop a good therapeutic alliance, with real and genuine empathy, as well as both the clients’ and the therapist’s positive expectations for change, and the hope that clients experience at the beginning of therapy. Clients need to feel heard, understood, accepted and hopeful for therapy to be effective. Clients themselves actually attribute 40% of the change they experience in therapy to external factors such as their own resources or supports and opportunities. About 30% of outcomes are tied to the therapist–client relationship, and only 15% to techniques. Though differences in positive outcomes of therapy from different theoretical approaches are not strong, the approach still should fit a clients’ needs. The therapeutic alliance is of great importance but the tools they use may be in part responsible for the development of the therapeutic alliance. The therapist’s confidence and competence in their method influences their ability to create hope and positive expectations. These factors are inter-related. Overall, the methods should be a good fit for the therapist and the client. Common Factors A common set of variables are important, regardless of the differences in approach. Some of the factors that are important towards effective therapy outcomes are:
Effective Therapists The quality of the therapy relationship is the most important aspect of the therapy process. A therapist should be friendly, patient, warm and genuine. They should be able to make appropriate and helpful self disclosures not sharing distracting stories because of over-relating. They should be encouraging, honest, and flexible with respect for differences without losing sight of what they believe to be healthy, based on in-depth knowledge of human development and wellbeing. They should be ethical, objective and fair with good communication skills that demonstrate enthusiasm and hope. Good therapists are self aware, up to date on relevant issues and research, dedicated to life-long learning, aware of their own limitations and open to feedback from clients. How to Get Started Sometimes clients are unclear about their goals. That is ok. It can take time to feel safe, heard and understood about what feels “wrong” and what the problems really are, before deciding what change would look like. Still, it is important to collaborate and come up with somewhat measurable goals in order to be able to track if therapy is helping. It is important to feel safe to ask questions and to give feedback to the therapist about client experience. Therapists are usually very well intentioned but not always effective at judging if the rapport is intact, or when there has been a rupture. Clients can feel just a little bit less understood one day and not return to therapy. At our clinic we value feedback and understand the importance of effective alliance building skills. Our therapists possess the personal qualities that make for effective therapy. We make it our ethical obligation to try to fit the client to the therapist and prefer to refer to another practice if we cannot meet the needs of a client rather than keeping them with us. Feel free to reach out by email, clicking here for a consultation about which therapist could best fit your needs. Clients with eating and body image concerns come to therapy after years of suffering in silence, and some after years of ineffective interventions. Our Clinic Director has had success in this area in part from research and personal experience suffering, extensive reading on this subject and have an approach that is personal, direct, honest and integrative. It is often different than what they are used to.
Shirley Katz, Ph.D., RP, our Clinic Director has written about her beliefs on this topic and supervises therapists who work in this area. She believes that any compulsive behavior, defined as that which is repetitive, unhealthy, unwanted, mindless - is avoidance of Self which is made up and informed by emotion. Most have learned for some reason or another that there was no room for the emotions. Trauma, childhood neglect or abuse, growing up with someone whose emotions were out of control - these are just some of the reasons people learn to sweep their feelings and opinions under the rug. People learn overt and not-so-conscious ways of controlling themselves and interpersonal relationships only to find that painful patterns keep coming back and they are out of control of their harmful behaviors despite so much effort. Without addressing underlying social learning about emotion, teaching new ways of coping with feelings, and changing the way people think about themselves and others, there can be no real healing from eating disorders. Whether it is body hate, counting calories, denying the self nutrition - its all the same. These obsessions take us away from healthy relationships with our Selves, with food, with out bodies and with others. The therapists in our clinic work with this model, including Audette, Chantel and Carolina. Therapy for eating disorders tends to be a bit difficult and long term. It takes more time to feel understood and to be understood when emotions and vulnerability are repressed. Out therapists understand the difficulty for our eating disorders clients to feel vulnerable, to trust and allow their feelings to emerge. They work patiently to build the therapeutic relationship and help clients feel respected, heard and understood so they can feel safe to explore and make valuable changes. This sometimes goes along with the process of learning to trust one's self and effectively manage emotional experiences. Audette is a Registered Social Worker therapist who is also a Registered Nurse with training and special interests in this area of work. Chantel also has special interests and training in working with this issue. She was a varsity athlete and understands how the role of competitive career areas interact with this issue. Carolina has experience in working with Eating Disorders including a past role as a hospital based Psychologist in Brasil. What shapes who we are and brings meaning and purpose to our lives if not our relationships? Many times the way we relate to other adults has roots in the way we were treated as children. Our personalities and experience in life also shapes how we interact in relationships. Do we trust others? Do we feel love worthy? Are we too needy of reassurance or hyper independent?
Significant experiences in different stages of life can have a huge impact on how we function in future relationships. Trauma can make it hard to feel seen, heard and supported in a relationship or to ask for what we need. Sometimes what we need is too complex and difficult or even triggering for a partner and therapy is needed either individually, in couples' counselling or both. What is relationship wellbeing? While there are some evidence based factors that help contribute to a healthy relationship, each person has to determine for themselves how satisfied they are. What is the meaning of the relationship you are in? What is its purpose? Does it nurture and nourish those who are committed to enhancing it? Are those who are committed to one another committed to nurturing the relationship in an equal manner? Or do you have to alter who you are and hide your feelings and needs to be accepted? Does your need to feel secure make you act in ways that interfere with your needs or your partners' comfort? Are there relationships in your life that you want to change or let go of, or struggle to hold on to? Therapy can help you and/or the other person work through those questions and function in ways that feel more helpful or meaningful and to change unhelpful pattern of thinking or reacting. Therapy can also help you understand why or how you may attract a type of person that does not enhance your wellbeing. Wherever you are at with significant people in your life, therapy can help you hear and speak to one another through a new lens or make choices for yourself that are more in line with your own wellbeing. Our approach draws from attachment theory, emotional focused therapy and other neurobiology informed methods. Some of us have special training in Attachment related issues and a few of us are specially trained to work with couples and families. Shirley is the Clinic Director and has training and experience working with relationships from her Doctoral program at UBC and experience working in the past as a Psychologist for the Ministry of Children and Families in BC. She consults, supervises and mentors therapists who want to work in the area of relationships as many Masters' level therapists do not have formal training in working with couples and families. Several of the associates in this practice trained under her and we are happy to provide potential clients with information about their training and background to help determine fit and suitability. Most counsellors and therapists abide by ethical codes that include something called "Limits to Competency" in that they will not take on client issues that they do not have the training to support. Unfortunately some will accept clients they have not the background to help effectively. Please ask questions about training and experience before making a decision. You do not invest money and energy in therapy to be discouraged. Shirley Katz, PhD., RP, our Clinic Director wrote a few articles for Marriage.com. Note that there are internal links to courses that were not part of the original articles and that the external site may include those without the author's permission. Feel free to read: https://www.marriage.com/experts/shirley-katz If you want to be matched with a clinician who works with couples or family members together, please contact us by email through this link. Many people suffer from sadness, loneliness and grief or normal fluctuations in mood due to events in life or even their physiology. Without sadness when we experience lack, or loss, we would have no attachments, no motivation to seek out betterment. Grief and loss, loneliness and frustration need to be heard and supported. This does not always require therapy.
Depression is not sadness. It’s a mood state that sometimes plagues a person like a dark cloud and often is marked by a state of apathy and a loss of interest in things that used to make a person happy. There is often a negative outlook on things that impacts choices and behavior. It can impact sleep, appetite, bonding, motivation, focus, and more. The very things that make a person feel alive and well tend to feel like too much of a burden to engage in and sometimes others are pushed away or stay away because they do not know how to be helpful, making depression potentially more severe. Poor physical health can worsen depressed mood, and depressed mood can worsen physical health. Therapy that takes a mind-body approach to depression is imperative. Empathy and support together with gentle behavioral activation, is helpful to bring back enough vitality to help a person work to enhance their own mood and wellbeing. Pacing is important. Enhancement of motivation needs to happen in the context of understanding the whole person, not their depression. People who struggle for a long time with depression tend to forget their true self and over identify with their depression. Our Psychotherapists are trained in Cognitive Behavioral Therapy and Acceptance Based Therapies like ACT and Mindfulness to treat depressions. Some of us have special skills in understanding how medication can interact with therapy and how fitness or time in nature can help. Most of us also understand how to draw from Self Psychology – enhancement of sense of self and self worth. Choose a therapist you feel can understand and connect with who you are as a person, but who also knows how to help you change your thoughts and behaviors in a respectful manner towards a more positive life. Make sure you are addressing mind-body wellness with attention to potential health factors that might relate to low mood and/or poor self care. Please ask us to match you with a therapist that helps with Depression, Low Mood or Grief by emailing us here. Most people addressing gender issues for the first time in therapy have kept it buried for so long...they feel shame and fear to disclose. A good therapy alliance is essential.
We are fully aware of how important the therapy relationship is. Trust that we are not judging and will make you as comfortable talking as you let us, and relief will come in addressing things you may have hidden from even your self. Clients dealing with gender issues may be in various places in their journey of self understanding, self acceptance, and potentially transition. There may be self esteem related issues, interpersonal or family history issues, lack of acceptance or self acceptance and sometimes a people pleasing problem. We have supported many clients in varying stages of awareness, identification and coming out as well as transitioning. We are aware of the research on this issue and am partial to the notion that being able to live as much as possible as who you genuinely are, finding acceptance and support for this Self- is the holy grail of well being. Happiness is a fleeting emotion. Satisfaction with life, dignity, and self-worth cannot be denied. Finding and expressing your truth is important as are healthy relationships that are reciprocal and adaptive with appropriate boundaries. We are also available to help friends and family who are learning how to support someone who is coming out or transitioning. When relationships are problematic, we work with clients to learn how to assert healthy boundaries. Clients experiencing gender dysphoria or going through transition often need support that is not standard Psychotherapy but may be related to wellbeing. We maintain a small referral and support net of helping professionals, and keep up to date on services available that are relevant and can be helpful. If letters are required, we can often write them, collaboratively, when suitable. There are a few therapists at the clinic with a background in helping with gender issues. Please email and ask to be directed by clicking here. Did you know anxiety is considered to be one of the most treatable conditions in therapy?
Many clients present with concerns about anxiety. Each person is unique and there are many ways anxiety can be experienced and expressed, ranging from mild stress responses in adjusting to new or difficult circumstances to extreme physiological patterned responses to earlier trauma(s). We take a trauma informed approach, assessing the nature of the concern thoroughly before making a therapy plan with you. We are trained to understand how thoughts, emotion, physiology and neurobiology, and environment or systems interact to create issues people bring to therapy. Maria, Chantel and Carolina work with trauma from different methods but with gentle and caring awareness. When anxiety is present there is some focus on a cognitive behavioral intervention to help alleviate distress, teach new coping responses to stress however we also pay attention to systemic or environmental issues, historic experiences and lifestyle variables that may be part of the problem or challenge a persons' efforts to change. Victoria takes a Cognitive Behavioral approach to reduce symptoms. Chantel is trained in Yoga and Relaxation and also works on new coping to manage symptoms. Maria is trauma trained and may use many methods including skill from DBT to help reduce symptoms. Elissa might help understand how to be more assertive and self aware to identify and deal with interpersonal triggers. Audette may take a look at past learning, triggers and new ways of coping. Ella might explore the early roots of distress and help a client heal through the relationship with the therapist. Carolina, who worked in hospital settings as a Psychologist in Brasil, does a thorough assessment and may work with other professionals on your care team if needed, using herself both a CBT approach and integrating expressive therapies if helpful. The method is not as important as feeling that the therapist is a good fit - please reach out to the Clinic Director to be matched. A common form of anxiety that causes a lot of distress is Obsessional Anxiety. Being obsessional can be a factor of personality, a response to traumatic events, or a diagnosable anxiety condition. Being obsessional and hypervigilant can also be a symptom of trauma. A good therapist can do a thorough intake and help a person determine this. Depending on the history/source and nature of the problem, treatment also varies. When there is a genetic predisposition to diagnosable OCD people can often recall that their parent did a lot of what is called “checking behavior”. While it may not have interfered directly with their lives, they may have been plagued with constant worry that led them to check and re-check things like locks, bank accounts, cleanliness, etc. The checking behavior provides some kind of short term relief of the fear but research shows that it also creates long term pain, in creating more and more obsessions and fears. Sometimes avoidance is used to not feeling the anxiety, rather than washing or checking for example. When there is a genetic predisposition, sometimes medication can help along side therapy. This is well known in the mental health field. If trauma triggers OCD type symptoms, then trauma needs to be delicately addressed before working on the symptoms that may be in place to cope with unbearable feelings. Choose a therapist that you feel can really understand you when you are dealing with these kinds of repetitive thoughts, feelings and behaviors. A few of our therapists can provide CBT or ACT to help, and one of our therapists Audette is also a nurse, well trained in a hospital setting with a good understanding of the impact and interaction of medication and therapy. Please ask. Email us by clicking here for an intake. Many people do not know how to search for help with career choices or career transition. Gone are the days where we chose a job and stayed with it, and it became our “career”. These days people train and re-train, come in and out of a field of work or the job market. Sometimes people go into careers or training with certain ideas of who they should be and then discover that their choice is not a good fit for who they are. They have different interests, and lack of motivation to stay on task with things that do not fit for them. Or sometimes there may be issues with attention and concentration, mood or anxiety – that interfere with people’s abilities to achieve in an area that is important to them.
A therapist who has been trained in career counselling and personal transition can help navigate issues and overcome bumps in the road to success. This can be done systematic career testing involving measures of personality, interests, values, etc – or qualitatively over time through a strong therapeutic relationship. There are evidence/science based measures to use in your therapy assessment and treatment plan. School issues can be addressed in collaboration with important people in the educational system or with the individual themselves to work on behaviors or thoughts/attitudes, addressing fear, procrastination, avoidance, shyness, performance anxiety, personality and preferences, dreams and hopes. We have a good understanding of the differences between trauma/anxiety related symptoms and the more chronic neurological symptoms of ADHD and are able to help people cope with these issues. If you are uncertain about your current or future career and want career counselling, or psychotherapy help towards achieving your career or life goals, do not hesitate to ask us for help. In a brief call, you can let us know your needs and we can try to match you with the right therapist. To email our intake team click here. Carolina currently works with international students in a university setting helping with Career Counselling. Victoria has worked in several fields and has special interest in supporting clients in Career transition. Shirley (Clinic Director) has taught Career Counselling and Career Planning at the undergraduate and graduate level and can guide clients in using formal and informal assessments when experiencing career transition. A kind, compassionate supervisor once said to me, "Have you ever met anyone who had enough validation today"?
No matter how you look at the research on human experience of challenges, problem solving behaviors, personality, mental health services, methods, etc. there is a ton of evidence that having social support is a key factor in overcoming hardship. Yet we are living in a world where social connection is in competition with internet connection, where we log on, hook up, swipe and sometimes seek attention rather than connection. We are all living in a world that is progressively more focused on material wealth, competition and greed and less on living in harmony with nature and one another. Therapy is not friendship or community, but can offer a caring, attentive and healing space for a person to be seen heard and understood. Therapy can help a person understand what makes them feel connected and whole and get back to a healthier life with a more satisfying and meaningful experience. Reach out. Therapists like Elissa, Maria, and Chantel work well with clients who are looking for meaning and connection or support in making those kind of connections outside of therapy. The pandemic created a huge market for mental health services. People began needing more help but also on a positive note, realizing that its ok to not be ok. Social media picked up the topic too. Some people with limited or no training or expertise are popular on social media talking about symptoms of mental health diagnostic categories and giving out coping tips. Therapy is not about simple tips. If it was, you could read a book and be fine.
As far as diagnosing goes, only a Registered Psychologist, or Medical professional are able to do this. They can also treat mental health conditions with medication only if they are a medical professional like an MD, Psychiatrist or sometimes a Nurse Practitioner. There are often higher fees and longer wait lists to see a Registered Psychologist since they are able to provide a diagnosis. They can also provide therapy. A Psychiatrist is a medical specialist and unless in an Emergency setting, most often require a referral from your Family Doctor. Wait lists can be excessive. They often offer short appointments that are focused on making sure a patient has the right medication for their condition. Some are trained in psychotherapy but it is rare to be able to see a Psychiatrist in Ontario for therapy. If you are seen in emergency for a mental health crisis, you may see a Psychiatrist. Registered Psychotherapists in Ontario are licensed to provide ethical and competent care that is relational and contractual, aiming to bring about positive change in thinking, feeling, behaviour, and social functioning when one or any of these factors has adversely impacted a persons day-to-day quality of life or relationships. They are bound by standards of practice set out by their college, in Ontario its the College of Registered Psychotherapists of Ontario. The public can look to see if a member is regulated, has any conditions on their license or are still in the Qualifying category requiring supervision. They can also look at the site to know what to expect, for example a clear goal setting process and evidence based practice that helps people make progress. A Registered Social Worker and some other professionals such as Occupational Therapists or Doctors can also provide Psychotherapy in Ontario though their training in methods may be different. The Ontario College of Social Workers and Social Service Workers (the College) is the regulatory body for social workers that assesses their qualifications for membership and protects the public. A Social Worker may look at an individual's wellbeing more in the context of the systems they live in and interact with, assessing their functioning as an interaction of biology, social factors, cultural or spiritual factors and offer a perspective or suggestions that connects outside factors to the cause and solution to challenges. Our team member Audette is both a Registered Social Worker and a Registered Nurse with experience in Psychiatry. What is also important is to recognize that the theoretical orientation of the therapist - the way they do therapy - is not the most important part of therapy outcome. There are many ways to get to a goal. However, relationship with the therapist is primary. If you do not feel heard, understood, comfortable and hopeful with a therapist they are not going to be able to help you. Focus on a good fit with a therapist and let them work with their experience and therapy lens to help you. At our clinic we are all licensed and regulated professionals. We use different methods, including ACT and CBT (Victoria, Maria, Shirley, Chantel), Emotion Focused (Elissa, Shirley), Systemic Therapy, Psychoanalytic (Ella), Attachment Focused (Ella), DBT (Maria), Mindfulness Based (Chantel, Shirley) Systemic/Family (Christy), Humanistic-Existential (Most of the team), Trauma (Chantel, Maria) and more. The intake coordinator or Clinic Director will help you find a fit to your expectations, personality and needs. You are welcome to have a free consultation with several therapists to see who feels like a good match for you. Reach out. Do you use your cell phone before bed to distract yourself into sleep? Let me assure you, its most likely contributing to sleep disturbance. Did you know, many people entering psychotherapy for help with their mental health experience sleep problems. In fact between 50 % to 80 % of adults who seek mental health help have sleep struggles, compared to about 10% to 18% of the average population.
People entering therapy or counselling may have sleep disorders, but most often they have difficulty falling asleep and ruminate or worry - or they wake up multiple times in the night. Some therapy clients may be suffering from insomnia, a difficulty getting to and staying asleep – or sleep deprivation, a lifestyle that continually deprives a person of enough opportunity to sleep. While short term sleep deprivation may lead to short term elevated mood and energy states, in those prone to bipolar disorder can be a red flag. Poor quality sleep and deprivation of sleep overall is related to poor cognitive outcomes and mood dysregulation. Sleep problems are seen a lot in psychotherapy when people struggle with mood, anxiety and ADHD. We often overlook the importance of sleep when we are struggling. At our clinic, some of our therapists do a very thorough initial assessment that includes sleep questions, others do it informally as they get to know the goals you bring to therapy. All of the therapists at Creative Transitions understand the importance of quality sleep. We will help you to work on sleep “hygiene”. We will remind you and coach you to get away from your devices (this is so important) before bed. We may teach mindfulness and other relaxation skills to help you clear your mind. We may work with CBT to help you direct your focus in order to reduce the anxiety you may have about waking up or losing sleep, so you can fall back asleep more readily. Please reach out and discuss any sleep concerns with your therapist. We are also open and willing to talk with you doctor with your expressed consent, if need be. Be well rested and restored. |
AuthorShirley Katz, Ph.D, Registered Psychotherapist and Associates Archives
August 2026
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