The Medical Clinic for Person-Centered
Psychotherapy
265 Yorkland Blvd., Unit 403
Toronto, Ontario, M2J 1S5
Telephone 416-229-2399 Fax 416-229-9771
Welcome to the Medical Clinic for Person-Centered Psychotherapy. Your decision to enter
psychotherapy is an important one. At your first appointment you will meet with one of our
trained physician therapists and together you will begin your therapy. Psychotherapy is a
recognized effective means of medical treatment for many emotional and psychiatric
conditions. The process is not always easy and can in fact be difficult at times. The
following is an information guide for the medical treatment, Psychotherapy, that you have
chosen. Following the information guide is a Consent form for you to complete.
1. What is psychotherapy?
Psychotherapy is commonly defined as an “interpersonal process”, i.e. an interaction between
people, designed to bring about change in the feelings, thoughts, attitudes and behaviours of
persons experiencing emotional and psychological problems. Psychotherapy is an
opportunity to help patients to better know, accept, trust and even mistrust aspects of their
own inner self. We recognize that patients who are better in touch with their “true” and
perhaps hidden selves will experience more courage, creativity, humour and general
satisfaction in their lives.
In psychotherapy the patient and physician therapist enter into a professional relationship, as
a team, to attempt to achieve this goal. Psychotherapy usually takes the form of an interactive
conversation and usually occurs regularly at a mutually agreed upon time and place. It can
occur once or twice a week for a varied length of time. As a rough guide, crisis intervention
is generally brief, short term psychotherapy is approximately 10-20 weeks and long term
therapy can be from 20-60 weeks or more in length.
Traditionally most psychotherapy is one physician therapist with one patient. There are many
variations for this. Group therapy with up to 12 people is a newer technique. There is also
couple and family therapy.
The overall aim of your psychotherapy is to help you psychologically. It is designed to help
you in terms of increasing your understanding of yourself and to lead a happier and more
fulfilled life. Usually therapy is emotionally supportive and almost always helps to make you
feel better. It is important to be aware that it is not unusual for therapy to be difficult and
painful at times. The process can feel confusing. If the therapy is too painful it may indicate
that the therapy is not effective and unhelpful. You must be the one to finally decide that.
Your therapist may not be able to determine this. Alternatively at some point the therapist
might believe that the therapy is excessively difficult for you. In that case the therapist may
1
have to suggest an end to the therapy. This would likely be done over a few sessions. Your
therapist will not abandon you. Every effort to find another therapist will be made. It cannot,
however, be guaranteed.
2. What are the different types of psychotherapy?
There are different types of recognized psychotherapy. The doctors here at the Medical
Clinic each vary in the methods they use. Most provide supportive or eclectic psychotherapy.
Some doctors at the clinic provide more specialized therapy such as psychodynamic or
cognitive behaviour therapy. It is important in your initial sessions here at the Medical Clinic
to discuss the type of therapy practised by your therapist so that you understand which
therapy you are consenting to.
Although types of therapy do differ, there are common elements to all the therapies offered.
In general therapy psychotherapy is an intensely personal, intimate, emotional and private
professional relationship between the patient and therapist. The relationship between the
patient and therapist is caring and open with confidentially strictly enforced. (There are
however some rare limitations to this.) The environment is one where emotional expression
is encouraged in a supportive and empathetic way. In therapy information on human
development and psychology is shared to enhance a patient’s knowledge and understanding.
In therapy, a frank and honest discussion of an individual’s unique life problems, issues, and
their unique pathway through life occurs. Psychotherapy strives to enhance creative energy,
resilience and self-empowerment skills. Self-esteem and self-actualization skills are nurtured.
It is a process that leads the patient in self discovery.
3. Who are the different types of professionals practicing Psychotherapy?
Some patients are confused by the different types of professionals who practice
psychotherapy. Psychotherapy can be practiced by a variety of health care professionals. GP
therapists are primary care medical doctors with special training and interest in psychiatry
and psychotherapy.
Psychiatrists are medical doctors who have at least four years of specialized training beyond
medical school in the field of psychiatry. Most physicians here at the Medical Center are not
psychiatrists. Psychiatrists are difficult to access and generally have long waiting lists. Many
emotional problems do not require the expertise of a psychiatrist.
Psychologists are not medical doctors but have extensive training in psychology and
psychotherapy. They have less training in medicine, biology, disease and medications. They
are not OHIP affiliated and charge privately per session.
The psychotherapy practiced by primary care physician therapists, psychologists and
psychiatrists differs somewhat. One is not better than the other. One type however may be
better suited to a patient over another type.
Here at the Medical Center most physician therapists are Primary Care Physicians. They are
licensed by the CPSO and some have qualifications from the CCFP. All of our therapists are
trained to provide psychotherapy. This training is varied with individual areas of interest and
2
experience among our therapists. They are all caring and motivated therapists. Each therapist,
as a licensed physician, is responsible for the quality of medical care they provide. The
Medical Center does not take any responsibility for the psychotherapy provided by each
independent associate.
It is important to understand that your therapist, as a medical practitioner, is required by
professional regulations to complete a medical assessment of your mental status, your
behaviour, and your personality. This includes diagnosis and a treatment plan. This is all part
of your medical record.
4. Informed Consent
It has become increasingly important in modern medicine to give patients more complete
informed consent. This simply means that patients should be educated more fully and in more
detail about issues related to the decisions about medical management and treatment. In the
interests of informed consent it should be pointed out that:
A.
Most physician therapists who are associated with the Medical Clinic are primary
care physicians. All physicians associated with the Medical Clinic are empowered by
law and by professional regulation to conduct psychotherapy with medical patients.
Although all the general practice and family practice physicians associated with the
clinic have training in the diagnosis and treatment of emotional problems, it should be
pointed out that, some physician associates have more and some have less experience in
different areas. The physician therapists associated with the clinic were taken on
because it was felt they are interested, able, motivated, and caring physicians.
Nevertheless it is generally the case that in private medical practice each medical doctor
is solely responsible for the quality of the medical care they provide. Therefore, the
Medical Clinic does not take any responsibility for the psychotherapy provided by our
independent associates.
B.
Psychiatrists are physicians that have four years of additional post-graduate medical
training in the diagnosis and treatment of emotional and mental disorders. Some would
argue that some psychiatrists are more qualified to do psychotherapy than are primary
care physician therapists. Certainly, for very difficult problems and for specific, more
specialized psychiatric disorders it may be important for psychotherapy to be conducted
by a psychiatrist. Nevertheless it is also widely believed that for many emotional
problems, a caring competent non-psychiatric therapist is adequate for high quality
psychotherapy. Most physicians associated with the Medical Clinic are not psychiatrists
and are not practising psychiatry. Although psychiatrists generally have more training
and experience in conducting psychotherapy there are very few available for seeing
patients. Psychiatrists generally have a long waiting list. If you would rather see a
psychiatrist, please let us know and we will try to point you to some resources.
C.
Physicians associated with the Medical Clinic are not psychologists and are not
practicing psychology. Psychologists often have more training in Psychotherapy but
have less training in medicine, psychiatry, human biology, illness and disease, as well
as drug treatment for emotional problems than do the physician associates of the
Medical Clinic. In addition, they must charge a fee per session, which is not covered by
3
OHIP. If you would rather see a psychologist, please let us know and we will try to
point you to some resources.
D.
It should be understood that “primary care” psychotherapy, “psychiatric”
psychotherapy and "psychological" psychotherapy may all be somewhat different, yet
also that, none is necessarily "better" then the other types of psychotherapy.
5. How can psychotherapy help?
The potential benefits of psychotherapy are many. Psychotherapy has been shown to reduce
anxiety, decrease depressive symptoms, give insight into causes of depression and anxiety,
improved interpersonal interactions and improved the ability to adapt and cope with stress.
Appropriate use of psychotropic medication is also supported by physicians at the Medical
Clinic.
6. How does therapy begin?
Initially you will meet with a therapist for a detailed assessment of your personal and social
history, your past and present symptoms and your past history of psychotherapy. This initial
assessment can take several sessions to complete. At this time a decision as to whether or not
to proceed with psychotherapy will be made by the therapist and you together. The next step
is treatment plan will be made and discussed with you. At times your initial therapist will
arrange a transfer to a more appropriate therapist in order to meet your needs.
When you are accepted into therapy you will be working together with one of the therapists
here in the Medical Clinic. It is important to clarify with your therapist what type of therapy
he/she will be using with you. Any detailed information regarding the particular type of
therapy can be provided by your own therapist.
7. What are the risks associated with psychotherapy?
It is important to realize that, although uncommon, psychotherapy can worsen a person’s
psychological problems.
It is important to realize that psychotherapy is an emotional process that can at times evoke
unwelcome emotions, like pain, anxiety and even anger. A patient can even experience a
worsening of depression symptoms. A patient may at times feel angry and frustrated at the
therapist. Other strong feelings a patient may feel towards the therapist are those of
dependency, love, personal concern and even sexual feelings. These are usually just
temporary. If these feelings occur it is best to discuss them with your therapist. They are
usually controllable. If they continue to exist for a long time it may be necessary to take
additional action.
In complex cases your therapist, in order to help you, may recommend that another physician
therapist, a consultant or supervisor, be retained to guide the therapist in your care. If this
becomes necessary your therapist will discuss it in detail with you. You will be required to
sign a consent, make available the time required and if necessary pay for the sessions if the
4
therapist is a non-OHIP covered physician therapist. This is not a usual requirement but can
arise in complex cases.
The patient and therapist should work together as a team in assessing if the therapist and the
therapy are suitable and effective for you, the patient. If appropriate, referral to another
therapist or type of psychotherapy should be made. You, as a patient and a medical service
consumer, must take some of the responsibility in determining if a GP therapist or your
individual physician therapist is adequate for your needs.
It is generally not viewed as an essential part of psychotherapy for patient’s to know their
detailed psychological diagnosis. It can in fact at times interfere with the therapy if the
information is misunderstood or viewed negatively by the patient or others. At times a patient
may not agree with the therapist’s diagnosis. This discrepancy may be harmful to the therapy
but does not have to be. You can “agree to disagree”, and therapy may be able to proceed
productively.
It is the policy of the Medical Clinic for patients wanting a detailed diagnosis to submit to
their therapist, in writing, their request. This will allow for an adequate amount of
preparation time.
On rare occasions your medical information may have to be given to a third party. This
would only be done either 1) with your explicit signed consent or 2) by order of the Law
Courts (yet this type of court order is very rare). It is important to realize that there may be
some negative consequences in terms of how people view you if this information is shared.
This information could be stigmatizing.
Although psychotherapy is usually beneficial, it is important to be aware that the following
problems can occasionally be associated with psychotherapy:
A patient may experience new symptoms or existing problems may get worse.
Some relationships, like your marriage may be adversely affected [consider omitting]. There
could be a failure of treatment. Diagnostic formulations can and do upset or disappoint
patients. This information can be misconstrued and misunderstood by the patient themselves
and/or by others. Your life may not in fact be better or happier at the end of treatment. The
very fact of having sought out treatment may be used against you when it comes to applying
for life or disability insurance. Sometimes psychotherapy brings up new traumatic memories
that leave you to determine their validity or importance.
8. When can confidentiality and privacy not be maintained?
Confidentiality is the strict privacy of the information that is shared and documented on the
medical record between the patient and therapist during their sessions. It is the therapist’s
professional obligation to strictly maintain each patient’s privacy. There are however a few
professional and legal situations where this is not possible. It is very important that patients
realize the limitations to this privacy/confidentiality. Listed are the possible situations that
could lead to breach of privacy.
5
A)
If you are suspected of being unfit to drive, the therapist has a mandated duty to
inform the licensing authorities in writing.
[Include threats of harm to others or eminent inability to care for self or risk of harm to self]
B)
If there is information concerning the abuse of a child or risk of harm to a child. By
law, Children’s Aid must be informed. Failure to do so carries legal consequences to the
therapist.
C)
If you have been the victim of sexual abuse or inappropriate sexual behaviour by a
registered health care professional e.g. doctor, nurse, physiotherapist etc and you tell the
therapist about this including the Health Professional’s name then it is necessary for the
therapist to report this to the |Health Professionals regulatory college
D)
At times, the Law Courts of Canada can demand the medical record and the physician
therapist must divulge the written record and their clinical impression/diagnosis.
E)
If you sign a consent for release of information to a third party, i.e. an insurance or
legal company.
These situations seldom occur but are nevertheless possible.
9. What is Informed Consent?
Informed consent is the process of giving the patient a reasonable amount of information
about their treatment so that they can, with knowledge of the benefits and risks involved,
agree or disagree with the proposed treatment. In modern medicine it is important that
patients are provided with sufficient information so they can truly give informed consent to
the treatment proposed. It is considered best to sign this before the treatment begins.
Consent Form for Medical Treatment Using Psychotherapy
Patient Name:
Date:
I have read and discussed the above information.
Physician:
understanding of the therapy I will receive.
and I am satisfied that I have reasonable
Patient Signature: ____________________
6