Note: this was originally a letter to the editor at The Globe & Mail, which in turn was published April 26th. It was in response to two articles posted in the G&M, the first a featured essay by Norman Doidge MD, a psychiatrist and psychoanalyst, and the second an op-ed by Ari Zaretsky, chief of the department of psychiatry at Sunnybrook Health Sciences Centre. Each of these were responding to cuts by the province of Ontario to the provision of psychotherapy. I have expanded upon my original letter, which was edited for publication.
Every few months I’m asked by someone seeking information on the process of finding a psychotherapist to describe what the landscape and rules are. The word “patchwork” is the first to come up in my attempt at an answer, what with it being a maze of publicly funded dead ends and privately available add-ons. But to call the mental health system in Canada a “patchwork” is to insult quilt-making. One only needs to scan the pieces by Norman Doidge and most recently Ari Zaretsky to discover how confusing this might be for the average person seeking support.
If this average person exists let’s attempt to make sense of the road ahead from their angle: a day devoted to research will show there are psychiatrists and psychologists, who, as it turns out, may or may not have extensive training in psychotherapy. Then you have psychotherapists, whose profession may or may not be regulated depending upon the province you live in. Assuming our average person isn’t privately wealthy we must then ask: which profession — psychiatrist, psychologist, psychotherapist, social worker — is covered by what public or private health plan, and for whom is this available? Imagine being in the midst of a panic attack then trying to find support when you most need it only to discover that, to use Ontario as an example, despite being the only profession covered by OHIP, more and more psychiatrists are less and less interested in delivering psychotherapy versus managing prescriptions where, coincidentally, they can see more clients in a day and make a larger income. Meanwhile social workers enjoy vastly more private health benefits coverage than do psychotherapists.
Both Doidge’s and Zaretsky’s pieces are coming from a perspective that seems to make things more about the therapist, justifying their modal belief system or cost benefit analysis over the basic needs of those who are not privately insured. They rightly hail the benefits and importance of psychotherapy, but in their own ways go on to mount a self-interested defence of their turf: psychodynamic vs cognitive delivery methods. This battle over which therapeutic approach is more quantitatively or qualitatively effective than the other reeks of the privilege of those who have probably never been in long-term individual therapy themself.
The cart before the horse is that there is too little public access to trained professionals — particularly those who don’t have the MD designation of psychiatrists or the PhD of a clinical psychologist, but nonetheless have specialized training in psychotherapy — while we are in the midst of a steadily growing demand, with grave consequences for some who aren’t able gain access to professional assistance. Let individuals decide on the right approach for them. To qualify for the College of Registered Therapists of Ontario (CRPO) I cannot practice psychotherapy in this province without qualifying for membership, which means being a graduate of (or currently in training with) one of the approved training institutes registered with the college. Given this thorough certification process why should we then disregard the diverse modalities the CRPO explicitly acknowledges and pretend that this can be boiled down to a binary choice between a conservative interpretation of psychoanalysis or the limitations of CBT? In my experience as both a therapist and someone who has been in long-term personal therapy as part of my training program’s ethos — an ethos I feel should be obligatory for anyone training to be a psychotherapist — therapy works best when the “fit” is good, not about which style is supposedly better than the other.
The most important point — and one lost in both Doidge’s or Zaretsky’s articles — is the primacy of allowing Canadians the ability to gain access to psychotherapy in the first place.
[I would also recommend reading Heather Weir’s contribution to the G&M letters to the editor]
