Don Edwards PhD, Dip GIT, Member OACCPP

Some thoughts on therapy

Some of us grew up around people who kept us perpetually off balance. Absorbed in the needs, unpredictability and drama of these adults, we as children may not have had the attention left over to grapple with our own challenges including learning to master the self-capabilities that we all need through life: understanding and dealing with what we are feeling and recognizing the feelings of others; becoming clear about the difference between self from others, and between fantasy and fact; and learning to be in healthy relation to others. The development of these capabilities requires the freedom to be reflective. It is in the therapeutic relationship that this reflective stance can be learned, repaired and practised from which will emerge the keys to more fulfilled living and ease with oneself.

It is often said that we hold the solutions to our problems within ourselves. The therapist facilitates the emergence of our own truth. One of the many ways that this is true is in learning to hear the inner voice that is our intuition, perhaps our most underutilized resource. Some distrust it, believing that logic and reason provide more valid direction. Others cannot hear it because their minds are awash in the ideas of others. However, to paraphrase Don Miguel Ruiz, "Truth is silent. It is something you can feel without words. There is nothing to know; there is nothing to justify." (Don Miguel Ruiz, The Fifth Agreement). I have observed many clients experience the awakening of awareness of their inner voice of truth and learn to trust it. We are taught to believe others and override this direct knowing within us. Healing often requires learning to mute the inner dialog from others to hear what is already quietly waiting to be heard. I believe this is key to personal growth and a healthy sense of self. Attuning to one's inner intuitive sense of the silent truth in things is – in my opinion – the first step to being at peace and finding purpose.

My guiding principles in therapy in no particular order are that agreements with self and others define the quality of our experience, learning to take more responsibility for ourselves positions us to take positive action in our lives, creativity is the truest expression of the self, the present is where we live like it or not, we initiate change when we are ready, resistance marks not only our self-imposed limit but also where change begins, incremental persistence has tremendous power, perfection is relative and ultimately a meaninglessness notion, and last, relaxing about all of this allows humour to emerge and facilitates our connection with others.

My practice

I see clients in Toronto (Cabbagetown) and Stratford, Ontario.

Founder of the All of You Wellness Centre in Toronto and a member of the Relationship Coaching Institute, a certified singles coach and a couples therapist using the PACT® method, I offer psychotherapy for individuals, couples and groups, coaching for singles and couples, life coaching and career counselling. With the permission of the client, couple or group, some sessions may involve the use of video for clients to better understand their interactions with others.

My Ph.D. is from the University of Toronto; my psychotherapy training, from the Gestalt Institute of Toronto; and I continually strive to expand my skill base through ongoing training. Other experience and influences that inform my work also include music training, two decades of working in industry (insurance, IT, human factors), research, recruiting, teaching, shamanic studies and volunteer work.

Working in either a psychotherapy or coaching modality depending on the needs of the client, my clients are principally:

• gay men
• young artists
• those coming out at whatever age
• students who are questioning their direction or feel creatively blocked
• young adults striving to redefine themselves as independent adults in their family
• in a relationship that is in trouble
• recovering from a recent break-up
• singles who feel they are getting nowhere trying to date
• singles who have sown their wild oats and want more
• professionals undergoing or contemplating a career transition
• individuals coping with illness,or other major life change
• newcomers to Toronto or to Canada

Cutting across these stages of life are depression, low confidence, low self-esteem, fears of disapproval, feelings of vulnerability, social anxiety, panic, procrastination, perfectionism, difficulty coping with loss or illness, grieving, confusion, despair, lack of motivation, loss of a sense of purpose in life, obsessive thoughts and compulsive actions, substance abuse, eating disorders, histories of bullying and other abuse, shame, being confused by one's own emotions and those of others, loss of ability to experience pleasure, communication problems, anger, co-dependency, family discord, inter-generational conflict, internalized homophobia, clash of cultural value systems -- to mention but a few frequently arising themes.

Sessions and fees

Individual therapy sessions are typically 60 to 90 minutes in length. Fees include HST and may be covered by insurance depending on the terms of your benefit plan. Allowances are made for students and those with special circumstances. Workshop fees vary depending on length. Coaching is program based: the coach is engaged for a pre-determined number of sessions in order to support the client in the process of achieving their goals.

Many people ask whether therapy and coaching fees are covered by insurance. Coaching fees are not covered by insurance but in some instances may be claimable as professional development. Mental health services provided in a provincial facility such as a hospital or by a physician may be covered by OHIP. Psychotherapy provided by a psychotherapist may be covered by employee benefit programs up to limits per session and per annum, subject to limitations on who may provide the service. As these conditions vary greatly from plan to plan, read your benefit prospectus carefully. The plan member is almost always responsible for paying a portion of the cost of the service and usually submits a claim for partial reimbursement after having paid up-front for the full cost of the service.

Insurance for psychotherapy treatment often brings out some problematic attitudes and assumptions:

• I have benefits at work, and I want to use them. There are many excellent and experienced psychotherapists not covered by insurance plans who charge less than insured providers. The most important element of therapy is to be working with a therapist you feel understands you and your problems. Not only do the large number of highly qualified but uninsured practitioners offer you greater choice in finding the therapist right for you, you are also likely to find that overall your therapy will be less expensive once plan member contributions toward the fees of insured providers are taken into account over the course of therapy, including the cost of any continuation of therapy after your insurance benefits have been exhausted. It is a valuable clarifying exercise for anyone considering involving their benefit plan to do the math around the full user cost of therapy after any reduction derived from benefit reimbursement, being realistic about the duration of therapy.
• Psychotherapy falls under the umbrella of health care. I shouldn't have to pay for it. We have become accustomed to think of health care being free for all and having a national pride in our public health care system. However, one does not have to look far for evidence that health care from a holistic perspective is nowhere close to being fully funded by the public system or by insurance. Psychotherapy, especially if highly tailored to your needs and delivered on demand, is unlikely to be free.
• My therapy will be quick. Others may need long therapy, but I only need one or two sessions. Even if that is not ideal, I will be better for it. If one is really ready to confront issues that have taken years to evolve and have gradually sapped the joy out of life to the point that you finally want to take action, it is only realistic to expect that it will require more than a few sessions and a few weeks to make the necessary changes and to reorganize your life.
• Along with the foregoing, is the assumption that therapy will be complete before my insurance coverage runs out. Most insured clients terminate their therapy when their coverage is exhausted even if an appropriate stopping point has not been reached. The client may look back on such segments of therapy as "ineffective" when in fact they were incomplete.

There are also some troublesome motivational issues related to insurance that have the potential to undermine change in therapy:

• The notion of insured services tends to change the role of the client from active initiator of change to passive consumer, thereby shifting the responsibility for progress from the client to the therapist. The medical model mindset of the therapist as a service provider, the client as a patient and therapy as a treatment undermine the proactive role of the client in making the the changes that only he or she can make. While too large a topic to embark upon here, the effectiveness of therapy derives from it being a relationship with ongoing dialogue, not from something applied to the patient like a medical treatment.
• I cannot afford to pay for therapy. In fact, I believe you cannot afford not to pay for it. The most crucial element in therapy is one's resolve to make changes and stay with the process even when the going gets tough. If a client is only committed to the extent that their therapy is paid by a third party, the resolve to make changes cannot be as strong as it might be were therapy a priority more important than other competing choices. If one is ready to spend discretionary dollars on a vacation, a expensive restaurant meal, night out, the latest smart phone or a new tattoo (none of which is insured) but balk at paying for therapy, then perhaps one is not ready to commence therapy. In the coaching realm, this motivational consideration is behind the requirement that coaching must be paid for by the client. Even gifted coaching undermines the client's engagement with the coaching process. I believe it is no different for therapy.

In summary, think over the many aspects of involving insurance in your psychotherapy. Estimate the real total cost to you after reimbursement and consider whether not using your insurance might be cheaper in the long run thereby opening up a greater range of choice of therapist. Ideally, it is motivationally superior for you to pay for your therapy yourself, even on a reduced fee basis if you quality: you are starting therapy because you're worth it and therapy is worth it to you.

My Toronto office is here and I have an office in Stratford, Ontario as well.