Counselling and therapy

How to find the right kind of help for you

We all have bad days — sometimes even bad weeks. And usually a bit of me-time, a quick pep talk or a big hug is enough to put us back on track. But what do you do when you can’t shake a bout of sadness? Or you’re so tightly wound you’re always snapping at people? If this sounds like you, it may be worth going outside your circle of family and friends for some professional help.

When it comes to therapy, the options are plentiful, and there’s no one treatment for any one problem. Here are some suggestions about how to find the help that suits you best.

You’re feeling…anxious

Anxiety is important: It can stop you from talking to a creepy stranger, or kick your butt into gear when you have a deadline to meet. But sometimes it can get unwieldy. You might find yourself fixating on worst-case scenarios or feeling frantic for no apparent reason. The anxiety actually becomes bigger than whatever is making you anxious.

Try: Cognitive Behavioural Therapy (CBT)
CBT has you flip back through your thinking and pull out your most worrisome thoughts. What had you so worked up yesterday when you couldn’t find your son’s puffer? Maybe it was the moment your mind told you, “I’m too irresponsible to be a parent.” CBT asks you to step back and evaluate whether this is reasonable. Does losing track of a puffer make you an unfit parent? The idea is to bring the problem back into perspective — that way you can do something about it, and move on.

On the behavioural side, CBT gets you to gradually do things you may be leery of. Let’s say you’re terrified of driving on the highway, but avoiding it means not going to work. CBT would give you incremental exercises to tackle the fear, starting with a quick exit-to-exit journey, building up to longer and longer stretches of road. “You get used to the situations, and the anxiety or discomfort [level] goes down,” explains Toronto psychologist Eilenna Denisoff.

Details CBT is done in groups and individually in weekly sessions over 10 to 20 weeks. The therapist should have special training in CBT. Depending on the therapist’s professional background and the province she practises in, sessions usually cost between $150 and $205, and many counsellors will negotiate a sliding scale. Often employment benefits cover costs for a limited number of sessions. Some social service agencies, where counselling is often free, have therapists trained in CBT.

To find out more
• read Mind over Mood: Change How You Feel by Changing the Way You Think by Dennis Greenberger and Christine A. Padesky
• look online at anxietycanada.ca or paniccenter.net

You’re feeling…depressed

Everyone gets the blues. But when the sadness sticks, and you’re frequently tearful or barely notice the cute things your kids say, the blues have gotten the better of you. (You may also have other mood problems or irregular sleep and appetite.) Depression can last anywhere from two weeks to two years — untreated, it can last even longer.

Try: Interpersonal Psychotherapy (IPT)
To see if you’re a candidate for IPT, your therapist will first look at whether you’ve become socially isolated. Is a bout of grief preventing you from feeling close to others? Are you finding an adjustment to a major life transition, such as parenthood or divorce, particularly lonely? Are you mired in conflict with your partner? Once you’ve answered these questions, you make a list of your most important relationships, then talk about them with your therapist. She may encourage you to invite a friend out for coffee, coach you on new ways to tell your husband you feel hurt, or listen attentively as you put to rest old feelings about someone who recently died.

Details IPT runs for 16 weekly sessions, and is usually done one-on-one (though some IPT groups are available). Counsellors should have specific training on top of a professional degree in one of the counselling disciplines, such as psychiatry or social work. As with CBT, fees vary by profession and province, with opportunities for sliding scales and subsidies.

To find out more
• read Mastering Depression Through Interpersonal Psychotherapy by Myrna W. Weissman
• look online at interpersonalpsychotherapy.org or ipt-institute.com

You’re feeling…stressed

Wake up, get breakfast together (make sure it’s healthy!), kids to daycare, off to work (just in time for your meeting), dash out at lunch to pick up a gift (check the BlackBerry en route), quick stop at the ATM (only how much in your account?!)…whoosh. There goes your whirling dervish of a life.

Try: Mindfulness-Based Stress Reduction (MBSR)
One way to regain a sense of control is through a program called mindfulness-based stress reduction. MBSR uses meditation and yoga to help you “go through” whatever is happening in your life. An instructor walks you through yoga flows and body scans, and then gets you (and the other 20 or so people typically enrolled in an MBSR course) talking about what you experienced while doing each exercise. There isn’t a lot of personal sharing, says Mary Ann Carmichael, a psychotherapist and social worker at Centretown Community Health Centre in Ottawa. “That may be important for people who hear the word ‘group’ and think, ‘Oh God, I’m going to have to go in and talk about what happened when I was three,’ or ‘I don’t do groups — I’m an introvert.’” In particular, MBSR can help people cope with stresses that never let up, such as caring for a child with special needs. “In MBSR, there’s a lot of time for silence and inner reflection. It can be very nurturing,” says Carmichael.

Details MBSR is usually taught over eight weeks, with sessions lasting as long as three hours, plus a daylong workshop. You’ll be expected to practise the exercises for half an hour each day, while enrolled in the program. Fees range from $100 to $650 and are often offered on a sliding scale. Some community centres offer MBSR for free. Instructors’ backgrounds are diverse as well, ranging from social work to yoga. As yet, there is no official certification for MBSR teachers.

To find out more
• read Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by Jon Kabat-Zinn, or Everyday Blessings: The Inner Work of Mindful Parenting by Myla Kabat-Zinn and Jon Kabat-Zinn
• look online at umassmed.edu/cfm/mbsr

Subject line: Help!

Maybe you’re still not sure therapy is for you. Or maybe there really isn’t any counselling available where you live. Why not seek help online? “It’s an opportunity to do counselling on your terms,” says Lawrence Murphy, co-founder of the Canadian service Therapy Online. “Rather than be in a room at a particular time in a particular spot, you can put the kids to bed, go up to your bedroom and review the email from your counsellor.”

When choosing a cybercounselling service, check to make sure it employs licensed or otherwise qualified professionals, follows ethical standards and offers strict assurances of privacy.

therapyonline.ca Talk to a professional therapist via secure email exchange. Cost: $85 per session (one session equals the one hour your therapist spends drafting your personal email).

mytherapynet.com
Book an online chat (15 to 50 minutes) with a licensed therapist or access “emmediate care” within 20 minutes for an unlimited period. Cost: about $1.60 US per minute.

paniccenter.net Do a 12-session self-guided CBT anxiety treatment and access an online support group (monitored by professionals). Cost: free.

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