Your Counselling Questions Answered By Dr Mike

What Is An RCT

Registered Counselling Therapists (also known as RCT’s) are master’s or doctoral level clinicians who have had specific training in the art and science of doing therapy and are Regulated Health Professionals. In Nova Scotia, RCT’s belong to the Nova Scotia College of Counselling Therapists (NSCCT). The college carries out the licensing function and all professional discipline should such functions be required.

What Is The Difference Between The Various Types Of Mental Health Therapists? 

There is considerable confusion in the public’s mind about the similarities and differences between Psychiatrists, Psychologists, Social Workers, Registered Counselling Therapists (RCTs), and other Counsellors/Therapists. The short answer is that:

1) as a discipline Psychiatrists tend to be medication based, and do not routinely do talk therapy; they are medical doctors first who then went on to specialize in psychiatry,

2) Psychologists tend to be more about standardized testing, assessment and diagnosis - most useful when you need a report for court or to gain access to services in the educational system, and many psychologists do not actually do any treatment beyond providing an assessment report,

3) Social Workers tend to be about societal change, child protection, and income assistance, but mater’s level (MSW) social workers may have additional training in talk therapy - or may not - they may have got their MSW degree in administration or some other topic, while

4) Registered Counselling Therapists (RCT’s) are primarily trained to do talk therapy, their focus is on helping develop therapeutic change in individuals, groups, families and couples

5) Other Counsellors/Therapists are generally trained to provide talk therapy and may or may not have additional education in specific areas of concentration related to psychotherapy.

It is true however that there is a great deal of overlap between the various disciplines. Select practitioners in each discipline may have gone on for additional training and become highly skilled talk therapists (sometimes called psychotherapists) and all of the above identified groups have a foundation in scholarship and research - often referring to research and theories developed in one or more of the other disciplines to inform their talk therapy practice within their own discipline.

What About Specific Therapy Types?

Individual advanced therapies like Eye Movement Desensitization and Reprogramming (EMDR), Cognitive Behavioural Therapy (CBT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Narrative Therapy, Family Systems Therapy (there are many types), Somatic Experiencing Therapy, Emotionally Focused Therapy, and Inner Child Therapy (to name just a few proven and effective therapies that are out there) may be available from select individuals from each of the groups identified above.

However, these are all therapies that are generally added to the clinician’s basic skills after graduation from their degree program and are available as advanced training to individuals in any of these disciplines. Therefore, when looking for a therapist it is more important to check for the training level and amount of experience of the therapist you choose rather than their specific discipline (Psychiatrist, RCT, Social Worker, Psychologist, or Other Counsellor/Therapist).

What Type Of Therapist Is Best For Me?

So, which type of therapist is right for you? Generally, you should make your choice of therapist based more on the individual skills and experience level of the clinician rather than the label of which discipline they received their training in.

A complicating factor is that many people prefer to use up their employee benefits and have to check which (if any) groups of therapists have been added to the list of approved regulated health professionals by the employer/insurance company (consult your benefits manager and if you don’t see the type of clinician represented on that list that you wish to hire - ask why not - it may be a fairly simple thing to get the HR department to ask the insurance company to adjust it’s policy to include the type of therapist you would prefer).

Remember that most individuals with mental health problems do not need an extensive written assessment nor do you need an official written diagnosis to get help from most competent clinicians. If you really need a written assessment, any of the six disciplines can write an assessment - however, if you need a written diagnosis you will probably tend towards seeing a psychologist or a psychiatrist. An alternative option is that a family doctor can review an assessment from a Social Worker or a Registered Counselling Therapist and based on that information form an opinion and issue a written diagnosis that is just as valid in law as one written by a psychologist or a psychiatrist.

However, the educational system tends to insist on a written diagnosis being provided by a psychologist to qualify for specific funding or modifications to programs of study. These are rules and policies carried over from the past when psychiatrists and psychologists were the only licensed professions in the field … not all systems, including the educational system, have caught up with the current reality.

How Do I Find Someone Competent To Help Me?

No one discipline is superior to any other when it comes to talk therapy (psychotherapy).

You can find competent and experienced clinicians in each discipline. Check online with the various directories that list mental health therapists. They often list their training, credentials, areas of study and expertise. Then it is a matter of interviewing some likely candidates to see if you feel like you could work well together.

Don’t be afraid to change therapists after one or two sessions if you feel that you are not working well together or that you need something different. And don’t be afraid to talk directly to your therapist about not feeling right about your therapeutic fit.

If may be that the therapist can alter their approach to be more in line with what you were expecting or they may have a reason why they are approaching your problem the way they are and would welcome a chance to explain their approach and why they think it is a good fit for you and your issues. 

Conversation is of course the core of talk therapy so please feel free to ask questions or make observations.

What About Insurance And Claiming Mental Health Therapy As A Tax Expense?

All fees from regulated health professionals are eligible to be claimed as tax deductions under the medical expenses section of your tax return. However, it is trickier regarding getting reimbursement from an employee benefits insurance program as each policy is individually negotiated and written. So, check with your benefit’s coordinator and, ask for them to add licensed health professionals to your policy - Social Workers and RCT’s can often be added to an existing policy at no added cost to the employer - and your cost savings is also the employer’s cost saving.

What Will It Cost To See A Licensed Mental Health Care Provider?

Psychiatrists are much more expensive to see ($300/hour and up) and often have a waiting list of about one year to get in to see them. And remember many psychiatrists only prescribe medications and do not do talk therapy.

Psychologists are the second most expensive with hourly rates of about $190 an hour and up and tend to have waiting lists of 1 to 6 months or more.

Social Workers and RCT’s tend to be similar in cost per hour at about $100-$150/hour (depending on experience and level of training - some have PhDs, have done advanced study, or have decades of experience).

Waiting lists for Social Workers and RCT’s are usually just a couple of weeks or they may be able to fit you in in a matter of a couple of days.

Unlicensed counsellors may be able to see you very quickly and change between $50-$80/hour but will not be covered by insurance nor in most cases are their fees tax deductible. They do not have licensing bodies to complain to if you believe they have done something wrong, may or may not carry malpractice insurance, and may or may not have the level of preparation you expect out of your talk therapy practitioner.

Again, individual differences mean that some unlicensed counsellors may be highly skilled.

You simply need to decide what you are looking for in a talk therapy counsellor, and which individual therapist is most likely to meet your needs.

Research indicates that most of the benefit from talk therapy comes from having a good therapeutic fit between therapist and client. So, keep looking until you find the therapist that fits for you.

How Do I Decide To Use My Insurance Coverage Or Not?

Are There Any Pitfalls I Should Avoid?

A word about insurance coverage. While most of us prefer to get our money’s worth when it comes to our employment benefits, you may need to exercise caution.

If your vehicle has transmission problems - you don’t get the window crack fixed just because you have glass coverage. You need a transmission specialist, or your vehicle will not be useful.

Likewise, in talk therapy - going to a psychologist or a psychiatrist just because that is what your insurance plan covers may not be a wise move depending on the amount of therapy needed. Since their fees are higher you will run through your coverage faster and in the case of $300 or $500 or even $1000 or more annual average you may not even get through the assessment phase of therapy before your insurance runs out. At that point you will be paying the higher amount per hour with no additional monetary support and it may cost you more than if you just paid for therapy yourself but with a clinician who charges less.

On the other hand, the size of the fee does not necessarily mean a better/or less prepared therapist. Your choice should be based on your needs verses the clinician’s skills, the style of therapy that works best for you, and the availability of the therapist - not just whether your employee benefits cover that kind of therapist.

We hear stories every day of people who have spent all their employee benefits and much more only to receive a written assessment report that they neither need nor want - and then are told that the mental health professional only does assessments they don’t do therapy. Which means that the money has been effectively wasted.