Imagine sitting on your couch late at night, scrolling through endless lists of therapists – wondering how to choose, how to pay and whether that first call will lead anywhere. That hesitation, that pause before reaching out, is familiar to many Canadians.
Mental-health struggles are common. About half of us will experience mental-health illness by the age of 40, according to the Centre for Addiction and Mental Health.
Yet knowing help exists doesn’t make it easy to find. Cost, stigma, fear, long wait times and “the sheer complexity of our health system” all stand in the way, says David Gratzer, a psychiatrist at CAMH, the largest mental-health teaching hospital in Canada.
“There are private clinics, public services, online platforms and community programs – each with unique approaches, different practitioners, costs and availability,” he says. “Sorting through these, while managing life and mental-health challenges, can be exhausting.”
It’s no wonder that more than half of Canadians struggling with mental health aren’t getting the help they need, according to Mental Health Research Canada.
To help make taking that first step less overwhelming, The Globe and Mail asked mental-health experts to unpack the types of professionals who offer psychotherapy (or “talk therapy”), some of the evidence-based treatments available and practical tips for choosing the right fit.
Taking that first step can be daunting, Gratzer says, but “it can make all the difference in the quality of your life.”
Four common misgivings about therapy, according to a therapist
Types of providers: Consider their credentials and oversight when choosing
Finding the right therapist can be transformative – and it begins with something simple yet essential: trust.
“Who you see matters,” says David Robertson, medical director of inpatient psychiatry at St. Michael’s Hospital in Toronto. “Feeling heard, understood and supported by the professional you choose can make all the difference.”
But who should you see? What do all those titles mean, and how do you find someone qualified to help? “There are so many vocational descriptions that sound the same – psychologist, psychiatrist, psychotherapist,” acknowledges Robertson, who also teaches at the University of Toronto’s Temerty Faculty of Medicine.
Here’s a snapshot of the main types of mental-health professionals in Canada.
Psychotherapists: Usually hold a master’s degree or equivalent graduate diploma in counselling or psychotherapy. They provide therapy using approaches such as cognitive behavioural, psychodynamic or humanistic techniques, but they can’t diagnose mental-health conditions or prescribe medication.
Psychologists: Have at least a master’s degree in psychology, and most need a doctorate (PhD or PsyD) to practise independently. They assess, diagnose and treat mental-health conditions using evidence-based methods and psychological testing.
Psychiatrists: Medical doctors specializing in mental health. They can diagnose, prescribe medication and often combine therapy with medication management for complex psychiatric conditions.
Social workers: Typically hold a bachelor of social work (BSW) or master of social work (MSW). They provide counselling and therapy while helping clients navigate community resources, often focusing on practical strategies and social support.
Counsellors: May have various degrees (including master’s degrees) or certifications in psychology, counselling or social work. Their work is often short-term and goal-oriented, focusing on issues such as relationships, addiction, grief or trauma.
Primary-care physicians: Often the first point of contact for mental-health concerns. They can assess, offer initial support and provide referrals – particularly for common issues such as anxiety and depression. They can also diagnose mental-health conditions and prescribe medications.
If you’re unsure where to turn, the safest option is “to deal with a licensed professional and member of a college, whose mandate is to protect the public, not the professional,” says Martin Drapeau, a clinical psychologist and professor of counselling psychology and of psychiatry at McGill University.
For instance, Quebec’s Ordre des Psychologues du Québec, the College of Registered Psychotherapists of Ontario, and the College of Psychologists and Behaviour Analysts of Ontario issue permits and investigate complaints. “These bodies ensure someone has your back if something goes wrong,” Drapeau says.
Ontario and Quebec are currently the only provinces that formally regulate psychotherapy.
As for counselling therapy, the Maritime provinces regulate the discipline through colleges. In contrast, the Western provinces and three territories remain unregulated, however British Columbia and Alberta have indicated they will begin regulating counsellors.
The lack of regulation in those regions means it can be too “easy for someone with minimal education and training to hang a shingle outside their door,” says Dawn Horner-Wilson, a counselling therapist in Warman, Sask., and regional director of the Canadian Counselling and Psychotherapy Association.
She recommends looking for practitioners affiliated with professional bodies such as the CCPA, which requires members to follow a code of ethics, maintain professional standards and carry liability insurance. “The vetting process provides clients with safeguards,” says Horner-Wilson. “Stay away from practitioners who don’t belong to a college or association, because if something goes wrong, there’s nowhere to turn.”
What are the treatment options? Decoding the ABCs of various approaches
Psychotherapy is more than just talking. It’s a form of psychological treatment that uses evidence-based methods to help people manage symptoms and change unhelpful thinking or behaviour patterns so they can live more fulfilling lives.
Different approaches emphasize different things: Some focus on breaking unhelpful patterns, others dig into your past and some blend both. If you’ve ever googled “therapy” you know that the alphabet soup of acronyms (CBT, DBT, ACT et cetera) can be dizzying.
The good news, according to CAMH’s Gratzer, is “our ability to help people with mental-health problems like depression and anxiety has never been better, in part because psychotherapies have grown more sophisticated, thoughtful and focused.”
He recommends starting with treatments with the most science behind them.
“For instance, today we know that somebody who has mild to moderate severity of depression could respond to cognitive behavioural therapy. In fact, CBT might be more effective than medications. And there is some evidence that the combination of the two is even better.”
Here are some of the most common approaches:
Cognitive behavioural therapy (CBT): The gold standard of talk therapy. CBT helps people rewire their thought loops and recognize how thoughts, emotions and actions feed into each other, then teaches them how to break the cycle. A person with social anxiety, for example, might learn to reframe the feeling that “everyone is judging me” into more realistic positive thoughts to gain confidence in social settings.
Dialectical behaviour therapy (DBT): An offshoot of CBT, DBT is often used for people dealing with intense emotions, self-harm behaviours, eating disorders or borderline personality disorder. It blends traditional CBT with mindfulness and acceptance strategies, helping people regulate emotions, build healthier coping mechanisms and see shades of grey rather than just black-and-white thinking.
Acceptance and commitment therapy (ACT): Another CBT cousin, ACT is about learning to accept difficult thoughts and feelings instead of fighting them. It’s especially helpful for intrusive thoughts or catastrophic thinking. If, for example, someone is terrified of public speaking, ACT helps them accept their anxious feelings (rather than trying to control the emotions), so they can move forward.
Exposure therapy: When a person’s fear is all-consuming, exposure therapy helps them face the fear so they can minimize the impact. It gradually introduces people to the situations or objects that trigger anxiety – for example, heights or flying – until the fear lessens. A specialized version, exposure and response prevention (ERP), often used for obsessive compulsive disorder (OCD), teaches people to face triggers while resisting compulsive behaviours.
Interpersonal therapy (IPT): This time-limited, structured psychotherapy approach focuses on improving interpersonal relationships and social functioning to reduce distress. It works by helping people identify and resolve problems in one of four key areas: conflict in relationships, major life changes (such as job loss or the birth of a child), grief and loss, and difficulties in starting or maintaining relationships.
Eye movement desensitization and reprocessing (EMDR): This method helps heal trauma one memory at a time. It uses guided eye movements (or other forms of bilateral stimulation) to help people reprocess painful memories. It can be especially effective in treating trauma-related struggles, including post-traumatic stress disorder (PTSD).
Emotion-focused therapy (EFT): As the name suggestions, this approach puts feelings at the forefront. By exploring how past experiences shape present-day emotion, clients gain self-awareness and learn new ways to relate. It’s particularly well known in couples therapy, but has also been shown to help with depression, anxiety and trauma.
Psychodynamic therapy: This is the classic “talk about your past” approach, but with a modern twist. It seeks to uncover the “why” behind the “what,” and explores how unconscious patterns and old relationships shape current behaviours. For example, a client with depression, a personality disorder or chronic physical ailments may explore how reactions to present-day circumstances are influenced by past events, and learn new ways to cope.
Humanistic/experiential therapies: These focus on growth, not just problems. Therapies such as person-centred, Gestalt, existential and narrative are all about building up your self-worth and potential. They emphasize personal growth, the present moment and the client’s unique story.
Cost considerations: Understand who pays, and how much
Therapy in Canada can be expensive, with sessions ranging from $100 to more than $250 an hour. Payment can come from a mix of sources: private insurance, government programs or your own pocket.
Psychologists are at the higher end of the pay scale, usually charging around $150 to $250 a session, while social workers and psychotherapists charge anywhere from $120 to $190.
Psychiatrists, who are medical doctors, are covered under provincial health plans – but wait times can be long. Some psychiatrists offer private services; if you go this route, fees will come out of your wallet unless you have health insurance coverage.
Many workplace and student health insurance plans cover therapy. It’s worth checking your plan closely, says the CCPA’s Horner-Wilson. Policies may cap the number of sessions, set annual minimums or cover only certain types of providers.
If you don’t have benefits, she recommends asking a therapist about sliding scale fees, “which are more common than you might think.”
Free or low-cost psychotherapy and counselling may also be offered through federal, provincial or community-based initiatives at hospitals, clinics or non-profit organizations such as the Canadian Mental Health Association (CMHA), although wait lists can be long.
Finding the right fit: It’s important to feel comfortable
After you’ve settled on an approach and type of therapist, there are still a few other important considerations to take into account.
“If you have water in the basement, you don’t call an electrician,” CAMH’s Gratzer says. “In the same way, if you are suffering from depression, look for a therapist with extensive experience helping people with your mental-health condition and who uses evidence-based methods.”
There are several ways to find a therapist who’s right for you. Websites such as Psychology Today’s therapist directory let you filter by location, issues (such as anxiety or trauma), treatment approach, cost, language and even session format (virtual or in person).
Most professional colleges and associations in Canada also list licensed practitioners. And your family doctor can be an excellent starting point for referrals. If you feel comfortable, ask trusted friends or family members for recommendations – this often leads to good matches.
Once you have a few names, check whether the therapist offers a free consultation. These short, introductory sessions are a chance to test the chemistry before committing to paid appointments. Think of it like a first date: Ask questions, be curious and trust your instincts.
“Feeling nervous at your first session is normal,” says Robertson of St. Michael’s Hospital. “Writing down topics or questions ahead of time can help you feel prepared. Ask about their experience, specialties and approach.”
Another key consideration is finding someone who understands your background. “Look for someone who shares, or is deeply familiar with, your cultural, racial, religious, sexual or gender identity,” says Angela Grier, a registered provisional psychologist based in Calgary. Many First Nations, Inuit and Métis people, she says, find mainstream mental-health services don’t always integrate traditional healing practices or cultural values.
“As a First Nations practitioner, when my clients see me, they see themselves, so I have an instant rapport with them,” she says. “… It’s important to find therapists with lived experience similar to your own.”
Therapy can be life-changing, but success often depends as much on the relationship you build with your therapist as on their credentials. You should feel safe, respected and not judged, says McGill’s Drapeau. After two or three sessions, you’ll probably know whether you’re in the right place.
“Trust your gut,” he says. “If that comfort isn’t there, it’s okay to keep looking.”
And above all, remember that seeking therapy is a sign of strength, not weakness, says Gratzer of CAMH. “It’s a courageous first step that requires vulnerability, a willingness to face challenges and a commitment to do really hard work so you can heal and grow.”
