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Ohsweken / Six Nations and surrounding area
What is a psychologist?
Psychology is a large field. There are many different types of psychologists. Some do interesting research and experiments, some consult to large companies and organizations on how to select and manage their staff. Some psychologists assess and treat people with illnesses and injuries. Some provide advice on how to manage your health and life circumstances.
All psychologists have a basic undergraduate education in the fundamentals of human behaviour. In order to get a bachelor's degree in psychology, you have to know about normal human development, learning, and motivation, social aspects that influence all of us, different personality theories about why we are who we are, some basic statistics to understand how to understand testing and research in the field, a beginning understanding of brain structures and how they function, and a bit about clinical disorders and how to identify them.
After the undergraduate degree, many psychologists choose to get advanced degrees in certain areas like Industrial/Organizational, or Developmental, Cognitive Science, or Social and Personality Psychology. Psychologists with those degrees often consult to businesses and organizations, have university positions, and/or do research that informs our personal and work lives.
Psychologists who go on to pursue degrees in Clinical, Health, Counselling and Rehabilitation Psychology also may consult to businesses and organizations, have university positions, and/ or do research. But, they also often see people for assessment and treatment. Even if they do consulting or research, their consulting and research tends to be about assessment and treatment interventions for improving health, functioning, and quality of life.
In Ontario, registered psychologists are required to have either a Master's Degree or a Doctoral Degree and meet certain requirements for their education and training. They also have to take a provincial exam about the laws and ethics of practicing in Ontario, and an international exam for all psychologists who want to practice in Canada or the US. Then, they have to undergo 2 years of practice while being supervised by two other members of the College of Psychologists. Finally, they have to pass an in-person exam with at least 3 other registered psychologists (or a second board of psychologists who might review the first 3 psychologists' decision).
Before that, any psychologists who are registered to provide clinical services in Ontario had to take advanced courses on assessment and treatment of different conditions and disorders. They also had to have hundreds of hours of practical clinical training while in school, followed by thousands of hours of supervised practice once out of school. They have to understand how the brain, our relationships, our environment, and our thoughts can influence our feelings and behaviour. If a psychologist went on to get a PhD, that means they also had to do their own research projects to prove they understand how research is done, so that they can be responsible contributors and consumers of the science in the field.
You can see a lot of different professionals for different types of treatment if you're suffering with a mental illness, some difficulties adjusting to a chronic illness or a difficult situation, or if you're having difficulty making the lifestyle changes you know you're supposed to make in order to be healthy or stick to your doctor's recommendations for your medication and diet. Maybe you should see a Psychologist, but maybe someone else would be better. How do you know?
How are Psychologists different from other treatment providers?
Some disciplines and their subspecialities in Ontario have access to the controlled act of communicating a diagnosis (this means they can identify and communicate to you that you have a certain condition, after they have done an appropriate assessment of you); some have access to the controlled act of Psychotherapy (this means that they can assess and treat cognitive, emotional or behavioural disturbances by using verbal or non-verbal therapy techniques within the context of a treating relationship).
Few have access to both.
Psychiatrists are Medical Doctors (MDs) who specialize in Psychiatry after completing their basic medical degree. Depending on where they were educated, they may have an undergraduate bachelor's degree before going into medical school to obtain their MD, or they may go straight into the medical degree program. Once this is completed, and they have their understanding of all the human body systems, they do residency training and specialized education (usually about 2 years), learning specifically about the brain, clinical disorders, and how to assess and treat them medically. It is not a hard distinction, but most psychiatrists in Ontario prescribe medications; most do not do psychotherapy or counselling. Even fewer have advanced training in specific psychotherapeutic assessment and treatment interventions. So, while many psychiatrists are interested in counselling and psychotherapy, because of the pressures of the OHIP system and the lack of access to OHIP-funded mental health care, most are pressured to try to help as many patients as possible in a day, which doesn't lend itself well to doing prolonged counselling sessions. Psychiatrists are physicians who have access to the controlled acts of diagnosing and prescribing. Only a few engage in psychotherapy (even if they have access to the act), and most haven't had as much training in advanced psychotherapeutic assessment and treatment interventions as many of the counselling disciplines.
Registered Social Workers (RSW) have at least a Bachelor's degree (BSW). They also may have a Master's Degree (MSW). Few have doctorates. Social Workers learn about policy, programs, and counselling techniques while obtaining their degrees. Some focus on one area, such as health policy. Some take extra courses on counselling techniques or understanding the social and policy aspects of specific areas such as addictions or domestic violence. There are no specific advanced assessment or treatment courses that Social Workers have to take in order to obtain their degrees. Most who do psychotherapy take extra courses on counselling and understanding clinical disorders in order to provide better service to those suffering in the community. Social Workers do not have access to the controlled act of diagnosis, but depending on their training, they may have access to the controlled act of psychotherapy. Most have not had advanced training in specific assessment and treatment interventions for clinical disorders. However, if they have had an appropriate education in counselling techniques, they should be able to engage in appropriate psychotherapy to help with many of the difficulties that people experience.
Registered Psychotherapists also have access to the controlled act of psychotherapy, but not diagnosis. Many counsellors and psychotherapists with different backgrounds and educations may be registered with this college and can provide general counselling for many conditions. Several disciplines have access to the controlled act of Psychotherapy, and many may register with the new College of Registered Psychotherapists of Ontario. Psychotherapists have to demonstrate that they have obtained relevant education and training in counselling and psychotherapy. But, they do not need to know about specific disorders or health conditions and they cannot diagnose them.
Some Nurses and Occupational Therapists also may engage in Psychotherapy, if they have specific training and education. Only Nurse Practitioners have access to the controlled act of diagnosis.
Registered Clinical Psychologists can both diagnose a disorder and treat it using psychotherapeutic interventions. This is exactly what their years of education focused on. While people pursuing education and training in other disciplines might have focused on learning the body systems or systems and policy, or medication delivery, Clinical Psychologists were learning about the brain, normal human development, and how to assess and treat clinical disorders. This makes us quite unique in the health care system.
When Should I See a Psychologist?
This is a good question. You can see a psychologist for many things. The good thing is, because of our education and training in normal and abnormal development, healthy and unhealthy behaviour, we are able to help with a lot of problems. In fact, most people could probably use some training in the kinds of skills we can teach for how to live your life better. We can advise you on everything from what colour to paint your walls, to how to talk and listen to your family members, how to focus and improve your game, or how to study or manage stress more effectively.
However, in our current health care system in Ontario, you may be most likely to see a psychologist if the counselling you can obtain from a Nurse or Social Worker and/or the medication you're receiving from your Physician doesn't seem to be adequate, you're not able to get in to see a Psychiatrist and your Family Doctor wants some help understanding your condition before providing medication, you have a more complicated condition for which psychotherapeutic treatments are the most effective, or you need some kind of cognitive assessment to help with school, a job, or planning care.
Unfortunately, most Psychologists in Ontario are not funded under OHIP. Most of us work in private practice and have to bill different insurance companies and systems for our services on an hourly basis. And, such specialized services can be costly, especially since most problems and conditions can't be solved in one session. An hourly rate multiplied by several sessions to treat a complicated condition can end up costing several thousand dollars. That's the bad part.
But, if you're wondering about seeing a Psychologist, we will try to help. Call our office and ask if we're the right place for you. If we can't help you or we think that someone else would be better or less expensive for you, we'll give you their name. If we think you should come in and meet with us, we'll tell you what you can expect from your visit and we'll do our best to make it worth the investment of your time and money or benefit dollars. Dr. Smith is especially concerned about providing high quality, efficient, and effective service, using reliable, evidence-based interventions. If she can't help you, or she thinks someone else will be better for you, she'll do her best to help you get what you need to feel better.
What is PTSD (Post-Traumatic Stress Disorder)?
You might have heard of this condition more often lately than you have in the past. It's been in the news. Clinical science is only just starting to understand it better, and people are starting to talk about it more. If you've heard of soldiers having "shell-shock" after WWI, that's PTSD. We just didn't know as much about the brain and how traumatic events are processed when clinical scientists came up with that name. Try talking with a "shell-shocked" vet about his or her experience, though. More often than not, they prefer not to think or talk about what produced the "shell shock". In some ways, even though it's totally understandable, that's actually part of the problem.
Post-traumatic stress disorder (PTSD) occurs after someone witnessed or experienced something scary or upsetting that they then can't get out of their heads. As much as they would like to forget whatever happened, it is stuck in their brain. Pretty much for good. If what happened was a surprise and threatened their life or health or the well-being of someone they love, that event can re-organize all the associations in your brain so that the memory of that event is encoded really, really well, and doesn't go away. Ever. So, if it was really upsetting, people with PTSD just don't want to think about it. Whenever possible, however possible. PTSD is a disorder of avoidance. It is a chronic illness and the people who have it DON'T want to talk about what they felt, saw, or experienced.
Unfortunately, their brains are still re-organized by the event (or events, if they were repeated) that occurred, and reminders keep popping up and triggering emotional responses that make them remember, which is, of course, tremendously upsetting. Sometimes people with PTSD have nightmares. Sometimes they have flashbacks. Sometimes the nightmares can be so bad, people affected are afraid to go to sleep because they know they're going to have another one. Sometimes the flashbacks are so bad, people affected don't want to go out because they don't feel safe anywhere.
Sometimes.... sometimes you can't even tell someone has PTSD because they seem so "normal" when they're not around any reminders of the event (or events). Sometimes, they're so good at avoiding those reminders, you don't even know they're triggers. Sometimes, reminders and triggers are of faraway times or places (surviving childhood abuse or escaping a war zone), so people think they're OK because they "left all that behind". Sometimes that's true as long as you don't ask about the upsetting situation. But, as soon as you do, the avoidance and symptoms come out. And, that can be upsetting and confusing all over again.
Sometimes, it isn't even just one event, or even one type of event. You can have PTSD that comes from the repeated trauma of growing up in an abusive environment over time, or repeated sexual abuse, or the type of cumulative trauma that many first responders experience after seeing so many violent and traumatic emergency scenes. Traumatic associations can even be passed on over time when entire groups of people are oppressed and traumatized (see below).
PTSD can make people jumpy, and angry, and they can end up feeling like no one understands them. Sometimes, they feel totally detached from their own emotions and the people who love them. Imagine that you've experienced these awful things, you keep getting reminded of them, and they're the last thing you want to deal with. But, no else experienced these things the way you did. So, you feel stuck and alone. Some people turn to drugs and alcohol. Some people think of suicide. Some just try to find other ways to "tune out".
It isn't always that severe. You can have a much smaller version of the same thing, but the features are basically the same: your brain learned that this particular type of situation is dangerous and now will remind you of it, even when you don't want or need to be reminded. Your brain will trigger safety behaviours like the fight or flight response to try and cope with what it thinks is a threatening situation, even when it isn't needed.
The good news is, some of those associations can be un-learned. We can't un-do what happened. But, we can un-do some of the learning and associations that were made as a result. This means, we can re-process some of what is happening so that it isn't as threatening now. And, then, sometimes, the nightmares and other symptoms stop. Your life may never be the same. But, it can be better.
What is Intergenerational Trauma?
Intergenerational trauma occurs when an entire group is subjected to repeated trauma and this keeps going over time so that the stories, lessons, and ways of adjusting to the repeated oppression are passed on through generations. As you can imagine, when the traumatic associations and learnings from these experiences are passed down through time, it affects nearly all aspects of the lives of the individuals within that group. You might be able to think of some ethnic and cultural groups that have endured multiple generations of trauma and oppression. Currently, multiple levels of government in Canada have started to recognize the traumatizing effects of hundreds of years of colonization and assimilation policies on our Indigenous peoples. Obviously, trying to create a better life when you've been raised with this kind of trauma requires a different kind of un-learning and re-processing that is far more challenging and takes longer to accomplish.
What is a Concussion?
A concussion is a type of traumatic brain injury. You may hit your head, fall, or just have a hard hit that shakes your head around so that your brain is jostled inside your skull. You don't have to have a bump, cut, or bruise to have a concussion. And, you don't have to lose consciousness. If you lose a few seconds of time that you can't account for, see "stars", feel disoriented, nauseous, or dizzy, lose your balance, have headaches, or have ringing in your ears after this kind of a hit or fall, you may have suffered a concussion.
We're understanding more about concussions. We used to think that concussions didn't do any harm to the brain. We also thought that it didn't matter if you had more than one. While our understanding of concussions is still evolving, we now know that both of these just aren't true. When you have a concussion, a series of events occur in your brain that can affect your thinking and behaviour initially, and make your brain more vulnerable and sensitive to a second injury right away. In the few immediate hours after a concussion, it is important not to risk having a second concussion. So, if you think you might have sustained a concussion, you should stop the activity that produced the injury and take a break. Go see your doctor or other health professional as soon as possible so that they can assess your injury and rule out some rare problems that sometimes occur when people hit their heads. You may need further assessment and monitoring.
Most people recover fully after a single concussion. That doesn't mean that they recover immediately. Sometimes, recovery after a concussion can take months. You may see some initial improvement within the first hours, days, or weeks; eventually some of the symptoms start to lessen and some go away completely. Sometimes, some symptoms stick around for longer. You may need someone like Dr. Smith to assess and monitor your symptoms and give you advice on how to manage them while you try to resume your usual activities.
It's rare, but sometimes one concussion produces long term impairments. Most of the time, such longer term impairments come after someone has experienced multiple concussions. If you've experienced more than one concussion in your life, your brain is more vulnerable and your risk of having long term problems after a subsequent brain injury is much higher. If symptoms after a concussion persist after about 6 months, you might need a special kind of assessment to assess and measure the impairments you're experiencing. Dr. Smith does not do this type of assessment, but she can assess and refer you if it looks like that's what you need.
So, figuring out how to deal with a concussion can be complicated. If you think you've had a concussion, go see your doctor. If you sustained the concussion in a car accident, or have some other coverage to see a registered psychologist, or you can pay out of pocket for the services, Dr. Smith might be able to help with the initial assessment and monitoring required for your rehabilitation.
Why should I see a Psychologist if I'm injured and in pain?
Some people might wonder how a psychologist can help with the physical pain they experience after an injury. But, if you think about it, every pain that you feel from your injuries and all of your responses to that pain (including your thoughts, feelings, and how you behave) go through your brain. Your brain processes the incoming information from the source of the pain, makes associations with other information about what and how to think, feel, and behave, and then sends the signals out to the rest of your body about how to respond. This makes sense if you consider that almost everything that happens inside you has to go through your brain somehow. Whether its your balance, how you see/ hear/ feel/ remember something, your love and affection for a pet, your memory, how you walk, regulating your heart rate and breathing, hunger, thirst, or whether and how you're attracted to someone, these all go through your brain. Even something as simple as your digestion goes through your brain. So, if people tell you that your pain is all in your head, you can tell them, they're right! Because everything that happens in your body is in your head at some point.
So, keeping that in mind, it might start to make sense that both your perception and your response to pain are "in your head"; that is, they occur in your brain. This also means that how you perceive and evaluate your pain can affect how you feel and behave. There are some classic things we all do that can end up causing more problems over time when it comes to pain. For example, we usually try to avoid pain. Makes sense, right? Except when it comes to something like participating in physio or physical rehab after an injury. That kind of work can be really painful while it is improving the functioning of your joints and muscles. So, while something may be painful, that doesn't mean it is harmful. But, if you're afraid that experiencing pain means that something is wrong, you're more likely to stop, or to feel like you need medication to make it go away. Another thing many people do is to try and do as much as possible when they're feeling good and then crash when the pain becomes too intense. This can make trying to plan your activities a bit of a challenge. Sometimes doing less at once and taking breaks means you get the same work done, but suffer less. Sometimes, modifying how you evaluate the meaning of your pain and how you plan your activities can actually end up affecting how intensely you feel the pain. That may sound weird, but if your brain sees pain as a threat, it activates the fight or flight system that then makes you hypersensitive to things associated with that threat. If the pain is less threatening, you're less sensitive. If you also pace yourself so that you don't experience the extreme ups and downs of pushing yourself and then crashing, living with pain becomes a lot easier and less frustrating, and the pain becomes much more manageable.
Our psychologists have many suggestions that can be helpful when it comes to trying to live with pain. Give us a call and see if we can help you.
How can a psychologist help me with my sleep?
Sleep can be tricky. There are certain relaxation skills and sleep hygiene tips that our psychologists can teach you. We also might do more of a diagnostic workup to make sure that there isn't something getting in the way of your sleep, like worry or depression. Both of these can affect your ability to fall or stay asleep. We have specific tools for each of these conditions and more.
So, whether you have a question about our privacy consulting services, or you're wondering if you should see a psychologist about one of these conditions, call us today. Speak with Lexi. We'll see what we can do to help.
Hamilton and surrounding area
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If you or someone you care about is feeling like they might hurt themselves or someone else, call 911, contact one of the services below, or go to your nearest emergency room. You also can call Telehealth Ontario at 1-866-797-0000 if you have questions about how to proceed.
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