“New year, new me” season is in full swing — and for Canadians seeking therapy, industry experts warn that a growing gap between demand and supply – particularly in the public system – is making it harder for people to find the right therapist, and in some cases, any therapist at all. Andrew Sofin, president of the Canadian Association for Couple and Family Therapy, says the divide between public and private care has widened dramatically. “There’s not enough therapists to go around in the public system. That’s why the private system has grown so much over the past 10 to 20 years,” Sofin told CTVNews.ca in an interview Tuesday. The shortage, he said, is also because psychotherapy has become more normalized compared to previous decades. Despite increasing public attention to mental health, many Canadians still struggle to access timely, quality care, in part because the supply of trained mental health professionals has not kept pace with demand. According to national workforce data from the Canadian Institute for Health Information, there are roughly more than 14,000 psychologists in Canada, equating to 4.7 psychologists per 10,000, and approximately 15,500 psychotherapists and counsellors registered in recent years. Some experts argue that this doesn’t keep up with the demand. The Centre of Addiction and Mental Health (CAMH) reported that one-in-five Canadians experience a mental illness and, by the time Canadians reach 40, one-in-two have or have had a mental illness. A changing training pipeline Sofin said the strain on public care is also reshaping how therapists are trained – and raising concerns about readiness. “For decades, the model was that you went into the public system, you got excellent training, supervision and mentorship, and only later went into private practice,” he said. “You got paid nothing, but you got unbelievable training.” That model, he argued, has weakened since the pandemic, particularly as therapy moved online and private practice became more accessible. “You’re seeing more people coming straight out of grad school and going directly into private practice,” Sofin said. “And that, to me, is scary.” While he stresses that many new therapists are capable and well-intentioned, Sofin worries that others may lack the depth of training needed to work independently – especially without mandatory supervision. “If you’re finding the right therapist, you want to pursue somebody with a provider who is licensed,” Shelley McMain, senior scientist at the CAMH, told CTVNews.ca in an interview Wednesday. Mental health professionals in Canada are regulated very differently depending on the province, McMain explained. In Ontario, the launch of the Ontario Structured Psychotherapy Program is an example of publicly funded and evidence-based therapy, which offers both low- and high-intensity psychotherapy across the province, aiming to provide “gold standard” care to people who need it, according to McMain. In B.C., government efforts focus on stepped-care and self-directed approaches, such as Bounce Back, a largely online program combining workbooks and coaching, designed to provide low-intensity psychotherapeutic support. According to Siri Brown, the B.C. and Yukon regional director of the Canadian Counselling and Psychotherapy Association, a common misconception is that therapists are just “good listeners” and “holding space.” “The opposite is that they’re very directive and going to tell you what to do. Neither are true,” they said. ‘People don’t know what they don’t know’ One of Sofin’s biggest concerns is therapists working outside their scope of practice — often unknowingly. “People don’t know what they don’t know,” he said. “That‘s where it becomes a problem.” He pointed to complex areas like couples and family therapy, eating disorders and traumas as examples. “Couple and family therapy is completely different than individual therapy,” Sofin explained. “They don’t realize that there’s this whole other skill set and a whole bunch of training to help you be good at it.” The question Sofin asks is: “What’s your training?” Canada’s broad licensing categories, he says, makes it hard for the public to tell who is properly trained in specialized areas. In Canada, the titles and training of mental health professionals vary widely. Psychiatrists are medical doctors who can diagnose mental illness and prescribe medication, while psychologists are provincially regulated professionals with advanced training in assessment and psychotherapy. By contrast, titles like “therapist” or “counsellor” are often used broadly, and in some provinces like B.C., Saskatchewan, Manitoba are unregulated, meaning levels of training and supervision can differ significantly. “There’s this huge umbrella now – registered psychotherapists, registered counsellors — but nothing to clearly differentiate the specialties underneath it,” he said. “A client that’s coming in with complex trauma or grief or negative childhood experience or abuse, they’re vulnerable emotionally, psychologically. If there’s someone (treating them) that doesn’t have an understanding of these mental health issues, they can do a lot of harm,” Brown said. Sofin is advocating for stronger use of professional designations that verify specialized training, such as the Registered Marriage and Family Therapist (RMFT) “The whole purpose of professional associations is to hold a high bar,” he said. “You only get that designation if you prove you’ve done the coursework, the supervised hours, the internship.” McMain stressed that regulatory frameworks, and the professional accountability they bring, matter for treatment quality. “Regulation is really important because it means that clinicians are licensed with professional colleges and it’s an important way to ensure that there’s some quality … that clinicians meet the bar in terms of their ability to practice,” she said. How to spot a good or bad fit For people seeking therapy, Sofin said the most important step is to interview your therapist. “Please don’t just go to the first one you talk to,” he said. “A therapist who works well for one person may not work well for another.” National health surveys show more than 40 per cent of adults with mental health concerns say their care was partially met or unmet in the past year, with unmet needs the highest among young adults aged 18 to 34. He encourages clients to come prepared with direct questions about training, specialties and professional memberships. “Write a list of what you want to help with and what you need your therapist to be skilled in,” he said. “We know that the therapeutic alliance – the extent that you feel trust and connection with your therapist – is a key predictor of success,” McMain emphasized. She recommends a methodical approach that includes seeking evidence-based therapies such as cognitive or trauma-focused treatments. “The goal is to empower you to grow and not to make you dependent on your therapist,” McMain stressed. Sofin also said progress – or at least hope – should come “within the first couple of sessions.” Sofin advised that after the first session, there should be a sense of hope or a path forward. When it’s okay to move on For people who feel stuck in therapy, Sofin said leaving isn’t a failure and shouldn’t feel like a personal breakup. “This is a professional relationship,” he said, “If a therapist can’t help you, you should go somewhere else.” Ideally, he said, therapists should support that transition. “I always joke that I’m in the only business where I try to get rid of my clients,” Sofin said, “That’s a sign of success.” McMain encourages a frank conversation. “If your gut is telling you that something feels off or you’re noticing that nothing’s changing, then I think (that’s) a red flag and it makes sense to pursue a different approach,” she said. McMain also listed a lack of rapport or trust, professionals claiming to be an “expert in everything,” promising quick fixes, therapists blurring clear boundaries, and discouraging second opinions also red flags. Brown points to jumping to suggestions or interpretations before hearing the full story, judgmental statements, therapists who are burnt out and are not engaged with clients as red flags. Before booking your first therapy session, Brown advises to self-reflect on what you want to accomplish or work on.
