Psychotherapy Safety, Duration, Cost, and Expectations

Psychotherapy is safe, effective, and backed by decades of research showing it helps people feel better, think clearer, and live fuller lives. Whether you're in Markham, Unionville, or anywhere in the Greater Toronto Area, understanding what psychotherapy involves can help ease your mind before you begin.

At Northville Rehabilitation Centre, we've seen countless residents from Kennedy Road, Highway 7, and the surrounding Markham communities take their first brave step toward better mental health. This guide will walk you through everything you need to know about psychotherapy from safety and cost to what happens in your first session and beyond.

What Is Psychotherapy and What Does It Do?

Psychotherapy, often called "talk therapy," is a treatment that helps you understand your emotions, thoughts, and behaviors. It's not about lying on a couch and talking about your childhood for years (though that's one option). Modern psychotherapy is practical, goal-focused, and tailored to your specific needs.

Think of it like physical therapy for your mind. Just as a physiotherapist helps you recover from a physical injury, a psychotherapist helps you recover from emotional struggles, trauma, or mental health conditions.

What Exactly Does a Psychotherapist Do?

A psychotherapist is a trained professional who guides you through the process of healing. They create a safe space where you can talk openly without fear of judgment. But they do much more than just listen.

Your therapist will help you identify patterns in your thinking that may be causing problems. They'll teach you coping skills for stress, anxiety, and difficult emotions. They'll also help you set goals and track your progress. Most importantly, they'll work with you, not just talk to you.

At Northville, our registered psychotherapist, ChrisB Liu, brings a Master of Science in Art Psychotherapy from Queen Margaret University. She combines talk therapy, creative expression, mindfulness, and EMDR to help clients in Markham and the surrounding GTA communities process trauma, grief, anxiety, and life transitions.

Is Psychotherapy Safe?

Yes. Psychotherapy is one of the safest treatments for mental health conditions. Unlike medications, there are no pills to swallow, no physical side effects like drowsiness or weight gain, and no risk of addiction.

Research published in the World Psychiatry journal confirms that psychotherapy is effective for a wide range of mental health issues, including anxiety, depression, and PTSD. The most recent meta-analysis of the therapeutic alliance included nearly 200 studies involving over 14,000 patients and found that the connection between therapist and client is one of the strongest predictors of good outcomes.

Understanding Psychotherapy Side Effects

That said, therapy isn't always comfortable. In fact, it can sometimes feel harder before it feels better. This is normal and expected.

Unwanted events occur in about 5 to 20% of psychotherapy patients. These might include feeling overwhelmed after a difficult session, increased anxiety when facing fears you've been avoiding, or emotional discomfort when discussing painful memories. These aren't signs that therapy isn't working, they're often signs that it is.

Think of it like exercise. When you start working out after a long break, your muscles feel sore. That soreness is part of getting stronger. The same is true for emotional work.

Safety in the Therapeutic Relationship

There is wide consensus in the psychotherapeutic literature that safety plays a central role in human development and psychotherapy. Your therapist is trained to create what experts call "psychological safety" a space where you feel secure enough to be vulnerable.

Confidentiality is a cornerstone of this safety. What you share in therapy stays in therapy, with rare exceptions (like if you're at risk of harming yourself or others). Your therapist will explain these limits in your first session.

What Happens During Psychotherapy?

Many people wonder what actually happens behind the therapist's door. Let's break it down.

What Should I Expect in My First Psychotherapy Session?

Your first session is mainly about getting to know each other. Your therapist will ask you many questions about you, how you cope, and your symptoms. Think of it as an interview where you're both figuring out if this is a good fit.

Here's what typically happens:

Paperwork and Intake: You'll fill out forms about your history, current concerns, and goals. At Northville, our team helps make this process smooth and welcoming.

Introductions: Your therapist will introduce themselves, explain how they work, and discuss confidentiality. Your therapist might briefly talk about their approach and background.

Your Story: You'll have space to share what brought you to therapy. You don't need to tell your whole life story just what feels important right now.

Goal Setting: The first session typically ends with a discussion of your goals for therapy. These don't have to be perfect. They can be as simple as "I want to feel less anxious" or "I want to understand why I keep having the same fights with my partner."

Questions: This is your chance to ask anything. How often will you meet? What's the therapist's approach? What can you expect in future sessions?

The First Few Sessions: Building Trust

Sessions 2–3 usually focus on clarifying goals, while sessions 3–5 involve exploring emotions and thought patterns. During this time, don't worry if it feels like "just talking." This phase is essential for building trust, which is the foundation of effective therapy.

Many Markham residents who come to our Kennedy Road clinic feel nervous at first. That's completely normal. The first session is a time for introductions, building rapport, and beginning to understand your goals.

Four Stages of Psychotherapy

Psychotherapy isn't random. It follows a general structure that helps you move from struggle to strength. The psychotherapeutic relationship proceeds through four main stages: Commitment, Process, Change, and Termination.

Stage 1: Commitment

This is where you and your therapist build trust and establish the therapeutic relationship. You'll discuss your concerns, set goals, and agree on a plan. The commitment stage lays the foundation by establishing trust between client and counsellor while setting clear therapeutic goals.

This stage is crucial. Research shows that the strength of the therapeutic alliance is one of the best predictors of success. If you don't feel comfortable with your therapist, it's okay to find someone else. The fit matters.

Stage 2: Process

Now the deeper work begins. In the process phase, clients examine unconscious thoughts, emotions, and behaviours to identify destructive patterns. You'll explore why you think and act the way you do.

This might involve talking about past experiences, identifying triggers for your anxiety or depression, or recognizing patterns in your relationships. Your therapist will guide you through this exploration with care and skill.

Stage 3: Change

This is where you start to see real shifts. Change requires relinquishing old patterns, initiating healthier ways of living, and developing procedures to protect your newly acquired strengths.

You'll learn and practice new coping strategies. You might challenge negative thoughts, try new behaviors, or approach old problems in fresh ways. This phase involves practicing change and strengthening skills.

Stage 4: Termination

Ending therapy is part of the process, not a failure. The termination phase is about reflecting, closing, and moving forward. You and your therapist will review your progress, celebrate your growth, and make a plan for maintaining your gains.

You'll leave with tools you can use for the rest of your life. And the door is always open if you need support again.

Three Main Types of Psychotherapy

There are hundreds of therapy approaches, but most fall into three main categories. Here at Northville in Markham, our therapists draw from multiple approaches to create personalized treatment plans.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is considered the gold standard in psychotherapy. Numerous clinical trials have found CBT effective for a spectrum of emotional health challenges, from anxiety and depression to addiction.

CBT focuses on the connection between your thoughts, feelings, and behaviors. If you think "I'm going to fail," you might feel anxious, which might lead you to avoid the task entirely. CBT helps you catch and challenge these unhelpful thoughts.

CBT is practical and skill-based. It typically lasts 12–20 sessions, focusing on changing negative thoughts and behaviors. It often involves homework between sessions, like keeping a thought journal or practicing new skills.

Psychodynamic Therapy

Psychodynamic psychotherapy starts with the framework that unconscious mental processes regularly influence your thoughts, feelings, and behaviors. It looks at how your past experiences, especially early relationships, shape your present life.

This approach tends to be longer-term and more exploratory. It digs deep into your emotional past with the help of a therapist to uncover deep-seated motives. It's ideal if you want to understand yourself on a deeper level.

Dialectical Behavior Therapy (DBT)

DBT focuses on learning skills to help you tolerate distress and navigate challenging interpersonal relationships. One core skill is mindfulness.

Originally developed for borderline personality disorder, DBT has proven helpful for anyone struggling with intense emotions, self-harm urges, or relationship difficulties. It emphasizes acceptance and change, making it a powerful option for those who feel stuck in patterns of emotional dysregulation.

Four Types of Psychotherapy Explained

Beyond the three main categories, let's look at four specific approaches you might encounter:

Therapy Type	Best For	Typical Duration
CBT	Anxiety, depression, phobias	12-20 sessions
DBT	Intense emotions, self-harm	6 months to 2 years
EMDR	Trauma, PTSD	6-12 sessions
ACT	Values-based living, acceptance	Varies

1. Cognitive Behavioral Therapy (CBT)

CBT is structured and goal-oriented. It's often recommended for anxiety disorders, depression, phobias, and obsessive-compulsive disorder.

2. Dialectical Behavior Therapy (DBT)

The goal of DBT is to build skills to help manage intense emotions, improve interpersonal skills, and develop distress tolerance tools. DBT has four modules: mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

3. Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a specialized treatment for trauma. It uses guided eye movements to help your brain process painful memories. ChrisB Liu at Northville Rehabilitation Centre is trained in EMDR and uses it to help clients in Markham and the GTA heal from trauma and PTSD.

4. Acceptance and Commitment Therapy (ACT)

ACT is about accepting our thoughts and feelings without trying to change them. This therapy focuses on helping people do what matters to them in life. It teaches you to make room for difficult emotions while still taking action toward your values.

Five Common Factors of Psychotherapy

Have you ever wondered why different types of therapy all seem to help people get better? Researchers have found that certain factors are common across all effective therapies. These core factors include the therapeutic alliance, empathy, goal consensus and collaboration, positive regard and affirmation, and emotional experience.

1. The Therapeutic Alliance

This is the relationship between you and your therapist. Alliance is the most researched common factor. A recent meta-analysis found significant correlation between alliance and outcome across nearly 200 studies the better you click with your therapist, the better your outcomes.

2. Therapist Empathy

Your therapist needs to understand how you feel not just intellectually, but emotionally. When you feel truly understood, healing happens faster.

3. Goal Consensus and Collaboration

When therapists and their clients agree on psychotherapy goals and actively collaborate, they tend to have more positive treatment outcomes. You and your therapist need to be on the same page about what you're working toward.

4. Positive Regard and Affirmation

Your therapist should see you as a whole person worthy of respect not as a collection of symptoms or problems. This unconditional acceptance creates the safety needed for growth.

5. Emotional Experience

Therapy works partly because it gives you a space to feel your feelings fully, without judgment. This emotional experience can be healing in itself.

At Northville Rehabilitation Centre in Markham, we prioritize these common factors. Our multi-disciplinary team works collaboratively to ensure you feel heard, respected, and supported throughout your healing journey.

Five P's of Psychotherapy

The Five P's is a framework therapists use to understand your situation thoroughly. It's a common approach in clinical psychology and helps create a complete picture of what's going on.

The 5 Ps formulation is a structured method that takes a biopsychosocial approach, considering biological, psychological, and social factors.

1. Presenting Problem

This is what brought you to therapy. Maybe it's anxiety keeping you up at night, depression making everything feel heavy, or relationship problems affecting your daily life.

2. Predisposing Factors

These are things in your history that make you more vulnerable to your current problems, childhood experiences, family history of mental health issues, personality traits, or past trauma.

3. Precipitating Factors

Precipitating factors are those that triggered the current difficulties. A job loss? A breakup? A pandemic? A move to a new city?

4. Perpetuating Factors

Perpetuating factors are those that sustain and possibly reinforce your current challenges. Maybe you're avoiding situations that scare you, which actually makes the fear worse. Maybe you're using alcohol to cope, which creates new problems.

5. Protective Factors

Protective factors help you manage this problem and make change possible. What strengths do you have? Support from family? A stable job? Hobbies that help you cope?

This framework helps your therapist at Northville create a personalized treatment plan that addresses your specific situation.

Three Goals of Psychotherapy

What should you actually expect to achieve in therapy? Research points to three main goals:

1. Response

The first goal is to get you to feel better. This means experiencing noticeable improvement in your symptoms, less anxiety, better mood, fewer intrusive thoughts. Response is reached when you report clinically meaningful improvement.

2. Remission

The second goal is bringing you to a full state of remission, a significant reduction in symptoms. However, partial remission signals the need to continue with your treatment.

3. Recovery

Recovery is clinically defined as the absence of symptoms for at least 4 months following the onset of remission. It involves maintaining your gains over time and building a life you find meaningful.

For many Markham residents dealing with anxiety, depression, or trauma, reaching recovery means returning to the activities they love whether that's enjoying time at Toogood Pond, exploring Unionville Main Street, or simply feeling at ease in their own home.

Psychotherapy Timeline: How Long Does It Take?

One of the most common questions we hear at our Kennedy Road clinic is "How long will this take?" The honest answer: it depends.

Short-Term Therapy

According to the American Psychological Association, more than half of people who seek therapy will recover within 15–20 sessions on average. That's roughly 4-5 months of weekly sessions.

Medium-Term Therapy

Research shows that 75% of people who seek treatment see positive results and improved symptoms. For moderate anxiety, depression, or relationship issues, you might need 3-6 months of regular sessions.

Long-Term Therapy

Deeper issues like complex trauma, personality patterns, or chronic mental health conditions may require longer treatment sometimes a year or more. Psychodynamic therapy can span several years for deep-seated issues.

What Affects the Timeline?

Several factors influence how long therapy takes: the nature and severity of your concerns, how long you've been struggling, your engagement in the process, external stressors, and the type of therapy used.

How Often Should You Have Psychotherapy?

Weekly Sessions: The Standard Starting Point

For most people, once a week works well. Weekly sessions for the first 8 weeks are often recommended to build a strong therapeutic relationship. Generally, in the initial phase, clients benefit from weekly sessions to establish support and momentum.

More Frequent Sessions

Some people benefit from twice-weekly sessions, especially during times of crisis or when working through trauma. Studies show that increased session frequency can accelerate progress, especially in the first three months.

Less Frequent Sessions

As you progress and develop coping mechanisms, the frequency can be adjusted to bi-weekly sessions. Eventually, monthly "maintenance" sessions or as-needed check-ins may be enough.

Psychotherapy Cost: What to Expect in Ontario

Average Costs in Ontario

A therapy session in Canada costs between CAD $100–$250 per session. Here's a general breakdown:

Provider Type	Average Cost per Session
Registered Psychotherapists	$90-$200
Social Workers	$125-$225
Psychologists	$170-$295
Psychiatrists	Covered by OHIP (with referral)

Is Psychotherapy Covered by OHIP?

Psychotherapy is not covered by the Ontario Health Insurance Plan (OHIP) unless you work with a psychiatrist or with a general practitioner doing psychotherapy.

Extended Health Benefits

Many extended health insurance plans cover psychotherapy. At Northville Rehabilitation Centre, we accept most Canadian extended health coverage providers, including Sun Life Financial, Manulife Financial, Greenshield, and many others. Our front staff help you submit claims on the day of your visit.

Tax Deductions

Fees paid to Registered Psychotherapists and Registered Social Workers may be deducted on your personal income tax return. In 2024, the CRA made additional GST/HST exemptions to psychotherapy and counselling services across Canada.

Common Conditions Treated With Psychotherapy

At Northville, we commonly see Markham residents for anxiety and stress, depression, trauma and PTSD (including from motor vehicle accidents), grief and loss, relationship issues, life transitions, substance use, and self-esteem issues.

Frequently Asked Questions

How do I know if I need psychotherapy?

If emotional struggles are affecting your daily life your work, relationships, sleep, or general happiness therapy can help. You don't need to hit rock bottom to seek support.

Is everything I say confidential?

Yes, with rare exceptions. Confidentiality is an important part of building trust with your therapist. Exceptions include situations where you're at risk of harming yourself or someone else.

What if I don't click with my therapist?

This happens, and it's okay. Not every therapist will be the best fit for you. If after a few sessions you don't feel comfortable, it's perfectly reasonable to switch providers.

Can I do therapy online?

Yes. Many therapists, including those at Northville, offer virtual sessions. Research shows that a strong therapeutic alliance can be developed in teletherapy.

How is psychotherapy different from just talking to a friend?

Friends are valuable, but therapists bring professional training, objectivity, and specific techniques. Therapy involves a purposeful, structured relationship aiming for real improvement.

Final Thoughts

Starting psychotherapy can feel like a big step and it is. But it's also one of the best things you can do for yourself and the people you love.

Psychotherapy is safe, effective, and supported by decades of research. Whether you're dealing with anxiety, depression, trauma, or just feeling stuck in life, therapy offers a path forward. It won't be easy every session, but with the right therapist and commitment to the process, you can experience real, lasting change.

Here in Markham and across the GTA, too many people suffer in silence. They think they should be able to handle it alone, or that asking for help is weak. The truth? Seeking therapy is one of the strongest things you can do.

At Northville Rehabilitation Centre, we're here to walk alongside you on this journey. Our team understands that every person is unique, and we tailor our care to meet your specific needs. Whether you're a new arrival to Canada navigating a life transition, a busy professional dealing with burnout, or a parent struggling to balance it all we're here for you.

Ready to take the next step? Book an appointment online or give us a call at 905-534-8666. Your path to better mental health starts with one conversatio

Serving Markham, Unionville, Richmond Hill, Scarborough, and the Greater Toronto Area for over 30 years.