Frequently Asked Questions

To meet the demands of the population's mental health needs, there are now a variety of professions that are trained to support mental health. These include:

• Psychologists - These can be either Masters or Doctoral-level clinicians. Doctoral-level psychologists are trained extensively in differential diagnosis, treatment planning, psychological/cognitive assessment, and non-medical resolution/management of full-syndrome mental health disorders. Psychologists cannot prescribe medication, but doctoral-level programs include a heavy focus on psychopharmacology in order to offer medication recommendations, determine when psychiatry referral is indicated, understand risk of interactions with other substances and/or behaviours, and inform expectations within treatment planning. There are different psychology specialties (Clinical, Experimental, Educational, Forensic, etc.) that apply research and theory to different areas. 

• Counselling Therapists (RCTs) - Counselling therapists have completed a Masters degree focused on professional counselling for mental health complaints. They cannot diagnose conditions but they may pursue added training to ethically treat specific severe conditions. 

• Social Workers (RSWs) - Social Workers have a Bachelors or Masters degree in Social Work. They receive broad training focuses in order to support individuals, families, and communities in a variety of settings and with a variety of challenges. Many Social Workers now provide counselling therapy, and can pursue advanced clinical training and practical experience in order to ethically diagnose and treat mental health conditions. These individuals would then be registered as 'RSW - Clinical Specialist.' 

• Psychiatrists - These are physicians with advanced training in psychotropic medications to treat mental health symptoms. Diagnostic considerations are limited to the appropriateness of medication and anticipated benefits. Some psychiatrists will choose to also offer neuropsychological assessment or counselling services. 

• Psychotherapists - This not a regulated term in Nova Scotia, which means that there is no defined role or established meaning. Other provinces differ around this. 

One of Dr. Ellwood's offered treatments is Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). UP targets the core psychological processes now understood to be shared by all emotional disorders. An emotional disorder is likely present if you experience 2 or more of the following: (1) a tendency to experience your emotions as intense and powerful, (2) a tendency to experience your emotions as unpleasant/unwanted, (3) a tendency to judge or criticize your emotional experiences/responses, and/or (4) a tendency to avoid experiencing certain emotions (distraction, substance use, reassurance-seeking, worrying, isolation, staying away from certain activities/locations, etc.). 

Examples of common conditions that fall within this conceptual framework are: Major and Persistent Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, Specific Phobias, Eating Disorders, Substance Use Disorders* (Alcohol, Cocaine, Cannabis, etc.), Obsessive-Compulsive Disorder, Adjustment Disorder, and Posttraumatic Stress Disorder. 

*Many Substance Use Disorders have a legitimately biological component in addition to the characteristics of an emotional disorder. UP treatment is optimized in these cases after medically supervised cessation. 

Examples of conditions that are not considered emotional disorders and therefore are unlikely to respond to UP as a primary treatment: Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Tic Disorders, as well as some conduct and specific personality disorders. Of course, neurodivergent conditions can make someone more likely to experience a comorbid emotional disorder, which would respond to UP.

Not usually, no. Like any emotional disorder, PTSD could become chronic for a variety of reasons. Dr. Ellwood will discuss with your recovery potential, and any interfering factors, transparently with you. 

PTSD actually tends to respond more quickly to evidence-based treatment than some other conditions. Of course, this requires strong patient motivation, absence of other complicating conditions, and between-session practices. Several PTSD-specific treatments resolve symptoms in 12-18 sessions. Depending on symptom severity and associated ability to engage meaningfully in treatment, antidepressant and/or sleep medications may be required to receive the optimal benefits of these evidence-based treatments.

There is a difference between active syndromal PTSD and isolated residual symptoms that may reflect persistent alterations in your stress response. Like most conditions, PTSD illness duration is informed by a number of things: developmental experiences, environmental factors (social/family supports, continued regular trauma exposure, etc.), ongoing stressors, substance use, and other lifestyle habits. Acquiring PTSD does make an individual more likely to acquire it again in the future following another instance of traumatic stress; however, psychological treatment can help mitigate this relationship through psychoeducation and increased emotional skill development.

There is also a phenomenon recognized clinically as 'complex PTSD' that is unfortunately not yet a diagnosis recognized by the DSM-5 because of its complex association with conditions like ADHD and BPD that require further clarification. Individuals who describe chronic PTSD may in actuality be experiencing 'complex PTSD', which is minimally responsive to evidence-based interventions for PTSD because of significant differences in symptom acquisition and repeated interpersonally-based traumatic experiences that often began in the childhood years. There are also, unfortunately, individuals who have received PTSD diagnoses when it is actually Major Depressive Disorder or Generalized Anxiety Disorder generating the distress. This misguides treatment significantly, and often occurs because of poor clinical understanding of other conditions more commonly acquired following trauma and a misconception that service-relatedness equates to PTSD.

No, that's not the case. 

People are often surprised to learn that PTSD is not the most common mental health condition to develop after traumatic experience(s). It is classified in the Trauma and Stressor-Related Disorders group in the DSM-5 because PTSD exclusively follows traumatic stress. Anxiety, mood, obsessive-compulsive, and substance use disorders are not in the same class only because they can be brought on by a variety of antecedents and influences - including traumatic stress.

Yes. A difficult upbringing very rarely explains away the impact of service on mental health. Transparency about pre-service experiences can provide a wealth of information to the psychologist that informs the most likely condition responsible for your symptoms, and often helps explain exactly why certain service experiences affected you deeply. Most importantly, this information helps inform the exact type of treatment that will provide you with meaningful improvements in the shortest amount of time. 

PTSD is most robustly resolved through the following psychological treatments: Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure Therapy (PE), or Unified Protocol (UP). For some individuals, collaboration with psychiatry is required to support progress in treatment.

Cannabis is not a psychological treatment for PTSD or any mental health condition. It may be an appropriate coping tool while you await treatment starting, or for managing limited residual symptoms (frequent nighttime waking, etc.). 

If you are curious about how to balance the potential risks/benefits of your prescribed cannabis or whether to acquire a cannabis prescription to support your mental health, please keep an eye on my 'Extras' page where I will be providing information about this in the near future.

PTSD is a condition that is inherently defined by both anxious and depressive symptoms (although it is common for presentations to lean more heavily in one domain than the other). If PTSD is present, an additional diagnosis of Major Depressive Disorder or Generalized Anxiety Disorder is redundant and only clinically indicated if the depressive or anxious features are in gross excess of what is typical of PTSD, or if the conditions developed separately from (before or after) the PTSD and is understood to be interacting with the PTSD acquisition, and potentially, the treatment response. 

Yes. This is a common presentation of military/law enforcement mental health disorder. It occurs because changes in environmental demands provide room for long-present but suppressed emotional responses you couldn't use, express, or attend to during your service. 

Treatment readiness is often informed by motivation and preparedness for change, willingness to experience temporary increases in distress for long-term reduction, and an ability to maintain some level of focus on your treatment goals between sessions. Treatment is different than supportive counselling and can be fatiguing at first as your existing 'operating system' is disrupted. Treatment is never intended to be overwhelming, and intensity of approach is a case-by-case collaborative decision involving understanding of your options and their expected outcomes.

Yes. Confidentiality is one of the central features of clinical psychology that promotes healing. All psychological treatment sessions are confidential except for the following situations: you express imminent intent to end your life or the life of someone else, you describe a minor or vulnerable adult (this means an adult living with a disability) either currently experiencing or very likely to experience abuse/neglect/exploitation, or there is a court order for your clinical file. Recent provincial regulatory changes now also require psychologists to report any regulated healthcare professional believed to be engaging in abuse of a patient. 

Even if your treatment is paid for by insurance, there is no reporting to third parties about treatment content or progress unless part of a pre-determined agreement between all parties for a specific purpose. 

Assessments paid for by an interested party (an organization using the report to make a decision) inherently include relevant historical and current information for the party's review. However, only clinically relevant information is shared and this ensures respect for the dignity of the individual assessed.