Therapy ≠ Medication: Clearing Up a Common Misunderstanding

Lately, as a therapist, I’ve encountered a common fear when speaking to people who are looking for a therapist. They hesitate to seek therapy because they are afraid it will lead to being medicated or being pressured toward medication for their mental health challenges. Have you ever worried about this? If you have, you aren’t alone, and your concern is valid. Many people have real concern over the use of medication for mental health for themselves. So, let’s clear up what therapy really looks like, and what choices you have.

The Roots of the Fear

For many people, these fears come from very real — and sometimes frightening — past experiences.

You might have fears about stigma, or the side effects of medications. It can be scary to try a new drug, not knowing how it will impact you in the short and long term. It can feel like a leap into the unknown. Your cultural background or community might have strong beliefs and/or stigma about mental health and medication, which can make it more complicated to reach for help.

Maybe you were once prescribed a medication for your own anxiety, depression, insomnia or other issue, and it didn’t go well. Or you remember it as a negative experience. Or you might know someone who was prescribed a medication that didn’t work out well for them. Sometimes medication was prescribed too quickly, or it took several tries to find one that worked with their body. And sometimes, medication just wasn’t the right fit at all — and that’s okay.

These are valid fears. Underneath them is often a deep concern over losing control over your own mental health care.

What Therapy Actually Involves

In Ontario, psychotherapy is considered a controlled act – a legally controlled activity that carries risk and can only be performed by qualified professionals. Each province is somewhat different in how it regulates psychotherapy, but this definition offers a helpful general framework.

The College of Registered Psychotherapists of Ontario (CRPO) defines it as, “Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning.” (https://crpo.ca/apply-to-crpo/controlled-act-of-psychotherapy/)

What does this actually mean for you?

At its heart, therapy is about talking. It’s about processing what’s challenging you right now, whether it originates in the present, the past or both. It means exploring thoughts, feelings, and examining patterns of behaviour. It means reflecting on relationship patterns, and what’s meaningful or valuable to you. It means, ultimately, understanding yourself and your world in clearer ways.

Therapy is not about prescribing medication. Most therapists, unless they are psychiatrists, or another medical professional, cannot prescribe. Even when medication is part of someone’s broader mental health picture, it’s not what therapy is.

Therapy is collaborative. You, the client, are the expert on yourself. Your therapist brings training in psychology, but you bring your lived experience. You are in charge. You are the one with the authority to make choices; you have agency and power. You get to ask questions, set boundaries and provide consent about your care. A good therapist will involve you in the process and inform you of risks and benefits.

The Role of Medication in Mental Health

Medication can be helpful for some people, but it’s not the first – or only – option for most. Medication decisions are separate from the decision to start therapy, and always up to the client.

There are some conditions that may benefit from medication – such as mood disorders, anxiety that isn’t responding to therapy for a long time, or depression that makes it difficult to get to the point of beginning therapy. In some cases, such as psychosis, medication can play a role in stabilizing symptoms. These are just examples, not an exhaustive list of times when medication might be helpful.

At the same time, therapy on its own is very effective for many people. Concerns such as anxiety, stress, grief, burnout, perfectionism, and difficult life transitions – often find respite and healing with therapeutic support – without any need for medication.

You Have the Right to Choose

Ultimately, you are in control. You can say no to medication – or yes – and decide what the right kind of support is for you. You are entitled to take time and make slow choices, to try one thing and then try another thing.

Healing isn’t Linear

It looks more like this ↓

So, remember there will be ups and downs in the process. It’s perfectly ok to try something and then change your mind, as well. Choose what feels right to you and know that it takes time to find the path that works.

Work with a therapist who understands you, respects your values and goals. Find the best good-vibe fit that you can. Therapy is about deepening your understanding yourself – and that’s a journey worth taking on your own terms.

When (and If) Medication is Ever Suggested

As your relationship with your therapist deepens over time, you might notice that sometimes they challenge a belief you hold, or bring a contradictory possibility, or point out a discrepancy in what you are sharing. They may name emotions that feel contradictory – “It sounds like you feel angry, and also sad too,” or highlight internal tensions, such as, “I notice you believe you must perform at a high level, and also you express feelings of exhaustion.”

These challenges to your thinking aren’t meant to be confrontational, so much as invitations to explore what’s going on inside you more fully. Through these gentle challenges, therapists help clients to think with more flexibility, consider other perspectives, and ultimately get to know themselves a bit better.

When this kind of rapport exists, and some things that have been challenging you for a long time are still bothering you, it’s possible that at some point your therapist might gently suggest seeing your physician for further evaluation.

It’s important to know that this doesn’t mean you choose to be medicated… this means exploring options that might help you get where you want to go, or learning they aren’t right for you. Sometimes physicians can help you narrow down a diagnosis, rule things out, or provide additional resources, not just medications.

For example, in my private practice, a client who had been working through intense anxiety for a long time eventually saw their doctor. It turned out that disrupted sleep and OCD were the bigger issues. Medication helped, and the anxiety became manageable very quickly. This client was very well resourced due to our extended work together, and with the addition of medication they could now use those mental health tools with much more ease.

When medication is suggested, it should be seen as one possible tool – not the only answer. Your therapist should not pressure you into a decision you are not comfortable with. Your therapist’s job is to help let you know about resources yet to be considered, and to help you find your own path forward.

Therapy as a First Step

For anyone seeking support – whether or not that will involve medications – therapy is often a good place to start. It’s completely normal to feel nervous, ambivalent or doubtful. In fact, it’s expected. One of the powerful things counselling can help you learn is that contradictory thoughts and feelings can exist at the same time. You can feel anxious and be ready to get help. You can be uncertain and curious. You can have doubts and still want to try.

You don’t have to feel totally sure to start. You can just begin.

💛 I encourage you to see that…

Mental health support is there to support you in the ways that are meaningful to you.

If you’ve been feeling unsure or afraid to take the first step, maybe this is the moment to reach out — just to talk. Many therapists offer a free initial phone call, so you can get a feel for each other before deciding. You have nothing to lose by exploring.

And if you’re in crisis or just need someone to talk to right away, you can call 988 in Canada for free mental health support anytime.

💬 Ready to Explore Talk Therapy — Affordably?

If you’re feeling curious about therapy but worried about cost, you’re not alone. That’s exactly why I created FindAStudentTherapist.ca — a directory designed to connect you with practicum student therapists offering low-cost or free talk therapy options across Canada.

Student therapists are qualified professionals-in-training who are supervised and committed to providing compassionate, high-quality care. This can be a meaningful first step if you’ve been holding back due to financial concerns — or if you simply want a space to talk things through at your own pace.

👉 Visit FindAStudentTherapist.ca to explore your options and take the first step when you’re ready.