Frequently Asked Questions

Pivotal Moments Mental Health Services is the private practice of Debbie Wagler, Registered Psychotherapist. Debbie offers individual and family therapy services in person in Kitchener or virtually for people in Ontario. 

I offer individual and family therapy to children, adolescents, and adults. I do not offer couple's therapy, but I will meet with couples to discuss parenting-related concerns or family therapy goals with parents and children. Family therapy typically involves parents and children, or sibling groups.

I collaborate with each person to understand their unique needs and form a customized plan of therapy. My therapeutic approaches are informed by: 

• Attachment based models like Emotionally Focused Therapy (EFT), Emotionally Focused Individual Therapy (EFIT), and Virginia Satir's family systems concepts.
• Trauma informed approaches like Eye Movement Desensitization and Reprocessing Therapy (EMDR) and Trauma Focused Cognitive Behaviour Therapy (TFCBT). Recently I have been doing professional learning about Internal Family Systems (IFS), and this is also a trauma-informed approach.
• Play based approaches, including use of sandtray, expressive arts, games, and books.
• Spiritually Integrated Psychotherapy. As a person of faith myself, I am attentive to how mental health and faith interact with one another. I am comfortable with exploring how my clients' own faith or religious experiences can be sources of comfort or of pain. 
• Body based grounding tools, such as Emotional Freedom Technique (aka "tapping"), Brain Gym, and other mindfulness approaches.
• I integrate concepts, skills, and tools from some Thought/Behaviour approaches like Cognitive Behaviour Therapy (CBT) and Dialectical Behaviour Therapy (DBT); however, I do not offer standard CBT or DBT.

Yes, therapy is confidential! What you discuss with a therapist will not be disclosed to others without your verbal or written consent (exceptions listed below). Child sessions are also private and confidential, and children will help decide how to share session information with caregivers. 

There are a few exceptions to confidentiality; therapists are legally required to report if there are safety concerns such as children being at risk of abuse or exposure to domestic violence, if someone intends to kill or seriously hurt themself or another person, a health emergency, or if there is a subpoena from a judge court-ordering treatment records. Note that therapy notes are designed to guide treatment and are not written to support court processes.  

Education

• Master of Arts in Theology: Spiritual Care and Psychotherapy (MA) - Wilfrid Laurier University, 2017
• Bachelor of Education (BEd) - Western University, 2010
• Bachelor of Arts (BA) - University of Waterloo, 2009

Certifications & Associations

• Registered Psychotherapist (RP) - The College of Registered Psychotherapists of Ontario (CRPO), #006871
• Canadian Certified Counsellor (CCC) - The Canadian Counselling and Psychotherapy Association (CCPA), #10000722
• Ontario Certified Teacher (OCT) - The Ontario College of Teachers (OCT), #596458

Specialized Trainings

• Eye Movement Desensitization and Reprocessing Therapy (EMDR)
• Emotionally Focused Therapy (EFT)
• Using Sand in Play Therapy
• Trauma-Focused Cognitive Behaviour Therapy (TF-CBT)

Yes! I offer clinical supervision and consultation to support the learning of other therapists, including RP or RP-Qualifying therapists who are completing requirements of their regulatory colleges. I do not host student therapists at my practice at this time.

To provide psychotherapy services and call themselves psychotherapists, people must be members of one of the following colleges and follow specific regulatory requirements from their own college:

1. College of Registered Psychotherapists of Ontario
2. Ontario College of Social Workers and Social Service Workers
3. College of Occupational Therapists of Ontario
4. College of Nurses of Ontario
5. College of Psychologists of Ontario
6. College of Physicians and Surgeons of Ontario 

Most people choose to see a Registered Psychotherapist or Registered Social Worker for therapy. Choose a therapist who feels like a good fit for your mental health needs, preferred form of therapy, and comfort level when talking to them. Note: RPs and RSWs do NOT diagnose mental health conditions or prescribe medications.

If you are seeking a mental health diagnosis, you should consult with your doctor, a psychologist, or ask your doctor about a referral to a psychiatrist. 

If you want to explore medication as part of your treatment, please consult with your doctor or ask your doctor to refer you to a psychiatrist.

Registered Psychotherapists (RPs) are specialists in psychotherapy - developing therapeutic relationships with people, exploring their mental health symptoms and social-emotional contexts, developing goals of therapy, and supporting people to seek changes in their thoughts, emotions, and behaviours. RPs have usually completed two years of Masters level training in mental health and psychotherapy, as well as a supervised therapy placement as part of their educational requirements. They are members of the College of Registered Psychotherapists of Ontario (CRPO), which has rigorous requirements for academic training, supervised practice, and ongoing professional development. Each RP works from a different therapeutic orientation and uses different forms of treatment based on their ongoing learning plans, personal style and interest, and philosophy of change. It's a good idea to ask your therapist to describe their approaches to therapy!

Like RPs, Registered Social Workers (RSWs) can offer psychotherapy services. The main difference between RPs and RSWs is their educational pathway. Social workers are trained in systems development and have a broader scope of training and practice than RPs. RSWs may have chosen a course load that includes a strong focus in clinical counselling and they may have completed a supervised therapy placement as part of their Masters training. RSWs who offer psychotherapy engage in ongoing professional development in psychotherapy, and each one has primary forms of treatment based on their chosen fields of study and prior experience. 

Occupational Therapists (OTs) are healthcare professionals who help people reach their best level of functioning in life and can also offer psychotherapy. They can help people regain skills or develop new ones, such as following an injury, stroke, or other significant change in their health or mental health. OTs may be able to support recommendations for children with challenging classroom behaviours or sensory differences who need a specialized plan to be able to cope in those settings.

Registered Nurses and Nurse Practitioners are authorized to offer psychotherapy, including in a private practice setting. The College of Nurses of Ontario (CNO) does not regulate their specific ongoing mental health education and training, though CNO does require nurses to engage in ongoing learning plans to ensure psychotherapy is within their scope of practice.

Psychologists hold either a Masters or Doctoral degree and have completed 6-10 years of graduate training in understanding how humans think and develop. Psychologists are often involved in research and training of other therapists. Psychologists can perform assessments to help diagnose mental illness, plan treatment, and offer therapy. You do not need a doctor's referral to see a psychologist, though some psychologists have a waitlist. Psychologists are members of the College of Psychologists of Ontario.

Psychiatrists are medical doctors who specialize in mental health. They can diagnose and treat mental illness, prescribe and monitor medication, and support recovery through counselling. They often work in a hospital setting. In Ontario, you need a referral from your doctor to see a psychiatrist, and their services are covered under OHIP. Psychiatrists are members of the College of Physicians and Surgeons of Ontario. 

Other medically trained doctors may specialize in mental health and perform psychotherapy, too, such as Family Physicians or General Practitioners. 

I offer 60-minute sessions for individuals and children. For families of 3 or more people, 90-minute sessions are recommended to allow each family member to fully participate.

When we plan your session schedule, we'll take into account your other responsibilities, financial constraints, goals of therapy, and treatment approaches. Therapy is most effective when it happens consistently, such as a weekly or biweekly basis. Sometimes after making progress on their goals, people begin to space their sessions farther apart, such as a monthly basis to check in and maintain progress. 

Pivotal Moments is located on Frederick Street in Kitchener, in a cozy house-turned office. The building is shared with a few other private practices. Come on in, take off your shoes, and have a seat in the waiting area. I'll greet you there, and we will walk to the second floor. The room is a comfortable and peaceful space with a couch, blankets, hot tea, water, and live plants. It is sensory-friendly with soft lighting and fidget toys available. 

I offer a free, no-obligation, 15-minute inquiry call to answer your questions before you get started. 

Session fees are listed on the online booking site, and psychotherapy services are tax-exempt. 

I accept payment by etransfer, and I do not offer direct billing to insurance or benefits plans at this time. However, many health and benefits plans cover services by Registered Psychotherapists, and you may be able to turn in your receipts for reimbursement. Please check with your benefits provider to ensure they cover services by RPs.

24 Hour Cancellation Policy – Your appointment time is reserved just for you! Therefore, a minimum of 24 hours’ notice is required to change your appointment time. The session fee will be charged for missed or late-cancelled sessions. 

For private therapists who do not receive a salary, late cancellations directly impact our income by making it very unlikely for new bookings to replace the cancelled ones. Thus, we cannot afford for late cancellations to happen regularly. 

In the event of a crisis, (we know life happens) the fee will be waived. For other situations, there are options to help you prioritize attending your sessions. E.g., Please monitor your weekly commitments and prevent double bookings. You can personalize reminder settings in your profile through Jane to get automatic “nudges” of upcoming sessions. Please also consider backup plans for childcare or transportation, such as switching to virtual sessions. 

Cold and Flu Season – Sickness can creep up without 24 hours’ notice. If you have new or lingering symptoms like cough, cold, fever, sneezing, or other flu-like conditions, please:

• Switch to a virtual session if you feel well enough. This change can be made up to the appointment start time. 
• Cancel if you are too unwell for a virtual appointment. If you can re-schedule to an open spot within 5 business days, the late cancellation fee will be waived. Otherwise, please refer to the late cancellation policy. 

Please use our online booking system.   

Start with a free, 15-minute inquiry call. During your inquiry call, I’ll explain the process of therapy, limits of confidentiality, and my approach to therapy. You can ask questions and outline your reason to seek therapy. If you want to move forward from that call, we’ll book your first session.

You will receive a link to a Health History Form and Consent Form to digitally complete prior to your first appointment. In your first session, we will review that and go a bit deeper on what’s important to you. Sometimes I will ask you to complete other forms or surveys to help me understand how you are feeling.