Currently my private practice as a counselling psychologist consists of
services to individual adults and couples, with a specialty in
providing psychological therapy to those who have been in motor-vehicle
and work-related accidents, or who, on psychological grounds, are
no longer able to wirk. I thereby migrated from counselling psychology
to what is called rehabilitation psychology. There is a wide range of
presenting problems among those who meet with me but most are suffering
chronic ailments such as chronic fatigue, fibromyalgia, and
posttraumatic stress symptoms. The lawyers of my clients sometimes ask
me to write an extensive report regarding their psychological
condition, diagnosis, dysfunction, and prognosis.
Clients come to my primary office at 2
Carlton Street, Suite 1009, at the College Station on the Yonge
subway line. I am fortunate to have Debbie Murray as my office manager at this location, and
our assistant, Lia Dancyian, to handle the record keeping, billing, accounts,
and numerous other tasks involved in operating a private practice.
At the Toronto
office, I sublet from Christian Counselling Services and am also on
staff part-time. As such, I work alongside several other staff members, who are now registered psychotherapists.
Some of them provide psychotherapy to my patients under my supervision.
As well, I supervise these colleagues when their patients
have an extended health plan that reimburses for the services of a
psychologist but not a social worker or psychotherapist. We also have
an internship program in which masters-level students provide counselling to clients who cannot afford regular rates.
On Tuesdays and about one Friday
a month, however, clients meet with me at my branch office in the medical building at 89 Queensway West, at the corner of Confederation Parkway, across from Trillium Hospital, in Mississauga.
At this Mississauga office,
I am fortunate to have a clinical assistant under my
supervision, James Whetstone, M.A., for the past twelve years. As well as having a masters in
psychotherapy from the Adlerian Institute, he is a senior driving
instructor with the Ministry of Transportation. His specialty is to
offer driver reintegration within a vehicle for those patients who have
become afraid to drive or ride in a motor vehicle. An added bonus is that I sublet from Dr. Shawn Vasdev, a psychiatrist.
am also doing an increasing number of home visits, mostly while
travelling to my weekend residence in Port Hope and back. I am also
starting to take more clients from the Port Hope area.
Referrals come from many sources but most often family physicians,
psychiatrists, legal representatives, and former patients.
Regarding fees, I generally operate on a sliding scale. On occasion, therefore, I charge
the full rate for a psychologist in Ontario,
that being $225 an hour. In most cases, however, I offer a reduced
hourly rate depending on the ability of the patient to pay and whether or
not he or she has access to insurance benefits. The rate of $150 an hour is
common, and I do have a few clients on a pro bono basis.
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Dr. Tory Hoff, Psychologist
2 Carlton Street, Suite 1009, Toronto, Ontario M5B 1J3
(at College Street subway stop on Yonge)
Christian Counselling Services
2 Carlton Street, Suite 1009, Toronto, Ontario M5B 1J3
(at College Street subway stop on Yonge)
89 Queensway West, Mississauga, Ontario
(northeast corner of Queensway and Confederation)
cell phone: 416-459-6311
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Surrey Place Centre, Child & Youth Division, 1996-98
Wellesley Hospital, Department of Psychology, 1995-96
Personnel Performance Consultants, Saskatoon, 1990-92
Toronto General Hospital, Psychiatric Ward, 1984-85
Counselling and Development Centre at York University, 1983-84
Earlscourt Children's Home, Toronto, 1974-76
Received B.A. in psychology from the University of California at Davis in
1970, M.A. in psychology from Carleton University in 1980, and Ph.D. in
psychology from York University in 1990. On faculty in the Department of
Psychology at the University
of Saskatchewan from
1987 to 1994. Published articles about 19th-century psychology. A
registered psychologist in Ontario
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Services Specific to
Those Involved in Accidents
Most people are affected mentally due to an accident. Regarding car
accidents, a common result is anxiety when driving or riding in
vehicles. Regarding accidents at work, some claimants are nervoous. It
is not uncommon that these persons also find themselves irritable,
frustrated, overly sensitive, and grieving about their losses.
Sometimes they are off work, which leads to boredom, and financial
difficulties increase, which causes more anxiety and depression. They
then become more difficult to live with, and thus the accident puts a
strain on their social relations. Also, the accident can result in
cognitive problems such as poor concentration, forgetfulness, and
mental confusion, even though an obvious head injury did not occur.
Dealing with the pain, especially the headaches, and the poor sleep
adds to the ordeal that the accident has become.
People with such symptoms usually benefit from talking with a mental health
professional like myself who is trained to help them to understand, to deal
with, and to overcome them.
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A person involved in a motor vehicle accident in Ontario is entitled to a psychological
assessment, the cost of which is paid by that person's insurance company.
If after the assessment I conclude that the person would benefit from
counselling, then I propose a treatment plan consisting of a given number
of hoursnover a period . If the insurance company considers this plan to be
"reasonable and necessary," then it pays my fees. If it refuses,
then an impartial psychologist is hired to decide whether the insurance
company must pay. Although this process can be stressful to the patient, it
reflects current legislation in Ontario. I do not
withdraw services when payment of my treatment plans isdenied as greater stress
increases the need for services. Work-related accidents involves dealing
with the Workers Safety and Insurance Board, the provincial insurer.
Similar legislation governs the way that claimants seek out my services and
how I get paid.
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The following are two short articles that are a product of the sessions I
have had with various people in comparatively minor motor vehicle
accidents. The stories they tell are very similar in terms of symptoms,
impact on life, and problems dealing with the insurance, legal and medical
systems here in Ontario.
Reflections on the Human Inability to Understand the Effects of Trauma
Regarding my experience assessing and counselling people who have been in
motor vehicle accidents, perhaps the first thing to say is that the ones I
see have not sustained "life threatening" injuries, but have been
in accidents ranging from minor fender bumpers to ones serious enough to
leave them unable to perform their daily activities including duties at
Those clients having the most difficulty are those with incessant headaches
and related intellectual impairments. Sometimes a minor closed head injury
and concussion to the brain is documented in reports. In other cases,
however, no such injury is evident. Nevertheless the person is suffering
headaches and, for instance, is unable to maintain mental focus on a task
such as reading. It is not only that their pain focus leaves them unable to
pay attention to other things or that they have become too anxious and
depressed to concentrate, but that mental confusion and disorientation
Physicians, lawyers, and insurance adjustors too readily attribute these
impairments to previous psychological problems, particularly if the tests
for physical injury reveal nothing. The implication is that a well
functioning person without an identifiable head injury would not have these
intellectual difficulties, and that therefore something must have already
been mentally wrong with the client to predispose him or her to acquire
these unexpected, lingering symptoms. This reasoning is not entirely fair,
and is not of any therapeutic value to the person who is struggling with
headaches and intellectual deficits and is therefore emotionally
What seems helpful to these unfortunate clients is the more holistic idea
that the collision led to shock and trauma that has affected their selfhood
deeply, that is, profoundly affected them in the physical, psychological
and spiritual dimensions of their being. The result is a kind of
post-traumatic stress, but the condition of these clients requires a much
broader concept that goes beyond notions such as flashbacks, emotional
numbness, and irritability. A way to understand these clients is to realize
that the trauma of the accident can include a disturbance of self identity
and personal beliefs brought on by a sudden loss of who they were and what
they did. Thus what physically speaking was not diagnosed as
"life-threatening" actually was.
Medical science does not have a good diagnostic category for these
individuals. The closest are perhaps post-traumatic fibromyalgia and
chronic fatigue syndrome. Likely the people that these categories include
are diverse medical groups with similar presenting problems, some of whom
can point to an identifiable trauma event/injury that precipitated their
symptoms. In other words, medical diagnosis in this area of the impact of
trauma on a person's life is currently not much more advanced that the
eighteenth century diagnoses in which many disorders among men were called
"hypochondriasis" and many ones among women were called
"hysteria." What is clear is that before the traumatic event, the
person was functioning reasonably well and after the accident he or she
does not recover within "the usual" expected time such as six to
A good percentage of my psychological practice consists of people in motor
vehicle accidents who are not recovering as expected. In most cases a
whiplash injury occurred. Exactly what is going on physically seems to be
something that few medical people are understanding, which is not
surprising given current diagnostic confusion. What also is not surprising,
to me at least, is that the injury does not show up on x-rays, CAT scans
and MRI's. The psychophysical reaction to the motor vehicle accident
instead appears as the headaches and cognitive deficits already mentioned,
plus fatigue, depression, poor sleep, and chronic pain to name the most
common problems. Also, there is emotional instability and the inability to
regulate affect as is common with post traumatic stress in general, plus
whatever corresponding dysfunction is occurring biochemically and
physiologically including neurophysiologically. Prescription drugs aimed at
knocking out the symptoms have their place as they can help the person
function. The problem, however, is that these drugs do not promote
systemic, psychophysical recovery of person, and might actually impede it.
Reflections About Those He Loves
I need a better theology of trauma. What I mean is, I am learning more
about the psychological and physical aspects of trauma, but the spiritual
aspects regarding how our faith life relates to the impact of a
life-threatening event are less clear to me.
Let me first say that many of my traumatized clients do not understand
their psychological injuries very well. They think that they are mental
cases because they have "become paranoid," for instance, about
going out of their houses, about sexual involvements,
about others acting maliciously, or about traumatic events happening again.
They avoid the world, and they want to withdraw socially. They
do not know why. They also start believing that they are "going
crazy" because of the way that they have changed emotionally. They
observe that they have developed an "I don't care" attitude in
which they are highly irritable and they readily "let everyone have
it," yet at the same time feel emotionally numb and indifferent.
Furthermore, their sense of self is shaken, that is, they report
feeling like they are not the same persons. "This is not me!" When the
trauma results in an inability to work and to conduct the usual daily
routines, then this threat to self is further intensified. It is almost
like a personal identity crisis because some kind of inner
disintegration is occurring. The integrity of self is disrupted.
Likewise, their basic sense of trust and of the world being safe is
taken away from them. That which previously did not upset them
emotionally now becomes an object to fear. Dormant memories of
upsetting events from long ago become energized again and haunt them.
People going through these experiences find it helpful when I explain
that their "symptoms" are the product of an emotional injury consisting
of a posttraumatic rresponse. I further explain that the trauma
involves a disinhibition of emotional energy resulting in a loss of the
ability to regulate emotions, though I usually state it in less
technical language. Although such explanations do not take away the
symptoms, they at least help traumatized people stabilize and acquire a
less anxious reaction to these symptoms. It means a lot to them to feel
understood and that someone can help them understand better.
Sometimes these traumatized patients do not understand their physical
injuries very well either, for the longer their physical pain persists and
the more they are sent for tests that are unable to detect any structural
problems, the more they wonder if it is "all in their heads" or
somehow imagined by them. However, I explain that in addition to any structural
damage they might have received due to the accident, this matter of being
nearly scared to death affects them physically in the form of abnormal
physiology including disrupted brain processes. For instance, all of the
emotional/mental disturbances tjat they are experiencing are from a physical
point of view physiological disturbances.
I further explain that people who
have been nearly scared to death are of course shaken and shocked at a
fundamental core of their being, that is, deep within themselves, which of
course includes their physical nature. Not surprising to me, this shock is followed
by aches and pains including headaches, by mental confusion due to
"mental fog," and by lack of energy, malaise, and
feeling depressed. Sometimes when I first meet a patient,
their body language suggests that the trauma occurred recently. Further inquiry, however, reveals that the original trauma
occurred weeks if not months ago. Somehow this traumatic event is
still live for the person and has entered their being. Possible retraumatization in
one form or other needs to be explored.
I try to communicate to these patients that the more
the original event was traumatic and the more additional traumas also occur, the
more likely their "symptoms" will persist and become deeply entrenched. I raise the
possibility that a more serious condition has developed such as when their
psychobehavioural presentation fits with posttraumatic fibromyalgia.
Even a brief discussion of possible methods to "treat" these
posttraumatic "symptoms" requires more space than this short essay provides. Let me say, however, a few words about a
counterproductive thing that most patients do, especially those who before
they were injured took charge, stayed in control, organized themselves and
others, and tackled problems head on. Many patients fight their
psychophysical symptoms, saying they "should" not have them, and
thus try to control, bully, or stamp them out. They cannot stand being weak and dependent. This does not help.
What I encourage these patients to do instead is, in essence, to forgive
themselves for having their psychophysical wounds. This requires a kind of
acceptance, of course not one in which they conclude that it is okay to
have their injuries but one in which they admit that they are injured and
that therefore they must change their self expectations during a perhaps
extended period of recovery.
The treatment of trauma requires a holistic perspective in which the trauma
is primarily viewed as an injury to a psychophysical self. To see only the
injuries that may have been sustained by body structures is to miss what
has occurred physiologically as well as psychologically, the result being
that the medical profession blames the patient for not getting better on
time. To see only the injuries that occurred psychologically is to forget that
psychological life has its bodily correlates and social context. Then the
mental health professional unfortunately approaches the problem
irrespective of correlates and context. For instance, I am becoming more
convinced that it is nearly impossible for someone to recover from
traumatic experience if they lack support from family and friends, if they
have become financially stressed, and if they are not eating and drinking
properly and not involved in some sort of physical rehabilitation.
is missed when the spiritual dimension of their traumatic experiences are
disregarded? Furthermore, what
might be a Christ-inspired way to understand the spiritual dimensions of
their trauma? These questions of course can be answered in many different
ways. Among other things, what makes sense to me so far is the Christian
concept of suffering, in which the psychophysical wounds resulting from
life threatening trauma are somehow a blessing. How can this perplexing if
not offensive assertion be true? Its reality, I believe, is reflected in
the Beatitudes that start with "Blessed are those who are poor in
spirit for they shall see God." Paraphrased it reads, blessed are
those who have the breath/spirit [knocked] out of them and are hence
dispirited and disheartened, for they shall have a sense of God's presence.
How can this be for those whose emotional lives are entirely disrupted to
the extent that they can feel irritable and numb and the same time?
Entering into this reality requires an acceptance of our status as
creatures, acknowledging that we are nothing in ourselves. God is the
giving agent and we are the receiving patient. That "patience" of Job
has its origins in an Aristotelian/Medieval concept that points to the
way that finally he accepted his role as patient despite the fact that
he had been irritable, angry, disconsolate, and grief struck, in sum,
entirely not patient. Spiritually speaking, he came to see his own
arrogance before God and in the process submitted to the creaturely
status of patient. When traumatized persons are able to accept their
injuries spiritually, then they are able to transcend the haunting
question, "Why me?" Once they have experienced their own "nothingness,"
then recovery becomes more possible. This healing from trauma includes
a rebuilding of basic trust, not only in regards to people around them,
but also with respect to their God.
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