For Athletes, Coaches & Sport Parents
Sport Performance Therapy
For athletes who train hard, prepare properly, and then cannot reproduce it when it counts. And for everything else that comes with a life organised around sport. In person in Kitchener, online across Ontario, or walking on the Iron Horse Trail.
Who you would be working with
This work is Leanne Wiese's area of practice. Leanne is a Registered Psychotherapist with the College of Registered Psychotherapists of Ontario, registration #15522.
She is also a former national-level and collegiate athlete, an NCCP certified coach, and has spent ten years working with athletes. You will not have to explain what a taper is, why you are still thinking about one race from four years ago, or what it feels like to be dropped.
Appointments are Wednesdays and Fridays, 11am to 2pm, in person in Kitchener or online anywhere in Ontario. Start with a free 15-minute consultation.
What athletes come in with
- Training well and competing badly, and not understanding why
- Nerves that used to be manageable and now are not
- Losing the thing you were good at, through injury, deselection or age
- Coming back from injury physically but not being able to commit to the movement
- Motivation that has quietly gone, and guilt about that
- Pressure from a coach, a parent, a scholarship, or yourself
- Eating and body image, which in sport gets tangled up with performance
- Balancing sport with school, work or a family
- Retiring, and finding out how much of your identity was in it
This is more common than the room lets on
Athletes are surrounded by people performing fine. Here is what the research actually finds.
Among current elite athletes, symptom rates run from about 19 per cent for alcohol misuse to 34 per cent for anxiety and depression. Among former elite athletes, from about 16 per cent for distress to 26 per cent for anxiety and depression.1 These are screening-questionnaire rates rather than clinical diagnoses, which matters, but the direction is clear enough.
Disordered eating is more common in sport than most people assume. Pooling 177 studies covering 70,957 athletes across 27 countries, self-reported disordered eating had a prevalence of 19.2 per cent (95% CI 17.0 to 21.6), rising to 41.5 per cent in gymnastics.2
And athletes mostly do not ask for help. A meta-analysis of athlete help-seeking found a pooled rate of about 22 per cent (95% CI 16.2 to 30.2). Documented barriers include low mental health literacy, stigma, and worry about being seen as weak.3
That last number is the one worth sitting with. The problem in sport is not that athletes are unusually fragile. It is that the environment makes asking feel expensive.
Does the mental side actually change performance?
Yes, moderately, and the honest version is more useful than the sales version.
Across 35 randomised controlled trials with 997 participants, mental and psychosocial interventions produced a moderate improvement in sport performance (Hedges' g = 0.57, 95% CI 0.22 to 0.92).4 A separate 2024 systematic review found moderate effects for mental skills training (g = 0.83), mindfulness and acceptance approaches (g = 0.67) and imagery (g = 0.75), while noting the underlying studies vary in quality.5
Some findings are specific enough to be worth acting on:
- Process goals beat outcome goals, by a lot. In a meta-analysis of goal setting in sport, process goals produced a large effect on performance (d = 1.36), performance goals a moderate one (d = 0.44), and outcome goals no reliable effect at all.6 Which is to say: "win the race" is close to useless as an instruction to yourself, and "hold my stroke rate through the third quarter" is not.
- Mindfulness work has decent evidence in sport. Across randomised trials, athletic performance improved (SMD 0.92, 95% CI 0.40 to 1.43) and competition anxiety fell (SMD -0.87). Effective courses in these trials ran roughly seven to twelve sessions, so this is not a one-conversation fix.7
- Injury cuts both ways. Preventive mental work was associated with fewer injuries across 11 trials with 1,287 participants, and after ACL reconstruction, structured mental work reduced fear of movement and re-injury on the Tampa Scale for Kinesiophobia (SMD -0.51 at three months).8
Two caveats we will not bury. Several of these pooled estimates come from small numbers of studies with wide confidence intervals and high variability between them. And an average effect across trials is not a promise about your season.
What sessions actually involve
The first session is a conversation about your sport, what is happening, and what you want to be different. From there it usually mixes two things: concrete mental skills work, and ordinary therapy for whatever sits underneath.
Leanne draws on cognitive behavioural therapy, acceptance and commitment therapy, solution-focused work, mindfulness-based approaches, motivational interviewing and narrative therapy, alongside mental skills work on goal setting, routines, attention and self-talk. Which of those appear depends entirely on what you bring.
- In person at Suite 304, 678 Belmont Avenue West in Kitchener, Wednesdays and Fridays, 11am to 2pm.
- Online anywhere in Ontario, which works for athletes travelling to compete or training out of town.
- Walking sessions on the Iron Horse Trail, weather permitting. Some athletes talk more easily while moving.
- Team sessions are a separate service: see Team Mindset Sessions for group work with minor sports teams.
One thing worth being clear about
This is psychotherapy, provided by a Registered Psychotherapist, with mental skills work inside it. That has two practical consequences. Sessions can cover competition nerves and everything else in the same hour, because in practice those are rarely separable. And because it is psychotherapy, it may be reimbursable under an extended health plan, which mental performance coaching generally is not.
Other places athletes can get support
If you are in crisis right now, call 911, or call or text 9-8-8, the Suicide Crisis Helpline, any time. For urgent support in Waterloo Region, Here 24/7 is on 1-844-437-3247, 24 hours a day.
Game Plan provides confidential mental health support to nationally carded and senior national team athletes, and to athletes recently retired from that level. In Ontario it is delivered through Canadian Sport Institute Ontario.9 If you qualify for it, use it: it is free and it is built for exactly this.
To report maltreatment in sport, the Canadian Safe Sport Program took over from the Abuse-Free Sport Helpline on 1 April 2025 and can be reached on 1-866-971-2777.10 If you have an old number for the Abuse-Free Sport Helpline, it no longer operates.
If you are a student athlete, your university or college counselling service is free and already yours. More local options are on our Waterloo Region mental health resources page.
Fees and coverage
| Session | 50 minutes | 80 minutes |
|---|---|---|
| Individual | $150 | $225 |
| Student | $130 | $200 |
The student rate applies to university and college athletes. OHIP does not cover psychotherapy from a Registered Psychotherapist in private practice, but most extended health plans that include Registered Psychotherapist benefits will reimburse these sessions, and many university student health plans do too. We offer direct billing to most major providers. There is no HST on psychotherapy sessions.11
Common questions
Is this mental performance coaching or therapy?
It is psychotherapy, delivered by a Registered Psychotherapist, with mental skills work inside it. That means one session can cover competition nerves and whatever else is going on, and it means sessions may be reimbursable under an extended health plan, which coaching generally is not.
Do I have to be a serious athlete?
No. Competitive youth athletes, university athletes, masters and recreational athletes, and people whose performance pressure is in music, dance or work all bring the same underlying material. If it matters to you and the pressure is affecting you, that is enough.
Will talking about it hurt my performance?
Common worry, and a documented barrier to athletes seeking help. A meta-analysis found only about 22 per cent of athletes sought help when they needed it, with stigma among the main reasons. The intervention research points the other way: across 35 randomised controlled trials with 997 participants, mental interventions produced a moderate improvement in performance.
Can you help with fear of re-injury?
Yes, and it is one of the better-evidenced areas. After ACL reconstruction, structured mental work has been shown to reduce fear of movement and re-injury on the Tampa Scale for Kinesiophobia. It is a common reason athletes who are physically cleared still do not get back to their previous level.
I am retiring from sport and do not know who I am.
A well-recognised transition, and a common reason athletes come in. Symptom rates among former elite athletes run roughly 16 to 26 per cent depending on what is measured, not far off current athletes. Leaving sport removes a structure that has often organised someone's whole life.
Do you work with coaches and parents?
Yes. Coaches carry their own pressure and rarely have anywhere to put it. Parents of competitive athletes often want help finding the line between supporting and pushing. Both are legitimate reasons to book.
Where these numbers come from
Every figure links to its source below. Effect sizes are quoted with their confidence intervals where the source reports them, because a pooled estimate without one is not much use. If you find something out of date or wrong, email leanne@kwtherapy.ca.
- Gouttebarge V et al., Occurrence of mental health symptoms and disorders in current and former elite athletes, British Journal of Sports Medicine, 2019.
- Meta-analysis of disordered eating in athletes, 177 studies, 70,957 athletes.
- Cosh SM et al., Athlete mental health help-seeking: a systematic review and meta-analysis, Psychology of Sport and Exercise, 2024.
- Meta-analysis of interventions on sport performance, randomised controlled trials only, 35 studies, 997 participants.
- Systematic review and meta-analysis, Sports Medicine, 2024.
- Williamson O et al., meta-analysis of goal setting in sport, 27 studies.
- Meta-analysis of mindfulness training and athlete performance, 11 randomised controlled trials, 582 participants.
- Li et al., interventions and sports injury, Orthopaedic Journal of Sports Medicine, 2020.
- Canadian Sport Institute Ontario, Game Plan. Eligibility is limited to carded and senior national team athletes and recent alumni.
- Sport Integrity Canada, Canadian Safe Sport Program. Replaced the Abuse-Free Sport Helpline on 1 April 2025.
- Canada Revenue Agency, GST/HST Memorandum 25-3, and Government of Ontario, what OHIP covers.
This page describes psychotherapy services offered by KW Therapy in Kitchener, Ontario. It is general information, not clinical advice. Leanne Wiese is a Registered Psychotherapist with the College of Registered Psychotherapists of Ontario, registration #15522, confirmable on the CRPO public register. Her NCCP certification is a coaching credential and is separate from her registration as a psychotherapist. Page last reviewed 20 July 2026.
Related: When your body betrays you: performance anxiety, an essay by Leanne · Team Mindset Sessions for whole teams · About Leanne · All services and fees
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