Joyce Rowlands, Registrar April 15, 2011

Transitional Council of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario www.collegeofpsychotherapists.on.ca

Regulation of Psychotherapists & Mental Health TherapistsTransitional Council College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario Joyce Rowlands, Registrar April 15, 2011 2

What is the Transitional Council? • Governing Council (“board”) • Appointed by Ont. Gov’t in 2009 • Develops Regulations for Psychotherapy Act • Registration Regulation • Professional Misconduct Regulation • Quality Assurance Regulation • Mandate a public protection 3

Transitional Period • 2009 – 2012 • Likely longer due to pre-registration • For now, under wing of government • 3 committees: • Executive Cttee • Registration Cttee • Professional Practice Cttee 4

Psychotherapy Act 2007 • Restricted titles • Registered Psychotherapist • Registered Mental Health Therapist • Scope of practice • Controlled Act of Psychotherapy • ‘Holding out’ clause 5

Other Regulated Professions may usetitle “Psychotherapist” (but not Reg. Psychotherapist) • Physicians • Nurses • Social workers • Psychologists • Occupational therapists … along with their professional designation or the name of their regulatory College 6

‘Holding Out’ Clause • Prohibits anyone who is not a member of the College (or one of the other authorized Colleges) from holding himself or herself out as a person who is qualified to practice psychotherapy or mental health therapyin Ontario. 7

Psychotherapy - Scope of Practice The practice of psychotherapy is the assessment and treatment of cognitive, emotional or behavioural disturbances by psychotherapeutic means, delivered through a therapeutic relationship based primarily on verbal or non-verbal communication. 8

Controlled Acts • Under the RHPA, unregulated individuals may not perform restricted activities, known as controlled acts • Members of regulated health professions may perform only those controlled acts authorized for their profession 9

Controlled Act of Psychotherapy “…to treat, by means of psychotherapy technique …an individual’s serious disorder that may seriously impair his or her judgment, insight, behaviour, communication or social functioning.” [Subset of Scope of Practice] 10

Exemption for Counselling • Exemption in Regulated Health Professions Act (RHPA) for counselling Defined as “…communication made in the course of counselling about emotional, social, educational and spiritual matters.” 11

HPRAC ‘Definition’(Difference between Counselling & Psychotherapy) “The practice of psychotherapy is distinct from both counselling, where the focus is on the provision of information, advice-giving, encouragement and instruction, and spiritual counselling, which is counselling related to religion or faith-based beliefs.” 12

If we apply HPRAC’s Definition …to the exemption for counselling in the RHPA, the following is exempt: “Counselling, where the focus is on the provision of information, advice-giving, encouragement and instruction, and spiritual counselling” 13

What does all this mean? • If your work falls into the scope of practice, you should become a member • If your work involves the controlled act of psychotherapy, you must become a member • But…determining whether you’re performing the controlled act may not be straightforward 14

Unregulated Practitioners … • must take care not to work with clients who have serious disorders… • cannot use any protected title, variation or abbreviation • cannot ‘hold themselves out’ as qualified to practice psychotherapy or mental health therapy in Ontario 15

Differences between the Two Titles Registered Psychotherapists • Those engaged primarily in one-to-one or group psychotherapy, on a contractual basis, often for an extended period Registered Mental Health Therapists • Practice psychotherapy as part of what they do; also provide other services Applicants will choose category 16

2nd Title: Registered Mental Health Therapist • Intention: to include those who do not see themselves primarily as “psychotherapists” • Gives flexibility to regulate broad spectrum of practitioners • Strengthens public protection 17

Questions and Comments?

Registration Requirements • As approved for consultation purposes • Consultation meetings March-April • Excellent feedback (new issues raised) • Regulations to be revised • Further consultation planned 18

Summary of Proposed Registration RequirementsDRAFT for Discussion Purposes ONLY (Subject to Change) Revised April 14, 2011 [1] Registration examination not expected to be available until 2013-14 [2] See over for definition of clinical supervision [3] See over for Scope of Practice 19

Registered Psychotherapist (RP) • Currency requirement… • Undergraduate degree (or equivalent) + 2yrs/10 courses education/training in psychotherapy • Min. 450 direct client contact hrs (1000 hrs for independent practice) • Min. 150 hrs clinical supervision • Written examination + Jurisprudence exam • Self-awareness training 20

Registered Mental Health Therapist (RMHT) • Currency requirement… • Min. 2 yrs post-secondary education/ training related to scope of practice (e.g. community college diploma) • Supervised practicum • Written examination + jurisprudence exam • Self-awareness training • Additional requirements for independent practice 21

Self-Awareness • Effective use of ‘self’ in the therapeutic process • Both categories of members • How will this be demonstrated? • One option: personal psychotherapy • Others? 22

Framework for Recognizing Education & Training Programs • Draft Regulation states: program approved by the College • Framework aCriteria & process for recognizing programs • To be developed by transitional Council • Great diversity of programs… • No established accreditation body • Goal is flexibility • Underlying concept: development of competencies 23

Grandparenting (bothcategories) • Currency requirement: 750 practice hrs in previous 3 yrs • Alternate route for established Ontario practitioners • Registration exam (no); Jurisprudence exam (yes) • Portfolio evidence of education, experience, type of practice, etc. (weighted point system) • PLA tool for grandparenting & for internationally trained professionals • May use appropriate title 24

2 Access to Controlled Act • All members have access, but … • under the RHPA, practitioners may only provide services for which they have the necessary competency (knowledge, skill and judgment) • If not, they must refer client to another professional 25

Concerns of Spiritual Counselors/ Therapists: • Role may be supplanted by psychotherapists • Won’t be able to use “Chaplain” • May be required to be registered • Wish to join college but may not meet requirements • Training process is different • Supervision is different • Lay visitors & delegation of controlled act • Other? 26

2 Professional Misconduct Regulation…the don'ts of professional practice

Professional Practice Regulation • 2nd major regulation needed for proclamation • Enforceable in law • Unlike the Code of Ethics, which is inspirational but not enforceable • Will discuss selected provisions 27

2 Abusing a Client Abusing a client or a client’s representative verbally, physically, psychologically or emotionally. NOTE: Sexual abuse is covered in the Procedural Code of the RHPA 28

2 Discontinuing Services …without due consideration given to: • reasons for discontinuing services • condition of the client • availability of alternate services • opportunity for client to arrange alternate services 29

2 Providing Unnecessary Treatment • Recommending or providing unnecessary treatment, or continuing to treat a client, where the treatment is no longer indicated or has ceased to be effective. 30

2 Supervision • Failing to appropriately supervise a person who the member is professionally obligated to supervise. 31

2 Conflict-of-Interest • Acting or being in a conflict-of-interest when in a professional capacity. 32

2 Unsubstantiated Claims • Making a claim about a therapeutic approach, modality, remedy, treatment, device or procedure other than a claim that can be supported as reasonable professional opinion. 33

2 Implying Specialization • Using a term, title or designation indicating or implying a specialization in an area or areas of practice, except in accordance with any formal specialist recognition program approved by the College 34

2 Failing to Provide a Report …to a client or the client’s authorized representative, within a reasonable time period, when requested to do so. 35

2 Failing to Report Unsafe Practice • Failing to promptly report to the College reasonable grounds of an incident of unsafe practice by another member. 36

2 Record-keeping • Failing to keep records in accordance with the standards of the profession. 37

2 Misleading Advertising • Employing advertising that is false or misleading, or includes statements that are not factual and verifiable. 38

2 Practising while impaired • Practising while one’s ability to do so is impaired by any condition, dysfunction or substance, which the member knows or ought to have known, impairs his or her ability to practice. 39

2 Disgraceful… conduct • Engaging in conduct or performing an act, in the practice of the profession, that would be regarded by members as disgraceful, dishonourable or unprofessional. 40

2 Conduct unbecoming… • Engaging in conduct [outside the practice of the profession] that would reasonably be regarded by members as conduct unbecoming a practitioner of psychotherapy or mental health therapy. 41

2 Business Practices • Failing to itemize an account when requested • Charging block fees for ongoing care • Charging excessive fees • Issuing a false or misleading invoice or receipt • Selling or assigning a debt 42

2 Failing to Co-operate • Failing to co-operate with a College investigation. 43

2 Purpose of Professional Regulation • Protect public from unqualified, unethical & unfit practitioners • Not about professional stature • Goal is to reduce risk of harm 44

Next steps • Revise draft Regulations: • Registration • Professional Misconduct • Quality Assurance • Formal Consultations (written submissions) • Competency Profiles • Framework for recognizing educ’n programs • Develop Exams • Prior Learning Assessment tools • Practice/other guidelines 45

UPDATE Transitional Council of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario www.collegeofpsychotherapists.on.ca

Joyce Rowlands, Registrar April 15, 2011