In a surprise move, the Ministry of Health and Long-Term Care announced on March 31, 2015 that the Psychotherapy Act, 2007 (the “Act”) would come into force April 1, 2015, thereby regulating psychotherapists and the practice of psychotherapy in Ontario. Significantly, however, the controlled act of psychotherapy has not been proclaimed into force at this time, meaning that, as in the past, any person can perform the act of psychotherapy.
The Act was introduced in 2007 as part of a move by the Province to regulate new health professions. Psychotherapists (excluding those who were also members of other health professions) had never previously been regulated in Ontario.
The Practice of Psychotherapy
The Act defines the scope of practice of psychotherapy as “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.”
The Act established the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario (since renamed the College of Registered Psychotherapists of Ontario) (the “College”) as the governing body for psychotherapists in the Province of Ontario. Its mandate, like that of all other health profession colleges, is to regulate members of the College in the public interest, striving to ensure that practitioners are competent, ethical and accountable. Since 2009, when parts of the Act were proclaimed in force, a Transitional Council was empowered to develop registration requirements and standards of practice for the College.
With proclamation of the bulk of the Act, the titles “psychotherapist,” “registered psychotherapist” and “registered mental health therapist” become restricted, meaning that only members of the College can use these titles and hold themselves out as people who are qualified to practice in Ontario as a psychotherapist or registered mental health therapist. Of note, it was anticipated that members of the colleges which regulate physicians, nurses, psychologists, occupational therapists and social workers and social service workers and who were permitted by their college to do so would be permitted to continue to use the title psychotherapist if they complied with the requirements of their college, for example, by identifying the college of which they are a member. However, the necessary sections of the Regulated Health Professions Act, 1991 to permit the use of the psychotherapist title by members of these colleges have not yet been proclaimed in force. Accordingly, at present, only members of the College can use the title psychotherapist. See this blog entry for more details.
Although “registered mental health therapist” remains a restricted title, the College’s Registration Regulation does not provide for a class of certificate of registration in this category, as was the case in a previous draft. Accordingly, at present, no one is authorized to use this title.
The Controlled Act
The Regulated Health Professions Act, 1991 (the “RHPA”) sets out 14 “controlled acts” which may only be performed by regulated health professionals who are members of health colleges whose members are permitted to perform such acts. The RHPA was amended in 2007 to include the controlled act of psychotherapy, defined 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
This section of the RHPA has not, however, been proclaimed in force, meaning that psychotherapy is not yet a controlled act; it is therefore not yet an offence for anyone to perform psychotherapy.
Health care providers have been very concerned about the proclamation of this section of the RHPA, as the controlled act of psychotherapy is harder to identify than other controlled acts because it involves numerous elements including: the treatment modality; the therapist-client relationship; the purpose of the treatment and assessment; and the health condition of the individual client (i.e. whether they have a mental disorder that is being treated through psychotherapy). All of these elements may be part of the determination as to whether what the health professional is doing is, in fact, psychotherapy. Further, communication made in the course of counselling about emotional, social, educational or spiritual matters may be excluded from the controlled act of psychotherapy, but it may be difficult to distinguish between psychotherapy and counselling about emotional matters.
Now that the Act is in force, the College can begin registering members. The College’s Registration Regulation outlines four classes of registration (registered psychotherapist, qualifying, temporary and inactive) and the requirements for same, as well as the pathways to registration. There are two main pathways to registration as a Registered Psychotherapist: the regular route, which requires completion of specified education and training, clinical experience, and successfully completing the Registration Exam after being deemed eligible to write it; and the grandparenting route for therapists who were practicing psychotherapy before the Regulation came into force, which requires demonstration of clinical experience and competencies. This pathway to registration will be available only for two years.
Members of the College will be permitted to use the title psychotherapist and to describe their services as psychotherapy services. Therapists who are not members of the College or another health college will no longer be permitted to describe their services as psychotherapy. However, until the amendment to the RHPA defining psychotherapy as a controlled act and the section of the Act authorizing members to perform the controlled act are proclaimed in force, there is no restriction on the performance of psychotherapy by non-College members.
Please contact us if you are a therapist seeking assistance with registration as a psychotherapist, or if you have any questions regarding the Act and its impact on the provision of health care.
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