Psychotherapy regulation for
dummies
(and the understandably confused)
A primer
Psychotherapy Regulation for Dummies
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Brenda Spitzer, M.Sc., RMFT
Ed Santana, MA, PhD (C)
Anna Toth, M.Sc., RMFT
Ron Mellish, MA, RMFT, CTS
What is regulation anyway?
• Psychotherapy will be regulated under the
Regulated Health Professions Act (RHPA, 1991)
to govern and hold professionals delivering
psychotherapy services accountable.
• Schedule R of the RHPA, also called Bill 171
became law in 2007 and is called The
Psychotherapy Act.
The Psychotherapy Act
• The Psychotherapy Act identifies the practice
of psychotherapy as a controlled act, legally
deliverable only by those registered in the
Colleges of Medicine, Nursing, Psychology,
Social Work, Occupational Therapy, or the new
College of Registered Psychotherapists and
Registered Mental Health Therapists (the
College).
The Psychotherapy Act
• The Psychotherapy Act defines the controlled
act of psychotherapy 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”
The Psychotherapy Act
• 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 on verbal or
non-verbal communication”
The new College
• The Psychotherapy Act restricts the use of the
titles “psychotherapist” and “registered mental
health therapist” to members of the College.
• The College will be operational once the
Psychotherapy Act is proclaimed (in 2014). At this
time, anyone wishing to hold the title
“psychotherapist” or “registered mental health
therapist” will need to be registered in the
College.
The new College
• The College will be governed by a Council, and
will oversee three psychotherapy regulations: the
Draft Registration Regulations, Professional
Misconduct Regulations, and Quality Assurance
Regulations.
• The regulations define and describe who is
eligible to join the college, practice parameters,
what legally constitutes professional misconduct,
and guidelines for addressing identified
professional shortcomings.
What’s the relationship between
membership in the new College and
membership in the OAMFT?
The new College
• To practice psychotherapy as defined by the
Psychotherapy Act, membership in the new
College will be obligatory.
• The only mandate and goal of a Professional
College is protection of the public.
• The College will control entrance requirements,
will set exams for those wishing to practice, will
set standards for developing and maintaining
professional knowledge and will have the power
to discipline members in various ways including
removing their right to practice.
The new College & O/AAMFT
• OAMFT is a professional association whose
mandate is to act in the interest of its
members.
• A professional association is voluntary.
• Professional associations advocate on behalf
of their members, provide services for
members such as liability insurance, create
marketing opportunities, professional
development and networking opportunities.
The new College & O/AAMFT
• OAMFT, as a professional association supports
its members in the pursuit of competent and
ethical service to clients.
• The registered marriage and family therapist
designation (“RMFT”) is a voluntary
professional designation to describe an
AAMFT Clinical Fellow’s attained level of
education, orientation and training.
Recent developments and OAMFT
lobbying efforts
• Lobbying Efforts 2010-2012: Transitional
Council, Ministry of Health, Coalition,
OACCPP/OASW
• OAMFT Successes: Title Usage, RMHTs
restricted practice, Misconduct Regulations
• Ongoing and Upcoming Initiatives:
Credentialing Standards, Supervision, Exam,
and RMHT Restrictions
Required hours of education for professional
designation as a psychotherapist
1000
900
800
700
600
500
400
300
200
100
0
900
900 870 900 900
720
360
Master’s
Degree
Without a higher education
and training threshold,
Ontario’s standards will fall
well below Canadian and
International professional
standards, putting the safety
of patients receiving these
important services at risk.
Quebec: Social Worker/Marriage & Family Therapist; Minimum creden al is a Master's degree, equal to approximately 900 hours of instruc on (or 60-semester credit hours) to obtain a degree in a non-thesis program. *Based on a typical
qualifying Master's program at an approved ins tu on without thesis, and with prac ca, not including addi onal course requirements or direct client contact hour requirements of the Quebec Order of Social Workers/MFTs.
Nova Sco a: Registered Counselling Therapist (RCT), Minimum creden al is a Master's degree of approximately 720 hours of instruc on (or 48-semester credit hours).
New York: Mental Health Prac oner, Minimum creden al is a Master's degree of approximately 900 hours of instruc on (or 60-semester credit hours).
California: Licensed Professional Clinical Counsellor, Minimum creden al is a Master's degree of approximately 870 hours of instruc on (or 48-semester credit hours plus addi onal prac cum of 150 hours).
Maryland: Licensed Professional Counsellor, Minimum creden al is a Master's degree of approximately 900 hours of instruc on (or 60-semester credit hours).
Florida: Mental Health Counsellor, Minimum creden al is a Master's degree of approximately 900 hours of instruc on (or 60-semester credit hours).
*(1 semester credit hour = approximately 15hours of classroom instruc on)
Recent developments and OAMFT
lobbying efforts
• Lobbying at Queen's Park: NDP, PCs, Liberal
and Ministry of Health
• Next Steps: Change of Players, Final Version of
Misconduct Rules, Changes to Registration
Regulations
• Thanks to OAMFT Members and Leaders: We
are making a difference!
Understanding the
Misconduct Regulations
And why we don’t need to panic
What is the difference between the
AAMFT Code of Ethics, the College’s
Code of Ethics, and the Misconduct
Regulations?
AAMFT Code of Ethics
• Sets standards of professional practice and conduct
that members agree to uphold
• Broad application to promote pubic trust, protect
clients, supervisees, students, and research
participants
• Code items may exceed legal expectations
• Conversely legal expectations may exceed the Code
• Contravention is investigated and disciplined by a
committee of AAMFT
• Ultimate discipline = permanent loss of membership
• Tends to be written in a language of “MFT’s do”
Code of Ethics of the new College
• Inspirational document
• Offers what the College sees as a preferred
way to embody an ethical stance
• Focused on clients
• Not legally binding
• Tends to be written more in the language of
“we strive to”
Misconduct Regulations
• Subsection of Psychotherapy Act, 2007 that defines
acts of professional misconduct and processes by
which new College will investigate and discipline
members who engage in such acts
• Legally binding
• Focused on clients only; no protection of
supervisees, research participants, students….
• Tends to be written in the language of “failure to”
Misconduct Regulations
Key areas of focus
…and why we still don’t need to
panic
Contravening practice standards
• Contravening, by act or omission, a standard
of the practice of the profession or failing to
maintain the standard of practice of the
profession (standards can be explicit or
implicit)
Failing to obtain informed consent
• Doing anything to a client for a therapeutic,
preventive, palliative, diagnostic or other
health-related purpose except,
– With the informed consent of the client or their
representative
– As required or authorized by law
• MFT’s need to be familiar with the health care
consent act, particularly sections 10 & 11
Health Care Consent Act, 1996
Sections 10 & 11
• We need to be of the opinion that the person is capable of
consent and is giving consent, or we need to have the consent
of a substitute decision maker
– Consent must be voluntary
– Consent cannot be obtained through misrepresentation or fraud
– Consent must be informed
• Client must receive information that any reasonable person in the
same circumstances would require to make a decision
• Client received responses to his/her requests for additional
information
• Consent to treatment may be express or implied
• If a client requests information about the risks of treatment,
they must be informed
Health Care Consent Act, 1996
• Clients need to be informed about:
– Nature of treatment
– Expected benefits
– Materials risks
– Material side effects
– Alternative courses of action
– The likely consequences of not having the
treatment
Confidentiality
• While always a hallmark of our services, it too
has now been codified into law
• Personal Health Information Protection Act,
2004
Discontinuing Services
• Unless the discontinuation would be
reasonably regarded as necessary due to:
– Member’s reasons for discontinuing
– The condition of the client
– The availability of other services
– The opportunity given to the client to arrange
alternate services
– Including closing your practice voluntarily or due
to death or disability
Unnecessary treatment
• Recommending or providing unnecessary
treatment
• Treating clients when treatment is no longer
working or beneficial
• Treating conditions that you know or ought to
know you do not have the knowledge, skills or
judgment to treat
• Performing acts that you are not authorized to
perform
Working with and consulting other
service providers
• Now more of an onus on therapists to work with other
health care professionals
• Failing to advise a client to consult
• Failing to work with other health care providers when
necessary
• Failing to refer when we know a referral is needed
• Delegating the authorized act except under certain
circumstances
• Permitting a service provider to misrepresent
themselves
Complaints processes and
disciplinary procedures
• Failing to advise a client of their right to complain
• Failing to provide the address and telephone
number of the College
• Various forms of failing to participate in the
College’s complaints processes in a timely fashion
• Failing to comply with disciplinary procedures
• Practicing when your registration has been
suspended
• Benefitting from someone else’s practice when
your registration has been suspended
Conflict of interest and
undue influence
• Working when we are in a conflict of interest
position
• Influencing clients to change their will
Billing, fees and finances
• Issuing bills and invoices that a member knows or ought to
know are false or misleading
• Charging a fee that is excessive
• Charging more than the usual fee when billing a third party
• Failing to advise a client of penalties for late payment etcetera
• Charging block fees without specifying certain aspects of the
fee in writing
• Offering or giving reductions for prompt payment of accounts
• Failing to itemize accounts when requested to do so
• Breaching contracts with a client relating to services or fees
• Selling debts
Record Keeping
• Failing to keep written records in accordance with
the standards of the profession (more to come)
• Signing or issuing documents that the member
knows or ought to know are false or misleading
• Falsifying records
• The transitional council, in earlier drafts of the
misconduct regulations, articulated what
constituted appropriate written documents
• These will likely come out as specific guidelines or
policies within the next year
Advertising
• Making claims about approaches, modalities,
procedures, etcetera that cannot be supported by
professional opinion
• Permitting advertising that is false or misleading
or that includes statements that are not verifiable
• Using testimonials in advertising
• Soliciting or permitting solicitations by phone or
electronic communication except under certain
conditions
Title, designations and names
• Inappropriately using terms, titles or designations
• Inappropriately using terms, titles or designations to
imply specializations in the profession
• Failing to use the title designated by the college while
acting in a professional capacity
• Practicing the profession using another name
(members are allowed to use business names, but their
documentation, receipts etcetera must use their
personal name as they are registered with the college)
• Failing to provide certificates of authorization to
perform the service
Jane Doe, M.Sc., RP, RMFT, CTS
Reporting other members
• Failing to promptly report members who
engage in unsafe practices
• Making a report about another member in
which you use the name of the client, unless
appropriate consent has been obtained or it is
required by law
Contravening a variety of laws
• Regulated health professions act
• Any law in Canada the purpose of which is to
protect the public or is relevant to our
suitability to practice
Providing services through electronic
communication
• Unless
– The client provides informed consent
– The member ensures their professional liability
insurance covers the services
– The member takes reasonable steps to ensure the
electronic communication technology employed is
secure, confidential and appropriate…
Generally doing bad things
• Abusing a client or their representative
• Practicing while impaired by any condition or
substance that you know or ought reasonably
to know would impair you
• Committing acts that would be reasonably
regarded as disgraceful, dishonourable or
unprofessional
• Generally engaging in conduct unbecoming as
a member
To keep in mind
• MFT’s remain accountable to both the AAMFT
Code of Ethics and the Misconduct
Regulations
• When there is discrepancy between the two…
– Make sure the law is followed
– Choose the higher ethical practice
– Consult consult consult
Registration
…because you have to
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