Family Therapy and
Mental Health
University of Guelph
Office of Open Learning
1
Reflections on the Course So
Far
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Comments
Questions
Assignments
2
Today
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This is the End!
Family Therapy and Eating Disorders
Life in the CRPO
Jeopardy
Evaluations
3
Family Therapy &
Eating Disorders
Assessment and Treatment
Spectrum of Weight-related Disorders
Bulimia
Nervosa
Anorexia
Nervosa
Unhealthy Dieting
Disordered
Eating
Binge Eating
Disorder
Obesity
DSM 5 Criteria: AN
A.
B.
C.
Restriction of energy intake relative to requirements,
leading to a significantly low body weight in the context of
age, sex, developmental trajectory, and physical health.
Significantly low weight is defined as a weight that is less
than minimally normal or, for children and adolescents,
less than that minimally expected.
Intense fear of gaining weight or of becoming fat, or
persistent behaviour that interferes with weight gain, even
though at a significantly low weight.
Disturbance in the way in which one’s body, weight or
shape is experienced, undue influence of body, weight or
shape on self-evaluation, or persistent lack of recognition
of the seriousness of current low body weight.
DSM 5 Criteria: AN
Restricting type:
 during the last 3 months, the individual has not
engaged in recurrent episodes of binge eating or
purging behaviour. This subtype describes
presentation in which weight loss is accomplished
primarily through dieting, fasting, and/or excessive
exercise
Binge-eating/purging type:
 during the last 3 months, the individual has
engaged in recurrent episodes of binge eating or
purging behaviour
DSM 5 Criteria: BN
Recurrent episodes of binge eating. An
episode of binge eating is characterized by
both of the following:
A.
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Eating, in a discrete period of time (any 2 hr.
period) an amount of food that is definitely larger
than most people would eat during a similar period
of time and under similar circumstances
A sense of lack of control over eating during the
episode (can’t stop or control what or how much
one is eating)
DSM 5 Criteria: BN
2.
3.
4.
5.
Recurrent inappropriate compensatory behaviours in
order to prevent weight gain (e.g. vomiting; use of
laxatives, diuretics, enemas, or other meds; fasting or
excessive exercise)
The binge eating and inappropriate compensatory
behaviours both occur, on average, at least 1x/wk for
three months
Self-evaluation is unduly influenced by body shape and
weight
The disturbance does not occur exclusively during
episodes of AN
DSM 5 Criteria: BED
Recurrent episodes of binge eating. An
episode of binge eating is characterized by
both of the following:
A.


Eating, in a discrete period of time (any 2 hr.
period) an amount of food that is definitely larger
than most people would eat during a similar period
of time and under similar circumstances
A sense of lack of control over eating during the
episode (can’t stop or control what or how much)
DSM 5 Criteria: BED
The binge-eating episodes are associated
with three (or more) of the following:
B.
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Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not hungry
Eating alone because of embarrassment
Feeling disgusted with oneself, depressed, or very
guilty afterward
DSM 5 Criteria: BED
C.
D.
E.
Marked distress regarding binge eating is
present
The binge eating occurs, on average, at
least 1x/wk for 3 months
The binge eating is not associated with the
regular use of inappropriate compensatory
behaviours and does not occur exclusively
during the course of AN or BN
Eating Disorders:
Prevalence
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Total # of cases in the population
Indicates the demand for care
Anorexia
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Bulimia
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0.3% for young females
1% in women; 0.1% in men
Binge Eating
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1% in general population
(van Hoeken, Seidell & Hoek,
2005)
Eating Disorders:
Incidence
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# of new cases in pop. in a specified period of
time (usually one year)
Represents the moment of detection vs.
onset
Anorexia
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8 per 100,000
Bulimia
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12 per 100,000
(van Hoeken, Seidell & Hoek,
2005)
Eating Disorders &
Mortality
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mortality rate associated with AN is 12 times
higher than the death rate of ALL causes of
death for females 15 – 24 years old
20% of people suffering from anorexia will
prematurely die from complications related to
their eating disorder, including suicide and
heart problems
Anorexia
Associated Disorders
National Association of
Nervosa and
Etiology
or
Etiology
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Eating disorders are multi-determined
“Unlike some illnesses, recognizing the
cause(s) does not necessarily suggest a
solution” (Lask & Bryant-Waugh, p. 51)
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e.g. CBT approach (Fairburn)
Predisposing, precipitating and perpetuating
factors
Individual, family, and sociocultural factors
Assessment
Screening
The SCOFF Questionnaire
1.
2.
3.
4.
5.

Do you ever make yourself Sick because you
feel uncomfortably full?
Do you ever worry you have lost Control over
how much you eat?
Have you recently lost more than One stone
(6.35 kg) in a three month period?
Do you believe yourself to be Fat when others
say you are too thin?
Would you say that Food dominates your life?
A score of more than 2 positive answers
indicates a need for a more detailed assessment
(John Morgan, BMJ, 1999)
Assessment
Symptoms of AN
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weight loss
amenorrhea
depression
irritability
sleep disturbance
fatigue
weakness
headache
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dizziness
faintness
constipation
non-focal abdominal
pain
feeling of “fullness”
polyuria
intolerance of cold
Mehler & Andersen, 1999
Assessment
Signs of AN
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emaciation
hyperactivity
cardiac arrhythmia
congestive heart
failure
bradycardia
hypotension
dry skin
brittle hair
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brittle nails
hair loss on scalp
“yellow skin”,
especially palms
lanugo hair
cyanotic and cold
hands and feet
edema (ankle,
periobital)
Mehler & Andersen, 1999
Assessment
Symptoms of BN
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weight fluctuation
irregular menses
esophageal
burning/heartburn
nonfocal abdominal
pain
abdominal
bloating/gas
lethargy
fatigue
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headache
constipation/diarrhea/
hemorrhoids
swelling of hands/feet
frequent sore throats
depression
swollen cheeks,
parotid/
submandibular gland
enlargement
Mehler & Andersen, 1999
Assessment
Signs of BN
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calluses on the back
of the hand
salivary gland
hypertrophy
erosion of dental
enamel
periodontal disease
tooth decay
brittle nails
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petechiae
perioral irritation
mouth ulcers
blood in vomit
edema (ankle,
periorbital)
Mehler & Andersen, 1999
Assessment
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Multi-disciplinary
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Individual
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Family
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Interview, self-administered questionnaires
Genogram, ecomap, family history
Boundaries, communication, conflict, emotional
expression, etc.
Nutritional
Medical
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Medical history, physical examination, lab tests
Assessment
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Individual Interview
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Get the “story” of the client’s problem(s)
“What brought you here today?”
Obtain a complete history of ED
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Track when and how concerns arose and how they
translated into specific behaviours
How it started, when it was at its worst, what it’s like now
Detailed nutritional history
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Describe a typical day of eating
Vegitarianism/veganism, nutritional supplements
Perceptions about family’s view on food, weight loss, and
health
Assessment
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Individual Interview
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Weight and shape concerns
Other changes: isolation, mood, school, social
Other mental health issues/diagnoses
Self-harm and suicidality
Family stressors/changes
For adolescents:
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Smoking, drinking, abuse of street drugs or
medications
Sexual history
Abuse history
Assessment
Comorbidities
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50-75%
25%
30%-37%
12%-18%
depression/dysthymia
O.C.D. (lifetime prevalence)
substance abuse in B.N.
substance abuse in A.N.
(binge-purge type)
42%-75% personality disorders
20-50%
sexual abuse
Assessment
Body Mass Index
Assessment
Body Image
Measure of Body Image Distortion
- Select the body that best represents the way you think you look
- Interviewer estimates actual size
- Degree of distortion = actual – perceived
(Figure Rating Scale, Skunkard & Sorenson,
1987)
Assessment
Questionnaires
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Most popular:
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Eating Disorder Inventory 3 (Garner, 2004)
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91 item self-report
Drive for thinness, bulimia, body dissatisfaction
Eating Disorder Examination 16.0 (Fairburn,
Cooper & O’Connor, 2008)
 Structured clinical interview, used most in research
 EDE-Q 6.0 – 28 item self-report; validated with EDE
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Eating Attitudes Test (Garfinkel & Garner, 1979)
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26 item self-report of symptoms
Assessment
Features of Medical Concern
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Marked food or fluid restriction
Frequent self-induced vomiting (>2x/day)
Frequent laxative or diuretic misuse (>2x/day)
Heavy exercising when underweight
Rapid weight loss (>1kg/week for several weeks)
BMI of 17.5 or below
Episodes of feeling faint or collapsing
Episodes of disorientation, confusion or memory
loss
Chest pain, shortness of breath
Swelling of ankles, arms or face
Blood-stained vomit
Assessment
Family Sessions
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Meet with both parents and client, if possible
Discuss confidentiality
Complete genogram
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At least three generations (child, parents &
grandparents)
Try to engage each member, allow client to listen
while mom and dad are interviewed (re. family secrets)
Ask about: addictions, abuse, moves, work, school,
bullying, separation/divorce, miscarriages, any hx. of
mental health issues, closeness/distance, conflict,
cutoff, how emotions are handled (re. validation)
Assessment
Family Sessions
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Ask client (if appropriate) to tell the story of ED:
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When did it first start? What happened? What did you
notice? What else was going on at the time? Often
goes on for a while before anyone knows
How did it progress? Normalize secrets and shame
When did others first notice? Who noticed? What was
said/done? How did you react?
When was the term ‘eating disorder’ first used? By
who? What happened?
Get history of treatment and response, what worked or
didn’t
Family involvement, reactions, response (e.g. anger,
fear/worry, hopelessness)
Levels of Intervention
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LEVEL 1
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LEVEL 2
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Non-intensive outpatient treatment (community, group based)
Psycho-education, motivation, body image, self-esteem
May include individual and/or family therapy
Medical management component (GP, psychiatrist, dietician)
Specialized intensive day treatment
CBT, DBT, EFT, etc.
Usually for clients not responsive to Level 1 approach
LEVEL 3
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Inpatient care for more severe cases of eating disorders
May include medical hospital admission for weight restoration e.g.
nasogastric tube
Medical stabilization then combination of individual, family, and
group therapy
The Stages of
Change &
Motivation
The Stages of Change
3. Preparation
“I know I have an eating disorder
and I am getting ready to change”
2. Contemplation
“I think I have an eating
disorder but I’m not sure
if I’m ready to change”
4. Action
“I have an eating disorder
and I am actively working
on changing it”
1. Precontemplation
“I don’t have an
eating disorder”
5. Maintenance
“I am in recovery from an
eating disorder and I am
actively working to
maintain it”
Relapse
“I have been in recovery
and slipped back into
old behaviors/patterns”
The Stages of Change:
Precontemplation
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clients present as HARD (hopeless,
argumentative, resistant, debate)
use MI principles: respect, empathy, nonjudgment
focus on engagement, therapeutic alliance
use of humour
give them information, don’t argue, counter
myths, raise some doubt, ask them to describe a
typical day for them, monitor/observe the
problem, screening tools
share information, be objective
The Stages of Change:
Contemplation
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ambivalence about change
write friend/foe letters
use decisional balance (cost/benefit analysis)
not pushing, but allow them to make decision
help decrease the cost of changing
help clarify their vision of themselves and their life (ACT)
encourage small steps to behaviour change with high probability
of success, frame as an “experiment”
look for and encourage any shifts (complimenting)
functional analysis - what function does the behaviour serve?
(behaviour chain, ABC exercise)
The Stages of Change:
Preparation
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feel consequences of behaviour more
internal emotional shift starts
increased commitment to self to change
has made some small changes
think about what you stand to lose and how you will
cope (5 yr. letter, goodbye letter)
social skills training, problem solving, assertiveness
validate small changes, goal setting
contracting for changes, monitor follow through
The Stages of Change:
Action
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have successfully altered behaviour
clients in action SOAR (substitute alternatives, open up to others,
avoid and counter high risk situations, reward themselves)
client may feel over-confident – discuss slips vs. relapse
relapse prevention strategies, coping w/triggers
response rehearsal – “Practice, practice, practice!”
substitute alternatives for problem behaviour
encourage honesty in talking about problems and progress
encourage self-reward for positive changes made
help them take responsibility (to own) changes made
reinforce stories of change and increase hope
Motivational interviewing is a “client-centered,
directive method for enhancing intrinsic motivation to
change by exploring and resolving ambivalence”
(Miller & Rollnick, 2002, p. 25)
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Three essential questions:
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Are they willing to change?
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Are they able to change?
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Has to do with the importance of change
When they connect changing with something they value,
something important to them
Difference between where you are and where you want to be
Identify and amplify values that are contrary to present behaviour
May feel willing but not able, high importance but low confidence
(e.g. past failures) – provide hope, encouragement, share success
stories, testimonials
If they believe it’ll work and that they can do it, they usually do
Are they ready to change?
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“I want to, but not now” – relative priorities
One can be willing and able to change, but not ready to do so
Motivational Interviewing
1) Expressing accurate empathy
 “accurate empathy involves skilful reflective
listening that clarifies and amplifies the person’s
own experiencing and meaning, without
imposing the counsellor's own material” (Miller &
Rollnick, p. 7)
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understand client without judging, criticizing or
blaming
acceptance of people as they are seems to free
them to change
helps to reveal ambivalence about change
Motivational Interviewing
2) Develop discrepancies
 MI is intentionally directed towards the resolution of
ambivalence in the service of change
 create and amplify a discrepancy between present
behaviour and broader goals and values (“cognitive
dissonance” - Leon Festinger, 1957)
 seek to enhance this within the person (internal
motivation)
 “people are more often persuaded by what they
hear themselves say than by what other people tell
them” (Miller & Rollnick, p. 39)
 rehearse eating disordered thinking when defensive
 discrepancy has to do with the importance of
change
Motivational Interviewing
3) Avoid argumentation
 “the more a person argues against change during a
session, the less likely it is that change will occur”
(p. 8)
 the least desirable situation is for the counsellor to
advocate for change while the client argues against
it
 avoid labelling which encourages a defensive
reaction
 monitor resistance for feedback about your
approach (e.g. is the client getting angry or
defensive?); it may be a signal to shift your
approach or respond differently
Motivational Interviewing
4) Roll with the resistance
 recognize and accept that a low level of importance
of change is a normal stage in the process
 reluctance to change problematic behaviour is to be
expected
 convey understanding and acceptance of resistance
 turn the question or problem back to the client,
actively involving them in problem solving
 counsel in a reflective, supportive manner, and
resistance goes down while ‘change talk’ increases
Motivational Interviewing
5) Support self-efficacy
 belief in oneself and hope for the future
 hope and faith are important elements of change (re. common
factors – 15%)
 enhance client’s confidence in his or her capacity to cope with
obstacles and to succeed in change (e.g. exceptions)
 recognize and acknowledge past success (complimenting)
 assign tasks geared toward their level, with high probability of
success
 give choices and options and let the client choose how to
proceed
 empower client by encouraging her/him to take responsibility
for any changes made, helping them own their success
Methods of Treatment
Family-Based Therapy
Family-Based Therapy
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Began with Salvador Minuchin and his team at the
Philadelphia Child Guidance Clinic
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Structural family therapy – applied family systems principles
to treatment; the family as the unit of treatment vs. the
individual
Identify and change transactions that maintained the illness
(second-order vs. first-order change)
Introduced the family meal as part of therapy in 1975
Reported effectiveness of 86% in 53 cases followed up
over almost eight years
Results and treatment described in: Psychosomatic
Families: AN in Context (1978)
Family-Based Therapy
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Research on family therapy with eating disorders
continued at the Maudsley Hospital in London through
the 80’s and 90’s
Result was the Treatment Manual for AN (Lock, Le
Grange, Agras & Dare, 2001)
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Became known as the “Maudsley model”
Believed parents should be seen as the most useful resource in
the treatment of adolescents with AN
Described as a “new form of family therapy” developed primarily
by Christopher Dare
Main contributions were: exonerating parents of blame, raising
parent’s anxiety to fully engage them in treatment, focusing on
weight restoration before any other issues are addressed
Family-Based Therapy
Principles
1.
2.
3.
4.
Agnostic – no blame, don’t look for cause
Pragmatic – initial focus on symptoms, other
issues can wait until less symptomatic
Empowerment – parents are responsible for
weight restoration, family as a resource
Externalization – not pathologizing, separate
child from illness, respect
Family-Based Therapy
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Phase I (Sessions 1-10)
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Phase II (Sessions 11-16)
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Transfer control back to adolescent
Phase III (sessions 17-20)
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Parents restore child’s weight
Focus on other issues
Termination
Family-Based Therapy
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Phase I
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Joining, family history, ED history, assess family functioning
(e.g. problem solving, communication, roles, emotional
expression, conflict resolution, boundaries, etc.)
Reduce parental blame, separate illness from client
Heighten concern and seriousness of illness
Charge parents with task of weight restoration
Family meal: “Bring in a meal that would set your child on
the path to recovery”
Coach parents: “One more bite”
Assess family process during eating
Family-Based Therapy
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Phase I
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Keep it focused on ED
Help parents take charge of eating
Mobilize siblings to support client
Phase II transition:
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When weight is at minimum 90% IBW
Client eats without significant struggle
Parents demonstrate empowerment over the eating
disorder
Family-Based Therapy
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Phase II
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Support parental management until client can gain
weight independently
Transfer control to adolescent
Explore adolescent developmental issues relative to
ED (friends, dating, sexual orientation, dependenceindependence, decisions about school/career)
Highlight differences between adolescent’s own needs
and those of ED
Close sessions with positive feedback
Family-Based Therapy
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Phase III transition:
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Phase III
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Symptoms have dissipated but body image concerns
may remain
Revise parent-child relationship in accordance with
remission
Review and problem-solve re. adolescent
development
Review progress and terminate treatment
Family-Based Therapy
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Strengths of model:
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Thought of as more holsitic treatment
Attempts to redress boundary issues, putting parents “back
in control”; empowering for parents
Separates the person from the problem – less shame
Weaknesses of model:
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Disrespectful of client’s suffering from AN
Seems manipulative at times (e.g. playing on parent’s fear)
Critique of ‘evidence’ on which approach is based – may
only be effective for those <19 with a <3 yrs. in ED
(Fairburn, 2005)
Multi-family Groups
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Between three and eight families with several therapists
for a number of sessions (8 – 12)
Grew out of FBT work; discuss issues and share a meal
Collective sharing of experience and expertise
Discuss both eating-related problems and non-eating
disorder themes
A resource-focused, non-pathologizing approach to
family involvement
Uses the ‘expertise’ of those who have struggled with the
illness – experienced families help new families
Research on effectiveness is currently underway
Methods of Treatment
Collaborative Care
Collaborative Care

Cognitive-interpersonal maintenance model (Schmidt &
Treasure, 2006; 2013)
1.
Thinking style
•
2.
Interpersonal relationships
•
3.
Expressed emotion; accommodating and enabling
Pro Anorexia (impact of symptoms on brain/body)
•
4.
Detail vs. global; rigid
Striving & mastery
Emotional & social style (vulnerabilities?)
•
Anxious; emotional suppression
Collaborative Care
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Involve carers as a bridge to improve socioemotional functioning
Carers support emotional functioning by:
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Moderating isolation
Modelling healthy emotion regulation
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Have to be the regulator when starvation makes it
difficult
Listen to and understand emotions
Collaborative Care
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Malnutrition/starvation damage
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Inhibits brain function
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The very organ you need to get you out of the problem
is offline
Problems become more complex
More rigidity, less flexibility
ED takes up more brain space
Similarities to autism spectrum traits
Collaborative Care
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“Divide & Rule”
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ED splits up the family
Happens so easily
Happens with teams of professionals
“Machiavellian rule”
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don’t negotiate with terrorists
Collaborative Care
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Family as part of the solution
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Working together
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Step out of ED traps
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Collaboration, shared understanding, shared skills
Care for self, regulate emotion, reduce accommodation, reduce
disagreement and division
Provide skills for change
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Compassion, positive communication, behaviour change skills
Collaborative Care

Carers emotionally driven behaviours
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Accommodating – fear, avoid anger
Enabling – fear, shame, disgust
Calibration – avoid anger, jealousy
Collaborative Care
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Parental avoidance
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Concern for child’s anxiety
Avoid conflict by not challenging food rituals, by reducing
portion sizes, etc.
Accommodation
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Impacts all family behaviours
A form of avoidant coping
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Short-term decrease in distress for both parent and child
Reinforces behaviour
Accept: food & meal rituals, safety behaviours
(e.g. exercise), OCD behaviours w/reassurance,
competition with other family members
Collaborative Care
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Enabling
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Try to protect the person and family from
consequences
of ED
Clean up kitchen/bathroom
Cover up for lost food or money (e.g. stealing)
Give money or resources to allow behaviour (e.g.
binge foods)
Make excuses for person with family, friends, and
work
Collaborative Care
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Calibration/competition
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
Others have to eat with the person
Person compares themselves to other family members,
especially siblings (e.g. twins)
Enlists sibs in enabling behaviours
Competes to eat less, exercise harder, etc.
Judge their success/failure by other family members
Person gets angry with others doing things he/she wants to
do
Pressures others to engage in similar behaviours (e.g.
binging)

Share the blame
Collaborative Care

Food exposure








Similar to anxiety treatment
Accept that anxiety will be present
Understand rationale – make new memories w/food
Extinction is context dependent – practice,
practice, practice!
Learning that the sky won’t fall down
Identify & challenge safety behaviours
Laddering – one rung at a time
Need to eat is non-negotiable
Collaborative Care

Collaborative care





Try to involve all family members (e.g. colluding)
Encourage families to care for themselves and
model good emotional regulation strategies
Help families develop a strong alliance
Teach families to reduce expressed emotion
(hostility, criticism, over-protection) and
accommodating behaviours
Teach families effective communication and
behaviour change strategies
Collaborative Care

Communication skills (MI)







Empathy – reflective listening
Explore discrepancies between values and
behaviour
Support self-efficacy re. confidence to change
Sidestep resistance w/empathy and
understanding
Not avoiding, not arguing
Don’t get defeated if person lashes out
Four day skills training workshop
Regulated Psychotherapy

Until this year, psychotherapy was
unregulated
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Early Steps


1990’s or earlier
Psychologists asked the Province for
exclusive right to the practice of
psychotherapy
74
Stakeholder Consultation

The Province undertook an early stakeholder
consultation and drafted legislation in the
1990’s. It was flawed and did not proceed
75
New Consultation




2000’s
The Province tried again
OAMFT got on the bandwagon and actively
lobbied for MFT inclusion
Psychotherapy Act 2007
76
disease or disorder as the cause of symptoms of the individual in circumstances in which it is
reasonably foreseeable that the individual or his or her personal representative will rely on the
diagnosis.
2. Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or
below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of
teeth.
3. Setting or casting a fracture of a bone or a dislocation of a joint.
4. Moving the joints of the spine beyond the individual’s usual physiological range of motion using a
fast, low amplitude thrust.
5. Administering a substance by injection or inhalation.
6. Putting an instrument, hand or finger,
i. beyond the external ear canal,
ii. beyond the point in the nasal passages where they normally narrow,
iii. beyond the larynx,
iv. beyond the opening of the urethra,
v. beyond the labia majora,
vi. beyond the anal verge, or
vii. into an artificial opening into the body.
7. Applying or ordering the application of a form of energy prescribed by the regulations under this
Act.
8. Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies
Regulation Act, or supervising the part of a pharmacy where such drugs are kept.
9. Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or
eye glasses other than simple magnifiers.
10. Prescribing a hearing aid for a hearing impaired person.
11. Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside
the mouth to protect teeth from abnormal functioning.
12. Managing labour or conducting the delivery of a baby.
13. Allergy challenge testing of a kind in which a positive result of the test is a significant allergic
response. 1991, c. 18, s. 27 (2); 2007, c. 10, Sched. L, s. 32.
Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is amended by the Statutes of
Ontario, 2007, chapter 10, Schedule R, subsection 19 (1) by adding the following paragraph:
14. 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.
77
Almost, but not quite, entirely
unlike tea…
The authorized act is
not yet in force
The practice of psychotherapy
is now restricted
The College regulates the
practice of psychotherapy
78
Psychotherapy Act

Restricted titles

8. (1) No person other than a member shall use the title “psychotherapist”,
“registered psychotherapist” or “registered mental health therapist”, a
variation or abbreviation or an equivalent in another language. 2009, c. 26,
s. 23 (4).

Representations of qualifications, etc.

(2) No person other than a member shall hold himself or herself out as a
person who is qualified to practise in Ontario as a psychotherapist,
registered psychotherapist or registered mental health therapist. 2009,
c. 26, s. 23 (4).

Offence

10. Every person who contravenes subsection 8 (1) or (2) is guilty of an
offence and on conviction is liable to a fine of not more than $25,000 for a
first offence and not more than $50,000 for a second or subsequent offence.
2007, c. 10, Sched. R, s. 10.
79
What this means



As of April 1st of this year
You cannot call yourself a “psychotherapist”
unless you belong to the College
For a limited time, you can still practice
psychotherapy without a license (as long as
you don’t say that you are a psychotherapist
or qualified to practice psychotherapy)
80
Who can practice
psychotherapy?





Doctors
Nurses
Social Workers
Occupational Therapists
Psychotherapists
81
Further information

www.crpo.ca

Regulated Health Professions Act, 1991, SO 1991, c 18

Psychotherapy Act, 2007, SO 2007, c 10, Sch R
82
Professional Associations


E.g. OAMFT/AAMFT, OASW, OMA
Support their members




Meeting places
Educational events
Insurance discounts
Do not regulate except to define who is and
who is not a member (e.g. may have a Code
of Ethics)
83
Colleges


E.g. CRPO, OCSWSSW, CPSO
Protect the public




Regulations
Restrictions
Penalties
Self-regulated

Run by members of the profession
84
You must belong to a College

You should belong to an Association


Friends, support, fun, insurance
The Association will help you practice within the
College’s guidelines!
85
Questions about the final
paper
86
Break
87
Final Evaluation and Closing





Goodbye!
Remember that papers are due next year!
Late penalty, 2% per day.
Please email your final paper to
carl@mftsolutions.ca or
williamcorrigan@rogers.com on or before
January 4, 2016 by 5:00 p.m. Eastern Time
Don’t worry, be happy!
88