Regulation of Psychotherapy

In the interest of helping to inform the profession and the public about this new development, the following outline describes some issues, protocols and processes for the new College of Psychotherapy and Registered Mental Health Therapists, based on a public presentation made by Catherine Yarrow, MBA, PhD, registrar and E.D., College of Psychologists of Ontario.

1.Implications for Practice, Role of Transitional Council

Implications for practice: certain activities and professional titles no longer in public domain
New controlled act: “Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, of 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 function”
'serious' highlighted the problem of this definition, which the Transitional Council (TC) will have to work out
The new controlled act may only be performed by members of the Colleges: Psychotherapist and RMHT, Psychologists, Physicians & Surgeons, Nurses, Occupational Therapists, Social Workers & Social Service Workers
The TC will most likely be chosen from the previously unregulated psychotherapists, but may also include members of other colleges whose members are licensed to practice psychotherapy
Implications for practice: only those within the Colleges will be permitted to perform the controlled act. Problem of spectrum of care, how to foresee 'serious' potential
Re. professional title. TC will define the 2 titles of 'psychotherapist' and 'registered mental health therapist' (RHMT)
Role of the TC: set out in Statute, time limited (but not specified in legislation), will work with new registrar
New Registrar will be mentored by the Federation of Regulatory Colleges (meetings with other College Registrars, lawyers, government reps.

2. Objects of the College

- Regulate practice of profession & govern members
- Set out standards/programs relating to:
  - Qualification for registration
  - Assuring quality of practice (staying competent)
  - Continuing evaluation, competence & improvement (note – there is an international trend toward government regulation superseding self regulation)
  - Professional ethics
  - Assisting individuals to exercise their rights (members & public)
  - Administer Psychotherapy Act, Code & RHPA
  - Perform other duties, exercise other powers imposed/conferred on the College (e.g. resource sharing, inter-professional collaboration)
  - Any other objects relating to human health care that Council considers desirable
  - Enhance relations between College & members, colleges, stakeholders & public
  - Promote inter-professional collaboration with other health profession colleges
  - Promote ability of members to respond to changes in practice environments, advances in technology and other emerging issues

3. College Structure and Function

3.1 Governance body: the Council. Operations bodies: Statutory Committees, Non-Statutory Committees, Registrar & ED who are responsible for staff and contractors

3.2 Statutory Committees:

Executive (members of Council, first to set up, operates with the authority of Council)
Registration (key committee, also first to be set up, develop policy and review applications to bring members into College)
Complaints (set up later)
Discipline (set up later)
Fitness to Practice (set up later, any kind of health problem, mental or physical that could affect work)
Quality assurance (set up later)
Patient Relations (set up later)

Meetings of the TC are public, so all can attend but not participate. Executive meetings do not have to be public. Check College website for dates of mtgs., also Federation will put ads in newspapers.

The TC can admit members and register them as soon as it's proclaimed. There's no guarantee that the members of the current professional assoc. will automatically be admitted. There will be a transition period of 5 – 7 years in which people with an equivalency to the registration requirements will be admitted (i.e. grandparenting). After that, all registration has to be standardized. During this transition period, regulation proposals will be entertained by the TC as they refine and develop standards
The TC may have reps from others Colleges as members, but this is not bound in regulation, only members of the profession and the public are bound.

3.3 Duty of College is to serve and protect the public interest

3.4 Duty of Confidentiality: Everyone employed, retained or appointed to administer this Act must observe strict confidentiality. Only exception is if there is a risk of harm (rare).

3.5 Powers of TC and Registrar – may do anything that is necessary or advisable for the implementation of the Act. The TC, Registrar and Council's committees can accept and process applications for registration, charge application fees and issue certificates of registration. Ad hoc estimate for fees based on other Colleges: application fee $250, membership fee $700. Prof. insurance not administered by TC.

4. Transition Tasks

Lieut. Gov. In Council:
- Appoint Registrar
- Appoint TC
Registrar and TC tasks:
- Regulations
- Bylaws
- Process applications
Key Transition Tasks (first order of business):
- Develop regulations for:
  - Registration
  - Professional misconduct
- Develop Bylaws
  - Administrative & internal affairs of College
  - Elections
  - Committee composition
  - Fees
- Consider appointing task forces/work groups (could be chaired by member of TC or they may appoint anyone outside the TC e.g. from prof. assoc, educational inst., based on expertise).This is an opportunity for the profession to have input

5. Scope of Practice

“The practise 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.”

6. Authorized Act

“In the course of engaging in the practice of psychotherapy, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to treat, 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

7. Regulation making authority

RHPA Code S. 95
Psychotherapy Act, s. 11 (additional)
- Prescribing therapies involving the practice of psychotherapy
- Governing the use of prescribed therapies, and
- Prohibiting the use of therapies other than the prescribed therapies in the course of the practice of psychotherapy
Note that other Colleges don't have this last provision, which gives the right to restrict the variety and range of forms of therapy – a possible problem for some e.g. transpersonal orientations, somatic approaches. The TC and College may or may not choose to enact this.
Anyone who is not a member of the College can offer a form of therapy, as long as it doesn't treat a 'serious' disorder, which is the controlled act
The only people allowed to do the controlled act who are not in the College are students, who must be in supervision with a member of the College

7.1 Regulation making authority: Registration

Prescribing classes of certificates of registration and imposing terms, conditions and limitations on the certificates of registration of a class
Respecting applications for certificates of registration and the issuing, suspension, revocation and expiration of the certificates
Prescribing standards and qualifications for the issue of certificates of registration
Prescribing certain registration requirements as non-exemptible requirements
Defining specialties (possible but not required)
Requiring examinations (possible but not required)

7.2 Registration regulation issue: Entry to Practice Standards based on 'competencies'

For the practice of psychotherapy, what are reasonable and appropriate requirements for 'competencies'. Competencies are defined by: knowledge, skills and judgement
How are these to be assessed (e.g. coursework, supervised practice, examinations, observation)?
In the public interest, ensure competent practice, minimize potential for harm
Consultation with the stakeholders could happen in the early stages of development or could happen after regulations are drafted and circulated to stakeholders.

7.3 Registration regulation Issue: Two title protection

Will the two titles (i.e. 'psychotherapist' and 'registered mental health therapist') be associated with different classes of certificates of registration?
If so,
- Will there be different terms, conditions or limitations on the different classes?
- Will there be different registration requirements?
The TC will have to define the two titles or could use them interchangeably re. entry requirements, scope of practice etc.

7.4 Registration regulation authority: professional misconduct

Defining professional misconduct
- Boundary issues
- Breech of agreement e.g. discontinuation of service
- Charging for a service not provided

7.5 Bylaw making authority

- RHPA Code s. 94
- Elections to the Council
  - Requirements for members to be able to vote
  - Electoral districts
  - Election recounts
  - Qualification and terms of office of elected council members
  - Disqualifying elected council members
- Council & Committees
  - Election of president and VP
  - Selection of committee chairs
  - Filling of a vacancy
  - Calling, holding and conducting meetings
  - Conflict of interest
  - Remuneration & expense payment
  - Composition of committees
  - Non-council members of Committees: qualification, selection, appointment, terms of office

7.6 Regulation Development Process

Ministry Guidelines
Process
- Consider regulations of other jurisdictions (esp. Quebec, U.S.), other professions, ministry guidelines, policies and templates
- Draft regulation
- Consult with potential college members and other stakeholders
- Revise draft regulation
- Council approval
- Submit to Ministry (there will be consultation with Ministry staff all along the process)
The order of regulation definition:

1) registration – has to be defined for College to start up
2) professional misconduct
3) election bylaw
4) quality assurance

8. Ministry/Government Process

Policy review (by MOH policy staff, they compare it to their other policies)
Consultation with stakeholders including other jurisdictions (have to demonstrate the consultation process)
Legal drafting
Standing Committee hearings (stakeholders can be present)
Sealing of regulation (end of debate process)
Cabinet: Order-in-council
Publication in Ontario Gazette