Part 1: Professional Regulation

RPs are regulated under the Regulated Health Professions Act, 1991 (RHPA) and the Psychotherapy Act, 2007. Together, these two Acts provide the regulatory framework for the practice of psychotherapy in Ontario.

The RHPA applies to all regulated health professions in Ontario. It helps protect the public from harm by requiring health professionals to be registered and to meet standards of practice and competence. The RHPA sets limits on the activities that non-regulated health professionals can do; e.g., only registrants of particular colleges, including CRPO, are authorized to perform 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 judgment, insight, behaviour, communication, or social functioning.

The Psychotherapy Act establishes CRPO to regulate Registered Psychotherapists. CRPO is a regulatory body, not an educational institution or a professional association. CRPO’s mandate is to protect the public interest, not the interests of the profession (e.g., CRPO cannot advocate for RP services to be covered by insurance policies). Professional self-interest activities are the role of professional associations, not CRPO.

CRPO is not funded by government. Its revenue comes from fees charged to applicants and registrants. To ensure CRPO remains able to fulfill its mandate, it imposes a fee for late payment and may suspend a registrant’s certificate of registration for non-payment.

CRPO has several functions allowing it to regulate RPs in the public interest. These include:

• registration requirements to ensure only qualified applicants are registered;
• a Quality Assurance Program to promote continuing competence;
• a Professional Conduct Department that investigates complaints and reports about registrants;
• holding discipline or fitness to practise hearings to consider allegations that a registrant has engaged in professional misconduct, incompetence, or is incapacitated; and
• a public register to provide transparent information about RPs, their registration status, and any conduct concerns.

Detailed information about these processes is available on CRPO’s website. Applicants and registrants are encouraged to review the site to become familiar with the work of CRPO.

There are a number of safeguards, set out in the RHPA, which ensure that all health regulatory colleges, including CRPO, serve the public interest in a fair and open manner.

Examples of these safeguards are listed below:

• Council meetings and discipline hearings are open to the public. Anyone may watch the proceedings.
• CRPO must consult with the profession and the public before establishing any regulation and some by-laws.
• Decisions of CRPO committees may be reviewed by other bodies. For example, most decisions of the Registration Committee or the Inquiries, Complaints, and Reports Committee (ICRC) may be appealed to the Health Professions Appeal and Review Board (HPARB). Decisions of the Discipline Committee or the Fitness to Practise Committee may be appealed to the Divisional Court.
• The Office of the Fairness Commissioner makes sure that registration practices are transparent, objective, impartial, and fair.
• CRPO is accountable to the Minister of Health. CRPO must report annually to the Minister and provide additional information to the Minister if requested. The Minister may make recommendations or even issue directives to CRPO. If there are serious concerns, the Minster may audit the operations of the College and has the power to appoint a supervisor to take over its administration.

Regulatory colleges are encouraged to work with each other to develop standards relating to the performance of controlled acts common to several health professions. In the case of psychotherapy, five other regulated professions in Ontario are authorized to perform the controlled act of psychotherapy and to use the protected title “psychotherapist”. They are

• psychologists and psychological associates;
• physicians;
• nurses;
• occupational therapists; and
• social workers and social service workers.

CRPO has a Council, similar to the board of directors of a corporation, which governs the activities of the College. Council members have a duty of loyalty and good faith to the mandate of the organization, which is to protect the public interest. Council is comprised of registrants, as well as public members appointed by the government. Professional and public members work together to ensure that the views of clients and the public are represented in the regulatory process. Council’s activities include setting policy and strategy; approving by-laws, regulations, and budgets; and reviewing the performance of the Registrar (CEO), who is the senior staff-person of the College.

The RHPA requires all health regulatory colleges to have seven committees (sometimes referred to as “statutory committees”). Committees oversee specific areas of the College’s work and report to Council. As an example, the Registration Committee sets registration policy and reviews applications where CRPO staff are unsure if they meet the registration requirements. Another College committee is the ICRC, which screens complaints and reports about registrants. Colleges may establish other committees (sometimes referred to as “non-statutory committees”) or working groups as needed. For example, CRPO has an Examination Committee that considers appeals from candidates who have failed the registration exam. CRPO periodically recruits registrants to serve on various committees.

1. CRPO serves the public interest and professional associations serve the interests of the profession.
2. CRPO and professional associations both serve the public interest.
3. CRPO and professional associations both serve the interests of the profession.
4. The professional associations direct the operations of CRPO.

The best answer is 1. CRPO’s mandate is to regulate the profession in order to serve and protect the public.

Answer 2 is not the best answer because professional associations are designed to serve the interests of their members. While professional associations care about the public interest and often take actions that assist the public interest, they are under no statutory duty to do so and are accountable only to their members.

Answer 3 is not the best answer because CRPO is not permitted to serve the interests of its registrants under its statute. While CRPO tries to ensure that it regulates its registrants fairly and justly, and consults with its registrants, CRPO’s mandate is to protect the public interest.

Answer 4 is not correct. While CRPO may consult with professional associations and consider their views, it is not under the control of any professional association.

CRPO’s Code of Ethics sets out certain principles of professional practice — ideals that registrants should aspire to in their professional practice and community roles. These principles differ from practice standards. Practice standards can be thought of as the minimum standard of professional practice expected of all registrants, whereas the principles included in the Code of Ethics are ideals that registrants should strive to uphold.

As a registrant of the College of Registered Psychotherapists Ontario, I strive to practise safely, effectively, and ethically, and to uphold the following principles:

Autonomy & Dignity of All Persons

To respect the privacy, rights and diversity of all persons; to reject all forms of harassment and abuse; and to maintain appropriate therapeutic boundaries at all times.

Excellence in Professional Practice

To work in the best interests of clients; to work within my skills and competencies; to maintain awareness of best practices; and to pursue professional and personal growth throughout my career.

Integrity

To openly inform clients about options, limitations on professional services, potential risks and benefits; to recognize and strive to challenge my own professional and personal biases; and to consult on ethical dilemmas.

Justice

To strive to support justice and fairness in my professional and personal dealings, and stand against oppression and discrimination.

Responsible Citizenship

To participate in my community as a responsible citizen, always mindful of my role as a trusted professional; and to consult on potential conflicts-of-interest and other personal-professional challenges.

Responsible Research

To conduct only basic and applied research that potentially benefits society, and to do so safely, ethically and with the informed consent of all participants.

Support for Colleagues

To respect colleagues, co-workers, students, and members of other disciplines; to supervise responsibly; to work collaboratively; and to inspire others to excellence.

Lenni has been practising as an RP for seven years. They meet CRPO’s requirements to serve as a clinical supervisor of students and newer RPs but are concerned about the risks and liability of doing so. Lenni carefully thinks over the implications of offering clinical supervision. They consult with peers, a lawyer, and their professional liability insurance provider. They note in CRPO’s Code of Ethics, under the heading Support for Colleagues, the ideal of inspiring others to excellence. They conclude that though they are not obligated to provide clinical supervision, in their circumstances doing so is worthwhile and upholds an ethical principle.

Professional practice standards explain the ways Registered Psychotherapists are expected to practise the profession. They may be written or unwritten. Written standards include those contained in legislation or College documents. Unwritten standards are requirements that are generally accepted within the profession. Falling below a standard is considered professional misconduct. This manual describes CRPO’s written standards in Section 2.

Professional misconduct is behaviour that falls below the minimum standards of the profession. Professional misconduct may lead to disciplinary proceedings potentially resulting in a reprimand, remediation, suspension, or in the most serious cases, revocation of a registrant’s certificate of registration.

The full definitions of professional misconduct are found in

• • Section 51(1) of Schedule 2 of the RHPA; and
  • CRPO’s Professional Misconduct Regulation.

The following are a few examples of professional misconduct:

• • sexual abuse of a client, (e.g., engaging in sexual touching or remarks);
  • failing to maintain professional boundaries (e.g., employing a client);
  • failing to keep adequate records (e.g., not retaining emails in the client file; not securely storing files);
  • breaching client confidentiality (e.g., identifying a client, even to their family member, without consent);
  • fraudulent billing, (e.g., falsely claiming for insurance reimbursement that one’s services were supervised); and
  • disregarding restrictions on one’s certificate of registration (e.g., a registrant who is required to practise with clinical supervision not doing so, or practising a type of therapy without adequate training).

Professional misconduct may also involve inappropriate conduct towards CRPO, including

• • publicly challenging the integrity of CRPO (though registrants are encouraged to engage in constructive dialogue about CRPO policy, e.g., by making submissions during CRPO consultations, and by offering to join CRPO working groups, committees, and Council);
  • breaching an undertaking (promise) given to CRPO;
  • failing to participate in the Quality Assurance Program;
  • failing to respond appropriately and promptly to correspondence from the CRPO; and
  • failing to co-operate in an investigation by the CRPO or obstructing an investigation by the College.

Incompetence refers to a lack of knowledge, skill, or judgment when assessing or treating a client. In serious cases, allegations of incompetence may result in a discipline hearing. If the Discipline Committee finds that an RP is incompetent, it could impose restrictions on the registrant’s practice, such as requiring intensive clinical supervision or upgrading courses. In the most serious cases of incompetence, the Discipline Committee could suspend or revoke the registrant’s registration.

In any investigation of incompetence, CRPO will usually look at the registrant’s records and speak with the registrant directly. CRPO will also interview the clients involved and ask other psychotherapists whether they think the conduct shows incompetence. The investigating committee and deliberating committee (i.e., the ICRC and the Discipline Committee) include RPs to assist in determining the difference between good and bad practice.

Incapacity occurs when a health condition prevents a registrant from practising safely. Usually, the health condition is one that interferes with the psychotherapist’s ability to think clearly. Often incapacity is related to substance abuse, addiction, or illness (mental and physical) that impairs the registrant’s professional judgment; e.g., a psychotherapist with a condition that includes delusions and lack of insight.

An RP who is incapacitated is not treated as if they have engaged in professional misconduct or incompetence. The investigation looks at the registrant’s health condition and the treatment they are receiving or may need. CRPO may require the RP to undergo a specialist examination. If the concern is justified, the registrant may be referred to the Fitness to Practise Committee for a hearing. The Committee may order the registrant to undergo treatment or receive medical monitoring in order to continue to practise, or it may restrict the psychotherapist’s practice. In an extreme case (e.g., where the registrant refuses treatment), the Fitness to Practise Committee may suspend or revoke the registrant’s registration, in order to protect the public.

Kearan, a psychotherapist, has been drinking a lot more alcohol the last few months. One day Kearan comes back from lunch drunk. Paul, a client, notices that Kearan smells of alcohol and is stumbling around the office. Paul also notices that Kearan has forgotten what Paul told him during recent visits and that he has been inappropriate and rambling in some of his comments. Paul reports this to CRPO.

At first Kearan denies there is a problem. However, during the investigation, CRPO learns that some of Kearan’s colleagues have noticed a significant change in his behaviour in recent months. CRPO also

learns that he has been charged with impaired driving. CRPO sends Kearan to a medical specialist who diagnoses him as having a serious substance abuse disorder.

The matter is referred to the Fitness to Practise Committee. Kearan and CRPO agree to an order requiring that he stop working until he is reassessed as able to return to practice. Kearan and CRPO also agree that on return to practice, Kearan is required to receive clinical supervision and regular monitoring of his condition by a physician.

Evan, a psychotherapist, works at a large community agency. He is currently experiencing burnout and has commenced a period of stress leave. Wendy, who works in the human resources department, inquires with CRPO whether the agency needs to report Evan as being incapacitated.

A CRPO staff-person advises Wendy to consider whether clients are at risk of harm, e.g., if Evan denies there is a problem and continues to treat clients. Wendy realizes this is not the kind of situation that falls under the definition of incapacity for CRPO’s purposes.

1. Failing to maintain client confidentiality.
2. Insulting a client by email because they wanted to stop seeing the registrant.
3. Charging a higher rate because a third party is paying for the service.
4. All of the above.

The best answer is 4. The Professional Misconduct Regulation describes many types of professional misconduct. All the situations described involve conduct that is specifically prohibited in the Professional Misconduct Regulation.

Answers 1, 2, and 3 are not the best answers because all the situations listed in the question are clear examples of professional misconduct.