What to Know About Psychotherapy

Everything You Need to Know About Psychotherapy

Psychotherapy is primarily a talk-based therapy and is intended to help people improve and maintain their mental health and well-being. Registered Psychotherapists work with individuals, couples and families in individual and group settings.

What to Know About Psychotherapy

Everything You Need to Know About Psychotherapy

Psychotherapy is primarily a talk-based therapy and is intended to help people improve and maintain their mental health and well-being. Registered Psychotherapists work with individuals, couples and families in individual and group settings.

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What is Psychotherapy?

 

Psychotherapy occurs when the Registered Psychotherapist (RP) and client enter into a psychotherapeutic relationship where both work together to bring about positive change in the client’s thinking, feeling, behaviour and social functioning. Individuals usually seek psychotherapy when they have thoughts, feelings, moods and behaviours that are adversely affecting their day-to-day lives, relationships and the ability to enjoy life.

 

As health care professionals, psychotherapists work in a wide range of settings. Settings include: private practice, hospitals, clinics, care facilities, rehabilitation centres/programs, employee assistance programs, universities, and more.

 

A psychotherapy client should be able to observe the following key elements over the course of their work with an RP:

 

  • a conversation about the benefits, risks and expected outcome(s) of the psychotherapy and the opportunity to give their informed consent
  • a clearly communicated, mutually agreed upon goal or plan for the psychotherapy
  • each therapy session has a clear beginning and a clear end where problems or concerns are presented and discussed and outcomes are explored
  • the Registered Psychotherapist demonstrates the appropriate use of boundaries to create a safe and confidential environment

 

These important elements are part of the effective client-therapist psychotherapeutic relationship that is the foundation of psychotherapy. Through this relationship, RPs are expected to:

 

  • ensure that the client’s well-being is at the forefront of the relationship;
  • work with the client(s) to gather relevant information that will support the formulation of a plan for psychotherapy;
  • continuously evaluate outcomes of each session and the impact on overall treatment goal(s);
  • practise safe and effective use of self throughout the psychotherapeutic process; and
  • adhere to the standards of practice for the profession.

 

Registered Psychotherapists will be competent to use a treatment approach or modality that is part of one or more of the categories of prescribed therapies, which include:

 

  • Cognitive and Behavioural therapies
  • Experiential and Humanistic therapies
  • Psychodynamic therapies
  • Somatic therapies
  • Systemic and Collaborative therapies

 

 

Controlled Act of Psychotherapy

 

Registered Psychotherapists are authorized to perform the controlled act of psychotherapy.

 

 

What to Expect from a Registered Psychotherapist

 

When you seek the services of a Registered Psychotherapist, you can expect to receive competent, ethical, quality care from a qualified professional who is registered with CRPO.

 

CRPO registrants are accountable to the College for the quality of care they provide and for their professional conduct. Only individuals who are registered with CRPO or another psychotherapy-regulating college in Ontario are able to use the title “psychotherapist” or to hold themself out as qualified to practise as a psychotherapist in Ontario (no matter what title they use). Anyone using the title “Registered Psychotherapist”, or any abbreviation or variation thereof in any language, must be registered with CRPO.

 

 

Standards of Practise

 

All RPs in Ontario must follow the established standards for the profession. CRPO’s Professional Practice Standards for Registered Psychotherapists are in place so you can be assured that your psychotherapist is practising in a competent and ethical manner. The standards provide clear expectations for RPs, covering everything from professional conduct to record-keeping and documentation.

CRPO holds all Registered Psychotherapists accountable for their conduct and practise.

Questions to Ask a Psychotherapist

If you are looking for a Registered Psychotherapist, or are trying to decide if a particular therapist will be a good fit for you, you want to have the information you need to make good decisions about your health and well-being.

  • Questions to Ask a Psychotherapist

    Here are some practical questions you can ask when you’re speaking with a Registered Psychotherapist for the first time:

     

    • What should I expect on my first visit?
    • How long will my appointment be?
    • How much will it cost? And how will I need to pay? Do you accept my health insurance?
    • When can I schedule a session (mornings, afternoons, evenings, weekends)?
    • What happens if I miss a session?
    • Can I contact you using email or text? Can I contact you outside regular business hours?
    • Will you make notes during our sessions? What happens to the notes?
    • Is everything I tell you confidential? How can I be assured of that?
  • Questions to Ask a Psychotherapist

    When you are looking for a Registered Psychotherapist, it is helpful to learn if the psychotherapist and the type of psychotherapy they offer will suit you.  Asking questions allows you to understand what to expect in psychotherapy and how it might be effective for you.

     

    Here are some questions that could help you decide if a Registered Psychotherapist is the right fit for you:

     

    • What type of psychotherapy do you provide?
    • I am here because ___________, and I’m having trouble with ___________. Do you have training and experience working with clients with issues like mine?
    • I’m from a ___________ How do I know you’re going to understand my perspective and where I’m coming from?
    • Do you see clients for short-term or long-term psychotherapy?
    • Some psychotherapists work by addressing the immediate problem, while others seem to focus on deeper issues. Which approach do you use?
  • Questions to Ask a Psychotherapist

    A Registered Psychotherapist follows professional practice standards so you can be assured that you can explore areas that may feel challenging in a confidential setting where there are clear and professional boundaries.  A Registered Psychotherapist will understand if you choose to meet with different psychotherapists in order to find the care provider that is the best fit for you.

     

    Here are some questions that might help you decide whether to continue to see a Registered Psychotherapist:

     

    • Do you have a limit to the number of appointments I can have?
    • How will I know psychotherapy is working for me?
    • What happens if this psychotherapy doesn’t seem to be working?
    • How do I end psychotherapy if I feel that I have worked through my issue or that psychotherapy is not working?
What to Know About Psychotherapy

Definitions

Defining commonly used words and phrases used in psychotherapy regulation.

Clinical Supervision

CRPO defines clinical supervision as a contractual relationship in which a clinical supervisor engages with a supervisee to discuss the direction of therapy and the therapeutic relationship; promote the professional growth of the supervisee; enhance the supervisee’s safe and effective use of self in the therapeutic relationship; and safeguard the well-being of the client.

 

Clinical supervision can be individual, dyadic or group. Group supervision may include structured peer group supervision if the supervision is formal and structured, and includes at least one group member who meets CRPO’s definition of a clinical supervisor (see below).

 

Structured peer group supervision differs from group clinical supervision, in that the latter is led by a clinical supervisor, whereas the former includes at least one member who would qualify as a clinical supervisor but is an equal participant (not the leader). Structured peer group supervision often occurs in an institutional setting but may be formalized outside such settings.

 

Informal “peer supervision” i.e. unstructured discussion of clients with colleagues, is not considered an acceptable form of supervision for registration purposes.

Clinical Supervisor

Clinical Supervisor in Ontario

 

Prior to proclamation (i.e., before April 1, 2015), a clinical supervisor is a practitioner who has extensive clinical experience, generally five years or more, in the practise of psychotherapy.

 

In the first three years following proclamation (i.e., April 1, 2015 – March 31, 2018), a clinical supervisor is a regulated practitioner in psychotherapy in good standing with their College*, who has extensive clinical experience, generally five years or more, in the practice of psychotherapy and who is competent in providing clinical supervision.

 

Three years after proclamation (i.e., April 1, 2018 to present), a clinical supervisor must be a regulated practitioner in psychotherapy in good standing with their College*, who has extensive clinical experience, generally five years or more, in the practice of psychotherapy, and who has demonstrated competence in providing clinical supervision.

 

The Registration Committee has approved the following criteria for demonstrating competence in providing clinical supervision:

 

  1. The supervisor must be a Member in good standing of a regulatory college whose members may practise psychotherapy.*
  2. The supervisor must have five years’ extensive clinical experience.
  3. The supervisor must meet CRPO’s “independent practice” requirement (completion of 1000 direct client contact hours and 150 hours of clinical supervision).
  4. The supervisor must have completed 30 hours of directed learning in providing clinical supervision. Directed learning can include course work, supervised practice as a clinical supervisor, individual/peer/group learning, and independent study that includes structured readings.
  5. The supervisor must provide a signed declaration that they understand CRPO’s definitions of clinical supervision, clinical supervisor, and the scope of practice of psychotherapy.

 

CRPO staff may request evidence of 30 hours of directed learning in providing clinical supervision and may also request a letter of verification and a statement describing the supervisor’s approach to providing supervision.

 

Upon request, a clinical supervisor should be able to provide their supervisee with a letter attesting to their competency, as set out in items 1 through 5 above. It is not necessary to submit this to the CRPO unless it is specifically requested by staff.

 

*Includes College of Registered Psychotherapists of Ontario, College of Nurses of Ontario, College of Occupational Therapists of Ontario, College of Physicians and Surgeons of Ontario, College of Psychologists of Ontario, Ontario College of Social Workers and Social Service Workers.

 

Clinical Supervisor Outside Ontario

 

Outside Ontario, a clinical supervisor is an experienced practitioner of psychotherapy qualified to provide clinical supervision in their jurisdiction.

Controlled Act

In the course of engaging in the practice of psychotherapy, a member is authorized, subject to the terms, conditions and limitations imposed on their 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. See Psychotherapy Act, 2007, Section 4 linked in Related Resources below.

Currency Hours

Currency hours include a broad range of professional activities related to the practise of psychotherapy, such as:

 

  • direct client work;
  • record-keeping and preparation in relation to direct client work;
  • professional development in psychotherapy;
  • engaging in clinical supervision as a supervisee;
  • conducting research or writing in the field of psychotherapy;
  • supervising;
  • teaching;
  • managing;
  • consulting; and
  • other professional activities that impact the practice of psychotherapy.

Date of Application

Date of application refers to the date on which a completed application (for registration) is submitted to the College.

Direct Client Contact (DCC)

Direct client contact is any activity in which the client and the therapist are directly and formally engaged in the psychotherapeutic process. Ordinarily, this process occurs face-to-face, but other forms of direct contact, for example, using telephone, Skype, video-link, or even email (with appropriate considerations for privacy and confidentiality) are relevant. The client may be an individual, couple, family or group.

Also included in direct client contact are:

 

  • interviewing for intake, as long as this activity is clinical in nature and then used to determine the nature and course of the therapy;
  • interviewing, administering a test or conducting a formal assessment as part of a clinical interaction with the client; and
  • facilitating or actively co-facilitating therapeutic sessions.

 

The following are not considered direct client contact:

 

  • observing therapy without actively participating or providing follow-up to the client immediately after the observed session;
  • record-keeping;
  • administrative activities, including report-writing;
  • conducting a psychometric assessment that primarily involves administering, scoring and report-writing, with little or no clinical interaction with the client; and
  • providing or receiving clinical or other forms of supervision.

 

A standard 45 or 50 minute session qualifies as one hour of DCC.

Grandparenting

Grandparenting was a time-limited, alternate route to registration for established practitioners in Canada. The grandparenting option was available for two years following proclamation of the Psychotherapy Act, 2007, and was designed for experienced practitioners whose competence will be assessed using a different set of criteria than regular applicants. This application route closed on March 31, 2017 and is no longer available.

Indigenous

Indigenous refers to Canada’s First Nations, Métis and Inuit peoples.

Psychotherapy vs. Counselling

“The practice of psychotherapy is distinct from both counselling, where the focus is on the provision of information, advice-giving, encouragement and instruction, and spiritual counselling, which is counselling related to religion or faith-based beliefs.” HPRAC: New Directions, 2006; Chapter 7, Regulation of Psychotherapy, p. 208.

 

CRPO does not regulate counsellors or counselling. However, psychotherapy and counselling can be highly interrelated.

Safe and Effective Use of Self (SEUS)

One of the defining competencies of psychotherapy practice, safe and effective use of self, refers to the psychotherapist’s learned capacity to understand his or her own subjective context and patterns of interaction as they inform his or her participation in the therapeutic relationship with the client. It also speaks to the psychotherapist’s self-reflective use of his or her personality, insights, perceptions and judgments in order to optimize interactions with clients in the therapeutic process.

 

Psychotherapeutic traditions and practices related to the development of a psychotherapist’s safe and effective use of self in the therapeutic relationship are diverse. Some applicants will have developed this competency while engaging in their own personal psychotherapy. Others will have taken courses that address use of self. These may include, for example, personal family history and dynamics, anti-oppression and diversity, power dynamics, relational boundaries, experiential practice as client or interpersonal relationship development. Others may have engaged in a guided and reflective Indigenous practice, such as the four directional way. For some practitioners, this competency may also be addressed in a particular form of clinical supervision.

Scope of Practice

The practice 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. See Psychotherapy Act, 2007, Section 3 linked in Related Resources below.

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