titles, licenses and who can do what to whom under Bill 21

A psychologist teaching at a major Canadian University who prefers to remain anonymous wrote to me because she was concerned that I was claiming that psychologists were “unlicensed and untrained”.

As I explained to her, nobody is disputing that psychologists are licensed and trained as psychologists.  What I am claiming is that psychologists do not always have specialized training or licenses in the specialized areas searched for by the public.

Most psychologists offering couple or family interventions, for example, are not licensed couple and family therapists.  So, when a person searches for a couple or family therapist using the Order of Psychologists' search engine and naïvely chooses "psychologist" as the first search criterion, this filters out all non-psychologist licensed couple and family therapists while leaving in psychologists without a license in couple/family therapy.

I explained to her that, when I said that psychologists were unlicensed in the specialties searched under, this was what I meant.  In the case of couple and family therapy, sex therapy, psychoanalysis, occupational therapy, art therapy and other specialized forms of therapy, professionals earn at least a master’s degree or have another equivalently high level of specialized training, and in many cases also a specialized license in these disciplines, which most psychologists lack. 

She made the interesting comment that, for psychologists, there was no "value added" by getting a couple and family therapy license since it was “covered” by their psychology license.

I reminded her that, although it may be legal for a psychologist to see couples, a psychologist needs to have a couple and family therapy license if she intends to treat them as a "couple and family therapist" or leads her clients in other ways to believe that she is a couple and family therapist when she is not.  So at least the title has some value under the law:

36.  No person shall in any way whatsoever:
(d) use the title “Marriage and Family Therapist”, “Marriage Therapist”, “Family Therapist”, or a title or abbreviation which may lead to the belief that he is such a therapist, or use the initials “M.F.T.”, “T.C.F.”, “M.T.”, “T.C.”, “F.T.” or “T.F.”, unless he holds a valid permit for that purpose and is entered on the roll of the Ordre professionnel des travailleurs sociaux et des thérapeutes conjugaux et familiaux du Québec
[my bold, Professional Code of Quebec; article 36]

Interestingly, my correspondent is not herself licensed to use the title of marital/family therapist but is currently training students to become licensed marital and family therapists in Quebec.  Whether that makes sense, whether it is even legal, is a question I ask myself.  It would be interesting to know how many couple and family therapists are training students to become licensed psychologists.

Finally, I said to my correspondent that, if she meant by "no value added" she meant no economic value, then I completely agreed: there is now *zero* economic value to being a licensed marital/family therapist.  That has been my main point from the beginning: those who have been trained and licensed as couple/family therapists (it used to take three years of post-graduate training and supervision of real clinical value to obtain this license), and who now pay their fees as psychotherapists to the Order of Psychologists and who also pay a fee to be included in the Order of Psychologists' referral system, can yet be excluded by the Order of Psychologists' search engine when the public is searching for a couple/family therapist.

Likewise insurance companies do not cover couple and family therapy offered by licensed couple and family therapists unless they are psychologists, while psychologists (and doctors!) who have no training, expertise or license as a marital/family therapist will be reimbursed for sessions of couple and family therapy.  This is not to say that all those who are reimbursed as psychologists or doctors have no training in this field...  But I never claimed that.

My main point has always been that none of this protects the public from those not qualified to practice, whereas public protection was the very raison d'être of Bill 21, and is now the Order of Psychologists' mandate.

I will end with a quote from my correspondent who said it better than I could:

for many of us, we have spent thousands of hours and thousands of dollars in training, supervision and supervised practice and the thought of getting yet one more license to do something we are already doing seems torturous.

This is exactly how all non-psychologist psychotherapists feel now that Bill 21 has been put into effect.

Bill 21 could have forced psychologists who are qualified to practice couple and family therapy to go to the Order of Social Workers and Couple and Family Therapists to apply for a permit, the way it is now forcing psychotherapists qualified to practice psychotherapy to go to the Order of Psychologists for a permit.  But it didn't.

Please sign my petition.

4.5 million dollars to reduce stigma?

The Toronto Star recently reported that the Canadian Alliance of Student Associations (CASA) released a policy paper asking for “an additional $4.5 million a year earmarked for the Mental Health Commission of Canada (MHCC) to ramp up its anti-stigma campaign in schools, colleges and universities.”

The MHCC already has 65 anti-stigma partners and 45 active anti-stigma projects.  By the end of this fiscal year, 210 million dollars will already have been spent on the MHCC, with anti-stigma projects being a primary focus.

Presumably one reduces stigma so that people are more likely to seek help, but we are also told that there are “long waiting lists” for those who seek help now. 

So the question arises: before giving another few million dollars to the MHCC so it can urge students to get help they are not seeking, wouldn’t it make more sense to use this money to get help for those already seeking it?  The 4.5 million dollars requested could buy five psychotherapy sessions for every student at the University of Toronto.  The MHCC budget to date could have paid for 21 million psychotherapy sessions.

Another question: who really benefits from making stigma the focus of the mental health conversation?  Is it a coincidence that this whole campaign was led by “one student from the University of Moncton” who now sits on the MHCC’s Board of Directors?

Is it another coincidence that psychotherapy is simultaneously being transformed by Bill 21 into a therapeutic specialty of doctors and psychologists to the exclusion of non-medically-based therapeutic models?

What if de-stigmatizing “mental illness” really means adopting a medical treatment model that pathologizes all psychological suffering?  What if it really means meeting psychosocial problems with psychological testing and psychiatric diagnoses?

After all, once mental illness is “de-stigmatized,” won't publicly funded programs and insurance companies quite logically require a psychiatric or psychological diagnosis of mental illness before covering psychotherapy?  Yet isn’t it that diagnosis which carries the very stigma that so many fear? And won't more people then be discouraged from simply going to talk to someone, from seeking help in the form of psychotherapeutic support and advice?

Something tells me that the MHCC won't be spending the 4.5 million dollars on considering these questions but on funding another "anti-stigma project" run by someone now sitting on their BOD.

Please sign my petition.

Psychothérapie- diversité et liberté de choisir

Hier j’ai parlé hier avec Mme Andrée Thauvette-Poupart, présidente de La Société Québécoise des Psychothérapeutes Professionnels (SQPP), des initiatives récemment entreprises par le SQPP dans le but de promouvoir les psychothérapeutes et de protéger la diversité des psychothérapies pratiquées au Québec.  (Pour signer la pétition réclamant un meilleur accès aux services de psychothérapie, cliquez ici.)

Le SQPP fait un travail remarquable de rassemblement de ressources et de sensibilisation et d'éducation auprès des compagnies d'assurance, des syndicats et des employeurs aux Québec afin qu'ils prennent des mesures vers une représentation plus équitable des psychothérapeutes au sein de leurs organisations.

Je tiens à exprimer la solidarité avec les initiatives de la SQPP, avec son engagement envers la diversification de la pratique de psychothérapie et sa représentation des intérêts de tous les psychothérapeutes agréés indépendamment de leur appartenance à des ordres professionnels différents.

Je tiens également à exprimer la solidarité avec les thérapeutes qui ne sont pas membres d'un ordre professionnel et ne peuvent pas, pour cette raison, faire une demande de permis de psychothérapeute, et avec ceux qui, dans un avenir proche, ne seront plus en mesure de faire une demande de permis par la reconnaissance des droits acquis.

Beaucoup de professionnels ayant une formation en thérapie des arts créatifs, thérapie somatique, la psychanalyse, la sexologie ou la toxicologie ont des compétences particulières dans certaines formes de psychothérapie.   Cependant, depuis la mise en vigueur du projet de loi 21, le public n'aura plus accès à leur expertise en tant que psychothérapeutes.

Il est tout de même curieux que ceux qui manifestent leur inquiétude à l’égard de la « crise en santé mentale » et réclament un meilleur accès aux services psychologiques («Mon cheval de bataille, c'est d'améliorer l'accès aux services psychologiques, quel que soit le niveau de revenu.») sont les mêmes qui sont en train de limiter l'accès du public à ces services.  C'est une erreur de politique publique de limiter l'accès et le choix du public aux services de psychothérapie, et l'OPQ à tort de s'approprier le droit de pratiquer des formes de thérapies dans lesquelles les psychologues ne sont ni formés ni qualifiés.

L’encadrement de la psychothérapie par l'Ordre des Psychologues du Québec (OPQ) a été justifié en raison de «protection du public», et suivi d’une campagne menée par l'OPQ à «ne pas laisser n'importe qui entrer dans votre tête».  Mais en fait, cette communauté dont la pratique se veut « fondée sur les données probantes » n'a aucune preuve que les thérapeutes détenteurs de permis sont moins dangereux ou plus efficaces que les autres.  Au contraire:

... il ya des preuves et des arguments petinents qui démontrent que [la réglementation] fera plus de mal que de bien, à la fois en matière de protection du public et à la profession en général. Un certain nombre de livres de fond ont remis en question l'argument du «sens commun» de la protection du public... or il n'existe pas de recherches comparables, si abondamment et soigneusement étudiées et soutenues de façon convaincante, pour soutenir la décision de réglementer.  (Therapy Today, vol 20/6, 2009.)

psychotherapy- diversity and freedom of choice

I spoke yesterday with Mme Andrée Thauvette-Poupart, Président of la Société Québécoise des Psychothérapeutes Professionnels (SQPP), who told me about some of the initiatives the SQPP has recently undertaken to promote psychotherapists and various modalities of psychotherapy practiced in Quebec.  (To sign the petition asking for better access to psychotherapy services, click here.)

The SQPP has been doing amazing work collating resources to promote psychotherapy as well as sensitizing and educating insurance companies, unions and employers in Quebec so that they take steps toward a more equitable representation of psychotherapists within their organizations.  

I wish to express solidarity with the SQPP’s initiatives, its overall commitment to the diversification of the practice of psychotherapy, and its representation of all licensed psychotherapists regardless of professional order.  

I also wish to express solidarity with those therapists who may not qualify for a psychotherapist’s permit because they are not members of any professional order and with those who, in the near future, will no longer be able to apply for the acquired right to practice psychotherapy as a psychoanalyst, sexologist, etc.  

Many competent professionals with backgrounds in creative arts therapy, somatic therapy, psychoanalysis, sexology or toxicology are uniquely qualified to offer certain forms of psychotherapy to the public.  Under Bill 21, however, the public will no longer have access to their expertise as psychotherapists.

It is very curious when the people publicizing a crisis in mental health and promoting access to psychological services ("Mon cheval de bataille, c'est d'améliorer l'accès aux services psychologiques, quel que soit le niveau de revenu") are the very same people limiting access to those services. It is a public policy error to limit public access and choice of psychotherapy, and wrong of the OPQ to appropriate all therapies when psychologists are not trained or qualified in them.

The regulation of psychotherapy by the Order of Psychologists (OPQ) was justified on the grounds of 'public protection' and was followed by a campaign by the OPQ to 'not let just anyone into your head'.  But in fact this "evidence based" community has no evidence that permit-holding therapists are any less dangerous or more effective than others.  On the contrary:

...there is evidence and substantive argument that [regulation] will do more harm than good, both in the matter of public protection and to the field generally.  A number of full-length books have undermined the ‘common sense’ public protection assumption... no such extensive, thoroughly researched and cogently argued literature exists to support the decision to regulate. (Therapy Today; vol. 20/6, 2009)

que charest charade

Un article publié au mois de février sur le site Protégez-vous.ca contient des informations erronées au sujet du service de référence de l’Ordre des Psychologues du Québec.

L'auteure de l'article précise que "la première information qui vous sera demandée est la région dans laquelle vous souhaitez consulter."

Malheureusement, ce n'est pas vrai.  En fait, la première chose qu’on demande à ceux qui consultent le service de référence de l’OPQ est de choisir entre "psychologue" et "tous les professionnels autorisés."

Imaginez que l'on vient consulter le site de l’OPQ pour de l'aide à cause d’un trouble relationnel ou un problème au travail.  On pourrait très bien penser la chose suivante : "Je suis à la recherche d’une thérapie, et la thérapie est un service psychologique.  Je suis sur le site de l'Ordre des Psychologues.  Je suppose donc que je suis à la recherche d'un psychologue."  Cela semble raisonnable, or les résultats de recherche excluront effectivement tous les thérapeutes conjugaux et familiaux, sexologues, ergothérapeutes, travailleurs sociaux et d’autres professionnels en mesure d’aider.   Ils incluront de nombreux psychologues avec peu de formation, et aucun permis, dans ces domaines spécialisés.

Pourtant, l'auteure de l'article nous dit que Rose-Marie Charest, le président de l'OPQ "assure que les psychologues ne sont pas privilégiés aux dépens des autres thérapeutes."

Malheureusement, ceci n'est pas vrai non plus.

que charest charade

An article posted in February on the Protégez-vous.ca website contains incorrect information about the online referral service of the Quebec Order of Psychologists.

The author of the article states that "The first information you are asked for is the location in which you want to search.”

Unfortunately, this is not true.  In fact the first thing that one is asked by the OPQ referral service is to choose between "psychologist" and "all authorized professionals."

Now let’s say that one comes to the OPQ website and needs help, perhaps with issues around a relationship or work.  One might very well think along lines such as this: “I am looking for therapy, and that is a psychological service.  I am at the website of the Order of Psychologists.  I guess I am looking for a psychologist.”  That would seem reasonable, but the search results will actually exclude all licensed couple and family therapists, sexologists, occupational therapists, social workers, psycho-educators and others who are able to help.  It will include many psychologists with little training and no license in these fields.

Yet, the author of the article tells us that Rose-Marie Charest, the President of the OPQ "assures that psychologists are not privileged at the expense of other therapists."

Unfortunately this is not true either.