Quebec steps in to regulate the practice of psychotherapy

Martin C. Barry

May, 2009

For decades, the prevailing view among psychotherapists was that their profession could never effectively be regulated. But Quebec’s Justice Department is forging ahead to do just that.

Newly appointed Justice Minister Kathleen Weil announced in March she was resurrecting a draft bill that diedon the order paper when the National Assembly was dissolved for the 2007 general election. The proposed legislation would modify the province’s code of professions for the mental health and human relations fields.

While the bill has wider implications, the Justice Ministry’s Office des Professions said in a press release that it is aiming first and foremost to define what psychotherapy is and who will have the right to practise it.

The title “psychotherapist” would be granted exclusively to doctors, psychologists, social workers and a few other licensed professionals such as educational and family counsellors. One of the minimum requirements will be a post-graduate degree.

Under the law, a mandate for licensing psychotherapists would be granted to the Ordre professionel des psychologues du Québec,which would regulate psychotherapy through a committee put in place for that purpose. An acquired right would be granted to anyone who was practicing psychotherapy up to the date the legislation is enacted. But the Office des Professions suggests the competency of such practitioners would hence-forth be subject to scrutiny.

While Weil said in a statement that the government wanted to be sure no one was prevented from providing psychotherapy within the scope of their abilities, she acknowledged in interviews that one goal is to protect the public.“The risks for people, who are sometimes fragile, were important,” she told Radio Canada.

As the order of psychologists noted in reaction, anyone in Quebec can practise psychotherapy, call himself or herself a psychotherapist, and receive clients who are often struggling with psychological problems. Clients currently have no effective means for verifying the credentials of psychotherapists and no recourse for making complaints.

“Any prosecution for the illegal practice of psychotherapy or for misuse of the title … will be launched by the Order,” said Rose-Marie Charest, the organization’s president. She said the system until now made it “too easy to take advantage of the vulnerability of persons in the grips of serious mental health problems.”

Quebec is not alone in imposing rules on psychotherapists. In Ontario, where a similar provincial government effort resulted in the passing of legislation, the Psychiatric Patient Advocate Office (PPAO), an arm’s length department of Ontario’s Ministry of Health, wrote in a 2005 submission that “the development of an accountability framework and complaint mechanism is fundamental to the protection of consumers and the public.”

In making recommendations, the PPAO said the practice of psychotherapy and counselling “carries with it a significant potential for harm to consumers.”

In interviews with The Senior Times, two Montreal-based help counsellors said they already do not refer to themselves as psychotherapists. Howard Riback, a former gambling addict who obtained a certificate in gambling therapy from the University of Windsor, describes himself on a business card as a therapist. “I never use the word psycho,” he said, adding that he prefers to introduce himself as a motivational speaker.

“I dropped the title of psychotherapy altogether,” said Yannick McCarthy, whose card states simply that she offers “counselling,” even though the situations she deals with include depression and relationships. McCarthy’s view, with which Riback and a third counsellor concurred, is that psychotherapy is inherently difficult to regulate.

Its ancestor, Freudian psychoanalysis, from which the hundreds of psychological therapies in existence today originate, was traditionally regarded as an unrestricted and highly subjective discipline. Hence the difficulty facing the government: How do you define psychotherapy as a first step towards regulation? This might also explain why it took so long for the process to reach this stage.

Dr. Henry Olders, a Westmount psychiatrist, suggested the Order may have other motives in seeking to regulate psychotherapy. If the problem is consumer protection, there are other ways of going about it such as “voluntary adhesion of therapists to standards-setting organizations (as is done for health facility accreditation),” he said in an email.

“The doctors and the psychologists seem to be heavily represented in the conseil consultatif, and the Ordre des psychologues will have a great deal of power over the whole enterprise.

“When a professional corporation prevents people who are not part of their professional group from practicing, it might be simply to protect the public from frauds, charlatans and incompetents, or it might be to protect their market, or some combination of the two,” he added. “It may be hard for the public to know exactly whose interests are being served.”

One area of Quebec’s mental health services sector that could be impacted by the regulation of psychotherapy is alcohol and substance abuse rehabilitation.

In March 2008, after the government wrapped up public hearings for its proposed code of professions changes, the Fédération québécoise des centres de réadaptation pour personnes alcooliques et toxicomanes, which represents 21 rehab centres, complained that addiction counselling was not among the professions recognized for accreditation. There are several hundred private and community-based alcohol and drug rehab centres in Quebec. While most offer psychotherapy as part of their treatment, there is no immediate word from the government as to how they will deal with regulation.