The purpose of this document is to ensure the safe, effective, and ethical delivery of psychotherapy services including the controlled act by occupational therapists (OTs) in Ontario. The Standards for Psychotherapy describe the minimum expectations for OTs to provide competent and safe psychotherapy intervention within the scope of practice of the profession of occupational therapy.
The College defines psychotherapy as follows:
Psychotherapy refers to planned and structured interventions aimed at influencing behaviour and function, by psychotherapeutic means1. Psychotherapy is delivered through a therapeutic relationship to change an individual’s disorder of thought, cognition, mood, emotional patterns, perception, or memory that may impair the individual’s judgement, insight, behaviour, communication, or social functioning as it relates to the performance of daily activities.
The College recognizes that this definition may not conform to all the published models or philosophies of psychotherapy and mental health care. The Standards for Psychotherapy are not based on any one psychotherapy theory or approach. This definition of psychotherapy is intended to apply in all circumstances in which OTs are practising psychotherapy.
Psychotherapy concentrates on the client’s emotional problems for the purpose of changing defeating patterns of thought, emotion, and behaviour. Psychotherapy through a therapeutic relationship aims at promoting positive personality change, growth and development, and re-organizing the personality. Psychotherapists frequently work with a variety of theories or combinations of theories and may use one or more procedures or models to try to achieve desired results2. Psychotherapy intervention can be delivered in individual, group, family, or couple formats. Psychotherapy may be a long-term intensive process that identifies emotional issues and their cause with a focus on a deep, fundamental process of change, and the development of insight about thoughts, feelings and behaviours.
The practice of psychotherapy is broad and can be performed in different clinical settings with diverse client populations. For this reason, the Ministry of Health & Long-Term Care (MOHLTC) directed the College of Registered Psychotherapists of Ontario (CRPO) to make regulations prescribing therapies involving the practice of psychotherapy including the development of policies, guidelines and other supporting resources that outline the activities that are not considered to be part of the controlled act of psychotherapy. In the provision of occupational therapy service, the following are examples of activities considered to fall outside the practice of psychotherapy: advocacy; providing education; counselling and support; teaching and problem solving; learning and re-learning skills to carry out activities of daily living. The College acknowledges that OTs perform many interventions with their clients; an OT who performs these interventions in the absence of having a formal psychotherapeutic relationship is considered not to be performing psychotherapy3.
Appreciating that psychotherapy can pose an increased risk to clients with serious disorders, a subset of psychotherapy has been defined as a controlled act under the Regulated Health Professions Act, 1991 (RHPA). The controlled act of psychotherapy can only be performed by certain regulated health professionals including OTs.
Controlled Act
Controlled acts are procedures or activities which may pose a risk to the public if not performed by a qualified practitioner. The Regulated Health Professions Act, 1991 (RHPA) grants OTs the authority to perform the controlled act of psychotherapy. The controlled act of psychotherapy is defined in the RHPA as follows:
“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, behavior, communication or social functioning.”
The following elements must be present for a psychotherapy activity or intervention to fall within the controlled act of psychotherapy:
- You are treating a client
- You are applying a psychotherapy technique
- You have a therapeutic relationship with the client
- The client has a serious disorder of thought, cognition, mood, emotional regulation, perception or memory
- This disorder may seriously impair the client’s judgment, insight, behaviour, communication or social functioning
The Standards for Psychotherapy apply to all psychotherapy practice and are not limited to the controlled act. OTs are required to perform all psychotherapy in accordance with the laws, regulations and standards of practice. For assistance in understanding when these standards may apply in a specific practice context, refer to the resource “Determining When the Standards for Psychotherapy Apply”.
Psychotherapy and Counselling
Psychotherapy and counselling are often viewed as interrelated. Whether the OT is practising psychotherapy or counselling with a client, the OT must understand that there are some distinctive differences
4 in the level of risk between the two approaches.
Counselling can involve education, guidance, encouragement, supportive problem-solving or informational advice. Counselling formats vary and can include: individual, group, family or couple. Counselling can be used in all areas of occupational therapy and is typically considered a lower risk activity for the client. The focus of counselling is on specific problems or changes in life that can impact occupational performance.
5 Counselling may or may not require grounding in a specific theory.
Although there is some overlap between counselling and psychotherapy, it is important for OTs to be able to identify when they are practising psychotherapy given the increased level of risk posed to the client. See Appendix 1 for additional information.
1 Adapted from the World Health Organization,2001
2 Corsini et. Al, 2008
3 College of Registered Psychotherapists of Ontario. (2018). Controlled Act Task Group Consultation Documents
4 Appendix 1
5 Psychotherapy & Counselling Federation of Australia