Controlled act of Psychotherapy

Introduction

The Regulated Health Professions Act, 1991 (RHPA), the governing legislation for regulated health professionals in Ontario, identifies 14 “controlled acts,” which may only be performed by regulated health professionals authorized to do so.  Controlled acts are restricted because of the risk of harm associated with their performance by unqualified individuals.

Definition

The RHPA defines the controlled act of psychotherapy 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 impaired the individual’s judgment, insight, behaviour, communication or social functioning.”

Treating

The practitioner responds to an assessed need or diagnosis through the use of therapeutic interventions or techniques.

By means of psychotherapy technique

The treatment involves one or more interventions or approaches based on recognized psychotherapeutic theories, models or frameworks and/or empirical evidence.

Delivered through a therapeutic relationship

The practitioner builds a strong therapeutic alliance with the individual. The relationship between the practitioner and the individual is integral to the treatment and based on clear professional boundaries.

An individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory

The descriptions below provide additional clarity on what is meant by a “serious disorder of thought, cognition, mood, emotional regulation, perception or memory.”

Thought

Impairment in concentration, persistence, and pace. May include delusions, or hallucinations, unwanted or intrusive thoughts that distort an individual’s ability to discern different states such as reality, fantasy and imagination.

Cognition

Persistent difficulty in understanding the meaning or importance of something, learning new things, concentrating or making decisions.

Mood

Prominent and persistent affective disturbance characterized by significant lows (diminished interest or pleasure in all, or almost all, activities) or significant highs (elevated, expansive or irritable disposition).

Emotional regulation

Persistent difficulty controlling emotion or emotional responses that do not appropriately fit the situation. May exhibit marked changes in moods or report difficulties with interpersonal relationships.

Perception

Difficulty recognizing or making sense of sensory stimuli needed to understand, learn or prompt a particular action or reaction; may be accompanied by diminished, exaggerated, distorted or impaired response to the stimuli.

Memory

Difficulty storing and retrieving or recalling information about their abilities and previously experienced connections, sensations, impressions, information or ideas. The descriptions below provide additional clarity regarding “seriously impair the individual’s judgment, insight, behaviour, communication or social functioning.”

The descriptions below provide additional clarity regarding “seriously impair the individual’s judgment, insight, behaviour, communication or social functioning.”

That may seriously impaired the individual’s judgment, insight, behaviour, communication or social functioning.”

Judgment

Difficulty making sound, reasoned or responsible decisions and contingencies. Reduced ability to predict and anticipate.

Insight

Difficulty recognizing mistakes, drawing connections between a problem, action and its consequences; lack of awareness of the impact behavior may have on oneself and/or others; may have difficulty formulating a plan.

Behaviour

Difficulty maintaining conduct within the limits prescribed by major societal norms, laws, rules; may violate the rights of others or disregard safety of self.

Communication

Difficulty receiving, sending, processing or comprehending concepts or words in context — verbally or nonverbally; may use words and meanings inappropriately, may not be able to follow directions; may have trouble getting others to understand what they are communicating.

Social Functioning

Difficulty with day-to-day functioning that interferes with performance at work or school, in relationships, taking care of self or connecting with others.

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