Psychotherapy and the controlled act component of psychotherapy
There is a component of psychotherapy that will become a controlled act in the future. The following addresses questions nurses have about psychotherapy and how this affects their nursing practice:
What is psychotherapy?
Psychotherapy is defined as “an intense client-therapist relationship which often involves the examination of deeply emotional experiences, destructive behaviour patterns and serious mental health issues.” (Health Professions Regulatory Advisory Council, 2006).
It involves a deep examination of life processes that focus on modifications of behaviour, thinking patterns, cognition, emotional response and social functioning. In order to competently practise psychotherapy, nurses need in-depth knowledge, skill and judgment.
What is the component of psychotherapy that will become a controlled act?
The controlled act is the component of psychotherapy considered to be the highest risk to the client. It does not include all psychotherapy practices and is not defined by a technique. The Regulated Health Professions Act, 1991 (RHPA) will restrict the controlled act component of psychotherapy to certain professions, including nursing.
The controlled act is defined in the RHPA as:
“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, behaviour, communication or social functioning.”
How will I determine if I’m performing the component of psychotherapy that will become a controlled act?
Based on the RHPA definition above, there are five components in the controlled act and all must be met for you to be performing the controlled act:
1. You are treating a client
2. You are applying a psychotherapy technique
3. You have a therapeutic relationship with the client
4. The client has a serious disorder of thought, cognition, mood, emotional regulation, perception or memory
5. This disorder may seriously impair the client’s judgment, insight, behaviour, communication or social functioning
It is possible you may be performing psychotherapy but not the controlled act of psychotherapy. For example, if only four of the above components apply, you are not performing the controlled act.
You are in the best position to determine whether or not you are performing the controlled act according to the criteria.
The diagram below highlights that the controlled act is one element in the wide ranging practice of counselling and psychotherapy. Many of the activities that nurses frequently engage in share some common traits with psychotherapy but they are not psychotherapy. For example, activities such as health teaching, providing information, encouragement, support or instruction are not psychotherapy.
Will I require an order to perform psychotherapy?
When the controlled act component of psychotherapy becomes law, RNs and RPNs will require an order to perform that component just as they do to perform most other controlled acts they have access to, such as administering a substance by injection.
However, you do not need an order to perform psychotherapy if it does not meet the threshold of the five criteria within the controlled act unless sector-specific legislation (e.g. the Public Hospitals Act) or organizational policy requires it.
Can I use the title “psychotherapist”?
Nurses can no longer use the title “psychotherapist” because it is now a protected title. The Psychotherapy Act, 2007 currently restricts its use to members of the College of Registered Psychotherapists of Ontario.
If you perform psychotherapy, you can describe your role without using the “psychotherapist” title. For example, you could state “I’m an RN and I will be using psychotherapy to treat your disorder.”
I’m a nurse and I perform psychotherapy. Should I also register with the College of Registered Psychotherapists of Ontario?
Ultimately, this decision is up to you. As a nurse, if you have the knowledge, skill and judgment to do so, you may perform psychotherapy. Just note that if you are an RN or RPN, you will need an order to perform the component of psychotherapy that will become a controlled act once it is passed into law.