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Initiation regulation approved for the controlled act of psychotherapy

The Ministry of Health has approved an initiation regulation for the controlled act of psychotherapy. This means nurses who have the knowledge, skill and judgement will be able to continue to independently perform the controlled act without an order beginning Jan. 1, 2020 in community settings.

However, even with the new regulation in place, RNs and RPNs still may need an order to perform the controlled act due to organizational policy or requirements under the Public Hospitals Act. Delegation of the controlled act of psychotherapy by NPs, RNs and RPNs is prohibited.

When the act was proclaimed in 2017, a two-year exemption period, which ends Dec. 31, 2019, was put in place. For nurses, that meant they were able to continue to practice the controlled act of psychotherapy without an order. During this time, CNO evaluated whether an order was in the best interests of the patient and public safety and drafted an initiation regulation accordingly. 

Not all psychotherapy falls under the controlled act. The following five criteria must all be met to be considered 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

RNs and RPNs who perform the controlled act of psychotherapy can use the title psychotherapist, provided they also make it clear they are registered with CNO, for example, Jane Doe, RN, Psychotherapist. Nurses also may wish to apply to register with the College of Registered Psychotherapists of Ontario, but will have to notify CNO notify of such registration.

To understand more about the controlled act of psychotherapy, FAQs have been posted.

Page last reviewed December 23, 2019