What is the controlled act of psychotherapy in Ontario?

The controlled act of psychotherapy is one of fourteen controlled acts in Ontario's Regulated Health Professions Act, 1991: activities risky enough that only authorized professionals may perform them. It is treating, by psychotherapy technique and through a therapeutic relationship, an individual's serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair their judgement, insight, behaviour, communication or social functioning. It is narrower than psychotherapy as a whole, which is why much counselling falls outside it.

The definition, word for word

The fourteenth controlled act in section 27 (2) of the RHPA reads:

"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 judgement, insight, behaviour, communication or social functioning."

Five elements, all of them needed

Break the definition apart. The act is controlled only when every element is present:

1. Treating: not assessing, educating or supporting.
2. By means of psychotherapy technique: a recognized psychotherapeutic method, not general advice.
3. Delivered through a therapeutic relationship: an ongoing clinical relationship, not a one-off talk.
4. A serious disorder of thought, cognition, mood, emotional regulation, perception or memory.
5. That may seriously impair judgement, insight, behaviour, communication or social functioning.

Remove one and the work may still be psychotherapy, but it is not the controlled act. The RHPA also says, in section 29 (2), that the prohibition does not apply to "a communication made in the course of counselling about emotional, social, educational or spiritual matters" unless a health profession Act authorizes it. CRPO gives examples of services that, provided on their own, would not be the controlled act, including case management, advocating, Applied Behavioural Analysis and single session counselling, and says its examples are not exhaustive.

Who may perform it

Members of six Ontario colleges may perform the controlled act of psychotherapy:

• College of Registered Psychotherapists of Ontario
• College of Psychologists and Behaviour Analysts of Ontario
• College of Physicians and Surgeons of Ontario
• College of Nurses of Ontario
• College of Occupational Therapists of Ontario
• Ontario College of Social Workers and Social Service Workers

Authorization is not the same as competence. CRPO's standard is that a registrant performs the act only when competent to do it safely and effectively, and the exam tests competence far more often than authorization.

Exceptions, students and applicants

Section 29 (1) of the RHPA lists exceptions that apply to psychotherapy, among them first aid or temporary assistance in an emergency, treatment by prayer or spiritual means, and a person fulfilling the requirements to become a member under supervision. Indigenous healers providing traditional healing to Indigenous persons are also exempt.

For students, CRPO adds limits. A student who will perform the controlled act needs a Registered Psychotherapist as clinical supervisor. Applying for registration does not by itself authorize anyone to perform the act, and a graduate who meets the requirements must register rather than keep practising under supervision to build hours. Students cannot use the protected titles.

Where the act applies

CRPO's position is that the controlled act applies to practitioners physically present in Ontario, and also to practitioners outside Ontario who serve clients in Ontario, for example by video. Unregulated practitioners may not perform it unless an exception applies, and CRPO can investigate them, take legal action and publish information about them.

Related rules on the exam

• No delegation. CRPO's standard is that registrants refrain from delegating the controlled act of psychotherapy. Any option in which an RP hands therapy to an unregulated assistant is a serious negative.
• No diagnosis. Communicating a diagnosis is a separate controlled act that RPs are not authorized to perform. An RP assesses and formulates, but does not tell a client which disorder they have.
• Protected titles. The Psychotherapy Act, 2007 protects "psychotherapist" and "registered psychotherapist", including variations and abbreviations.

The library module The Legal Framework explains each rule with its source, and the free practice case shows how a title question is scored inside a simulation.

Common questions

Is all psychotherapy a controlled act in Ontario?

No. Only treatment of a serious disorder that may seriously impair functioning, by psychotherapy technique through a therapeutic relationship, is controlled. Counselling about emotional, social, educational or spiritual matters is not.

Can an RP (Qualifying) perform the controlled act?

Yes. Registered Psychotherapists (Qualifying) are CRPO registrants and practise the act under clinical supervision, as the terms of their registration require.

Can students perform the controlled act of psychotherapy?

Yes, under the clinical supervision of a Registered Psychotherapist, as part of meeting the requirements to register. They may not use the protected titles.

Does the controlled act apply to therapists outside Ontario?

CRPO says it applies to practitioners outside Ontario who provide services to clients in Ontario, for example by video.

Sources

• CRPO: Controlled act of psychotherapy (opens in a new tab)
• Ontario: Regulated Health Professions Act, 1991 (opens in a new tab)
• Ontario: Psychotherapy Act, 2007 (opens in a new tab)
• CRPO: Professional Practice Standards (opens in a new tab)