{"id":1297,"date":"2024-11-27T14:59:55","date_gmt":"2024-11-27T19:59:55","guid":{"rendered":"https:\/\/live-coto.pantheonsite.io\/?post_type=resource&p=1297"},"modified":"2025-01-16T18:57:39","modified_gmt":"2025-01-16T23:57:39","slug":"standard-for-psychotherapy-2023","status":"publish","type":"resource","link":"https:\/\/www.coto.org\/resources\/standard-for-psychotherapy-2023\/","title":{"rendered":"Standard for Psychotherapy, 2023"},"content":{"rendered":"\n\n
\n
\n

Standard for Psychotherapy<\/h2>\n <\/div>\n\n
\n
\n\n

This Standard applies to <\/strong>occupational therapists who perform psychotherapeutic techniques, including psychotherapy as a controlled act under the Regulated Health Professions Act, 1991<\/em> (RHPA). The Occupational Therapy Act, 1991<\/em>includes regulations that apply to occupational therapists when performing the controlled act of psychotherapy (see Appendix 1).<\/p>\n\n\n\n

The definition of the controlled act of psychotherapy references a client\u2019s \u201cserious disorder\u201d (\u201cof thought, cognition, mood, emotional regulation, perception or memory\u201d) that may seriously impair their \u201cjudgement, insight, behaviour, communication or social functioning\u201d (Occupational Therapy Act<\/em>, s. 3.1 [1]). Because psychotherapeutic services that occupational therapists provide carry with them a risk of harm even when the client\u2019s disorder may not be \u201cserious,\u201d to ensure the greatest public protection, these Standards apply to occupational therapists performing all types of psychotherapeutic techniques, including the controlled act of psychotherapy. Refer to the supporting document \u201cWhen the Standard for Psychotherapy Applies: Occupational Therapy in Mental Health\u201d <\/em>in Appendix 2 for more information.<\/p>\n\n\n\n

The College recognizes that clients\u2019 disorders and levels of impairment can fluctuate during the provision of services. In response, occupational therapists providing psychotherapy are to have the competency to adapt to clients\u2019 evolving needs.<\/p>\n\n\n\n

This Standard does not apply when occupational therapists are using approaches that are not psychotherapeutic, such as health teaching, supportive listening, and coaching. Again, even if the client\u2019s current level of impairment may not be considered \u201cserious\u201d or one that may \u201cseriously impair\u201d their judgement or other areas mentioned above, this Standard applies when the occupational therapist is using any psychotherapeutic technique.<\/p>\n\n\n\n

Occupational therapists are expected to:<\/em><\/p>\n\n<\/div>\n <\/div>\n<\/div>\n\n\n\n

\n
\n

1. Obtain and maintain competence<\/h2>\n <\/div>\n\n
\n
\n\n

Performing psychotherapy is not an entry-level practice competency. It is an intentional and defined approach, and it is not recommended to be an occasional practice. Occupational therapists must obtain and maintain competence in each psychotherapy technique they intend to use.<\/strong><\/p>\n\n\n\n

Occupational therapists are to obtain psychotherapy training that has these components: instructional (is instructor led, not self-taught), theoretical (is based on psychotherapeutic theories), and practical (involves supervision). Pairing supervision with instruction and theoretical training allows for the practical application of theory to practice.<\/strong><\/p>\n\n\n\n

Instructional and theoretical educational requirements<\/strong>
<\/h3>\n\n\n\n
\n
\n\n
\n
\n

1.1<\/h3>\n <\/div>\n
\n\n

Select training that is appropriate for the occupational therapist\u2019s learning needs. At the beginning, it is expected that the instructional and theoretical components of training provide foundational understanding of the psychoeducational modalities. Afterwards, it may be appropriate to use other methods to continue competence (for example, workshops, professional networks, literature reviews, and continuous quality improvement initiatives). Factors that may contribute to the selection of education options include client needs, evidence-informed approaches, the scope of services, previous training and experience, comprehensiveness, and the relevance of the training.
<\/p>\n\n<\/div>\n<\/div>\n\n\n<\/div>\n<\/div>\n\n\n

Practical (supervision) requirements<\/strong><\/h3>\n\n\n\n

 
Supervision is an intentional arrangement where an experienced and qualified provider of psychotherapy assists the occupational therapist being supervised in their professional growth. This structured process allows the occupational therapist to develop foundational competence and the ability to provide safe, ethical, and efficient services. Supervision can be tailored to the occupational therapist\u2019s individual needs. Methods of supervision may include one-to-one meetings or supervision in a small group setting. The requirements for supervision are outlined as follows:<\/p>\n\n\n\n

\n
\n\n
\n
\n

1.2<\/h3>\n <\/div>\n
\n\n

Participate in a period of formal, practical psychotherapy supervision that includes the following:<\/p>\n\n\n\n

    \n
  1. Quantity<\/strong>: Supervision is a formal arrangement and a long-term commitment. It is to occur at regular intervals for the duration of the supervisory period, with a recommended minimum of 50 hours of supervision over at least the first two years of psychotherapy practice. This may extend longer for an occupational therapist who is not performing psychotherapy full time. Some training institutions may require specific supervision beyond this minimum.<\/li>\n\n\n\n
  2. Quality<\/strong>: Supervisors must be experienced, competent to provide supervision, and eligible to perform the controlled act of psychotherapy. Supervisors can be occupational therapists or other health professionals. The supervisor must be a member of the College of Nurses of Ontario, the College of Occupational Therapists of Ontario, the College of Physicians and Surgeons of Ontario, the College of Psychologists of Ontario, the College of Registered Psychotherapists of Ontario, or the Ontario College of Social Workers and Social Service Workers. Supervision needs to align with the occupational therapist\u2019s experience and specific psychotherapeutic approach. Occupational therapists who provide supervision do not take accountability for clients. The occupational therapist being supervised is responsible for the client services they provide.<\/li>\n<\/ol>\n\n<\/div>\n<\/div>\n\n\n\n\n
    \n
    \n

    1.3<\/h3>\n <\/div>\n
    \n\n

    Have a supervisory agreement which should include:<\/p>\n\n\n\n

      \n
    1. Administrative details (for example, start and end dates and frequency of meetings)<\/li>\n\n\n\n
    2. Responsibilities of the supervisor and the occupational therapist being supervised<\/li>\n\n\n\n
    3. Confirmation of accountability for client services<\/li>\n\n\n\n
    4. Processes to follow in the case of emergency<\/li>\n<\/ol>\n\n<\/div>\n<\/div>\n\n\n\n\n
      \n
      \n

      1.4<\/h3>\n <\/div>\n
      \n\n

      Maintain supervisory or meeting notes that do not contain personal information or personal health information. This requirement applies to both the supervisor and the occupational therapist being supervised, and it applies for at least the duration of the supervisory agreement. Notes that contain clients\u2019 information must be retained in accordance with the Standard for Record Keeping<\/a><\/strong>. Meeting notes can include:<\/p>\n\n\n\n

        \n
      1. Meeting dates<\/li>\n\n\n\n
      2. Summary of any ethical or professional issues addressed<\/li>\n\n\n\n
      3. Any direction, recommendations, feedback, or evaluation provided<\/li>\n\n\n\n
      4. Record of payments made for supervision<\/li>\n<\/ol>\n\n<\/div>\n<\/div>\n\n\n\n\n
        \n
        \n

        1.5<\/h3>\n <\/div>\n
        \n\n

        During the consent dialogue with clients, inform them of any supervisory arrangements.<\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        1.6<\/h3>\n <\/div>\n
        \n\n

        Never participate in supervisory arrangements solely for billing purposes. Financial records should clearly identify who provided the direct services to clients.
        <\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        1.7<\/h3>\n <\/div>\n
        \n\n

        If requested by the College, provide verifiable documentation of the completion of both an educational program and a required period of psychotherapy supervision.<\/p>\n\n<\/div>\n<\/div>\n\n\n<\/div>\n<\/div>\n\n\n

        After the required period of formal supervision, the occupational therapist may choose to continue with this supervision or move to a consultation arrangement in their psychotherapy practice. Consultation enables an occupational therapist to continue their professional growth. Consultation is with an experienced and qualified regulated psychotherapy professional to meet, discuss and review client care and share expertise. Individual or group consultation methods are acceptable. The individuals involved in this arrangement can determine the method of documentation for the consultation process.<\/p>\n\n<\/div>\n <\/div>\n<\/div>\n\n\n\n

        \n
        \n

        2. Practise safely<\/h2>\n <\/div>\n\n
        \n
        \n\n

        The Standard for Psychotherapy applies to occupational therapists providing psychotherapy across all sectors and settings. Because settings vary, it is important for occupational therapists to consider the cultural origins of the psychotherapy techniques and modalities being used and use them in culturally sensitive ways. Through the therapeutic relationship, occupational therapists develop an understanding of the client\u2019s unique perspectives and personal experiences.<\/strong><\/p>\n\n\n\n

        \n
        \n\n
        \n
        \n

        2.1<\/h3>\n <\/div>\n
        \n\n

        Before services begin, review the referral information to confirm that the client needs psychotherapy services. The occupational therapist must determine whether they have the competence (knowledge, skills, and judgement) to deliver the appropriate psychotherapy services, including the controlled act of psychotherapy.
        <\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        2.2<\/h3>\n <\/div>\n
        \n\n

        Ensure that clients are aware that they are taking part in psychotherapy services. Obtain ongoing consent.
        <\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        2.3<\/h3>\n <\/div>\n
        \n\n

        Understand and follow the laws and regulations governing the practice of psychotherapy.
        <\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        2.4<\/h3>\n <\/div>\n
        \n\n

        Perform psychotherapy within the occupational therapist\u2019s role and the scope of occupational therapy practice. Make referrals to other qualified providers as needed.
        <\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        2.5<\/h3>\n <\/div>\n
        \n\n

        Identify, minimize, and manage the risks associated with performing psychotherapy.
        <\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        2.6<\/h3>\n <\/div>\n
        \n\n

        Establish and maintain professional boundaries as outlined in the Standard for Professional Boundaries and the Prevention of Sexual Abuse<\/a><\/strong>.<\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        2.7<\/h3>\n <\/div>\n
        \n\n

        Hold a general certificate of registration to practise psychotherapy unless permission from the Registrar has been obtained (temporary certificates may be issued to occupational therapists who are registered in another jurisdiction and are providing in-person services in Ontario on a temporary basis).<\/p>\n\n<\/div>\n<\/div>\n\n\n<\/div>\n<\/div>\n<\/div>\n <\/div>\n<\/div>\n\n\n\n

        \n
        \n

        3. Do not delegate or assign psychotherapy services to others<\/h2>\n <\/div>\n\n
        \n
        \n\n
        \n
        \n\n
        \n
        \n

        3.1<\/h3>\n <\/div>\n
        \n\n


        Use clinical judgement to determine when or if it is appropriate for students or re-entry candidates (those returning to the profession after a prolonged absence) to be included in psychotherapy practice. While students or re-entry candidates may be able to independently provide general mental health interventions, they can observe psychotherapy or employ psychotherapy techniques with clients only when their supervisor is present.<\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        3.2<\/h3>\n <\/div>\n
        \n\n

        Never assign any part of psychotherapy practice or delegate psychotherapy to anyone else, including occupational therapy assistants.<\/p>\n\n<\/div>\n<\/div>\n\n\n<\/div>\n<\/div>\n<\/div>\n <\/div>\n<\/div>\n\n\n\n

        \n
        \n

        4. Use title appropriately<\/h2>\n <\/div>\n\n
        \n
        \n\n

        Section 33.1 of the RHPA permits occupational therapists to use the title \u201cpsychotherapist\u201d only if they identify themselves as members of the College by using the title \u201coccupational therapist\u201d as well. This applies to both oral and written communications.<\/strong><\/p>\n\n\n\n

        \n
        \n\n
        \n
        \n

        4.1<\/h3>\n <\/div>\n
        \n\n


        Determine, based on their competence, when it is appropriate to add the title \u201cpsychotherapist.\u201d<\/p>\n\n<\/div>\n<\/div>\n\n\n\n\n

        \n
        \n

        4.2<\/h3>\n <\/div>\n
        \n\n

        Use acceptable versions of title, such as:<\/p>\n\n\n\n

          \n
        1. First name Last name, OT Reg. (Ont.), Psychotherapist<\/li>\n\n\n\n
        2. First name Last name, Occupational Therapist, Psychotherapist<\/li>\n\n\n\n
        3. First name Last name, Occupational Therapist, practising psychotherapy.<\/li>\n<\/ol>\n\n<\/div>\n<\/div>\n\n\n<\/div>\n<\/div>\n<\/div>\n <\/div>\n<\/div>\n\n\n\n