psychotherapy; one title, many specialties

[cliquez ICI pour la version franaise]

Introduction
Since the adoption of Bill 21 in Quebec in 2009, both the use of the title of
psychotherapist and the practice of psychotherapy have been restricted.
Bill 21 defines psychotherapy as follows:
A psychological treatment for a mental disorder, behavioural disturbance or
other problem resulting in psychological suffering or distress, and has as its
purpose to foster significant changes in the clients cognitive, emotional or
behavioural functioning, interpersonal relations, personality or health. Such
treatment goes beyond help aimed at dealing with everyday difficulties and
beyond a support or counselling role.
The Order of Psychologists of Quebec (OPQ) has been given the mandate to
issue permits to psychotherapists and thereby protect the public from just
anyone claiming to be a psychotherapist and/or offering psychotherapy.
This blog documents my conversation with the Order of Psychologists of
Quebec on the subject of psychotherapy and the OPQ's mandate to protect
the public, which began with my initial conversation with Mme Marie-Hlne
Bertrand, and was followed by subsequent email exchanges with Krystelle
Larouche and Diane Ct of the OPQ.
Public protection or self-promotion?
The Office des Professions defines the Mission of an order as follows:
The main mission of a professional order is to protect the public, namely all
persons who use the professional services in the various spheres of regulated
activities. The order protects the public by adequately meeting its role and
responsibilities.
PLEASE NOTE*
It is false to assume that a professional order is an association that protects
the interests of its members. The latter can subscribe to separate and
independent organizations that will represent its members in this way.
[*original bold]
It is specifically stated here that the mission of a professional order is to
protect the public, not to represent the interests of its members.
Nevertheless, the Order of Psychologists of Quebec is doing just the opposite
by marketing its own members on its online site.
Their online referral service filters its search results so that the public is

frequently referred to privileged members of the OPQ over other

psychotherapists who are, in many cases, more qualified in the type of
psychological treatment sought. To find out how exactly it does this, click
here.
The result is information that is misleading:
When consumers, in good faith, consult the Order of Psychologists's website
to find a psychotherapist, they will not necessarily be referred to those with
specialized licenses in the fields searched under. But they will always be
referred to those without any specialized license to practice in those fields.
They will not systematically be referred to the professionals best trained and
qualified in the type of psychological treatment sought. But they will always
be referred to certain privileged members of the OPQ.
In practice this means that, when I consult the OPQs online referral service
in search of help for couple issues, for example, I am very likely to come
away with a long list of providers that includes professionals who are not
licensed couple therapists, i.e., psychologists who have no specialized
license in the field, but that excludes professionals who are licensed with a
specialized permit to practice couple therapy. And this, in the exclusive
interest of OPQ members who are not licensed couple therapists.
Imagine consulting a referral service for the College of Physicians and
Surgeons because you have a sore throat, only to be provided with a list of
doctors excluding those with specialized licenses in ear, nose and throat
medicine, because including them would not be in the best interest of
general practitioners!
This makes no sense and is not in the public interest.
Moreover, by preventing public access to specialized providers of
psychological treatments, the Order of Psychologists of Quebec is enabling
the irrational practices of the insurance industry.
Currently, some policies reimburse the cost of a specialized psychological
treatment when offered by psychologists with no specialized license to
practice in this discipline, but do not reimburse when offered by other
psychotherapists who do hold a specialized license in this discipline and who
are licensed to provide psychological treatment by the same professional
order as psychologists: the OPQ.
This discrimination against qualified psychotherapists does nothing to
contain insurance costs, is not in the public interest, and should be
immediately rectified.

When the coverage for a psychological treatment is limited to treatment

provided by a psychologist, the publics choice of providers is irrationally
limited to professionals who may have no specialized training in the type of
treatment sought. Coverage for a psychological treatment, which is
the definition of psychotherapy by law, should include services from
the complete range of qualified providers of that treatment:
psychotherapists.
One would expect the Order of Psychologists to educate and accurately
inform the public, if not to correct insurance inequities, then at least to not
reinforce them with their referral service. But apparently the OPQ is too busy
promoting its members to be protecting consumers; so we have to take
action to protect ourselves.
Action
On May 21, 2014, I wrote to the Order of Psychologists of Quebec asking
them to review their online referral service so that consumers could make
more informed choices about the professionals they choose to consult than
what they are currently able to do using this service.
I received an answer from Mme Larouche on May 26, 2014 which gave some
general information about the Order of Psychologists public protection
mandate and the history of its referral service.
I replied to Mme Larouche on May 30,2014, asking her two specific
questions. These were:
1) whether she thought that the OPQ, by offering the public a referral service that excludes the
majority of psychotherapists specialized in the field searched under, was adequately fulfilling its
public protection mandate applied precisely by informing and sensitizing the public, as she
said in her letter [my translation].
2) whether, by asserting that "searching by problem type is the best way to inform the public so
that people can find the right professional according to their needs"[my translation], she was
admitting that the OPQ, by offering the public a referral service that is not organized in this way,
was providing an inferior service.
I did not receive an answer from Mme Larouche. Instead, on June 6, 2014, I
received an email from Dane Ct in which she defends the Order of
Psychologistss online referral service, claiming that it is "not regulated by
their professional code" [my translation] and informing me that it will not
be changed in the near future.
My two questions were left unanswered.
The Order of Psychologists of Quebec is not adequately meeting its
public protection mandate. This is unacceptable for both consumers and
providers of psychotherapy services.

Petitions
I have drafted a petition addressed to Mme. Rose-Marie Charest, President of
the Order of Psychologists of Quebec, asking that, in the public interest, the
OPQs online referral service cease interfering with the publics freedom to
choose its providers of psychological treatments, that it refer the public to all
psychotherapists qualified to meet the type of treatment sought, that it
cease filtering search results using criteria to exclude specialized permit
holders in the field searched under, and that it provide the public with
complete and relevant information on all meetings, discussions, negotiations
and agreements with government organizations, insurance carriers or third
parties, that determine how and in what matter psychotherapy services are
to be provided to the public.
When you sign here, the petition is automatically forwarded to Mme. Charest
and a copy sent to the Office de Professions du Qubec, which assigns the
Order of Psychologists its public protection mandate.
For those who wish to take action to ascertain that their insurance policies
cover all licensed psychotherapists qualified to provide psychological
treatment, you can send a letter to your employer simply by clicking on this
link and sending the sample letter to your employer's Department of Human
Resources.
Some may fear that rectifying coverage in this way will increase insurance
costs. This fear is unfounded. The change requested is not for the coverage
of an additional psychological service, but for access to a larger pool of
providers licensed to provide that service. This is actually more likely to
reduce the cost of these services.
Your feedback in the form of comments, questions and criticism is welcome
on this blog.
All original documents can be consulted here.
Please forward to friends and colleagues.