psychotherapy; one title, many specialties

[cliquez ICI pour la version française]

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 client’s 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-Hélène Bertrand, and was followed by subsequent email exchanges with Krystelle Larouche and Diane Côté 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.
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 OPQ’s 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 public’s 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.

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 Psychologist’s 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 Dîane Côté in which she defends the Order of Psychologists’s 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.

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 OPQ’s online referral service cease interfering with the public’s 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 Québec, 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.

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