So you’ve decided that you would like to get some support and are ready to seek therapy. Who should you see? A Social Worker? Psychotherapist? Counsellor? Psychologist? Therapist? Psychiatrist? As if reaching out for help wasn’t already hard enough, who even are all these people?? Tobi Baker explains the differences.
Before we go into the specifics of some of these roles, let’s talk about regulated professions.
What is a regulated profession? It’s a job category or class that requires a certain level of education and training in order for an individual to be allowed to use the title. Of the titles listed above, the following are professions regulated to provide psychotherapy (the regulated term for therapy or counselling!): social worker, psychotherapist, psychologist, and psychiatrist. Professions are regulated through colleges which exist to protect the public and ensure that those using the title keep an ethical practice. This means that if there are concerns or complaints, this individual may no longer be able to use the title. If someone is registered in a college, you should be able to look them up in the college’s directory and see if there are any limits placed on their registration. Also noteworthy, psychotherapy, as a controlled act, came into effect in December 2017, however, the act will not be enforced until the end of 2019.
Here is a list of the online registers for the aforementioned regulated professions:
The College of Physicians and Surgeons of Ontario (Psychiatry)
Not mentioned above, but also regulated to provide psychotherapy are:
*Side note about non-regulated professions* Every profession was once not regulated, so just because someone is offering a non-regulated service, it does not mean that it is not something that you won’t find helpful. Always inform yourself, ask around, look up research on the topic. If it sounds like a good fit, go for it!
So what’s the difference between social work, psychotherapy, psychology, and psychiatry? What about nurses and occupational therapists? Sometimes not much, sometimes a lot!
Social workers must have completed a Bachelor or Master of Social Work degree (BSW or MSW) which includes practicum placements. Regulated by the same college are social service workers who may also provide psychotherapy. Social service workers must have a social service work diploma. In private practice, hospitals, community health centres etc., those providing psychotherapy from this college are most likely to be MSWs . Because psychotherapy training is not a mandatory part of social work and social service work education, a registered member of the OCSWSSW who provides psychotherapy must be thoroughly trained in biopsychosocial and psychotherapy theories and models. What is unique about social work? Regardless of our areas of interest, social workers are trained to look at individuals in their context using an anti-oppressive, strengths-based perspective. Everything from genetics, family, community, and social policies can impact an individual’s functioning, and we keep this in mind in our assessments and treatment. You can read more about social work psychotherapy practice guidelines here.
Psychotherapists can have a variety of educational backgrounds, and are required to have 450 hours of direct client contact hours and 100 hours of clinical supervision before they can qualify for the title. Like social workers, psychotherapists use a variety of treatment modalities, such as Cognitive Behaviour Therapy, Emotion Focused Therapy, Eye Movement Desensitization and Reprocessing and more. Going through the different types of therapy is a whole other topic, but if you aren’t sure what’s best for you, ask your psychotherapist about their approach and decide if it sounds like a good fit for you. Psychotherapy professional practice standards for registered psychotherapists can be found here.
Psychologists are mental health professionals who have received a doctorate degree in psychology. They require a minimum of 1500 hours of supervised clinical practice and must pass intense written and oral examination in order to become registered. Unlike social workers and psychotherapists, psychologists can provide mental health diagnoses such as Generalized Anxiety Disorder and Major Depressive Disorder. Many are also trained in assessing cognitive and adaptive functioning and provide what are called “psychoeducational assessments” to help determine how individuals learn best and areas in which they may struggle. In terms of the type of psychotherapy they provide, this again is on an individual basis and based on their training. See here for information on the professional conduct of psychologists.
Psychiatrists are medical doctors who, in addition to completing the requirements to become a physician, have done additional residencies in psychiatry. Like psychologists, psychiatrists can provide DSM-5 diagnoses but do not offer learning assessments. Because they are medical doctors, psychiatrists can also prescribe medication. Not all psychiatrists have received extensive training in psychotherapy, and not all offer this service. Of all of the professionals listed, this is the only professional who is covered by OHIP. The medical psychotherapy association of Canada offers practice guidelines for physicians here.
I’ll give a brief shout-out to GP Psychotherapists, who are general practitioners that have taken additional qualifications in psychotherapy. GP Psychotherapy services are also covered by OHIP.
Nurses are trained to provide health care in varying degrees of complexity based on their training. According to the College of Nurses of Ontario website, nurses may self-identify as psychotherapists based on their “knowledge, skill, and judgement”. During the period before the controlled act of psychotherapy is enforced, nurses do not require a doctor’s order to perform psychotherapy, however, this may change. You can find more information here.
Occupational therapists are trained to support recovery from physical and mental illness through improving access to and engagement in the activities of daily living. In order to provide psychotherapy, an occupational therapist must “ensure that they have adequate knowledge, training, skills, and judgement” as well as completed relevant coursework. In my experience working in mental health with children, occupational therapists are referred to in particular when sensory sensitivities are an important component of treatment. See here for the occupational therapy standards for psychotherapy.
So Who Should You Choose?
If you are looking for free services, as mentioned, Psychiatry and GP Psychotherapy are covered by OHIP. You can also receive free psychotherapy services through programs at some hospitals, through a family health team, or a community health centre. Typically these services are offered by social workers and are more short-term.
If you are have benefits through your employer or a partner’s employer, take a look at which professionals are covered. If you are covered for more than one, take a look at how much is covered, and the cost of the individual practitioner. Budgeting out how many sessions you can afford may help you make a decision.
If you don’t have coverage, what will suit you best comes down to you and the individual practitioner. As you have likely noted, different colleges have both different and overlapping guidelines for the provision for psychotherapy. Overall, it is important for you to consider:
- The professional’s psychotherapy training and education;
- The professional’s experience and practice area;
- If you like their style and approach.
Book a free phone consultation, ask around for recommendations, and make the informed decision that’s right for you.