Information from the Practice Advice Service

QUERIES

During the second quarter of this year (September 1, 2022 –  December 31, 2022), the College’s Practice Advice Service addressed 448 queries. The five most common topics queried during this period, in descending order, were:

1. Mobility and Practice in Other Jurisdictions; mostly relating to member practice outside of Ontario;
2. Fees and Billing, the most common queries related to the setting of fees;
3. Records, focussing primarily on Health Information Custodian Successors, File Contents and File Retention;
4. Supervision, primarily concerning the supervision of non-members; and
5. Release of and Access to Information, related mostly to the client’s right of access and substitute decision-making, particularly with respect to children’s records.

Answers to many of these queries can be found on the Professional Practice FAQ page of the College website which includes the following recent additions.

Supervising members must assess the knowledge, skills and competence of their supervisee and provide supervision as appropriate to the supervisee’s knowledge, skills, and competence, based on this assessment;

Unless a supervisor has sufficient information about a client and the client’s difficulties, they would not be able to provide adequate supervision appropriate to the supervisee’s knowledge, skills and competence.

It is the responsibility of a supervisor to be sufficiently familiar with the client’s demographics and needs before permitting their supervisee to commit to provide services.  The adequacy of the supervision could be in question if a supervisor reviews and signs off on reports without having been involved in a direct or supervised intake process, or does not actively supervise the work leading up to any final reports.

Even though the Standards do not require supervisors to meet and interact with clients receiving services under their supervision, a supervisor should only permit a supervisee to work with a client after they have satisfied themselves that the client is within their authorized areas of practice and belongs to a population with whom they are authorized to work.

Area of Practice and Client Groups

Q:   Would it  be appropriate for a practitioner authorized in Counselling Psychology to work with, or to  conduct an assessment, including the formulation of a differential diagnosis, of a person presenting with symptoms of a psychological disorder? At what point would a client’s presenting problems no longer be considered to fall within the area of Counselling Psychology and indicating a need for a referral to a member authorized in Clinical Psychology?

A:   The Definition of Practice Areas are published as part of the Registration Guidelines.  Within the Guidelines, the definition of Counselling Psychology stresses fostering and improving human functioning by helping individuals solve problems, make decisions and cope with stresses of everyday life.  These can include work/career/education, family and social relationships, and mental health and physical health concerns.  In other words, these are the types of difficulties which may cause distress to an otherwise well-functioning or psychologically healthy individual. Some common examples of such problems are bereavement, unemployment, marital separation, or bankruptcy, etc. Generally, an individual presenting as having a disorder of behaviour, emotion or thought, should be assessed and treated by a member authorized in Clinical Psychology.

As described in the Definition of Practice Areas, members who practice Counselling Psychology, at a minimum, are expected to have “the ability to formulate and communicate a differential diagnosis in order to develop an appropriate counselling intervention and to identify clients who must be referred elsewhere”.

In contrast to that of Counselling Psychology, the definition of Clinical Psychology, as described in the Definition of Practice Areas, is “the application of knowledge about human behaviour to the assessment, diagnosis and/or treatment of individuals with disorders of behaviour, emotions and thought”.

It is sometimes unclear at the initial stages of involvement whether a client has a “disorder”, and this is an important reason that those authorized in Counselling Psychology be able to perform a differential diagnosis.  When a client presents with indicators of a disorder of behaviour, emotion or thought, a member who is not authorized in Clinical Psychology should refer them to a member authorized in this area.

If, at the time of referral, an individual presents with indicators that suggest they may have a diagnosable disorder, it would be most appropriate for an assessment to be conducted by someone qualified to work with those with clinical disorders. One should carefully consider the implications of beginning to work with someone that is likely to need to be transferred to someone else’s care. This could be quite disruptive to the client and the clinical relationship, and may even be damaging to their well-being and/or treatment.

At times, the extent of a client’s difficulties may not be apparent at the initiation of services, and it may later become evident that the client is suffering from a clinical disorder.  If a member, authorized in Clinical Psychology, is not available to accept a referral, it would be permissible to obtain supervision from someone so authorized.  This should be considered a “last resort” however, and not a “workaround” for appropriate authorization.