What this document is about
Almost all counsellors who make themselves accountable to a code of ethics and a standard of practice know that, helpful as this is, voluntary self-regulation still leaves the public vulnerable, under-informed, and open to mis-representation. Self-styled people calling themselves therapists and counsellors can offer services to the public with no oversight or accountability. The consequences of unethical or incompetent counselling practice can be devastating. Harms range from economic and emotional exploitation all the way to death by suicide that a well-prepared therapist would have assessed for and very possibly prevented.
Associations that attempt to regulate counselling find themselves in two kinds of “double-bind”. First, they are trying to serve the interests of the public and the interests of the membership at the same time. And, as if this wasn’t hard enough, they are also trying to apply and enforce standards under legislation where all someone has to do to avoid professional discipline is resign from the association. When someone is no longer a member, we lose jurisdiction, and the situation most in need of correction is outside of our reach.
This document is about what is being done about this unsustainable state of affairs that compromises professional standards while leaving the public without adequate protection from harms.
Who speaks on behalf of public protection?
A first step in making things better is to form an organization that
speaks on behalf of the need for public protection. Over the past decade
and more, that voice has been the Task Group for Counsellor Regulation.
In early 2014, the Task Group (TG), an ad hoc group of counselling
associations, “upped its game”. The TG incorporated as the Federation of
Associations for Counselling Therapists in British Columbia, FACTBC.
The interest of FACTBC is protection of the public, and its goal in
serving that interest is the creation of a college under the Health
Professions Act.
It is part of the constitution and bylaws of FACTBC that college
advocacy is all it does. And when FACTBC’s mission is complete, it will
cease to exist. The associations may collaborate in other ways in the
future through other ways of organizing, but FACTBC serves the public
interest by advocating a college. Period. Full stop.
Why a College? And why under the Health Professions Act?
A college can regulate counselling in ways that an association never
can because a college has legislation that gives it jurisdiction even
when someone resigns from the college, or when someone behaves as if
they were a member of the college. That provides much more public
protection. As well, a college can issue orders, hold hearings, do
audits, hold inspections, and compel the cooperation of college
registrants. It simply has more authority to keep the public safe.
A college under the HPA is important because counselling and
psychotherapy are health care, usually associated with mental health.
This gives counselling a clear connection to all our partners in health
care—nurses, doctors, pharmacists, and so on—as well as a place on the
extended health programs of third party payers and tax schedules. This
makes for more access by the public at a lesser cost because the service
is not subject to GST.
A college also protects a title, in this case, “Counselling
Therapist”. It is part of the job of the college to make the title as
well known as “nurse”, or “doctor” or “pharmacist” so that potential
clients know that when choosing someone identified as a “Counselling
Therapist” they are working with a regulated professional whose practice
is accountable to a code of ethics and a standard of practice that is
backed up by legislated authority.
The public, and the counsellors, both benefit from a college’s rules and protections.
Who is in FACTBC? And why these groups and not others?
The following associations are members of FACTBC:
• American Association of Pastoral Counsellors
• Association of Cooperative Counselling Therapists of Canada
• Association of Registered Clinical Hypnotherapists
• BC Association of Clinical Counsellors
• British Columbia Art Therapy
• British Columbia C Association for Marriage and Family Therapy
• Canadian Counselling and Psychotherapy Association
• Canadian Professional Counsellors Association
• Music Therapy Association of BC
• Professional Association of Christian Counsellors and Psychotherapists
The following associations are observers at FACTBC meetings, and may choose to become members:
• Working Group for Spiritual Health Professionals in British Columbia
• Canadian Association for Spiritual Care
Government has made it clear that they are not interested in working with a diversity of interests, and that they will not tolerate “turf wars” and “professional rivalries”. Consequently, FACTBC unites all of the associations in BC that protect the public by having registration processes, standards of practice, a code of ethics, and a complaints process. These groups have shown that they are willing to act on behalf of the public interest.
Other groups that represent counsellors are important, too. But they are not in the business of providing third party accountability for the competence of their members. Their interest is in developing modality specializations, particular treatments, work with particular client populations, or services related to particular client problems. Fortunately, the vast majority of people who are part of addictions groups, play therapy groups, trauma organizations, expressive therapy associations, and so on, are also registrants with FACTBC member associations.
How do you handle all the diversity within FACTBC?
Let’s start with the context. The authority to regulate professions in Canada belongs to the provincial governments. And the provincial governments have agreed through Chapter Seven of the Agreement on Internal Trade that registration in the professions is to be done through competency assessments. This does not mean that credentials are unimportant, but it does mean that those competencies that reduce or eliminate risk of harm to the public are the core of how one enters the professions.
Competencies, as almost everyone knows, are not just skills. They are a combination of perception, skills, judgment, modulation, assessment, discernment, and timing that allow a professional to provide the correct intervention for a specific client at a particular time and in a unique set of circumstances. Competencies are demonstrated in “real time” with particular clients in particular circumstances in the presence of particular problems. Competencies are much, much more than answer on an exam paper.
In 2005 the Task Group developed a Competency Profile for a Counselling Therapist, and that profile has since been validated as a national standard. It is the basis for Ontario’s protected title “Psychotherapist” and has been adopted in Nova Scotia, New Brunswick and Prince Edward Island.
It is the Competency Profile that levels all the diversity. All Counselling Therapists must demonstrate all the competencies in the profile because they are basic to client safety. Beyond this, of course, are many advanced competencies, designations, degrees, and certifications. But it is the competencies in the profile that provide core protection for the public and an entry-to-practice standard.
Other professions work in a similar way. Nursing is a good example. Nurses have core competencies, and at the same time they branch out into community nursing, emergency room specialization, surgical nursing, pediatrics, geriatrics—and on and on. Similarly, counselling therapists go beyond the core competencies to use music, art, family approaches, specialized trauma therapies, and on and on. Still, the common ground is the core competencies.
Isn’t a college going to limit availability of service by setting standards too high? Or dilute the quality of service by setting standards too low?
A professional standard that does not have a rationale in reducing risk of harm is, almost by definition, a standard that limits public access without an adequate rationale.
Similarly, a professional standard that fails to address a risk of harm is insufficient.
The standards are not intended to create “practice monopolies” or “special turf”. The standards are intended to mitigate risk of harm.
Unless you have looked into the specifics of professional regulation
through title protection and competency-based regulation, you might
arrive at the notion that, by embracing much diversity, an initiative
like the one FACTBC is undertaking will just go to “the lowest common
denominator”. This thinking misses the point that regulation is not
about the interests of counsellors and their identity and “market
share”. It is about public interest. The common denominator is risk of
harm. Therapists registered with the college, and who have advanced
competencies will be able to identify with these accomplishments, and no
one without the entry-to-practice competencies will be admitted to the
profession.
This model of regulation requires that, in many cases, professionals are
able to separate their professional identity from their source of third
party accountability. My professional identity might be as an Art
Therapist, and my source of professional accountability is my
Counselling Therapist registration—two dimensions, two descriptions.
What FACTBC advocates is that registrants in a college will also be able to hold out their earned credentials, certifications, and designations. That means that those with advanced competencies or depth of experience can communicate that to members of the public who are choosing a professional to act on their behalf. And because it is a college, and not an association, the college will have the authority to ensure that such descriptions and claims are accurate and that they do not suggest or imply abilities that the registrant does not have. Once again, this is a win-win situation. Therapists win by “owning” their professional identities earned through their preparation, experience, and study, and clients win by being assured of the basic competencies and accountability of all counselling therapists.
These plans sound good. But what is being done about them?
A lot is being done about these plans!
Beginning in 2012, the Task Group began actively lobbying political
authorities to create a college. Until then, the TG (later to become
FACT) had been working with ministry of health officials. Over time, it
became clear that the nature of government had shifted, and that the
real drive to create a college would need to come from the political
will of elected officials.
The TG hired a lobby coordinator, John Gawthrop, an experienced therapist and organizer, and took matters further by retaining Hill & Knowlton Strategies (H & K), a lobbying firm, to assist with the lobbying efforts. H & K worked diligently to create a clear, core message for political decision-makers: Lack of a college puts all British Columbians at risk of harm, a college can be created under the HPA without new legislation, and the college is self-financing through its member fees. A college doesn’t spend taxpayer money, it is relatively easy to set up, and it improves mental health services and protects the public from harms.
This message has been embraced by MLA’s across the province and on both sides of the legislature. Teams of therapists visited the MLA’s in their constituency offices, made their case for a college, and answered questions. Understandably, political leaders wanted to know who would oppose such a college, why it hadn’t happened already, and what controversies would follow from taking this initiative. When these questions arose, the decades of policy work done by the TG shone through. The inclusion of virtually all self-regulated therapists at the FACTBC table, the rigorous work on competencies, and the cooperation built with other professions all paid off.
That’s a lot of work! Who did it, and how was it paid for?
Most of the work has been by volunteers. The FACTBC board is entirely volunteer, and the teams visiting the MLA’s were also counsellors who stepped up on their own time and at their own expense to advocate for the profession. Costs have been for a much-needed professional coordinator as well as consulting services from H & K.
The FACTBC budget works on a per capita basis—each member organization contributes in proportion to the number of counsellors in their organization. Last year, the per capita contribution was $17.00, and this year it will be $20.00.
What about the higher political authorities? Cabinet? The Health Minister?
Following our work with the members of the legislature, Health Minister Terry Lake met with FACTBC leaders on March 19th, 2014 and agreed to canvas members of the cabinet for their support. In addition, he assigned Ted Patterson, Deputy Minister, Mark MacKinnon, Assistant Deputy Minister, and Melissa Murdock, Director, to work with Glen Grigg, Chair, FACTBC.
It has been very clear that the provincial government is interested a single protected title, and that work can proceed when counsellors speak with one voice, which is the achievement of FACTBC.
Discussion has moved from informal planning talks with mid-level officials all the way to the Minister and to the Cabinet. Whereas nothing is certain, this is very big progress in putting the regulation of counselling on the political agenda in BC!
Planning and discussion are at a very high level. What’s next?
The next move belongs to government. FACTBC has made its case, and is working on a confidential basis with a working group to provide information and perspective as government moves this file forward. We are expecting that when government completes its review of the Health Professions Act, a College of Counselling Therapists will be “on the table”.
Meanwhile, FACT has work to do in preparing for a college. The
competency profile was updated in Ontario in 2012, but has not been
formally reviewed in British Columbia, so that update has been set in
motion. If the timing is right, this may lead into direct work on a
competency assessment protocol that might be adopted by a college.
FACTBC is currently reaching out to other professions for formal support
of a College of Counselling Therapists, and we continue to work
directly with political authorities whenever the opportunity presents.
Right now, we have asked to present our case to the government caucus,
and are awaiting a reply.