Amidst This Mental Health Crisis, Why Is It So Hard to Perform Psychotherapy in Quebec?

Article written by: Bianca Zawadzki (contact: [email protected])

Mental Health Crisis

I quit my job as a lawyer to transition into a career field that was more aligned with my interests, passions, and values. In the months leading up to that decision, I researched different career options that my title as a lawyer could open doors to. I started researching mediation.

Although I was taught that mediation was to be favored above contentious mediums in my years of law school, I was surprised to find that there were specific criteria needed to become a mediator. One of those was that I first required three years of experience in practice as a lawyer. Naturally, this didn’t sit right with me.

Indeed, mediating parties is always an option in the legal field, even without formal mediation training, but this is not the same as being an accredited mediator. For instance, two lawyers would still be able to negotiate and mediate with their separate clients without the accreditation, leaving less room for an objective perspective.

So When Should You Go for Mediation?

I feel it is crucial to understand that not all cases should go to mediation, but there are also many instances where it is very possible and beneficial for everyone involved.

If our new generation of lawyers is being programmed to prioritize mediation strategies as a form of conflict resolution, why not allow them to acquire this skill set early on? Why not enable lawyers fresh from law school to learn how to mediate professionally?

Eventually, for many personal and professional reasons, I decided that I wanted to leave the field of law behind me. I keep paying my bar fees, just in case I change my mind,

but I don’t think that’s likely. As you read on, you’ll see that this new path led to many roadblocks as well.

My Research Lead To My Personal Journey

Consequently, my new research emerged. After years of deep work on myself in therapy, yoga, and self-development, I decided I wanted to help people through their own personal journeys in a similar way.

Ergo, my research focused on finding a career where I could help people develop their self-knowledge, emotional capacity, and self-acceptance and help them expand and evolve.

I wanted to deep dive into their past traumas and help them create the most fulfilling lives possible. In addition, I wanted to explore their developmental issues and their coping mechanisms. Moreover, I had the need to work through their inner conflicts, etc.

There were several options in Quebec that resembled my description; here is a list of careers that I have explored (This is by no means an exhaustive list):

  • Mental health coach
  • Psychologist
  • Social worker
  • Marriage and family counselor
  • Sexologist
  • Psychotherapist

I crossed becoming a mental health coach off my list pretty quickly when I realized that there was no in-depth training I was looking for. Most of the training was six months to one-year training. Sure, the classes were truly compelling, but I personally felt the curriculums to be centered around problem-solving.

The Need for a Deeper Understanding

And while problem-solving is fantastic, I also wanted to learn how to explore one’s conscious and unconscious facets. And although I know many coaches have extraordinary abilities and knowledge, I wanted more thorough training to feel prepared and confident in my work.

I also understood that becoming a coach in this province could potentially leave me unprotected and unguided legally, which was scary. The coaching field is not yet regulated, but the International Coaching Federation (ICF) is there. This institution assures that schools that have their approval stamp meet specific standards.

That being said, I will say that there are so many interesting, enriching coaching programs. In fact, I have done a few myself and am completing an ICF-accredited coaching program that has been incredible and so transformative. I learned so much about asking powerful questions, building rapport, holding space for someone, and so much more.

However, as the founders have repeatedly disclaimed, this type of training does not prepare us to perform therapy with our clients. I knew I wanted to learn how to lead people through their rehabilitation with therapeutic processes, and the coaching training would not help me in that aspect. Thank you, next.

I’d be lying if I said I’ve never dreamed about becoming a psychologist. What a mind-blowing specialty to be an expert in psychology. The process of stepping into those shoes was not so promising for me.

To practice as a psychologist, I would need to do a propédeutique period before a master’s degree since I do not have a bachelor’s in psychology, then do my master’s, then get my Ph.D. After that, I would need to finish it off with a ton of clinical work. It goes without saying that completing these programs would take many years of strenuous work.

The Search for the Tangible Training in Psychology

From what I could gather, though, most of the psychology programs are based on more of a medical model and oriented towards neurobiology which wasn’t exactly what I was looking for. I wasn’t looking to administer psychological tests or diagnose anyone.

I wanted more interactive, communicative and tangible training to help people find themselves. Either way, after extremely rigorous studies in Law, I wasn’t ready for this big of a commitment. I was surprised to find that doing a master’s in psychology would not be sufficient to allow me to perform any kind of therapy. This was disheartening, but I continued my probing.

Social Work? Still No. I Wanted to Be the Support, Not Refer to Support

Furthermore, looking into social work as a potential career path seemed promising. The curriculums were engaging, and I found out that I could get into the social work order by simply getting a bachelor’s degree in social work or doing a master’s in social work. However, this still meant that I would need to do a propédeutique period if I decided to go with a master’s degree.

I noticed that social work integrated issues of social justice and anti-oppressive practices. Social workers can be trained to perform psychotherapy, but without that training, the emphasis of their work is focused on connecting people with their community and support services there. I wanted to be the support, not refer to support. Social work was not quite what I was looking for.

I then heard about the Marriage and Family counseling masters offered at Mcgill through a professional. I was thrilled. Although I mostly want to do individualized therapy, this was the closest I had gotten to the goal. Furthermore, pursuing this master’s would get me directly into the Social worker and family counseling and marriage counseling order and immediately admissible to receive my psychotherapy permit. Excellent!

Unfortunately, when communicating with the Student Affairs Coordinator, I gathered that only ten students were admitted into the program per year with an average GPA of 3.7.

Now, I’m all for being optimistic, but I had several conversations with Mcgill representatives for different programs in which my GPA didn’t fit the description and was told flat out that I would not be considered. Nevertheless, I was still hopeful and checked to see if any other university offered this master’s. None, niet, nada.

At that point, I stumbled upon the most exciting curriculum.

Sexology Truly Is a Sacred Work. However…

I reached out to an administrative assistant from the Psychology order of Quebec to ask her a few questions about obtaining a psychotherapy permit. I learned that the sexology master’s was a good option for what I was looking for because they offered a lot of clinical work, which would further help my application for the psychotherapy permit.

Similarly to the social work masters, I would also need a propédeutique period before the master itself. Nevertheless, the curriculum was fascinating, and I sincerely believe that a sexologist’s work is as crucial as ever. The world is waking up to the importance of understanding our connection to our bodies.

Moreover, humans are opening up to sexuality and the correlation between trauma and psychological blocks in the sexual realm. This work is sacred. Despite that, I knew this kind of sex work was not my calling, not for now, at least. Eventually, I landed on specifically researching the psychotherapy permit.

How Does One Become a Psychotherapist?

The Permit is managed by the Ordre des psychologues du Québec. These are the prerequisites, as published:

  • Being a member of one of the following orders:
  1. Ordre des conseillers et conseillères d’orientation du Québec
  2. Ordre professionnel des criminologues du Québec
  3. Ordre des ergothérapeutes du Québec
  4. Ordre des infirmières et des infirmiers du Québec
  5. Ordre des psychoéducateurs et des psychoéducatrices du Québec
  6. Ordre professionnel des sexologues du Québec
  7. Ordre des travailleurs sociaux et des thérapeutes conjugaux et familiaux du Québec
  • Having a masters in the mental health industry/ human relations
  • 765 hours of theory in psychotherapy at the university level
  • 600 hours of a stage in psychotherapy

I unreservedly understand why the requirements are so grueling. Working with people on such an intricate and intimate level is a sensitive matter.

And yet still, I find it particularly puzzling that there be the necessity of belonging to one of the listed professional orders. Why is it that with a master’s in psychology, I would not be admissible for the psychotherapy permit, whereas a master’s in sexology or in social work would allow this access simply for being a part of the respective professional orders?

I’ve asked many orders if maybe doing a master’s in counseling would be sufficient to let me in their order. This way, I would be able to directly apply for a psychotherapy permit, but not surprisingly, they answered that this would not be possible.

To be more specific, they mostly responded that I would need to take ample classes to make up for the fact that the master was not explicitly tied to the subject of the order, and even then, they could not tell me for sure because I would need to put in a formal application. However, upon this application, they would be able to tell me what classes I would need to be accepted into the order.

What I mean by that is that I had no way of knowing until trying a master’s and some courses and asking the professional order formally if this was enough or simply by doing the actual masters tied to the professional hierarchy and getting directly into the order after my application. I didn’t even want to be a part of any of these orders or do their masters for reasons already explained, but I felt more and more like this was the only way.

Professional Order Benefits Are Considerable

Admittedly, belonging to a professional order comes with many benefits. It provides guidelines, ethical standards, networking opportunities, mentorship opportunities, and training, among many other advantages. Although it cannot be denied that professional orders put in place regulations to protect professionals and patients, couldn’t the Ordre des psychologues du Quebec (OPQ) create its own subcategory for psychotherapists?

For instance, someone who has done their masters in the mental health industry and or human relations, their 765 hours of theory in psychotherapy at the university level, and their 600 hours of the stage in psychotherapy could fall entirely under the OPQ’s umbrella instead of needing to be a part of a separate order.

I understand this would require some changes in legislation surrounding the OPQ and maybe even several different orders, but there will never be a better time for this.

Or perhaps, we could fall under Canadian Counseling and Psychotherapy Association. For this, we must hold a Master’s degree in counseling or a related professional field and meet the CCPA’s certification criteria. Then, to sum up the rest of the certification criteria, we would need some direct practice, supervisor qualifications, references, and a criminal background check, as published in the Canadian Counseling and Psychotherapy association Certification Guide.

I considered becoming a part of this association and working in Quebec, but I will explain why this is a tricky business in a few paragraphs.

The Psychotherapy Permit Process Is Too Complicated

I’m a disability case manager, and I am constantly exposed to clients struggling with their mental health with nowhere to turn to. Since the pandemic, many mental health professionals are no longer taking new clients. They are overwhelmed. The waiting lists to see a psychotherapist, social worker, or psychologist are unending. People are in crisis. We are finally in an era where seeking help is less and less seen as a weakness and more and more a sign of wanting to grow and heal, but this isn’t even an option for many people in Quebec because resources are limited.

In fact, about 1 in 5 people in Quebec will experience some kind of mental illness throughout their life. Yet, despite that, less than 50% of the people who experience mental illness consult a professional published by the Government. For those who have the resources and the desire to seek help, shouldn’t we give them the best fighting chance possible to find a professional who will best suit their needs?

The Precise Definition of Psychotherapy

Meanwhile, not only is it complicated to get this psychotherapy permit but what you can and cannot do with it is incredibly confusing. To compare and contrast, here is the Ordre des psychologues definition of what psychotherapy is, followed by a list of what is not considered to be psychotherapy:

“Psychotherapy is a psychological treatment for a mental disorder, behavioral disturbance, or other problem resulting in psychological suffering or distress. Its purpose is to foster significant changes in the client’s cognitive, emotional, and behavioral functioning, interpersonal relations, and personality or health. Such treatment goes beyond help and aims to deal with everyday difficulties and beyond a support or counseling role.”

Here is a list of what is not considered to be psychotherapy:

  • Support intervention to support a person so that the person may maintain and consolidate acquired skills and adaptation strategies by targeting strengths and resources through regular or sporadic meetings or activities. The intervention includes reassuring, advising, and providing information related to the person’s condition or the experienced situation.
  • Conjugal and family intervention is designed to promote and support the optimal functioning of the couple or family by utilizing interviews that often involve all the family members. Such intervention is intended to change the factors in the functioning of the family or couple that impede the couple’s or family members’ blossoming or offer assistance and advice in the face of everyday life’s difficulties.
  • Psychological education is intended to teach skills through the information and education of the person. Such instruction may be used at every step of the care and service process. It consists of teaching specific knowledge and skills to maintain or improve the person’s autonomy or health, mainly to prevent health or social problems, including mental issues or the deterioration of their mental condition. Such teaching may pertain, for instance, to the nature of the physical or mental illness, its symptoms, its treatments, including the role that may be played by the person in the maintenance or restoration of his health, as well as stress management techniques, relaxation techniques, or assertiveness techniques.
  • Rehabilitation aims at helping a person deal with the symptoms of an illness or improving the person’s skills. Such rehabilitation is used, among other things, with persons suffering from significant mental health problems so that they may reach an optimal level of autonomy towards recovery. It may form part of meetings to accompany or support the person and include, for instance, the management of hallucinations and the practice of day-to-day and social skills.
  • Clinical follow-up consists of meetings to update a disciplinary intervention plan. It is intended for persons who display behavior problems or any other problem causing suffering or psychological distress, or health problems, including mental problems. It may involve the contribution of various professionals or interveners grouped in interdisciplinary or multidisciplinary teams. Such follow-up may be part of an intervention plan within the meaning of the Act respecting health services and social services (chapter S-4.2) or the Education Act (chapter I-13.3), take the form of meetings or interventions to accompany or support the person and also include psychological rehabilitation or education. It may also include the adjustment of pharmacotherapy.
  • Coaching to update one’s potential by developing talents, resources, or skills in a person neither in distress nor in pain but who expresses particular needs in terms of personal or professional achievements.
  • Crisis intervention consists of an immediate, short, and directing intervention adjusted to the type of crisis, the person’s characteristics, and their surroundings. It is intended to stabilize the person’s condition or environment in connection with the crisis situation. That type of intervention may involve exploring the case and assessing possible consequences, for instance, the danger potential, suicidal risk or risk of decompensation, defusing, support, the teaching of adaptation strategies to deal with the experienced situation, and orientation towards services or care more adapted to the needs.

I personally love to read and research and have taken several classes in law school to help me interpret what specific words might mean in different contexts, but when reading about what was considered to be or not to be psychotherapy, I was dumbfounded.

So Many Fine Lines, So Many Gray Zones

I have even met professionals who have gotten in trouble for unwittingly crossing this line. This can lead to severe repercussions legally, financially, and reputation-wise.

I know I am not the only one bewildered concerning all of the blurred lines. I’ve spoken to countless professionals and individuals from the different orders listed to determine if they fully understood the differences. They did not. They, too, were distraught.

Quebec Should Help Those Who Feel This Profound Calling

Alas, Quebec needs to make the psychotherapy permit more accessible and intelligible for people like me. For the people who feel a profound calling to help in this paramount field of work but are discouraged because of how complicated it is to obtain the psychotherapist permit and the complexities of what therapy means and what it does not.

But, on the other hand, everyone I’ve spoken to from each order, particularly the OPQ, was obliging, courteous, and bright. That’s why I know that Quebec’s professional orders can do better. Maybe the OPQ truly is doing their best, but as our dearest Maya Angelou has said, “Do the best you can until you know better. Then when you know better, do better”.

Written by:
Bianca Zawadzki
Please email me if you would like to discuss the topic at [email protected]