Commonly reported among creative clients and those with ADHD is a sense of agitation around apathy.  A combination of low mood and energy, confusion about what a person wants or needs but not feeling settled.  In this state one can spend hours coming up with ideas about what to do, and feel a strong sense of missing out.  It is akin to chasing a tail in circles.  It leads to frustration.  Basically, it is an unsettling feeling or impulse that one must do something or figure something out and not being able to.  It emerges when there is little structure.  What is the best thing to do when feeling this way?  Realize, like a little bit of anxiety, it can help to use mindfulness and relaxation.  Radical acceptance works too.  Speaking to oneself by journal or outloud saying compassionate things and accepting things helps.  

by Shirley Katz, Ph.D., RP, Clinic Director
Many people come to therapy without knowing if their therapist has the background to meet their needs.  Sometimes extended health insurance specifies what kind of credentials are needed for coverage to apply.  Clients need to know the differences between practitioners before choosing.  The following information is meant to help potential clients navigate their decisions.
In Ontario, Psychotherapy is a controlled act, considered a healthcare activity that is legally restricted to authorized regulated professionals related to the risk of harm if it is performed improperly. For Registered Psychotherapists, the controlled act is “Using psychotherapy to treat a serious disorder of thought, mood, cognition, perception, memory, or emotional regulation that significantly impairs a person's functioning”.  Outside of the controlled act, psychotherapy or counselling can include stress management, personal growth, supporting someone through life transitions or with general relationship concerns.  Treating a person with severe or serious mental health concerns or diagnosed issues that impair functioning is usually classified under the controlled act.  It applies when treating a serious mental health disorder through psychotherapy, not simply providing support, education, or guidance.  Counselling, support and guidance are not regulated or controlled – hence anyone can call themselves a Counsellor or “Therapist” in Ontario without being trained or regulated, although some may seek membership in a professional association that requires and verifies certain amounts of training.
In Ontario, the controlled act of psychotherapy can only be performed by regulated professions who are authorized to do so.  This includes Registered Psychotherapists (RP), Doctors, Psychologists and Psychological Associates, Registered Nurses and Nurse Practitioners, Occupational Therapist and Registered Social Workers and Social Service Workers.  The regulatory bodies determine if their members require specific and/or additional training and supervision and how they determine that this training is appropriate or adequate.  The following is a breakdown of the requirements of each regulatory body for the practice of the controlled act as well as for supervision.
Registered Social Workers and Registered Social Service Workers performing the controlled act of psychotherapy are required to have the necessary psychotherapy education, supervised experience, and competence to do so safely and effectively.  The Ontario College of Social Workers and Social Service Workers (OCSWSSW) does not determine in advance whether a member has sufficient psychotherapy training.  Instead, the member is responsible for ensuring and being able to demonstrate that competence if their practice is reviewed related to a complaint, for example. An RSSW typically has a 2-year college diploma, and an RSW typically has a BSW or MSW. Both can legally provide psychotherapy if they have the appropriate training, supervision, experience, and competence.  It is noteworthy that not all social work training is clinically focused as some programs focus on social justice work.  Regarding clinical supervision, the OCSWSSW expects a supervisor to be an experienced, competent psychotherapist with appropriate clinical expertise and supervision skills.  At this time, it is not mandated that a Social Work Supervisor have specific or minimum supervision-training program to supervise OCSWSSW members however if supervising members of the CRPO they do need to meet certain requirements including training in Supervision and completion of a Supervision Module with CRPO.
College of Occupational Therapists of Ontario (COTO) regulates Occupational Therapists.  Their members are specifically required to have formal psychotherapy training (including supervised practical training) or an equivalent combination of training and experience before performing the controlled act of psychotherapy.  They do not determine the qualification of supervisors.  If supervising members of the CRPO they are required to meet requirements including additional training in Supervision and completion of a Supervision Module with CRPO.
The College of Nurses of Ontario does not require a specific psychotherapy certification, number of supervision hours, or approved training program before a nurse performs psychotherapy. Nurses are responsible to ensure that they have the necessary knowledge, skill, and judgment to practice psychotherapy competently and safely. They use a self-assessment model similar to social work.  To supervise members of CRPO they must meet specific requirements and complete additional training in Supervision and completion of the Supervision Module with CRPO.
The College of Physicians and Surgeons of Ontario (CPSO) member physicians can practice psychotherapy.  They typically do not need additional authorization however they are expected to practice only within their competencies.   Psychiatrist members typically receive psychotherapy training during residency.  In Ontario due to high demand and long waits, psychiatrists tend to spend more of their practice on assessment and medication management than on providing ongoing psychotherapy. To supervise members of CRPO they must meet specific requirements plus additional training in Supervision and completion of the Supervision Module with CRPO.
Specific members of The College of Psychologists and Behaviour Analysts of Ontario (CPBAO) are authorized.  Psychologists and Psychological Associates are authorized to perform the controlled act of psychotherapy and typically enter the profession with graduate-level training and supervised clinical experience. Behavioral analysts are not authorized to practice the controlled act.  Historically in Ontario, a Psychological Associate had a Masters’ degree (followed by many hours of supervised practice) and a Clinical Psychologist had a Ph.D. with several additional years of formalized education in psychotherapy, assessment, diagnosis and report writing beyond the Masters’ level training.  However, related to inter-province mobility, some Registered Psychologists in Ontario are fully qualified with a Master’s level degree.  Rates for Psychologists and Psychological Associates tend to be higher, with more demand and longer wait times due to their ability to assess and formally diagnose. To supervise members of CRPO they must meet specific requirements plus additional training in Supervision and completion of the Supervision Module with CRPO.
The College of Registered Psychotherapists of Ontario (CRPO) regulates Registered Psychotherapists.  To be a member, one must have specific education and extensive supervision after graduation before practicing independently.  Members in the “Qualifying” category are authorized to practice with significant oversight from supervisors.  Supervisors must have at least 5 years of experience and have completed specific education related to being a supervisor.  A Registered Psychotherapist (RP) typically completes a dedicated psychotherapy education program (often at the graduate level) and must demonstrate psychotherapy-specific competencies as part of registration.
In summary, members of several professions can perform the controlled act.  They may develop psychotherapy competence within their profession and some within their training, whereas Registered Psychotherapists enter the profession through a specialized psychotherapy training and competency pathway that is focused on delivering Psychotherapy.  Not all psychotherapy falls under “The Controlled Act of Psychotherapy” such as supportive counselling.  Third parties paying for therapy such as insurance companies may determine which services and service providers are covered.  Provinces differ on how and if they regulate psychotherapy and counselling.  Potential clients should always check with their insurance and ask their therapist any and all relevant questions before getting started.  
 

Shirley Katz, Ph.D., RP, CCC, Clinic Director

Use of AI is rapidly growing and working its way into conversations about mental health.  Clients often tell us they use chatbots to support their work in therapy or compare it to their therapy.  At our practice, we do not use AI to generate ideas or treatment suggestions.  Some therapists may use it with client permission to write their notes, but only a confidential, legally compliant health related system.  Most of us prefer to use the writing process to reflect on our therapeutic relationship, goals and progress and to make plans for follow up sessions. This also consolidates memory.  Its how we spend more time processing a case even when we are not client facing.  Overall, we discourage the use of AI tools to substitute or compare psychotherapy experience.  This is not based on fear of technology but more so about ethics, regulatory responsibility and what the science actually shows about the topic.  There are good reasons.
Psychotherapy is a regulated health profession, not a wellness or self-help tool like a workbook.  Therapy is relational and interactive.  It is also controlled by the College of Registered Psychotherapists of Ontario (CRPO) and also has standards related to client safety, informed consent, confidentiality and privacy, competence, scope of practice and limits, crisis and risk assessment and intervention, accountability and professional liability.  AI systems are not regulated professionals.  These systems cannot hold licensure, be held accountable for competency, or be disciplined for ethical or privacy breaches.  They are not human and do not offer attuned health attachment-based experiences.  Therapeutic relationships are the cornerstone of mental health treatment.   
Research on the topic has shown that when AI systems take on therapist‑type roles, they operate outside existing health‑care regulation demonstrating serious gaps in protection for clients.  Studies further found that even when AI was asked to follow evidence-based models it violated core ethical standards showing problems with boundaries, inappropriate reassurance and failures in handling potential risk or crisis.  Licensed clinicians are required to practice in ways that protect the public.  Offering or endorsing tools that have known ethical problems does not meet that obligation.  Therapists at our clinic would likely ask clients to refrain in using these tools. 
Another issue that comes up with the use of AI actually pre-dates it.  Historically, there has always been concern about clients seeking therapy from multiple, non coordinated sources. This emerged from an ethical principle called nonmaleficence (do no harm) and supported by ethics of fidelity, integrity and responsibility. When client care is uncoordinated, they can get conflicting input leading to potential confusion or overwhelm which can undermine the effectiveness of treatment.  At the very least, if clients are seeking input from AI they should be discussing how it is impacting them and ensure that it is coordinated information, which supports reflection or skills practice in line with the treatment goals of therapy and not harmful, confusing or contradictory.
It is essential to remember that AI systems do not do well at identifying and managing risk.  Crisis care requires human accountability and judgement.  AI is inconsistent and unreliable in this regard and does not escalate proper supports. Conversely, a trained therapist knows how to assess risk over time, due to the emphasis on alliance and an ongoing therapy relationship, noting any subtle shifts or incongruence for example. They are obligated to respond and accountable if harm occurs and was mismanaged.  For example, therapists have a duty‑to‑warn when there is impending harm, a duty‑to‑protect, a duty to report.  Emergency response protocols are not optional.
Therapy happens by a real human relationship that requires tuning in, building rapport, assessment, repair of rapport if there has been a rift, reflection on that relationship strength, embodied presence over time, genuineness, etc.  It’s a central mechanism of change.  Most clients have experienced their hurts in the context of relationships, and healing and relearning happens in the context of a human relationship.  The relationship is central to the treatment in all modes of therapy.  This is evidence based.  Conversely, research has demonstrated that AI’s empathy is not relational, it’s performance. Clients can feel comforted in the moment or reassured, while being misunderstood or misguided in meaningful ways that impact how they cope or respond in human circumstances.  This can further create a problem if people do not access real care or if they have trauma, as they can mistake an AI response as a replacement for real human relational witnessing and safety.  
Further problems include how these systems are based on data generated by humans and reflect bias, such as demonstrating greater stigma towards certain diagnoses.  For clients who are marginalized this can be harmful.  In regulated practice ethics emphasize justice, equity, inclusion and cultural safety. 
Overall, the evidence base for the utility of AI in mental health is very limited and large, peer reviewed studies conclude that it is not supported as a replacement or adjust for professional, human relationship-based therapy.  It is also not confidential.  AI systems do not meet Canadian consent and privacy standards for mental health data use and storage.
Our position on AI is that it may have some use in administrative support when used cautiously and with human oversight.  Psychotherapy is human, relational, ethical and regulated.  AI systems currently do not offer that.   Choose therapy not AI.  Human healing happens in a relationship with all its potential imperfections.  Change that happens in such relationships reflects what it is to be human.  If you want to discuss how your use of AI may fit into your mental health plan or progress please ask your therapist. You are not a robot, and neither are we.