Psychotherapist vs Psychologist vs. Social Worker in Ontario: Which Mental Health Professional Is Right for You?

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.