March is National Social Work month! The Canadian Association of Social Workers advises you to celebrate the profession with colleagues and friends. There have been significant changes to social work in the past decade. Each province and territory oversees the profession, such that social work is regulated differently across Canada. There are essential codes of ethics and standards of practice that we all share. Similar to other professions, Social Work is regulated by professional colleges, again at the provincial levels. The Canadian Association of Social Work, CASW, is not a regulatory body and is principally designed to support and grow the profession and professionals similar to the Ontario Association of Social Workers, OASW. Depending on the sector of society in which the social worker is employed like education, healthcare, or criminal justice, there are specific bi-laws and legislations that oversee the mandatory duties to protect clients and their families. So, the landscape to practice social work in Canada is quite complex.
Closer to home for me here in Ontario, with the enactment of the Psychotherapy Act in 2007, clearer definitions of providing the “controlled act” of psychotherapy was developed formally. This legislative definition ensures that only trained and qualified professionals engage in services designed to “treat” serious mental, emotional, and cognitive disorders using specific techniques. The act reads as follows:
Treating, by means of psychotherapy technique, delivered through a therapeutic
relationship, an individual’s serious disorder of thought, cognition, mood, emotional
regulation, perception or memory that may seriously impair the individual’s judgement,
insight, behaviour, communication or social functioning (Regulated Health Professions Act, 1991, section 27 (2)14 retrieved from http://www.e-laws.gov.on.ca).
Social Workers were acclaimed under this act ten years later in 2017. This means that social workers with mental health training can legally provide psychotherapy and be referred to as a Social Worker, Psychotherapist (OCSWSSW) in Ontario. Social Workers are expected to engage in annual training, and professional development to ensure that their qualifications are up to date and expert known as the Continuous Competence Program, CCP. There is no real formal requirement to have additional certifications in a specific psychotherapy model in order to provide services, as most professional social workers develop nuanced eclectic models of intervention that integrate evidence-based strategies and skills found to be most effective for use in that field. For example, my early formation as a professional social worker occurred in children’s mental health services, where interventions offered included a blend of play-based, cognitive behavioural, narrative, attachment-theory, psychodynamic approaches, and more. The training and work was irreplaceable. Learning in the field is where it happens best, and the profession sets a high standard to ensure that practices grow to meet the needs of clients. Most of my professional training and development was also provided by the employers I worked for over many years. Monthly trainings, annual conferences, professional seminars were regular aspects of workplace expectations, which supported the professional requirements of the college as well.
Counselling is defined differently under the law, and is usually rendered by a larger group of professionals, assistants, aids, support staffs and more. Counselling is generally less directive and does not claim to “treat” serious disorders that impair judgement or functions. Instead, counselors aim to guide, support, advocate, connect, navigate both with and on behalf of clients seeking care. Of course, supportive counselling has therapeutic merit, and for some people there is no need for psychotherapy services per se. Having the ability to assess this difference is also more important than ever, now that professional psychotherapists can offer services through health insurance plans. Does your client really need psychotherapy? Are you professionally prepared to provide psychotherapy, or are you better suited to offer counselling?
For those of us in the field for over thirty years, some of these changes in Social Work have been excellent. Further defining what we do, and how we do it is always important in fields that wish to grow, remain competitive, and excellent. In my view, professional social workers are best equipped to lead these significant changes on behalf of clients and the public, as most of us working in large publicly funded institutions fully understand the unintentional negative impacts created by systemic processes. The spaces where systemic hiccups occur are usually discovered in the field, in practice, and with people. Clients complain about problems with processes in systems, and social workers do our best to empower people to overcome any challenges created by these hiccups, disruptions, or in some rarer cases, unintentional harm.
Specifically, questions related to consent around personal health information is an excellent example of systemic processes that clients have complained about to social workers in child protection; education; mental health; sexual health; healthcare; and criminal justice for years. When and how professionals share information about a minor or adults without consent has caused quite a bit of chaos in all systems over the past two decades. Again, with the creation of the Personal Health Information Act or PHIPA in Ontario, this freedom to speak to collateral service providers about clients without formal verbal or written consent is simply no longer possible, except under certainly extreme situations that can be reviewed independently at the Ontario College of Social Workers, and Social Service Workers.
Similar to other seasoned social workers who have decided to offer some private care, I have been approached to formally supervise qualifying psychotherapists. So, I thought it prudent to also explore registration with the College of Registered Psychotherapists of Ontario, CRPO. I initially assumed that as a professional social worker, psychotherapist with so many years in the field currently owning and operating a fully independent and successful private practice, my application would be streamlined. However, this ideas was naïve and presumptuous. Of course, I passed their jurisprudence exam, and learned some significant differences between our two colleges. I learned that “psychotherapists” defer to the medical team as the “circle of care” whereas social workers would view the family as the primary circle of care. Social workers would work hard to inform clients and families about each process of medical intervention and defer to them around recommendations made by a medical team. For example, your attending physician and occupational therapist recommend the following, do you and your family believe this recommendation would work in your case or situation? Where there is disagreement, the social worker would advocate with the medical team and mediate some concessions on behalf of the family. It is not social work to persuade a family to buy into recommendations that they decline based on a variety of legitimate reasons that has nothing to do with incapacity to make decisions, or due in part to that often over-used word to characterize non-complying clients as “resistant” or resistance.
I also learned that my Master of Social Work Degree, my placements in child and family therapy at the Hinks Dellcrest Centre, and my years of experiences in the field did not in and of itself meet the criteria for registration with this CRPO college. Instead, they sought evidence of certifications, and course work to prove that I am able to adequately provide psychotherapy services that I currently provide. After spending close to a decade working on a doctor of philosophy degree in education, I simply decided to stop pursuing this double registration. I have remain committed to staying in my own professional lane and to withdraw my supervisory support to qualifying psychotherapy students.
I was fortunate this year to teach at my alma mater, Factor-Inwentash, Faculty of Social Work at the University of Toronto. I was assigned to teach, Essentials to Social Work Practices & Lab, which of course ought to have been a perfect fit. I have learned that students of social work do not yet see the ethical issues presented by the nuanced spaces of disempowering processes that hinder social work in the field, thereby misrepresenting the needs of clients seeking service in that sector. The challenge for me moving forward will be to find the balance between theoretical considerations in social work and practice implications – really only best understood by new social workers in casework in the field.
I have explored the margins of social work and often push the limits of my own practices in my client’s best interests. So, for example, I do provide some Wellness Services under a second business in my practice, where I draw on Clarity & Executive Coaching Models to corporate clients whose work and family demands create consistently high levels of stress. I continue to use my title, Social Worker, Psychotherapist as per usual, since my professional identity is so truly informed by this privilege to journey alongside people seeking support, guidance, connection, counselling, psychotherapy, and wellness. I recently had a medical emergency of my own, and remain under the care of a team of specialists hoping to return to my post by late spring.
Thank you social worker today and reap the benefits of hard work!
Happy Social Work Month Canada.
Lisa Romano-Dwyer, BSc, MSW, PhD, RSW