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

Repurposing empty commercial retail is simply a smart update in Ontario. In Toronto, many of us noticed closures of stores and retail in hot spot locations like the Danforth, the Beaches, and even in the central downtown core.

We wondered what would happen to local communities as younger consumers continued to prefer online shopping. In part, my own mental health and wellness practice aimed to keep professional health services local and easily accessible for people choosing private options.

Of course, having no idea that soon after the ink dried on my commercial lease agreement the city would be under Covid lockdown, my timing for offering in-person counselling and wellness service options proved to be unwise.

Nevertheless, the local East Toronto community was extremely supportive and explored virtual services offered through my small business. Fortunately, my company continues to thrive. In fact, leasing local unused commercial real estate is most welcome to landlords. Professional health services are clean, less noisy, and risky relative to other businesses in Toronto.

The current decision to support day surgeries, like my own endoscopy in office towers really works well. In truth, these services are already happening.

Patients seen in professional sites in local communities will decrease pressures on hospital staff by reducing the volume of daily traffic in larger institutions. It will also reduce everyone’s risk to spreading viral infections and diseases by diverting people to locations that have fewer extremely ill patients on-site.

The view that Smart Innovation in healthcare is code for privatization smacks of conspiratorial rhetoric that has been fueling fear in this province for decades. Where public dollars are used to support the decentralization of services in hospitals by allowing a range of care to be provided locally is just smart.

I envision our city lined with easily accessible professional offices in lieu of retail shops offering health, legal, and medical services. The call to convert some retail space into affordable housing is also a smart idea!

Toronto is an amazing city that lifers like me hope to keep vital and healthy. Jumping at the opportunity to offer private regulated mental healthcare services once enacted under the Psychotherapy Act was also a smart next step for someone with my tenure in the field. I can make work-life truly balanced.

Certainly, many clinicians provide virtual care exclusively without any need for traditional office space. Some of my clients appreciate having the option to meet in person or online. Deciding to retain my lease beyond the current contract will be based on many factors as costs to run my business have risen in all areas.

Looking forward to the future!

Lisa Romano-Dwyer, Owner

For centuries, alternative health practitioners have explored the healing potential of natural rhythms and vibrations of the earth itself. The view that Mother Earth possesses healing powers to restore itself is substantiated by examples of positive long term outcomes following natural disasters such as forest fires, and droughts where local ecosystems bounce back over time. The acute or chronic negative impacts of nature’s chaos on itself is often reversed or set-right by a homeostatic flow back towards stability, evenness, and wholeness. Nature has a way to settle itself even after horrifying events threaten or kill ecosystems. Nature by definition is a life-force, or a force of life that propels itself forward in a perpetually regenerative motion at a molecular and perhaps quantum level. When the world is silent, and when you are silent in the world, it is possible to feel the earth’s vibration created by life’s regenerative motion.

I am often reminded about the alarm bells ringing in Ontario over the purple loofstriffe plant debacle of the time that warned people about this plant’s ability to suffocate fresh water systems in smaller lakes, creeks, and bodies of water outside the city. Similar alarms were raised about the health of declining frog populations and birch trees across the province as well. Although distressing trends and warnings were real at the time, these shorter-term impacts did reverse. I witnessed the revival of the beautiful birch tree, diverse fresh water shorelines, and rebounding frog populations firsthand as a cottage owner for over twenty-five years.

As a therapist, these examples of nature’s resilience both taught and reminded me about healing. People, like the earth ebb and flow between periods of good health and happiness, and poor health and distress. This is a natural flow, an oscillation of physical and mental well-being that like Mother Earth herself is in constant motion. Even when the earth is silent and still, similar to the experience of looking up at the stars on a dark clear night while standing on an expansive field, you can feel the earth’s vibrations. So too, when you allow yourself to be still and silent, will you begin to feel your own vibrational life force. This journey into the self is only possible when you learn to practice what being still feels like. Being still with yourself will allow you to get in touch with your personal life energy and to grow in familiarity with it, who you really are, and for those in need, how to heal.

Your healing journey in this sense requires that you trust your own natural regenerative force to continually drive you forward to a state of balance that simply feels good and right to you personally. A state of wellness is an entirely subjective and personal assessment. Only you know how you feel. One of the most rewarding aspects as clinician for me is the privilege to witness so many people grow into themselves lovingly. In recent times, my high achieving clients have been asking me where this need and desire to think about the “next” personal goal comes from when their list of achievements is already so long! Posed in this way, ambitious people begin to appear to be suffering with some sort of compulsion to achieve that is pathologically manipulated to block the completely appropriate and healthy desire to achieve more. It is not your personal drive towards success and achievement that is unhealthy, but rather the tendency of a few to pursue ambitious goals without concern for personal wellbeing, the wellbeing of family, community, society at large, and the earth. It is this compulsive desire to achieve without consequence that contaminates your regenerative life force by threatening your own health and wellness in so doing.

When you begin to practice self-awareness in body, mind, and spirit by learning to be still and feeling your own life force, you will grow more and more attuned to what you need and want in your life. A less common but strongly suggested New Year’s Resolution for yourself is to learn to be still with yourself -to feel your own personal vibration or life force and to enjoy it. You will begin to see the places and people in your life who align, compliment, and boost your vibrational energy levels, and those people and places that do not. You will begin to trust your own feelings and allow them to guide you forward on decisions at work, home, or leisure. You will learn to separate the stressors and emotional pain of others from your own without a loss of compassion or care. You will learn to be available to the people who need and love you without disrupting your own inner sense of balance. The notion of finding purpose in the New Year must have this emotional aspect for you to get it right. In other words, continuing to live your life without this deep sense of awareness of yourself in nature is bound to lead you in directions that you cannot trust. None of us can trust decisions that are void or emptied of any personal or emotional feelings.

On the other hand, your personal life will vibrate with serenity and peace when you trust what you feel, even in the face of multiple demands. Give yourself the gift of personal awareness this New Year, and begin to find or reclaim purpose in all the little things that make up your life. Achievement means different things to different people, as it ought! If your desire this year is to learn how to knit like your grandmother did, to become the CEO in your company, to get married, to start a family, or to start a business, it is your life force that propels you forward as life has a way of doing. Make your New Year promise to yourself to protect that innermost gift of your own nature to be whole, happy, and well no matter where your life journey takes you.

Happy New Year in 2023!

Lisa Romano-Dwyer BSc, MSW, PhD, RSW