Buyer beware: Do some research before engaging in online talk therapy
As stressed Canadians increasingly turn to talk therapy to deal with self-isolation, it is important to know that the world of online emotional support is still an unregulated wild west.
Mental health, emotional support and personal growth are big business. Counselling and therapy apps Talkspace and BetterHelp are just two of many online services with more than 1 million users each. It’s not surprising that social media is overflowing with ads for online therapy and sponsored posts from influencer “life coaches” trying to take their bite out of the market.
The branding and cost-effectiveness of these services advertised on social media may seem attractive to consumers who have struggled with access and cost of mental health services. However, people who call themselves life coaches, counsellors or online therapists might have vastly different or even lack credentials compared with psychiatrists and registered psychotherapists.
This is not to say that online therapists, counsellors and life coaches should be avoided at all costs. But they shouldn’t be automatically trusted, either. It’s an unregulated world of service providers, including some who may excel more at personal branding than in the areas of expertise they claim.
It’s important for consumers to determine the professional credentials of those advertising on social media. While online therapists or coaches may be well meaning, a lack of training may lead to a misunderstanding of their scope of practice and induce harm. If psychotherapists, life coaches or counselors are not qualified, they might miss important issues or use inappropriate treatment plans, says Barbara MacCallum, CEO of the Canadian Counselling and Psychotherapy Association (CCPA).
Every day, coaches, psychotherapists and counsellors influence their clients when they are in a vulnerable state. An under-trained or unethical mental health professional could cause someone to make poor choices, become dependent or to not seek more appropriate care such as medication. In an extreme example, in 2009, three people died in a sweat lodge ceremony gone wrong led by a self-help guru.
Talk therapy, also called psychotherapy, is the treatment of mental, emotional, personality, and behavioural issues using discussion, listening and counseling. According to the College of Registered Psychotherapists of Ontario (CRPO) website, “individuals usually seek psychotherapy when they have thoughts, feelings, moods and behaviours that are adversely affecting their day-to-day lives, relationships and the ability to enjoy life.” In Ontario, it is a protected title and can be a controlled act. But “therapy” alone is not a protected title.
To become a registered psychotherapist with the CRPO, one must have completed either an approved psychotherapy program, a master’s degree in an approved program, or other education and training considered equivalent by the registrations committee. According to the CRPO website, “Generally, programs are expected to be taught at a graduate level and provide at least 360 hours of training and education central to the practice of psychotherapy, not including direct client contact hours and clinical supervision hours.” Supervision is also required.
The CCPA generally does not differentiate between counselling and psychotherapy, but in Ontario, counselling is a separate and unregulated profession. “In Ontario, counselling is giving advice,” says MacCallum.
The CRPO defines counselling activities as: “Counselling and support, including advising/advice-giving, instruction, assisting in resolution of dilemmas, assisting in improvement of coping strategies,” “Single session counselling” and “Spiritual or faith guidance/counselling.”
As for coaching, it’s less about going back and healing, more about making your life better going forward. “Coaching is really fundamentally about change, and about facilitating change. And it is really about facilitating change from where you are today to where you want to go,” says Lydia Roy, dean of professional coaching at the Adler Graduate Professional School.
Coaching is also an unregulated profession. But the International Coaching Federation (ICF) awards credentials to coaches and accredits training programs that meet their standards. “Coaching is a complex communication process. It’s not something you can learn in school one day and be a professional the next day,” says Carrie Abner, vice president of credentials and standards at the ICF.
A comprehensive coach training program includes, “at least 125 hours of coach training on the ICF core competencies, the definition of coaching and the code of ethics … mentor coaching and a final performance evaluation,” says Abner.
Many online coaches advertise their seemingly impressive credentials, such as “Certified Neuro-Linguistic Programming (NLP) Practitioner” or “Clinical Hypnotherapist,” but both of these certifications are available as inexpensive online courses on Udemy. Unlike psychotherapy in Ontario and other Canadian jurisdictions, these are not protected titles. And these credentials alone do not equate to psychotherapy, counselling or coach training and do not necessarily provide training in scope of practice.
“When I hear individuals who say they do neuro-linguistic programming . . . and also coach, I would really be mindful of that . . . A person who has a specialty in NLP might have also gone through coach training and might offer that specialty in addition to coach training but coach training does not require you to have an NLP background,” says Roy.
Prior to regulation in Ontario, psychotherapy faced similar challenges to those of coaching – that of under-trained people practicing psychotherapy – according to Philip McKenna, a registered psychotherapist who was a member of the transitional council for the CRPO. McKenna says that when the council reviewed the credentials of those who had been practicing, “you wouldn’t believe the number of university degrees from the U.S. that were really just degree mills.”
Many registered psychotherapists in Ontario as well as credentialed counsellors and coaches from all jurisdictions offer Skype or phone sessions, which is perfectly acceptable. But online therapists, counsellors and coaches outside of Ontario who are not registered with the CRPO can’t be held to the same standard as those in Ontario.
This doesn’t mean that it’s unsafe to seek help outside of Ontario. It simply means that Ontario clients of coaches, counsellors and therapists outside of Ontario should research their credentials.
It’s important to understand what help you need when looking into support from helping professions outside of the Ontario health care system and to check the credentials of potential service providers.
For instance, if online coaches have credentials from the ICF, they will be held to its ethical standards and should only work within a professional coach’s scope of practice, no matter where they are.
Similarly, in provinces where psychotherapy is not regulated, an online psychotherapist or counsellor could have credentials from the CCPA and be held to that organization’s standards. According to the CCPA website, in addition to Ontario, psychotherapy or counselling is currently regulated in Quebec, Nova Scotia and New Brunswick. In other jurisdictions, counsellors and psychotherapists can still earn credentials from the CCPA and be held to its standards.
Each of these organizations have directories in which the public can check a psychotherapist, coach or counsellor’s credentials as well as extensive information on what each profession does to help consumers make informed decisions and have ethical standards and procedures to hold the service providers accountable.
Consumers have the right to seek help from whomever they see fit. But if you want to see real change and keep yourself safe, buyer beware. It’s important to be able to see past the branding and pricing and do some research prior to purchase.
Marina Eckersley is a freelance journalist based in Toronto.