The hidden dangers of therapy
Buyer beware: Many counsellors are not subject to regulatory oversight
Kevin McConnell was a man of many charms and talents. But Kevin found himself severely depressed in his 30s. Living in Metro Vancouver, he was not realizing his career dreams.
He attempted suicide in 2014. Kevin’s bewildered partner urged him to immediately see a therapist.
The therapist’s website was attractive and professional looking. So Kevin (not his real name) agreed to talk to her. The therapist asked him to “contract” to not take his own life. The next day, Kevin drowned himself.
Kevin’s mother, Brenda, a psychiatric nurse, and her husband, a retired administrator in B.C.’s mental health system, are struggling to cope with their beloved son’s death. Brenda (not her real name) agonizes over what happened, or did not, during Kevin’s therapy session. Why did the therapist not call 911 or take Kevin to the emergency ward?
Brenda has contacted the therapist, trying to get to the bottom of things. But she’s not getting far.
The therapist Kevin saw — whom Brenda thought was a registered psychologist — does not appear to be a member of any therapists’ association. Thus, there is no professional body to which Brenda can take her inquiries. The therapist is also not a member of a government-mandated regulatory college.
Like many therapists, the woman Kevin took his troubles to operates in a moral grey zone — where codes of ethical conduct are either non-existent, self-created or difficult to enforce. That’s the situation across Canada for tens of thousands of therapists (the generic name for a range of mentalhealth specialists).
Even though millions of people in North America have benefited from therapy, procedures to safeguard patients from reckless therapists are often weak or illusory. And the public, for the most part, has no clue.
It’s not surprising the public is confused, because the situation is indeed confusing.
Some responsible therapists in B.C. are making moves to provide patients with more protection. But they’ve made limited progress. The public remains largely unaware that virtually anyone can advertise themselves as a “therapist,” “counsellor,” “psychotherapist” or “mental health” expert. They can do so without belonging to any professional group, let alone a government-monitored regulatory college.
There is an additional hidden danger: Even some professional associations that represent therapists do a poor job of holding members accountable.
Many associations have haphazard or intimidating complaint procedures. It’s not unusual, for instance, for a patient’s ethics complaint to take years to be heard, let alone resolved.
In the field of therapy, the groups of professional therapists who are an exception to this Wild West “buyer-beware” approach include psychiatrists and registered psychologists. Psychiatrists, who are medical doctors, and psychologists, who have earned PhDs, are expected to belong to their regulatory colleges, which demand adherence to strict ethical codes and which have the legal obligation to investigate complaints and discipline wayward members.
Awareness campaign
Anyone who reads the news will know one of the worst things some therapists have done is sexually exploit patients. But more subtle things can go awry when people in anguish seek help from a therapist, even one who seems kind.
Some therapists can and do make incorrect diagnoses, misread suicidal signs, use unproven psychological techniques, get into financial conflict of interests with patients, provide therapy while impaired by alcohol or drugs, betray patients’ confidences and make clients believe they’re more unhealthy than they are.
It’s not at all easy for the public to sort out the highly trained therapists from the quacks, the conscientious therapists from the arrogant ones or the selfaware therapists from those whose judgment is skewed by their need to be needed. While moves are afoot to increase the regulations surrounding therapists, for the most part these efforts have a long way to go.
A group calling itself the Health Profession Regulators of B.C. Society has launched an awareness campaign that urges the public to become more knowledgeable about which health practitioners are to be trusted. Health Profession Regulators, co-led by nurse Cynthia Johansen, is running an advertising campaign emphasizing that people should seek help from practitioners who are accountable to a regulatory college, such as dentists, doctors, naturopaths, and psychologists.
While it’s a worthy effort, the Health Profession Regulators Society has a limited mandate in regards to mental health. It is not yet pushing, for instance, for regulation of the province’s many unregulated therapists. A group did try exactly that in 2001. It tried to convince the B.C. Liberal government to regulate the province’s roughly 4,000 therapists. It failed.
The movement has not died, though.
Therapists calling themselves the Task Group for Counsellor Regulation in B.C. are hoping to persuade the province’s diverse mental-health specialists to form a body to be called The College of Counselling Therapists.
The proposed College of Counselling Therapists, operating under a government charter, would be responsible for regulating a range of mental-health workers, many of whom don’t even belong to a professional body. The College of Counselling Therapists, if it were approved, would cover alcohol and drug counsellors, art therapists, drama therapists, immigrant counsellors, family therapists, pastoral counsellors, genetic counsellors, career counsellors and more.
Ethics complaint process
Andrea Kowaz, of the B.C. College of Psychologists, believes that, even though it would be a challenge to regulate such an array of therapists, it’s well worth trying.
As registrar of the college that oversees and investigates any complaints about the province’s 1,200 registered psychologists, Kowaz wants people to “seek mental health services when they need it — but to do it safely and to ask some questions.”
Kowaz receives many calls each month from B.C. patients who mistakenly think their therapist is a registered psychologist and therefore that Kowaz can assist them, when, unfortunately, she can’t. She believes members of the public deserve to know when they are dealing with a registered psychologist or an unregulated therapist.
“People have trust,” Kowaz said. “And they assume that if they’re in distress and they go to someone for help, that person will be able to help them … But there’s a certain quality of people who exploit vulnerable people.”
In this day and age, Kowaz said, almost anyone can get online training and “a nicelooking certificate” containing misleading claims that they’re a “certified” or “registered” therapist.
It’s relatively obvious for the public to know when a doctor or nurse dealing with physical ailments makes a mistake, Kowaz said.
Everyone has seen the shocking X-ray photos of scissors left inside a person’s intestines by surgeons.
“But if you’re in emotional turmoil, at what point do you know the person who is supposed to be helping you is not working in your best interests?”
That’s why, Kowaz said, it’s crucial all therapy patients, not just those who see registered psychologists and psychiatrists, have access to a comprehensive ethics complaint process.
“We have come so far in addressing mental health issues, when powerful (therapeutic) tools are in the right hands. But how do you protect these gains? By giving people more knowledge and safety.”
The movement to regulate all of B.C.’s therapists has a long way to go.
And Brenda, still mourning the loss of her son, knows future improvements will not bring him back.
Still, with her and her husband’s combined knowledge of the mental health field, Brenda is doing what she can to try to raise awareness of gaping holes in the monitoring of therapists.
It will never stop the terrible pain. But it’s something.
There’s a certain quality of people who exploit vulnerable people.
ANDREA KOWAZ
B.C. COLLEGE OF PSYCHOLOGISTS