Editing Psychotherapy (section)

== Regulation ==
{{see also|Psychologist#Licensing and regulations|Counseling psychology#Counseling ethics and regulation|Psychiatrist#Professional requirements|Health professional requisites|Social work#Qualifications|Mental health professional#Professional distinctions}}
Psychotherapists traditionally may be [[mental health professionals]] like psychologists and psychiatrists; professionals from other backgrounds (family therapists, social workers, nurses, etc.) who have trained in a specific psychotherapy; or (in some cases) academic or scientifically trained professionals. In addition to the training, many countries require psychotherapist to register with a professional body in order to be permitted to offer services.

[[Psychiatrists]] are trained first as physicians, and as such they may prescribe [[drugs|prescription medication]]; and specialist psychiatric training begins after medical school in psychiatric residencies: however, their specialty is in mental disorders or forms of mental illness.<ref>{{Cite web |title=How to Become a Psychiatrist – Career Path, Salary and Job Description {{!}} UniversityHQ |url=https://universityhq.org/how-to-become/psychiatrist-careers/ |access-date=13 March 2022 |website=universityhq.org}}</ref> [[Clinical psychology|Clinical psychologists]] have specialist doctoral degrees in psychology with some clinical and research components. Other clinical practitioners, [[social workers]], mental health counselors, pastoral counselors, and nurses with a specialization in mental health, also often conduct psychotherapy. Many of the wide variety of psychotherapy training programs and institutional settings are multi-professional. In most countries, psychotherapy training is completed at a postgraduate level, often at a master's degree (or doctoral) level, over four years, with significant [[clinical supervision]] and clinical placements. Mental health professionals that choose to specialize in psychotherapeutic work also require a program of continuing professional education after basic professional training.<ref>{{Cite web |title=Psychoanalytic Psychotherapy Training {{!}} APsaA |url=https://apsa.org/psychoanalytic-psychotherapy-training |access-date=26 March 2022 |website=apsa.org}}</ref>

A listing of the extensive professional competencies of a European psychotherapist was developed by the European Association of Psychotherapy (EAP) in 2013.<ref>{{cite web |url=http://www.psychotherapy-competency.eu/index.php |title=The Professional Competencies of a European Psychotherapist: Home Page |access-date=25 January 2018 |url-status=live |archive-url=https://web.archive.org/web/20170708052131/http://psychotherapy-competency.eu/index.php |archive-date=8 July 2017 }}</ref>

As sensitive and deeply personal topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality. The critical importance of [[client confidentiality]]—and the limited circumstances in which it may need to be broken for the protection of clients or others—is enshrined in the regulatory psychotherapeutic organizations' codes of ethical practice.<ref>Ethical Principles (2010) of the American Psychological Association, Standard 4: Privacy and Confidentiality online at {{cite web |url=http://www.apa.org/ethics/code |title=Ethical Principles of Psychologists and Code of Conduct |access-date=1 April 2015 |url-status=live |archive-url=https://web.archive.org/web/20150401172733/http://www.apa.org/ethics/code/ |archive-date=1 April 2015 }}.</ref> Examples of when it is typically accepted to break confidentiality include when the therapist has knowledge that a child or elder is being physically abused; when there is a direct, clear and imminent threat of serious physical harm to self or to a specific individual. In some countries psychotherapists are required by law to be [[Mandated reporter|mandated reporters]].<ref>{{cite book|last1=Mathews|first1=Ben|year=2022|chapter=Developing Countries and the Potential of Mandatory Reporting Laws to Identify Severe Child Abuse and Neglects|chapter-url=https://link.springer.com/chapter/10.1007/978-981-16-9820-0_27|chapter-url-access=subscription|location=[[Singapore]]|editor-last1=Deb|editor-first1=Sibnath|title=Child Safety, Welfare and Well-being|url=https://link.springer.com/book/10.1007/978-981-16-9820-0|url-access=subscription|language=en|edition=2|publisher=[[Springer Publishing]]|pages=485&ndash;521|doi=10.1007/978-981-16-9820-0|isbn=9789811698200|oclc=1322042243|access-date= }}</ref>

=== Europe ===
As of 2015, there are still a lot of variations between different European countries about the regulation and delivery of psychotherapy. Several countries have no regulation of the practice or no protection of the title. Some have a system of voluntary registration, with independent professional organizations, while other countries attempt to restrict the practice of psychotherapy to 'mental health professionals' (psychologists and psychiatrists) with state-certified training. The titles that are protected also vary.<ref name=Woelbert>{{cite tech report |last=Woelbert |first=Eva |date=2015 |title=Psychotherapy for mental illness in Europe: An exploration on the evidence base and the status quo |number=JRC94870 |isbn=978-92-79-46165-1 |url=https://ec.europa.eu/jrc/en/publication/eur-scientific-and-technical-research-reports/psychotherapy-mental-illness-europe-exploration-evidence-base-and-status-quo |archive-url=https://web.archive.org/web/20150722131907/https://ec.europa.eu/jrc/en/publication/eur-scientific-and-technical-research-reports/psychotherapy-mental-illness-europe-exploration-evidence-base-and-status-quo |archive-date=22 July 2015 |url-status=dead |institution=[[Joint Research Centre]], Publications Office of the European Union}}</ref> The [[European Association for Psychotherapy]] (EAP) established the 1990 Strasbourg Declaration on Psychotherapy, which is dedicated to establishing an independent profession of psychotherapy in Europe, with pan-European standards.<ref>{{cite web|url=http://www.psychotherapy-competency.eu/Appendices/appendix1.php|archive-url=https://web.archive.org/web/20110127013001/http://www.psychotherapy-competency.eu/Appendices/appendix1.php|url-status=live|archive-date=27 January 2011|title=Appendix 1a}}</ref> The EAP has already made significant contacts with the European Union & European Commission towards this end.

Given that the [[European Union]] has a primary policy about the free movement of labor within Europe, European legislation can overrule national regulations that are, in essence, forms of restrictive practices.

In Germany, the practice of psychotherapy for adults is restricted to qualified psychologists and physicians (including psychiatrists) who have completed several years of specialist practical training and certification in psychotherapy.<ref>{{Citation |title=A guide to psychotherapy in Germany: Where can I find help? |date=2016-12-23 |url=https://www.ncbi.nlm.nih.gov/books/NBK279513/ |work=InformedHealth.org [Internet] |access-date=2023-10-02 |publisher=Institute for Quality and Efficiency in Health Care (IQWiG) |language=en}}</ref> As psychoanalysis, psychodynamic therapy, cognitive behavioral therapy, and systemic therapy meet the requirements of German health insurance companies, mental health professionals regularly opt for one of these four specializations in their postgraduate training. For psychologists, this includes three years of full-time practical training (4,200 hours), encompassing a year-long internship at an accredited psychiatric institution, six months of clinical work at an outpatient facility, 600 hours of supervised psychotherapy in an outpatient setting, and at least 600 hours of theoretical seminars.<ref>{{cite web|url=https://www.gesetze-im-internet.de/psychth-aprv/BJNR374900998.html|title=PsychTh-APrV – Ausbildungs- und Prüfungsverordnung für Psychologische Psychotherapeuten|website=www.gesetze-im-internet.de|url-status=live|archive-url=https://web.archive.org/web/20170928222210/http://www.gesetze-im-internet.de/psychth-aprv/BJNR374900998.html|archive-date=28 September 2017}}</ref> [[Social worker]]s may complete the specialist training for child and teenage clients.<ref>[https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072697/ A guide to psychotherapy in Germany: Where can I find help?] {{webarchive|url=https://web.archive.org/web/20160101111335/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072697/ |date=1 January 2016 }} January 2013; Next update: 2016. IQWiG (Institute for Quality and Efficiency in Health Care)</ref> Similarly in Italy, the practice of psychotherapy is restricted to graduates in psychology or medicine who have completed four years of recognised specialist training.<ref>{{cite web |url= http://www.psy.it/normativa/legge_56_eng.html |title= Regulation of the profession of the psychologist |access-date= 19 March 2015 |ref= {{Harvid|Ossicini Act|1982}} |url-status= live |archive-url= https://web.archive.org/web/20150402154716/http://www.psy.it/normativa/legge_56_eng.html |archive-date= 2 April 2015 |df= dmy-all }}</ref><ref>{{cite web |url= http://www.salusaccessibile.it/Laienanalyse/ossicini.pdf |title= Cosa regolamenta effettivamente la legge Ossicini? |language= it |last1= Moreno |first1= Manghi |date= December 2004 |access-date= 19 March 2015 |ref= {{Harvid|Moreno Manghi|2004}} |url-status= dead |archive-url= https://web.archive.org/web/20150402093138/http://www.salusaccessibile.it/Laienanalyse/ossicini.pdf |archive-date= 2 April 2015 |df= dmy-all }}</ref> Sweden has a similar restriction on the title "psychotherapist", which may only be used by professionals who have gone through a post-graduate training in psychotherapy and then applied for a licence, issued by the [[National Board of Health and Welfare (Sweden)|National Board of Health and Welfare]].<ref>{{cite web |url= http://www.socialstyrelsen.se/applicationforswedishlicencetopractiseeea/psychotherapist |title= Application for licence to practise as a psychotherapist |publisher= [[National Board of Health and Welfare (Sweden)]] |access-date= 31 March 2013 |url-status= dead |archive-url= https://web.archive.org/web/20140109100230/http://www.socialstyrelsen.se/applicationforswedishlicencetopractiseeea/psychotherapist |archive-date= 9 January 2014 |df= dmy-all }}</ref>

Legislation in France restricts the use of the title "psychotherapist" to professionals on the National Register of Psychotherapists,<ref>{{cite web |url= http://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000022336754&dateTexte=&categorieLien=id |title= Arrêté du 9 juin 2010 relatif aux demandes d'inscription au registre national des psychothérapeutes |access-date= 21 July 2010 |language= fr |ref= {{Harvid|Arrêté du 9 juin 2010 relatif aux demandes d'inscription au registre national des psychothérapeutes|2010}} |url-status= live |archive-url= https://web.archive.org/web/20100707010353/http://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000022336754&dateTexte=&categorieLien=id |archive-date= 7 July 2010 |df= dmy-all }}</ref> which requires a training in clinical psychopathology and a period of internship which is only open to physicians or titulars of a master's degree in psychology or psychoanalysis.<ref>{{Cite web |title=Psychotherapy in France |url=https://www.europsyche.org/situation-of-psychotherapy-in-various-countries/france/ |access-date=2024-01-28 |website=European Association for Psychotherapy |language=en-US}}</ref>

Austria and Switzerland (2011) have laws that recognize multi-disciplinary functional approaches.{{citation needed|date=July 2015}}

In the United Kingdom, the government and [[Health and Care Professions Council]] considered mandatory legal registration but decided that it was best left to professional bodies to regulate themselves, so the [[Professional Standards Authority for Health and Social Care]] (PSA) launched an Accredited Voluntary Registers scheme.<ref>{{cite web|last= UK Department of Health|author-link= Department of Health (United Kingdom)|title= Trust, assurance and safety: The regulation of health professionals |url= http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_065947.pdf|archive-url= http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_065947.pdf|url-status= dead|archive-date= 7 January 2013|type= White Paper |publisher= [[The Stationery Office]] |location= London |date= 21 February 2007 |access-date= 22 February 2013}}</ref><ref>{{cite journal  |last1= McGivern |first1= Gerry |last2= Fischer |first2= Michael Daniel | title = Reactivity and reactions to regulatory transparency in medicine, psychotherapy and counselling | journal = [[Social Science & Medicine]] | volume = 74 | issue = 3 | pages = 289–296 | date = February 2012 | pmid = 22104085 | doi = 10.1016/j.socscimed.2011.09.035 |url= http://wrap.warwick.ac.uk/45260/1/WRAP_McGivern_McGivern__Fischer_SSM_2012_Reactivity__Reactions_to_Regulatory_Transparency_in_Medicine_Psychotherapy__Counselling_%28Authors%27_version%29.pdf }}</ref><ref>{{cite book |title= Statutory regulation and the future of professional practice in psychotherapy and counselling: Evidence from the field |last1= McGivern |first1= Gerry |last2= Fischer |first2= Michael |last3= Ferlie |first3= Ewan |last4= Exworthy |first4= Mark |url= http://www.kcl.ac.uk/sspp/departments/management/news/StatutoryRegulation1.pdf |date= October 2009 |publisher= [[Economic and Social Research Council]], [[King's College London]] |access-date= 22 February 2013 |url-status= live |archive-url= https://web.archive.org/web/20140109102311/http://www.kcl.ac.uk/sspp/departments/management/news/StatutoryRegulation1.pdf |archive-date= 9 January 2014 |df= dmy-all }}{{Page needed|date=January 2014}}</ref><ref>{{Cite legislation UK |type= act |year= 2012 |chapter= 7 |act= Health and Social Care Act 2012}}</ref><ref>{{cite web |title= Voluntary Registers: About Accreditation |url= http://www.professionalstandards.org.uk/voluntary-registers/about-accreditation |publisher= [[Professional Standards Authority for Health and Social Care]] |access-date= 9 January 2014 |url-status= dead |archive-url= https://web.archive.org/web/20140109103930/http://www.professionalstandards.org.uk/voluntary-registers/about-accreditation |archive-date= 9 January 2014 |df= dmy-all }}</ref> Counseling and psychotherapy are not protected titles in the United Kingdom. Counsellors and psychotherapists who have trained and qualify to a certain standard (usually a level 4 Diploma) can apply to be members of the professional bodies who are listed on the PSA Accredited Registers.

=== United States ===
In some states, counselors or therapists must be licensed to use certain words and titles on self-identification or advertising. In some other states, the restrictions on practice are more closely associated with the charging of fees. Licensing and regulation are performed by various states. Presentation of practice as licensed, but without such a license, is generally illegal.<ref>[http://counsellingresource.com/lib/therapy/aboutcouns/licensure/ Counselling Resource, "Professional Licensing in Mental Health".] Accessed 11 March 2015.</ref> Without a license, for example, a practitioner cannot bill insurance companies.<ref>{{cite web |first1=Abraham |last1=Wolf|first2= Gabor |last2=Keitner |first3=Barbara |last3=Jennings |title=The Psychotherapeutic Professions in the United States of America |url=http://c.ymcdn.com/sites/www.psychotherapyresearch.org/resource/resmgr/imported/events/barcelona/reports/report_usa.pdf |access-date=1 April 2015 |url-status=dead |archive-url=https://web.archive.org/web/20150402120813/http://c.ymcdn.com/sites/www.psychotherapyresearch.org/resource/resmgr/imported/events/barcelona/reports/report_usa.pdf |archive-date=2 April 2015 }}.</ref> Information about state licensure of psychologists is provided by the [[American Psychological Association]].<ref>{{cite web|url=http://www.apapracticecentral.org/ce/state/index.aspx|title=State Licensure|website=apapracticecentral.org|url-status=dead|archive-url=https://web.archive.org/web/20150402121302/http://www.apapracticecentral.org/ce/state/index.aspx|archive-date=2 April 2015|access-date=1 April 2015}}</ref>

In addition to state laws, the American Psychological Association requires its members to adhere to its published ''Ethical Principles of Psychologists and Code of Conduct''.<ref>Ethical Principles (2010) of the American Psychological Association, online at {{cite web |url=http://www.apa.org/ethics/code |title=Ethical Principles of Psychologists and Code of Conduct |access-date=1 April 2015 |url-status=live |archive-url=https://web.archive.org/web/20150401172733/http://www.apa.org/ethics/code/ |archive-date=1 April 2015 }}.</ref> The [[American Board of Professional Psychology]] examines and certifies "psychologists who demonstrate competence in approved specialty areas in professional psychology".<ref>{{cite web|url=http://www.abpp.org/i4a/pages/index.cfm?pageid=3285|title=PUBLIC – American Board of Professional Psychology|website=www.abpp.org|url-status=dead|archive-url=https://web.archive.org/web/20110613131341/http://www.abpp.org/i4a/pages/index.cfm?pageid=3285|archive-date=13 June 2011|access-date=1 April 2015}}</ref>

=== Canada ===

Regulation of psychotherapy is in the jurisdiction of, and varies among, the provinces and territories.

In [[Quebec]], psychotherapy is a regulated activity which is restricted to psychologists, medical doctors, and holders of a psychotherapy permit issued by the Ordre des psychologues du Québec, the Quebec order of psychologists. Members of certain specified professions, including [[social work]]ers, couple and family therapists, [[occupational therapy|occupational therapists]], [[guidance counsellor]]s, [[criminology|criminologists]], [[sexology|sexologists]], [[psychoeducation|psychoeducators]], and registered nurses may obtain a psychotherapy permit by completing certain educational and practice requirements; their professional oversight is provided by their own professional orders. Some other professionals who were practising psychotherapy before the current system came into force continue to hold psychotherapy permits alone.<ref>{{cite web |title=Qui pratique la psychothérapie ? |url=https://www.ordrepsy.qc.ca/qui-pratique-la-psychotherapie- |website=Ordre des psychologues du Québec |access-date=2 November 2020}}</ref>

On 1 July 2019, Ontario's Missing Persons Act came into effect, with the purpose of giving police more power to investigate missing persons. It allows police to require (as opposed to permit) health professionals, including psychotherapists, to share otherwise confidential documents about their client, if there is reason to believe their client is missing.<ref>{{Cite journal |date=October 2019 |title=New Legislation: Missing Persons Act, 2018 |url=https://cpo.on.ca/wp-content/uploads/Complete-Issue-October-2019.pdf |journal=The E-Bulletin |volume=10 |issue=4 |pages=6}}</ref><ref>{{Cite news |date=6 June 2019 |title=New Missing Persons act gives Ontario police more power to investigate |url=https://www.cbc.ca/news/canada/kitchener-waterloo/ontario-missing-persons-act-maureen-trask-1.5164532}}</ref> Some have expressed concern that this legislation undermines psychotherapy confidentiality and could be abused maliciously by police,<ref>{{Cite web |last=Mares |first=Beth |date=23 December 2019 |title=New police powers trump privacy in Ontario |url=https://www.therapytorontotherapist.ca/pp2.htm}}</ref> while others have praised the act for how it respects privacy and includes checks and balances.<ref>{{Cite news |last=Gillis |first=Wendy |date=18 July 2019 |title=New Ontario law expands police powers in missing persons cases |work=Toronto Star |url=https://www.thestar.com/news/gta/2019/07/18/new-ontario-law-expands-police-powers-in-missing-person-cases.html}}</ref>