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Pursuing jobs in the field of psychotherapy isn’t just for doctors; nurses can do it too. Benjamin Evans, DD, DNP, RN, APN, past president of the New Jersey State Nurses Association, has his own practice as a nurse psychotherapist in addition to consulting. He made the change in the 1980’s after he had completed his nurse practitioner training. Based on his work with people living with chronic and catastrophic illnesses, he decided to earn a master’s degree in counseling because it would be a good fit.
Evanstalked with us about what a nurse psychotherapist does and what nurses who arethinking of entering this area of the field should keep in mind.
What exactly does a nurse psychotherapist do?
A nurse psychotherapist does the same work as any other educated psychotherapist — using psychological and counseling methods to assist in behavior and mental health changes. Usually the state board of nursing incorporates some form of health counseling within the definition of nursing practice. Psychotherapy can be done with individuals, families, and groups.
What should nurses keep in mind if they are thinking of becoming a nurse psychotherapist?
Nursesneed to understand their reasons for wanting to become psychotherapists.Psychotherapy is not about “fixing” others who have similar issues to thetherapist.
Itis not solely health counseling for issues like nutrition, stress, or weightcontrol. It is not nurse coaching. Psychotherapy is undergirded withtheoretical frameworks that are used by the psychotherapist to help in thechange.
Nurseswho wish to become psychotherapists will be integrating nursing theories withtheoretical frameworks from psychology, psychiatry, social work, and otherdisciplines.
Psychotherapy education is usually done at the graduate level. For this reason, the nurse wishing to do psychotherapy needs to determine if she or he will pursue psychotherapy education through a graduate nursing program like a psychiatric mental health nurse practitioner/clinical nurse specialist role or through another discipline like psychology, educational counseling, or social work.
Whatkind of certification or other education would they need?
Certification can be obtained by credentialing organizations like the American Nurses Credentialing Center or through various certifying bodies outside of nursing. Some types of psychotherapy have non-degree supplemental experiential training and then “certify” the practitioner in a particular modality — for example, training in cognitive behavioral therapy.
Whatelse should they do?
Anurse wishing to become a psychotherapist should meet with and shadow a nursepsychotherapist to really learn all that the specialty initials. She or heshould become familiar with modalities of psychotherapy and vet programs fortraining.
What are the greatest challenges to being a nurse psychotherapist?
Challengesinclude training (time and cost), building a practice, obtaining referrals, andongoing maintenance of competency.
Additionally,reimbursement issues play into the challenges of practice as many insurers donot cover nurses for psychotherapy.
Whatare the greatest rewards?
Thereare many rewards to being a nurse psychotherapist, including watching as behaviorchanges and mental health improvements are accomplished by the patients.
Is there anything else important for our nurse readers to know?
The practice of psychotherapy as a nurse is quite rewarding. The nurse who chooses to go into psychotherapy practice must want to help others to make behavioral or mental health changes. The nurse must have clear boundaries — being able to be empathic and not take on the issues of the client. Nurse psychotherapists must be mindful of self-care and to develop a sound network for referrals when the issues presented are outside of the psychotherapist’s area of expertise.
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Certified Nurse Psychotherapist – CNP or Certified Psychotherapist nurse CPN are nurses including: registered nurses, registered practical nurses, nurse practitioners, registered psychiatric nurses and license practical nurses who have obtained additional education and skills training in professional counselling skills, and psychotherapy namely Cognitive Behavioural Therapy. CNP’s – CPN’s can independently perform the controlled act of psychotherapy without a doctors order.
Our goal is to provide nurses with the skills, knowledge, and judgement to perform the controlled act of psychotherapy safely to individuals, couples, and group in private practice, the community, and hospital settings.
Certified Nurse psychotherapist- CNP-CPN treat a number of mental health disorders, and provide a neutral ground to
individuals, families, couples, and groups. Certified Nurse psychotherapist – CNP-CPN focus is to help individuals heal, energize, and become aware of their inner strengths. This is achieve by providing a neutral safe space, listening to client’s or patient’s concerns, and customizing a treatment
Nurse Psychotherapist Certificate
The Nurse Psychotherapist Certificate Program is offered online hybrid and is designed to assist nurses in obtaining the skills, knowledge, and experience in performing the controlled act of psychotherapy safely in private practice, in the community, and hospital settings.
Nurses can now initiate the controlled act of psychotherapy without an order, (CNO the Standard 2020).
Psychotherapy is a controlled act in which nurses can perform independently providing that the nurse has the necessary training, skills, experience, and judgement to perform the task.
Psychotherapy is defined as “an intense client-therapist relationship which often involves the examination of deeply emotional experiences, destructive behaviour patterns, and serious mental health issues,” (Health Professions Regulatory Advisory Council, 2006). It includes a deep assessment of life processes that focus on behaviour modifications, thinking patterns, cognition, emotional response, and social functioning. In order to competently practice psychotherapy, nurses need in-depth knowledge, skills, and experience using theoretical framework.
This course utilizes counseling and psychotherapy methods including; Cognitive Intervention, Behavioural Intervention, and CBT Psychotherapy Theoretical frameworks to assist in behaviour and mental health changes. Usually nursing incorporates some form of health counseling within the definition of nursing practice. Structured Psychotherapy, such as Cognitive Behavioural Therapy, (CBT), can be done with individuals, families, and groups.
The nurse must be registered with their respective College of Nurses and their nursing association which provides malpractice insurance.
This course duration is 1 year and includes 750 hours, comprising of online theory and practice hours using direct client contact that the nurse will obtain from their communities
The nurse will be expected to submit 50 case studies, recordings of CBT Therapy Sessions, with clients’ consents including history, formulation, and treatment plans for each client.
The nurse will be expected to complete 100 hours of clinical supervision under the mentorship of an experienced nurse psychotherapist or a registered psychotherapist.
Course content covered in this course includes
Course duration is 750 hours online. Course includes; providing direct client care, case studies, providing individual treatment, and facilitating supervised psychotherapy group sessions with client consent. 100 clinical supervision hours will be provided under the mentorship of an experienced Nurse Psychotherapist or Registered Psychotherapist. Clinical Supervision and support will be provided throughout the program and after the nurse completes the program.
Upon completion of the program, the Nurse Psychotherapist Certification will be awarded and the nurse will be able to use the protected title CNP – Certified Nurse Psychotherapist. Students will also receive membership with the Nurse Psychotherapist Association
If you are interested, please fill out and submit the contact form.
Enrollment in this program is restricted to a limited number of students per year.
For inquires please contact us at (905) 452-8139 or (905) 965-1966 or fill out the form and submit.
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Psychotherapy and the controlled act component of psychotherapy
The following addresses questions nurses have about the controlled act of psychotherapy and how this affects their nursing practice:
What is psychotherapy?
Psychotherapy is defined as “an intense client-therapist relationship which often involves the examination of deeply emotional experiences, destructive behaviour patterns and serious mental health issues.” (Health Professions Regulatory Advisory Council, 2006).
It includes a deep assessment of life processes that focus on behaviour modifications, thinking patterns, cognition, emotional response and social functioning.
What are the educational requirements for nurses to perform psychotherapy?
To competently practice psychotherapy, nurses need knowledge, skill and judgment. Nurses are accountable to reflect on their practice, determine their individual learning needs, developing a learning plan annually. Nurses continually reflect on their practice and determine what best helps them achieve their objectives (for example, taking refresher courses or obtaining certifications). CNO does not require nurses to obtain specific additional training or certification (e.g. courses, hours, supervision, etc.) with respect to psychotherapy. Nor does CNO approve or endorse specific continuing education programs or certifications.
It is up to the nurse and/or their employer to determine the appropriate training or requirements (certifications, degrees, etc.) necessary to safely perform psychotherapy.
What is the controlled act component of psychotherapy?
The controlled act is the component of psychotherapy considered to be the highest risk to the patient. It does not include all psychotherapy practices and is not defined by a technique.
The controlled act is defined in the Regulated Health Professions Act, 1991 (RHPA) as:
“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 judgment, insight, behaviour, communication or social functioning.”
How will I determine if I’m performing the controlled act of psychotherapy?
Based on the RHPA definition, there are five elements in the controlled act. All five elements must be met for you to be performing the controlled act:
- You are treating a patient
- You are applying a psychotherapy technique
- You have a therapeutic relationship with the patient
- The patient has a serious disorder of thought, cognition, mood, emotional regulation, perception or memory
- This disorder may seriously impair the patient’s judgment, insight, behaviour, communication or social functioning
Nurses may perform elements of psychotherapy, but not the controlled act of psychotherapy. For example, if only four of the above components apply, you are not performing the controlled act.
You are in the best position to determine whether or not you are performing the controlled act according to the criteria.
The diagram below highlights that the controlled act is one element in the wide-ranging practice of counselling and psychotherapy. Many of the activities that nurses frequently engage in share some common traits with psychotherapy, but they are not psychotherapy. For example, activities such as health teaching, providing information, encouragement, support or instruction are not psychotherapy.
Do I require an order to perform the controlled act of psychotherapy?
RNs and RPNs can independently perform the controlled act of psychotherapy without an order in some practice settings. However, workplace policies or legislation governing the practice setting (For example, the Public Hospitals Act), may require nurses to obtain an order to perform the controlled act of psychotherapy. Delegation of the controlled act of psychotherapy by NPs, RNs and RPNs is prohibited.
Are nurses able to use the title “psychotherapist”?
Yes. If you choose to use the “psychotherapist” title, you must:
- When speaking to patients you may only describe yourself as a “Psychotherapist” if you also use your restricted nursing title .
For example: “I am an RN, psychotherapist.” Or, “I am an NP and a psychotherapist.”
- When describing yourself in writing, you must provide your full name as it appears on the College’s Register (Find a Nurse), your protected title, and the title, “psychotherapist.”
For example: Jane Goode, RN, Psychotherapist
I’m a nurse and I perform psychotherapy. Should I also register with the College of Registered Psychotherapists of Ontario?
This decision is up to you. As a nurse, if you have the knowledge, skill and judgment to do so, you may perform psychotherapy in your nursing practice.
If you register with the College of Registered Psychotherapists of Ontario, this must be reported to CNO.
As a nurse, can I open an independent psychotherapy practice?
Yes. Our Independent Practice guideline outlines the accountabilities of nurses who are in independent practice. As a nurse in independent practice, you should obtain legal and business advice as needed, so you can identify, understand and comply with the laws that apply to your practice (for example, laws relating to privacy, employment standards and taxation). The College does not provide legal advice. Nurses in independent practice remain accountable to all applicable CNO standards and guidelines.