Toronto - On the journey from a hospital bed back home, a patient may be visited by licensed doctors, licensed nurses, licensed psychologists, licensed pharmacists, licensed physiotherapists and a chaplain.

This is scheduled to change some time in 2014, when chaplains in Ontario hospitals, jails and other institutions will be licensed and held accountable to a professional college — just like doctors, pharmacists and nurses.

“People who work in spiritual care are really touching very deep, vulnerable places in people,” said Christine O’Brien, spiritual care trainee at Bridgepoint Health in Toronto. “There should be some regulation about training. It shouldn’t be simply that I have a nice background and I’m a nice person. There’s too much involved in what actually happens in patient care.”

The provincial government isn’t trying to regulate religion or oversee prayer, said Joyce Rowlands, the registrar of the Transitional Council of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario.

“There are people in the province who are pastoral counsellors or spiritual care therapists, as some call themselves, who actively have wanted to be part of this process and become members of the new college,” Rowlands told The Catholic Register.

Chaplains, particularly those employed by hospitals, will want to be part of the college because hospitals will begin to make membership the minimum standard for working in their spiritual care departments. A 1991 law specifically rules out prayer and ritual as a form of therapy that the government needs to regulate. But anyone who enters into a specifically therapeutic relationship with people who suffer serious emotional, cognitive or psychological issues will need to be part of the new college when it’s up and running.

Chaplains employed by the Church to provide sacramental ministry, anything from delivering communion to hearing confessions, will be exempt.

O’Brien is taking a 12-week, intensive Clinical Pastoral Education (CPE) program at Bridgepoint, a major rehabilitation hospital in Toronto. O’Brien already has a Master of Divinity degree from Toronto’s University of St. Michael’s College and will need four such units of CPE training plus a course on the legal responsibilities and limits of caregivers before she qualifies to be licensed by the new college. While the college can’t dictate who the hospitals hire, nobody in the field believes hospitals will hire chaplains who aren’t members of the college.

In the early going, working under a supervisor, O’Brien sees how her work fits into a team of professionals working toward healing for patients.

“We’re talking about talking with patients who are in a vulnerable state, because they are ill, about issues of meaning and purpose in their lives,” she said. “About perhaps whether they believe in an afterlife. Are they feeling judgment? Are they terribly frightened because they think of their mortality? Their doctor doesn’t want to talk about their mortality and all those issues. These are spiritual issues.”

Catholic clergy and volunteers who visit Bridgepoint are also part of the bigger, healing picture. Even though O’Brien is Catholic she can’t do her job and deliver communion to all the Catholic patients. Neither can she say Mass or hear confessions. But she can help people to see their lives in a broader spiritual context — an insight that will make Mass and sacraments less isolated events and more part of the fabric of life as patients heal.
But making chaplains into therapists might not be such a good idea, says Jesuit Father Desmond Buhager, Regis College lecturer in family therapy and pastoral counselling.

“It could be conceived of as a medicalization of the role of chaplain,” he said. “They’re part of a health care team, but we don’t start calling social workers occupational therapists. They simply aren’t. So why try to glom them (chaplains) together with psychotherapists? They’re not mental health workers... They’re chaplains.”

How people are held accountable matters, said Buhage. Spiritual care staffers, especially at hospitals, will find themselves part of a College of Psychotherapy and Registered Mental Health Therapist. The problem is they’re not psychotherapists, Buhager said.

“The idea of levelling everything to making chaplains all of a sudden psychotherapists or requiring them to be mental health therapists is inappropriate,” said Buhager, himself a registered psychotherapist in the United States. “It’s weird. Excuse me. We (psychotherapists) did five or six or seven years of training as therapists with specific course curriculum and clinical hours of supervision simply to be treated the same as people who have done a few CPE units? Doesn’t sound right.”

The act which mandates the college was passed at Queen’s Park in 2007. It is one of five new health care colleges being created in Ontario. But the 2007 act can’t be proclaimed into law until regulations are in place. Trying to figure out how to regulate psychotherapy has been a huge challenge and the transitional council long ago abandoned hopes it would make an April 2013 deadline for establishing the new college.

“We spent two years trying to figure out, who are we regulating? What is the difference between these two titles (psychotherapist and registered mental health therapist)? What kinds of training and education does this very diverse spectrum of practitioners have? What should the requirements of registration be?” said Rowlands.

Psychotherapists will be required to complete 360 hours of supervised clinical training in a program that requires an undergraduate degree. RMHTs will more typically have community college training and 180 hours of supervised clinical work.

For spiritual care the usual standard is four units of CPE leading to specialist certification plus a Master of Divinity, Master of Theological Studies or equivalent degree.

Some psychotherapists have pushed for more stringent requirements — namely a masters degree in psychotherapy or a related counselling discipline, plus time spent in supervised clinical work. The problem with that is there’s only one masters psychotherapy degree in all of Ontario — Wilfrid Laurier University’s MA in theology with a specialization in spiritual care and psychotherapy. It also leaves out Jungian, Gestalt and other kinds of therapists who train in independent institutes that don’t award a masters degree.

However the work is labelled and licensed, O’Brien is convinced it’s necessary work.

“It’s a grace. It’s a satisfaction. Grace is in knowing that somehow I’ve been able to journey along even in a small way with this person who is in great need,” she said.

Published in Canada: Toronto-GTA