How do therapists accurately describe the work we’re qualified to do? Scope of practice in light of the Lindsay Clancy trial
This is part 1 of a 3-part series for mental health therapists and their supervisors. I am a Registered Psychotherapist in Ontario, Canada and have been practicing for 20+ years. I have an active supervision practice and the topic of the Lindsay Clancy trial is coming up in most of my supervision sessions. This series represents my attempt to clarify the issues relevant to Psychotherapists and provide my perspective on how Psychotherapists can mindfully improve their practice while staying out of the anxiety loops that a trial like this can cause for professionals. My perspective reflects the role and scope of Registered Psychotherapists in Ontario and may not apply directly to other jurisdictions.
-Carly Fleming, M.Ed., RP
The Lindsay Clancy trial is heartbreaking and tragic in a multitude of ways. Much has been written about the tragedy from various perspectives. What I’ve been hearing in my supervision practice reflects the unease that has been created for mental health professionals working with clients suffering from a wide range of mental health issues. In this blog post, I’d like to spend some time reflecting on the lessons this trial and this tragedy can teach therapists about working within (and describing) their scope of practice.
What you say on your website matters, but it’s just the beginning
New therapists are bombarded with messages from well-meaning business coach-types encouraging them to pick a niche and write their website copy to speak to people struggling with the thing they’ve chosen as their niche. That advice isn't wrong. But picking a niche and being competent in it are two different issues, and therapists must ensure competence before claiming it on their website. The College of Registered Psychotherapist says therapists can “advertise an area of practice only if they have verifiable training in that area of practice”.
The College leaves the definition of what constitutes “verifiable training” up to the therapist. But this doesn’t mean this standard can just be bypassed as a simple wording issue. What we’ve seen in the Lindsay Clancy case is that professionals who stated an expertise in the area of postpartum mental health are being asked in a court of law to verify their expertise. This doesn’t need to scare therapists who are deciding what their niche is and how to describe it, but it should act as a moment of self-reflection. For example, is that one-semester course in grad school about trauma therapy enough to state that trauma is an area of specialization? Is working with a handful of clients struggling with OCD in internship enough to say that a therapist has expertise working with this population? CRPO says that therapists may “use terms, titles, or designations implying a specialization only if they are earned, conferred by a recognized credentialing body, meets established standards”. Ask yourself honestly - does your training match your website, or does your website need to catch up to your training?
I’ve seen quite a lot of talk amongst therapists getting into the weeds of the exact wording they use to describe their niche. There seems to be a commonly held distinction between using words like “expertise” and “specialization” compared to the less stringent words like “works with” and “has experience with”. I’d like to push back on this game of scrabble….
The general public is not using the same eyes as therapists are to understand your qualifications. A therapist who states “I specialize in postpartum mental health” and one that states “I have experience working with women struggling with mental health issues in the postpartum period” likely sound exactly the same to a new mom struggling. While the first statement may be flagged by the College as inappropriate advertising and the second may not, the point is, the public deserves an honest description of what you're actually trained to do, not a list of everything you're willing to try.
Ongoing conversations with clients about scope of practice
It is clear that a website or listing service bio isn't a clinical agreement. Therapists need to proactively engage with clients about scope of practice from the initial consultation throughout the therapy process. A postpartum client might arrive because your listing said "maternal mental health" but that phrase can mean anything from "I've read the literature and do general supportive therapy with new parents" to "I have specific training in recognizing postpartum mood and psychotic disorders and know when they require psychiatric referral." Those are very different levels of expertise, and the client in front of you has no way to tell them apart from a listing service blurb.
There is real nuance here – and the burden is on the therapist to bring these nuanced conversations into the therapy space throughout the process - at intake, and again as the picture changes. A client whose symptoms looked like ordinary adjustment stress in session two can look very different in session six. Many mental health issues are fast-moving and easy to miss if you're not specifically trained in assessment for what is in front of you – it is up to the therapist to understand when their client needs a different level of care than they are qualified to offer.
The abandonment trap
There’s an ethical bind at play here that rarely gets talked about but that quietly troubles many therapists navigating these tricky waters.
It is unethical to work outside your scope. It is also unethical to abandon a client. Many therapists feel the pull of both at once, especially with a client they've built rapport with, who doesn't want to leave, who says "I trust you, I don't want to start over with someone new." Referring out can feel like letting someone down when they need you most.
This is where supervision becomes essential. The instinct to keep helping is not a flaw, it's an instinct inherent to being a good therapist. But it isn't a substitute for competence, and a client's preference to stay with you doesn't mean scope of practice becomes less important.
The resolution isn't "abandon them" versus "keep them regardless." It's: refer with them, not away from them. Stay involved in the handoff and help them understand why the referral ultimately helps them rather than experiencing it as rejection. Consult with the new provider if the client consents. Continue supporting the parts of their care that are within your competence while someone else takes the parts that aren't.
What this looks like in supervision
As a therapist, the moment you notice yourself thinking "this might be past what I'm trained for, but I don't want to refer them out" is the moment to bring it to supervision, not after you've talked yourself out of the discomfort. The CRPO says “Knowing when to seek clinical supervision or consultation, and when to refer a client to another professional is integral to a registrant’s professional obligations as a regulated practitioner.” Seeking supervision in these moments isn’t just a “nice to have’ – it is an essential component to being an ethical therapist.
If you're a supervisor, being on the lookout for these scope of practice struggles will help open the door for important conversations in supervision. Many therapists understandably don't have the words for "I think I'm out of my depth," and some gentle curiosity can help create a safe space for this essential exploration.
While the Lindsay Clancy case may cause some therapists to recoil and feel afraid that they too may end up in court needing to justify their expertise in a tragic situation, the reality is that there are legitimate, professionally responsible ways to do this well. When you start with an honest review of your own training and continue through real and courageous supervision conversations, you will be able to ensure that your clients get the best care possible, whether from you or another trusted provider.
Next in this series: why documenting your clinical thinking — not just what happened in session — is the skill we get too little training about.