Or: Why Group Practice Ownership Is a Terrible Get-Rich-Quick Scheme

Psychology Is at a Crossroads: It’s Time for Prescriptive Authority

by jennbossio | Jul 10, 2025 | Advocacy, Therapy, Training

If you’ve been following my recent posts, you know I’ve been sounding the alarm about something that’s hard to ignore: clinical psychology is at a critical juncture. The market is saturated. Therapy is in demand, and everyone wants to do it. That should be a good thing, right? But here’s the problem: when it comes to what we actually do as psychologists, there’s very little that differentiates us in the public eye from social workers, psychotherapists, or counsellors, despite our years of training, research expertise, and clinical skill.

And that’s not just a branding issue. It’s a professional identity crisis.

Most clinical psychologists in Ontario work in private practice, doing one-on-one therapy. But when our day-to-day looks identical to the work done by those with far less training, how can we justify the length, cost, and intensity of our education? And more importantly, how can we ensure that the field of psychology survives and thrives in a crowded, competitive landscape?

It’s time we stop underplaying what we’re capable of.

What Makes Psychologists Different From Other Therapists?

Here’s the thing we forget: we’re not just therapists. We’re diagnosticians. We’re researchers. We’re scientists. We’re case conceptualization machines.

We are trained to understand not just what a client presents with, but why and how that should inform the course of treatment. We’re taught to read research critically (not just quote it from a slide deck) and to integrate complex evidence bases into our clinical work. That is not a universal skill across the mental health professions.

And yet, as a field, we’ve let that go quiet. We’re not stepping into positions of influence, consultation, or thought leadership in the way we could be. And we’re losing ground to professions that are simply better at marketing, regardless of whether their approach is scientifically sound.

Need an example? Let’s talk about EMDR…

EMDR is treatment that’s exploded in popularity, largely because it’s easy to market and sounds revolutionary. But when you actually dig into the research (which, again, most psychologists are trained to do), the evidence tells a different story. Multiple meta-analyses have shown that EMDR is no more effective than other established treatments for PTSD, like Cognitive Processing Therapy or Prolonged Exposure. The “bilateral stimulation” component, often touted as the secret sauce, doesn’t appear to add any benefit beyond what you’d get from exposure-based therapy alone. And yet, EMDR is everywhere. Precisely because many clinicians and clients don’t have the research literacy to question its claims. This is where psychologists should shine: translating science into practice, and helping the public—and our colleagues—separate evidence from hype.

Why Prescription Rights Matter

Here’s where I see a path forward: clinical psychologists should be able to prescribe.

Psychiatrists are overburdened and hard to access. Family doctors are often uncomfortable with psychopharmacology and are flying blind when it comes to complex mental health cases (and that doesn’t even touch on the complete lack of time that GPs have to deal with it properly in their practice). Meanwhile, psychologists—the very professionals most skilled in diagnosis, assessment, and and case formulation—are sidelined when it comes to medication.

We could be the bridge. We should be the bridge.

Imagine a model where psychologists are trained in psychopharmacology through a postdoctoral master’s program (as is already the case in some U.S. states). We’d be uniquely positioned to prescribe with a level of diagnostic clarity and caution that many prescribing professionals simply don’t have time for. Our deep understanding of evidence-based psychological treatment would allow for a nuanced, integrated approach; one that prioritizes both medication and therapy, not one over the other.

And for those who think psychologists would never go for more schooling… have you met a psychologist? We’re exceptional students. We love learning. Many of us would leap at the opportunity to return to school for something that actually excites us and helps us better serve our clients. In fact, I’d argue a lot of us are bored in private practice, precisely because we’re underutilizing the full scope of our training.

How To Get Prescription Rights as a Psychologist?

So what would it actually take for psychologists to gain prescriptive authority in Ontario? In short: legislative change, regulatory oversight, and the development of standardized training pathways; likely in the form of a postdoctoral master’s degree in psychopharmacology, as has been done in several U.S. states. And this kind of professional expansion isn’t unprecedented! We would not the the first!

Optometrists, for example, fought for and won the right to prescribe medications related to eye care, dramatically expanding their role in patient treatment. More recently, pharmacists have gained prescribing privileges in many provinces, especially for minor ailments and chronic conditions, recognizing that their expertise in medication can meaningfully improve access to care.

Psychology is arguably even better positioned for this kind of evolution, given our diagnostic scope, depth of training, and understanding of both the biological and psychological underpinnings of mental illness. The infrastructure isn’t impossible. it just requires the will to build it.

The Field Is Shrinking (and We’re Letting It Happen)

Psychologists are being outpaced in every direction. Social workers are doing therapy. Psychotherapists are doing therapy. Even occupational therapists are doing therapy. And many of them are excellent at it! Our silence around what we could offer on top of one-on-one therapy is costing us our place in the mental health ecosystem.

This isn’t just about professional identity or job protection. It’s about stepping up during a mental health crisis that’s overwhelming our systems and leaving too many people behind. Psychologists are uniquely trained to assess, diagnose, conceptualize, and treat complex mental health conditions, and yet we’re not using those skills to their full potential. Why? Because we’ve been boxed into doing the same therapy as everyone else—just with more debt and more years of school behind us.

Meanwhile, the public is desperate for better care. Waitlists for psychiatrists stretch months (sometimes years). Family doctors are expected to manage mental health with 10-minute check-ins and minimal training. And evidence-based treatments often get lost in the noise of trendy modalities and slick marketing.

This is where we come in. We have a responsibility—not just to ourselves, but to the public—to do more. To speak up. To lead. To integrate what we know into systems that desperately need it. Expanding our scope isn’t about professional ego. It’s about public health.

If we want to protect the future of our profession, we need to act now.

We need to differentiate ourselves, not just in rhetoric, but in scope.

We need to fight for prescriptive authority; not to become mini-psychiatrists, but to offer something better: a hybrid, science-informed, psychologically grounded model of care.

Where Do We Start?

I know there are barriers. Regulatory hurdles. Funding questions. Training logistics. But the first step is raising our voices.

Let this be a rallying cry: to the Ontario Psychological Association, to our peers, to the students we’re training—our profession has more to offer than we’re currently allowed to give. Let’s fix that.

Let’s stop disappearing into the crowd. Let’s lead.

If you’re a fellow psychologist who feels this too—reach out. Let’s collaborate, consult, or just brainstorm how we can move this profession forward together.

jennbossio

Dr. Jenn Bossio is a Clinical and Health Psychologist, the founder and director of the Tri Health Clinic—Ontario’s largest sex and couples therapy practice—and a passionate advocate for system-level change in mental health care. Based in Kingston, she was named Business Person of the Year (2025) and recognized as one of the Top 40 Under 40 (2024). Jenn is committed to redefining the role of psychologists in a rapidly evolving health care landscape.

Read my recent blog posts:

• Nine Months to $2,000,
• The Economics of Group vs Solo Private Practice
• Why Over 1,200 Psychology Registrants in Ontario Have Signed a Letter of Non-Confidence
• The CPBAO Wants to Rewrite Psychologist Training in Ontario. The Data Says That’s a Terrible Idea.
• Why Solo Practice Can Be Risky in Sex Therapy (And What We’re Doing Differently at the Tri Health Clinic)

Why Ontario Must Uphold High Standards for Psychologists: A Call to Protect the Integrity of Our Profession

by jennbossio | Jul 7, 2025 | Advocacy, Therapy, Training

As a clinical psychologist, clinic director, and lifelong advocate for evidence-based care, I want to sound the alarm on a concerning development in our profession. The Ontario Psychological Association (OPA) recently sent out a message to its members about proposed changes by our regulatory college that could profoundly reshape what it means to be a psychologist in this province.

Below is the full message from the OPA Board of Directors:

IMPORTANT MESSAGE TO MEMBERS FROM THE OPA BOARD OF DIRECTORS

We are writing to inform members about a proposal we recently became aware of under consideration by the College of Psychologists and Behaviour Analysts of Ontario (CPBAO). This proposal, which was brought to our attention in May, has reportedly been passed by the CBPAO council and recommends a revision of the educational and training standards required for registration as psychologists and psychological associates in Ontario.

—

By way of background, the Office of the Fairness Commissioner (OFC), which oversees registration practices for regulated professions in Ontario, rated the CPBAO as ‘medium to high risk’ in its 2022 and 2024 assessments. The most recent report cited concerns related to frequent appeals to the Health Professions Appeal and Review Board (HPARB), labour market shortages, and the under-representation of racialized individuals among PhD registrants. Recommendations included more flexible pathways for internationally trained psychologists and regular review of HPARB outcomes.

—

We understand that the CPBAO proposal outlines several potential changes aimed at addressing the concerns raised by the Office of the Fairness Commissioner (OFC), which may include:

1. Changes to program accreditation standards,
2. The removal of the doctoral standard for psychology,
3. The removal of the 4-year period of supervision required for registration among psychological associates.

We acknowledge the OFC’s concerns and understand the government’s emphasis on improving interprovincial mobility. Differences in registration requirements across provinces, coupled with Canada’s Free Trade Agreement, have created challenges including a rise in professionals with varied titles, training, and qualifications. This variation has led to public confusion and underscores the need for greater consistency and alignment across the profession.

—

The OPA is committed to discussing the identified issues with key stakeholders to further understand and advance appropriate alternatives. We recognize the need to expand the psychological workforce and address the Fairness Commissioner’s concerns, however we believe there are more thoughtful and effective ways to do so, without increasing confusion or compromising the safety of psychological services to Ontario residents. We are also committed to fair and inclusive access to psychology training and are proud of the progress underway.  We believe there is a path forward for retaining standards, addressing OFC’s concerns and maintaining the integrity of the profession.  

—

Simply revising or removing standards will not appropriately address challenges related to diversity, access, or the costs associated with mental health care; rather, it risks eliminating safeguards that protect Ontarians, while significantly eroding our professional reputation as experts in the field of mental health assessment and treatment. Like physicians and nurse practitioners, psychologists and psychological associates hold the protected act of diagnosis and require training that reflects this responsibility. 

—

Since becoming aware of this proposal, we have been actively engaged in clarifying the facts, conducting outreach with key stakeholders, and developing materials to support the maintenance of the current appropriate registration standards. We are pleased to share that our advocacy efforts have facilitated meaningful connections and dialogue with stakeholders similarly devoted to upholding the overarching registration standards for psychology in Ontario. At the same time, we recognize that continued vigilance and advocacy will be necessary. We remain committed to promoting adherence to best practices in training, education, and supervision to ensure that psychologists in Ontario continue to be recognized for their high standards of competence and professionalism. As discussions around mobility and regulatory modernization continue, it is essential that any changes occur in partnership with key stakeholders, including the OPA. We look forward to continuing this important work.

—

Please be assured that we will continue to update the membership.

—

The Ontario Psychological Association and the Board of Directors

This proposal passed by the College of Psychologists and Behaviour Analysts of Ontario (CPBAO) has sparked serious concern among Ontario psychologists. As outlined by the Ontario Psychological Association (OPA), the proposed changes could significantly lower the educational and training requirements for registration as a psychologist or psychological associate. These changes may include:

• Removing the doctoral degree requirement for psychologists;
• Eliminating the four-year supervision requirement for psychological associates;
• Altering accreditation standards for training programs.

These proposals appear to be a response to pressure from the Office of the Fairness Commissioner (OFC), which is advocating for increased access to the profession and improved interprovincial mobility. While access and fairness are essential goals, this approach is fundamentally flawed.

There Is No Shortage of Therapists

Let me be blunt: there is no shortage of therapists in Ontario. Since the creation of the College of Registered Psychotherapists in 2015, the mental health landscape has been flooded with competent, hardworking professionals, adding many psychotherapists to the existing field of social workers and nurse psychotherapists. These individuals provide the bulk of mental health services, and they are doing valuable, often life-changing work.

But here’s the reality: none of these professions are authorized to perform the controlled act of diagnosis. Nor do they receive the advanced, in-depth training required to manage complex clinical presentations, supervise other clinicians, or lead interdisciplinary treatment planning. That is the role of the psychologist.

If the goal is to allow easier movement across provinces or create faster pathways to practice, then aspiring professionals already have options. One can obtain a master’s degree and become a psychotherapist with far fewer barriers. The suggestion to dismantle the rigorous standards of psychology in the name of mobility is not only short-sighted—it’s dangerous.

Psychologists Are the Dentists of Mental Health

Think of it like this: in a dental office, you have dental assistants (technicians), dental hygienists (primary care providers), and dentists (diagnostic and treatment leaders). Dental hygienists provide most of the routine care, but it is the dentist who diagnoses, develops treatment plans, and supervises the entire process.

Psychologists play the same supervisory, diagnostic, and consultative role within the mental health system. Our training prepares us to assess the full clinical picture, understand differential diagnoses, supervise and support the work of others, and lead the system in evidence-based care.

To remove these responsibilities—or to water down the standards needed to attain them—is to risk collapsing this entire structure. We would no longer have a class of highly trained clinicians to lead the system forward. We would instead flatten the profession into a sea of generalists with minimal differentiation in training and expertise.

Prescription Rights: The Next Logical Step

Rather than weakening psychology’s entry requirements, we should be expanding our scope of practice to include prescription rights—a logical and evidence-based solution to our mental health crisis.

Research consistently shows that combined treatment using psychotherapy and medication is the most effective intervention for conditions such as depression and anxiety (e.g., Cuijpers et al., 2020; Thase, 2013). Psychologists are already experts in evidence-based psychotherapy. With additional training, they can—and should—become prescribers.

This model is already in place in several U.S. jurisdictions, including New Mexico, Louisiana, and the Department of Defense, where prescribing psychologists have been shown to provide safe, effective, and accessible care (DeNelsky & Garb, 2006).

Currently, however, medication for mental health conditions in Ontario is typically managed by:

• Family physicians, who may lack the time, training, or continuity of care to prescribe appropriately.
• Psychiatrists, who are in such short supply that waitlists can stretch for months or years. When accessed, these appointments often last just five to ten minutes.

In this climate, prescribing psychologists could dramatically improve access, continuity, and treatment quality—especially for patients with complex, treatment-resistant conditions. But this will never happen if we simultaneously reduce the educational requirements for entering the profession.

Granting prescribing rights demands high standards. It requires advanced diagnostic knowledge, pharmacological training, and strong clinical judgment. If we allow psychology to become a low-barrier profession, we are effectively disqualifying ourselves from the very future we should be moving toward.

What We Risk Losing

Lowering entry standards won’t make our system more equitable. It won’t address psychiatric shortages. It won’t improve patient care. Instead, it will:

• Undermine public trust in the title of “psychologist.”
• Confuse patients and referral sources.
• Reduce the profession’s ability to lead, supervise, and innovate.
• Widen the gap between our current scope and the future we should be fighting for.

Ontario needs more highly trained psychologists—not fewer. We need to invest in more doctoral-level training programs, create financial supports for students from underrepresented backgrounds, and expand the career opportunities of psychologists by evolving the scope of practice. That’s how we address workforce shortages without compromising care.

What I’m Doing—and What You Can Do

I’ve already written to my MPP to express my concerns. I urge all of my fellow psychologists, trainees, and clinic directors to do the same. Let your MPP know that these changes are a step in the wrong direction—and that Ontario deserves better.

In the meantime, I will continue to advocate for a system where psychologists are positioned as clinical leaders: experts in diagnosis, treatment, supervision, and—eventually—prescribing.

This is not the time to shrink our profession. This is the time to grow it into what Ontario’s mental health system truly needs.

References:

• Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A. (2020). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. The Lancet Psychiatry, 7(6), 491–505.
• Thase, M. E. (2013). Combining psychotherapy and pharmacotherapy for depression: Psychodynamics, cognitive-behavioral therapy, and the sequence of treatment. Biological Psychiatry, 73(1), 47–53.
• DeNelsky, G. Y., & Garb, H. N. (2006). Prescription privileges for psychologists: A dangerous precedent. Professional Psychology: Research and Practice, 37(2), 219–227.

If you would like a template to email your MPP or help getting involved, don’t hesitate to reach out.

jennbossio

Dr. Jenn Bossio is a Clinical and Health Psychologist, the founder and director of the Tri Health Clinic—Ontario’s largest sex and couples therapy practice—and a passionate advocate for system-level change in mental health care. Based in Kingston, she was named Business Person of the Year (2025) and recognized as one of the Top 40 Under 40 (2024). Jenn is committed to redefining the role of psychologists in a rapidly evolving health care landscape.

Read my recent posts here:

• Nine Months to $2,000,
• The Economics of Group vs Solo Private Practice
• Why Over 1,200 Psychology Registrants in Ontario Have Signed a Letter of Non-Confidence
• The CPBAO Wants to Rewrite Psychologist Training in Ontario. The Data Says That’s a Terrible Idea.
• Why Solo Practice Can Be Risky in Sex Therapy (And What We’re Doing Differently at the Tri Health Clinic)