The Case for Regional Registration of Counsellors

I very recently registered as an Associate Counselling Psychologist in my home country of Jamaica and a number of thoughts came to mind about the regional need for service from qualified therapists across the Caribbean Single Market and Economic (CSME) area. As I lay awake pondering and pondering, a few irksome issues began to flood my mind about how the field of psychology globally is missing key opportunities to better the lives of people. I was so motivated to think the issue through that I later contacted a more senior therapist in Jamaica to voice my concerns and get her feedback about the progress of a Caribbean Community (CARICOM) certification process by which islands with smaller populations can eventually be served by therapists from other member states. Of course, as I sit here in Vancouver at the end of the first COVID winter, I began to wonder why it is that there is a lack of federal licensing which allows people to operate across Canada. The more I thought, the more I wondered whether or not the issue was inadvertently reinforcing white supremacy in North America.

One of the issues that COVID has highlighted is the fact that people in pain need support. This was compounded by the racial tensions arising from anti-Black and anti-Asian hate which has increased across Canada with a 717% increase in Vancouver alone. Although all people of colour are struggling right now, special emphasis must be placed on the Asian and Black communities of Canada and the world. We simply cannot make sense of what is happening to us. Obviously, this is because racism and xenophobia are senseless but, when you are the target, there is even greater confusion and hurt that arises from your situation.

In the case where there are inter-sectional factors, (sex, gender, sexual orientation, religious affiliation etc.), there is an even greater concern about the fact that people can find themselves as a marginalized group within a marginalized or racialized group. How can such people be expected to open up to people outside their cultural, racial and gender context when most of the time, the people offering them service do not understand their background? How can we expect clients to be willing to engage with us when we also require them to educate us about their worlds? Why do we then turn around and force marginalized or minority people to find support in their very white contexts simply because they cannot find someone with the cultural competence to handle them based on nothing but geography?

I have had several people from other provinces reaching out to me for help because my Caribbean identity is more important to them than my resumé. It breaks my heart to have to turn them away because of the standard practices in our field. It upsets me deeply to know that they are coming to me because they have had bad experiences with white therapists who are strictly Western in their views and have treated the clients poorly because of their own ignorance. It makes me wish I were registered in all provinces. However, it would be unnecessarily expensive if I were to register in every single province where there is a college. Essentially, this creates a strange situation in which a competent professional with the appropriate cultural lens is being kept from serving the people who need me the most simply because I happen to live in one province and they live in another. It is time for the powers that be to re-examine whose interests are served by this absurd problem.

In Canada, the level of absurdity around this issue is even more pronounced for me as we are part of the same country. If ALL practitioners are held to the same ethical standards across provinces, why on earth is there a problem for someone in Ontario as a queer, black woman from the Caribbean who is a therapist herself, prohibited from seeing someone in British Columbia who best serves her needs? If she is part of the handful of Black therapists in Ontario and knows most of her colleagues, how can she be expected to share personal information with them and feel safe? What happens when everyone’s case load is full? Is she then required to wait until one of them has space even though this may become an ethical issue for her in seeing her own clients?

It is well documented that ethnic minority communities in the United States of America tend to under utilize mental health services or, they begin and then stop treatment at much higher rates than white Americans. We know that a huge part of this is because historically, the field of psychology has been very “white” in its construction of “normal” human behaviour and easy to pathologize non-white people. In many of Canada’s institutions of higher learning, there is a recognition that cultural competency is important. It is one of the key ingredients in my own training programme at Adler University which has a strong social justice leaning and expectations that its graduates will understand cultural competency. So why is it then that our institutions train us to honour cultural competency and yet the regulatory bodies neglect this fundamental issue of ethics?

In smaller Caribbean islands where everybody knows everybody and has for generations, how can people access service? For example, if someone was part of a couple and was engaged in couple’s therapy what happens if the relationship ends and both parties need further individual counselling? To whom will each person be referred if they are all part of the same small society? Which member of the couple then gets to “keep” the therapist they were seeing? How is any of this fair to the clients whose needs we are trained to see as more important than our own? This is a major issue as it also puts clinicians in the complicated situation where they have to constantly manage the dual relationships that our profession cautions us against. If as therapists, we are supposed to live our lives in service to others, how can we do this when outdated standards of practice prohibit us from creative problem solving?

If the English-speaking Caribbean, Canada and other countries are all part of the same Commonwealth, why don’t we have “Commonwealth certification”? If there are twenty CARICOM countries, most of which are small, why don’t we have CARICOM certification so that people can move freely among the different member states and provide service quickly? Why can’t we promote telehealth for those cases in which online counselling is suitable?

I am in the process of getting my Caribbean Single Market and Economy (CSME) certificate which allows me to register in other CARICOM states but, it is a process that takes upwards of six weeks. If COVID has taught us anything, it is that old systems no longer suit the context in which people actually live as there is a concurrent pandemic of mental health problems happening alongside a virus. Every clinician knows this even though policy makers may still not really understand it. It is time for that to change.

The twisted blessing within this pandemic experience and the social justice approach that is rising to prominence is that now, the world is starting to decolonize its practices. Shouldn’t the field of psychology be paying far greater attention to this? Shouldn’t they be looking at how these isolationist practices are harming racialized people? If the field is truly serious about battling oppression in all its forms, it has to evolve in order to do so. The old guard is not working anymore and it is a potentially exciting time to alter the way things “are done”.

When we in the field think about our legacy, these are the questions we need to answer. Are we serving the vulnerable as well as we could? Are we actually avoiding harm to them if we continue to put up barriers based on geography so that culturally competent professionals cannot access clients in need? Whose needs are we actually serving? Are we inadvertently gatekeepers of white supremacy if we do not challenge the current thinking? It is high time we start to seriously think on these issues as we craft the “post-pandemic normal” lest we miss the opportunity for creating lasting social change.