Q1: I am working in an area of dietetic practice where principles of Cognitive Behaviour Therapy (CBT) are being applied in the context of a client’s weight loss goal. Is it within my scope to apply these principles or is this psychotherapy?
Cognitive Behaviour Therapy (CBT) is a subcategory of psychotherapy. CBT can be defined as: “a process of teaching, coaching, and reinforcing positive behaviours. CBT helps people to identify cognitive patterns or thoughts and emotions that are linked with behaviours” (BC Gov’t Ministry of Health: Cognitive Behaviour Therapy – Core document Information).
Dietitians and Psychologists are regulated professions under the BC Health Professions Act.
“Dietetics” is defined in the Dietitians Regulation, as “the assessment of nutritional needs, design, implementation and evaluation of nutritional care plans and therapeutic diets, the science of food and human nutrition, and dissemination of information about food and human nutrition to attain, maintain and promote the health of individuals, groups and the community.”
The “practice of psychology” is defined in the Psychologists Regulation, as “includes, for a fee or reward, monetary or otherwise,
- the provision, to individuals, groups, organizations or the public, of any service involving the application of principles, methods and procedures of understanding, predicting and influencing behaviour, including the principles of learning, perception, motivation, thinking, emotion and interpersonal relationships
- the application of methods and procedures of interviewing, counselling, psychotherapy, behaviour therapy, behaviour modification, hypnosis or research, or
- the construction, administration and interpretation of tests of mental abilities, aptitudes, interests, opinions, attitudes, emotions, personality characteristics, motivations and psychophysiological characteristics, and the assessment or diagnosis of behavioural, emotional and mental disorder.”
While the practice of psychotherapy is not a Restricted Activity in BC, it is included in the scope of practice of Psychologists. Psychotherapy is not included in the Dietitians Regulation. Other health professions may include elements of psychology, including psychotherapy, within their scope. These professions include, but are not limited to, social workers, physicians and nurses.
Dietitians in BC graduate with foundational knowledge of the psychological aspects and behavioural theories of food choice and eating and are able to provide counseling and address nutritional problems that may arise as a result of having mental health issues. Dietitians may also consider Trauma Informed Practice concepts and readiness to change within their scope of dietetic practice.
Q2: So, based on Q1, I may be able to practice aspects of psychotherapy. What are some additional considerations?
Is psychotherapy (CBT) in your personal scope?
You are encouraged to refer to the CDBC’s Decision Tool for New Aspects of Dietetic Practice. This tool can assist you in evaluating your individual scope and determine:
- Aspects of practice where you may need to gain additional education (Standards of Practice 3.2 and 3.3), and
- Aspects where you may need to refer to another health regulated professional whose scope explicitly includes psychotherapy (Standard of Practice 2.3).
Dietitians may also want to review the Professional Practice Guidelines (scroll down to policies), to make sure they address all aspects of competent, ethical and safe practice.
Q3: I have found a course that certifies me to practice psychotherapy (CBT) within the context of my dietetic practice. Is it sufficient to complete this course as a part of my learning needs in order to provide CBT?
It is possible that a course or certification in CBT provision can potentially enhance competent and safe practice of dietetics. Dietitians need to assess and manage risk of harm and recognize the limits of their competence to ensure safe client-centered care.
Whether or not psychotherapy, and consequently CBT, becomes a restricted activity in the future, collaborative and interprofessional care are essential when it comes to mental health. You need to assess properly the risk of harm and recognize the limit of your competence to ensure client-centered care. Where there is a professional who is better suited to provide psychotherapy, you should consider referring this task out.
Q4: My patient/client’s capacity to make health-related decisions is in question. Am I able to perform a capacity assessment?
Assessment of competence/capacity is NOT within scope for dietitians in BC. Please refer to the Ministry of Health Incapacity Assessment Report , which stipulates that an “assessor” is defined as a “medical practitioner, registered nurse, nurse practitioner, registered psychiatric nurse, social worker, occupational therapist, or psychologist (registered with their respective regulatory colleges)”.
In a multi-disciplinary workplace, it is reasonable for you to collaborate with members of the healthcare team to contribute your nutrition assessment details and details of your interaction with a client/patient who is being assessed for capacity. If you work in a setting without such support, you need to refer to a professional that is able to assess capacity, per Standard 2.3: “A dietitian practices within CDBC scope of practice…. by… determin[ing] situations beyond a Dietitian’s professional scope of practice and refer to another health professional.”