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Translated by Lauren Amelie Nathan and Zoe Yarymowich

Open Letter

By Nicole Desjardins, M.A., sexologist and psychotherapist in private practice, and 94 signatories in support of this letter.

As many of us know, the response towards those living with sexual disorders has always been at the heart of the expertise of sexologists/psychotherapists. However, now they will have to obtain authorization to evaluate these individuals because new legislation gives the medical and legal world exclusive control over sexual disorders.

Since February 1st, 2017, L'Ordre professionnel des sexologues du Québec (OPSQ) requires sexologists/psychotherapists to hold an authorization to assess sexual disorders, which will be conditional on obtaining a training certificate in the assessment of mental disorders if they want to continue to assess sexual disorders. Depending on the case, some will be exempt from taking the training (Gazette officielle du Québec, 2017).

The reason? Sexual disorders are classified in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as well as the International Statistical Classification of Diseases and Related Health Problems (CIM-10). The Act to amend the Professional code for mental health professionals clearly states that only doctors and psychologists, as well as certain guidance counsellors and nurses, are authorized to assess mental disorders (National Assembly, 2009)

The OPSQ informed its members of these measures in July 2016. The press release implied that the restriction had been established by the Office des professions since 2009 as part of Bill 21 and that to comply, sexologists had to submit a request for authorization and pay a fee of approximately $150 for their case to be reviewed.

The Expertise of Sexologists Questioned

The new requirement has had the effect, of course, of causing an outcry amongst sexologists. The OPSQ attempted in vain to reassure its members by saying that it would grant an exemption to most sexologists who graduated with a bachelor’s degree AND a master’s degree in clinical sexology before September 2015, but this did not manage to quell their anger. The reality is that there was no room for discussion as if sexologists just had to bow down without saying a word. However, it was a good opportunity to reflect on the issue. Only one information session was held in Montreal, on a weekday between 12:00 p.m. and 1:00 p.m.; only about ten sexologists were able to attend.

Curiously, the new regulations only apply to sexologists, although the evaluation of sexual disorders is at the very heart of their university training and clinical practice (UQAM, 2016a; 2016b). This is their field of expertise. Sexual disorders have long been found in the DSM and sexologists have always been able to handle them. The tool classifies disorders according to diagnostic criteria and thus makes it possible to guide treatment in sexual psychotherapy (APA, 2017).

What is repugnant about the new requirement is that it is as if sexologists suddenly no longer have any competence in this field. However, for more than thirty years, sexologists/psychotherapists have been responsible for evaluating and treating sexual disorders, in addition to being entrusted with teaching duties in faculties of medicine and to other professionals, both here and abroad.

Searching for Logic

The new legislation gives psychologists, doctors, guidance counsellors, and registered nurses free rein to assess sexual disorders, which have traditionally been the primary area of expertise for sexologists. And yet, a majority of these professionals are accustomed to deferring to sexologists to assess and treat these disorders, a clear sign that they trust their abilities.

The law is made in such a way that it allows other authorized professionals to assess mental disorders without having to follow any specific training relating to sexual disorders. Conversely, a sexologist would never be permitted to assess a mental disorder such as a mood disorder, post-traumatic stress disorder or attachment disorder. It would be argued that these disorders are outside of their field of expertise (OPSQ, 2014a). However, comorbidity is often present (Nia et al., 2017; Rajkumar & Kumaran, 2015; van Lankveld & Grotjohann, 2000; Yehuda & Lehrner, 2015).

A Dangerous Path

Psychiatry currently divides sexual disorders into three categories: paraphilic disorders, gender dysphoria and sexual dysfunctions (APA, 2013a; 2013b, 2013c). For the latter, in everyday language, they are commonly referred to as sexual “difficulties” and “problems”, and these are the most common reasons for consulting sexologists/psychotherapists (Godbout et al., 2015). In addition, some sexologists/psychotherapists have developed expertise in sexual delinquency, with victims of assault or incest, or in trans identities.

Anyone who claims to be able to draw the line between a sexual problem and a sexual disorder is well advised. For example, it is considered that experiencing a lack of sexual desire or erectile difficulties for a few months, despite marked suffering, is a sexual problem. But what if the condition continues for six months? The problem then becomes a sexual disorder, therefore a mental disorder! (APA,2013a).

It is interesting to take note of the fluidity of psychiatric diagnoses which change according to the evolution of mores. Psychiatry constantly adds or removes diagnoses from its repertoire. For example, homosexuality has ceased to be included since the publication of the DSM-III-R (APA,1987) and no doubt that within a more or less distant future, trans identities will no longer be included either. What about sexual fantasies? According to the latest DSM-5, half of the population would have abnormal fantasies (paraphilias) (Joyal, 2014). If that is the case, that means that half of us live with abnormal fantasies!

Moreover, I question the relevance of “legally” treating sexual disorders as mental disorders, and more specifically sexual dysfunctions. If it proves impossible to remove them from the DSM to list them elsewhere, such as in the book Médecine Sexuelle (Courtois and Bonierbale, 2016), they could simply continue to appear in the DSM, even if one day a group of activists demands their removal!

A Double-Edged Policy

When the Act to amend the Professional Code was adopted, the Office des professions did not see fit to require psychologists holding a master’s degree to prove that they had the necessary skills to assess mental disorders. Why should it be any different for sexologists who also hold master’s degrees?

Lest we forget that university training in sexology was updated in 2015, which in no way means that currently practicing sexologists are incompetent.

Training standards for new sexologists have been adjusted but those in service, like other professionals, have gained experience over the years of practice and kept their skills up to date (OPSQ, 2014b). Why should the bar be raised for them?

The approximately 300 sexologists/psychotherapists in Quebec, compared to 8,652 psychologists (Office des professions du Québec, 2016) are affected by this new policy. Of course, it is unlikely that they will be seen taking it to the streets to oppose it. I believe that there is still a debate to be had on this subject and it would be right to do so.

Public Protection

It is claimed that the new regulations in question are justified as they serve to protect the public. The fact remains that each professional order, including l’Ordre professionnel des sexologues, already complies with this obligation (OPSQ, 2014c). Their members must undergo professional inspection at various levels, such as record keeping, compliance with standards and the evaluation of their overall clinical practice (OPSQ,2014d).

Mental health professionals, more specifically those practicing psychotherapy, must also adhere to continuing education requirements. This ensures that professionals keep their skills up to date​​ (OPQ, 2016a; 2016b).

Finally, a union assumes both the role of investigator and prosecutor concerning those who have committed ethical breaches which also protects the public (OPSQ, 2014e).

Given that the system to protect the public already exists, if more needs to be done, why not just impose a more rigorous inspection? Provided, of course, this same standard can be applied to all professions!

Conclusion

Given what has preceded, it is permitted to question if the new measures aim to effectively protect the public or if they serve to defend the interests of certain professionals.

We all know that there are power struggles between the various professional orders and that this creates private hunting grounds (Desharnais, 2006). This new piece of legislation obligating sexologists to ask for permission to evaluate sexual problems only serves to enhance the status of some professionals to the detriment of others. Sexologists are offended by this new regulation since sexual problems have been part of their field of expertise for years. They must oppose the obligation to prove their competence in their field and in which they have already proven themselves.

For my part, I do not want to find myself at odds with the OPSQ by refusing to submit to their obligations, that being said, I refuse to kowtow to their “general order” evaluations when I know that I am fully capable of evaluating sexual problems, as I always have been.

This is why I find it incomprehensible to obligate sexologists to present a file aiming to prove that they have the required training, only to satisfy requirements that ignore the skills that have already been recognized. It is not a few hours of training that will make sexologists deviate from the safe and proven methods they have been taught, such as the evaluation of sexual disorders that are part of the exercise of clinical judgment as well as communication of this judgment.

Without wanting to sign myself up for the anti-psychiatry wave, I feel obligated to express my disagreement here, if only to put a brake, in my way, on the current momentum aimed at medicalizing “problems” of all kinds.

I conclude with a reflection from Gilles Voyer (2015), professor of philosophy at Université de Sherbrooke, who maintains that in a human group, while the rules are necessary, they do not necessarily produce more ethics. In other words, more rules do not assure on their own a guarantee of doing better. Conversely, these rules risk encumbering us and undermining our freedom in our means of action.

I invite all those who feel concerned by this question, particularly my colleagues, to pursue the reflection and to open the door to discussion, rather than retreating too quickly by signing a blank cheque to our professional order.

C. c. Office des professions du Québec / Conseil interprofessionnel du Québec / Ordre professionnel des sexologues du Québec / Association des sexologues du Québec / Ordre des psychologues du Québec / Collège des médecins du Québec / Association des médecins psychiatres du Québec / Stéphanie Vallée, ministre de la Justice.

To sign the open letter (Indicate your full name, your level of education and your professional status), click here.

Signatures in support of this letter

We, the undersigned, acknowledge the expertise of sexologists/psychotherapists in assessing sexual disorders:

To remain as faithful as possible to the information provided to us, we have not translated the professional titles of the signatories.
 

Dr Édouard Beltrami, MD psychiatre. Professeur Honoraire (UQAM). Professeur au département de sexologie, UQAM (1976-1996). Sexologue Émérite ASQ, membre de la Société des Experts en Évaluation Médico-légale du Québec.
Dr Pierre Alarie, MD., chargé de cours à la maîtrise en sexologie clinique, UQAM; professeur adjoint de clinique, département de Médecine familiale, Université de Montréal; Coordonnateur de l’unité des Dysfonctions sexuelles du CHUM. 
Dre Francesca Sicuro, PhD., psychologue, psychothérapeute, bureau privé. Ex- chargée de cours et de stages, ex-superviseure à la maîtrise en sexologie clinique, UQAM. 
Dr Serge Tremblay, Ph.D., psychologue, psychothérapeute, bureau privé. Exprofesseur titulaire à la maîtrise en sexologie clinique, UQAM. 
Michel Lemieux, M.A., thérapeute conjugal et familial, psychothérapeute, bureau privé. Sexologue retraité. Ex-enseignant et superviseur à la maîtrise en sexologie clinique, 
UQAM. 
Rachel Guay, M.Sc., t.s., thérapeute conjugale et familiale, sexologue à la retraite. Exformatrice et superviseur clinique à la maîtrise en sexologie clinique, UQAM. 
Dre Lise Marcotte, D.Ps., M.Ps., M.A., (sexo), consultante, psychologue, sexologue, bureau privé. Ex-superviseure à la maîtrise en sexologie clinique, UQAM. 
Dr Marc Steben, MD., directeur médical, Clinique A, santé sexuelle; Clinique médicale l’Actuel. 
Dre Gabrielle Landry, MD., directrice médicale Refresh MD, Clinique A, santé sexuelle; Clinique médicale l’Actuel. 
Dre Caroline Cardonna, MD., Clinique A, santé sexuelle. 
Dr Jean-François Caron, MD., Clinique médicale privée Humani. 
Jean-Luc Lacroix, B.A., M.Sc., travailleur social, thérapeute conjugal et familial, psychothérapeute, formateur et superviseur clinique, détenteur d’un baccalauréat en sexologie. 
Marie-Josée Lord, M.Sc., Pht., physiothérapeute, Clinique Physio Santé Pelvienne. 
Stéphanie McClish, M.Sc., Pht, physiothérapeute, clinique privée. 
Maryse Chagnon, M.Sc., pht., physiothérapeute, clinique privée. 
France Claude Létourneau, M.Ps. psychologie, professeure de psychologie, CEGEP de Maisonneuve. 
Rémi Desgagné, B.Sc., travailleur social, Ilot Centre de crise et de prévention du suicide de Laval. 
Karine Tremblay, B.Sc., travailleuse sociale, Centre de réadaptation en dépendances de Montréal, Institut universitaire. 
Nicolas Courcy, B.Ed., Intervenant LGBTQ, Centre Sida Amitié. 
Fanny Grégoire, B.A. psychologie, M.A, professeure de psychologie, CEGEP régional de Lanaudière à Terrebonne. 
Henri Labelle, B.Sc., travailleur social et psychothérapeute, Clinique de psychothérapie des Laurentides et CLSC. 
Stéphane Marcotte, Bacc. en travail social, agent de surveillance communautaire en délinquance aux problématiques multiples, région Saguenay, Association canadienne pour la santé mentale.

Sexologists/psychotherapists, and psychologists:
Jocelyne Robert, sexologue et écrivaine.
Iris Marceau, Bac + 5., psychologue clinicienne en unité de psychiatrie & association
Lise Lantagne, Professionnelle santé mentale justice, Criminologue, sociologue et étudiante au DESS en santé mentale

Sexologists-psychotherapists and psychologists signatories

François Blanchette, M.A., sexologue, psychothérapeute, superviseur clinique universitaire en thérapie cognitive-comportementale au Département de sexologie de l'UQAM, pratique en bureau privé. Président de l'Association des sexologue du Québec de 2001 à 2003 et 2004 à 2006. 
Diane Brouillette, M.A., biologiste, sexologue clinicienne, formatrice et superviseur à la retraite, bureau privé et à l’unité des Dysfonctions sexuelles du CHUM. 
Dre Isabelle Hénault, M.A., Ph.D., sexologue, psychologue. Directrice de la Clinique Autisme et Asperger de Montréal. 
Sophie Dutrisac, M.A., psychologue, sexologue, bureau privé. 
Marcel Couture, M.A., sexologue, psychothérapeute, praticien certifié EMDR et superviseur clinique. Ex-membre du comité provincial/normes de pratique des agresseurs sexuels. Fondateur et ex-coordonnateur à la clinique d’évaluation et de traitement des troubles du comportement sexuel à l’Institut universitaire en santé mentale de Québec (CH Robert-Giffard). 
Isabelle Avril-Pronovost, M.A., sexologue, psychothérapeute, superviseur clinique, bureau privé et chargée de cours à l’Université Laval. 
Normande Couture, M.A., sexologue clinicienne, formatrice, à la retraite. Bureau privé et en délinquance sexuelle au CH Robert-Giffard. Ex-chargée de cours en sexologie à l’Université Laval et ex-superviseur à la maîtrise clinique à l’UQAM. 
Lydie Bouchard, B.A, sexologue, psychothérapeute. Conseillère spécialisée en délinquance sexuelle. ACSMS-CHC La Relève, Service d’évaluation et de traitement en délinquance sexuelle. 
Mylène Desrosiers, M.A. sexologue, Clinique A rue McGill et coordonnatrice de recherche au Laboratoire d’étude de la santé sexuelle de la femme du Département de psychologie de l’Université de Montréal. 
Stéphanie Ledoux, M.A., sexologue, sexoanalyste, psychothérapeute spécialisée en délinquance sexuelle au programme PAAS pour l'organisme l'Arc-en-soi et à la Clinique des Troubles Sexuels de l'Institut universitaire en santé mentale de Québec. 
Camille Chamberland, M.A., sexologue, psychothérapeute spécialisée en transgenre, bureau privé; délinquance sexuelle au CIDS de Laval. 
Caroline Guay, M.A., sexologue, psychothérapeute, Centre d’entraide et de traitement des agressions sexuelles et en bureau privé. 
Latifia Boujallabia, M.A., sexologue, psychothérapeute, bureau privé. Chargée de cours au département de sexologie de l’UQAM et à la Faculté de médecine de l’Université Laval. 
Marie-Christine Courchesne, M.A., sexologue, ARH à la Clinique jeunesse CLSC des Faubourgs. 
Dre Anik Ferron, Ph.D., sexologue, psychothérapeute, bureau privé. 
Lise Desjardins, M.A., sexologue, psychothérapeute, superviseur clinique, formatrice Québec/Europe, bureau privé. 
Sylviane Larose, M.A., sexologue, psychothérapeute, formatrice à la PSI, bureau privé. 
Dominique Themens, M.A., sexologue, psychothérapeute, bureau privé. Superviseur clinique à la maîtrise en sexologie clinique, UQAM. 
Joanne Lépine, B.A., M.A., infirmière, sexologue, psychothérapeute sexoanalyste, superviseur clinique, formatrice, bureau privé, Centre de médecine sexuelle Concorde. 
Francyne Tessier, infirmière, M.A., sexologue, psychothérapeute; M.A., éducation intervention en sexologie, bureau privé. 
Véronique Boisvert, M.A., sexologue, psychothérapeute, auteure, superviseur clinique à la maîtrise clinique en sexologie clinique, UQAM. Bureau privé. 
Nicole Audette, M.A., sexologue, psychothérapeute, sexoanalyste, formatrice Québec/ Europe en thérapie sexocorporelle, bureau privé. 
Martine Drapeau, M.A., sexologue, psychothérapeute, bureau privé. Chargée de cours au département de sexologie de l’UQAM. 
Marc Bilodeau, M.A., sexologue, a.r.h., CLSC Des-Pays-d’en-Haut. 
Julie Laurion, M.A., sexologue, psychothérapeute, bureau privé. 
Cécile M. Barcelo, B.A., sexologue, psychothérapeute, bureau privé. 
Linda Brouillette, M.A., sexologue, psychothérapeute, sexoanalyste, bureau privé. 
Denyse Cusson, M.A., criminologue et sexologue, bureau privé. Membre retraitée. 
Julie Fournier, M.A., sexologue, psychothérapeute, bureau privé. 
François Gastonguay, M.A., sexologue et psychothérapeute, superviseur clinique, bureau privé. 
Guylaine Gélinas-Martel, M.A., sexologue, psychothérapeute, bureau privé et au CHUS oncologie/gynécologie. 
Claudette Berthiaume, B.A., sexologue retraitée. Bureau privé, milieu carcéral et oncologie au CHUM (Notre-Dame). 
Catherine Grégoire, M.A., sexologue, psychothérapeute, bureau privé; Clinique médicale privée Humani. 
Alain Gariepy, M.A. sexologue, psychothérapeute sexoanalyste, formateur, conférencier, bureau privé. Responsable du programme Sexologues Sans Frontières. 
Genny Harvey, M.A., sexologue, psychothérapeute, bureau privé. 
Geneviève Héneault, M.A., sexologue, bureau privé et CISSS. 
Mélissa Marcotte, M.A., sexologue, psychothérapeute, superviseur clinique en sexoanalyse, bureau privé. 
Nancy Perron, M.A., sexologue, psychothérapeute, bureau privé. 
Martine Lemay, M.A., sexologue, psychothérapeute, bureau privé. 
Pierre Kirouac, M.A., sexologue, psychothérapeute, auteur, bureau privé. 
Justine Lallier-Beaudoin, M.A., sexologue, psychothérapeute, bureau privé. 
Marie-Josée Desjardins, B.A., sexologue, massothérapeute. 
Manon Leclerc, M.A., sexologue, psychothérapeute, bureau privé. 
Isabelle Le Goff, M.A., sexologue, psychothérapeute, bureau privé. 
Élise Bourque, M.A., sexologue, psychothérapeute, bureau privé. Superviseur clinique universitaire à la maîtrise en sexologie clinique, UQAM. 
Jeanne Bourdon, M.A., sexologue, psychothérapeute, bureau privé. Superviseur clinique à la maîtrise en sexologie clinique, UQAM. 
Kim Fafard-Campbell, M.A., sexologue, psychothérapeute, bureau privé. 
Suzanne Drouin, B.Sc., M.A., travailleuse sociale, sexologue, psychothérapeute, bureau privé. 
Annie Barbier, M.A., sexologue, psychothérapeute, bureau privé. 
Kathy Francis, M.A., sexologue, psychothérapeute, bureau privé. 
Annie M. Grégoire, M.A.. sexologue, psychothérapeute, bureau privé. 
Gabriel Aubé, M.A., sexologue, psychoéducateur, psychothérapeute, bureau privé. 
Claudia Bernard, M.A., sexologue, psychothérapeute, bureau privé. 
Josée Leboeuf, M.A., sexologue, psychothérapeute, bureau privé. 
Natalie Suzanne, M.A., sexologue, psychothérapeute, sexoanalyste et superviseur en bureau privé. Auteure et conférencière. 
Marie-Ève Demers-Morabito, M.A., sexologue, psychothérapeute, bureau privé. 
Josée Thiffault, M.A., sexologue, psychothérapeute, bureau privé. 
Louise Morin, M.A., sexologue, psychothérapeute, bureau privé. 
Marie-Claude Blanchet, M.A., sexologue, psychothérapeute, bureau privé. 
Jacqueline Comte, M.A., sexologue clinicienne, auteure, membre retraitée. 
Amélie Blanchette, M.A., sexologue, psychothérapeute, bureau privé. 
Nancy Tremblay, B.A., M.A., sexologue, travailleuse sociale, psychothérapeute, bureau privé. 
Marcela Quiroz, M.A., sexologue, psychothérapeute sexoanalyste, bureau privé. 
Isabelle Barber, M.A., sexologue, psychothérapeute, bureau privé chez Servirplus. 
Jean-Michel Soulard, B.A., sexologue, DESS en santé mentale, sexologue sportif, Institut Kiné-Concept. 
Gilberte Talbot, B.A., sexologue, psychothérapeute, bureau privé. 
Rachel Mailhot, M.A., sexologue, psychothérapeute, bureau privé; CIDS Laval en délinquance sexuelle. 
Marilyne Beauchemin, M.A., sexologue, psychothérapeute, bureau privé. 
Chantal Turcotte, M.A., sexologue, psychothérapeute, bureau privé.
Kim Boisvert-Sorel, M.A., sexologue, psychothérapeute, bureau privé; Centre d’intervention en violence et agressions sexuelles (CIVAS Montérégie).
Nathalie K. Côté, M.A., sexologue, psychothérapeute, chargée de cours et superviseure clinique à la maîtrise, UQÀM
Annie Caron, M.A., M.Sc., sexologue et psychothérapeute en pratique privée, criminologue à Côté cour, CIUSSS Centre-sud-de-l’Île de Montréal
Mériza Joly, M.A. , sexologue et psychothérapeute en pratique privée, Longueuil
Annie-Karine Beauchesne, M.A., Sexologue, psychothérapeute en pratique en bureau privé
Sylvie Lavallée, M.A., sexologue, psychothérapeute, auteure et chroniqueuse médias
Caroline Abram, M.A., sexologue clinicienne et psychothérapeute, superviseure a la maitrise en sexologie clinique, bureau privé.
Cynthia Patenaude, B.A., sexologue, Intervenante psychosociojudiciaire au Centre d'aide aux victimes de la Montérégie
Sylvie Modérie, M.A., sexologue, psychothérapeute, superviseur clinique à la maîtrise en sexologie clinique UQAM, bureau privé
Sylvie Lavigueur, sexologue en relation d'aide, clinique privée
Michelle Gagnon, B.A., sexologue, psychothérapeute, bureau privé
Marie-Eve St-Cyr, B.A. sexologie et B.A. psychoéducation, Intervenante en Centre jeunesse
Véronique Faubert, M.A. sexologue et psychothérapeute, Centre régional de santé mentale et toxicomanie, Hôpital Général de Hawkesbury & District
Marie-Josée Thivierge, M.A. sexologue, psychothérapeute, CISSS de Lanaudière
Mélissa St-Jacques, M.A. sexologue, psychothérapeute
Michèle St-Amand M.A., sexologue et psychothérapeute, pratique privée

Students in sexology and related disciplines

Carol-Ann Morier, étudiante au baccalauréat en sexologie, UQÀM
Myriam Gauvreau, doctorante en psychologie profil intervention, Université du Québec à Trois-Rivieres
Laura Morin-Parent, étudiante au baccalauréat en sexologie, UQÀM
Émilie Chantal Tremblay, étudiante au baccalauréat en sexologie, UQÀM
Ariane Blanchard, B.A. sexologie, étudiante à la maitrise en sexologie clinique, UQÀM
Roxanne Guyon, étudiante à la maitrise en sexologie profil recherche et intervention, Assistante de recherche pour le Laboratoire de Mylène Fernet sur la violence et la sexualité, Éducateur pour le CIUSS centre-sud de Montréal
Agathe Pérusse-Deschênes, étudiante au baccalauréat en sexologie, UQÀM

March 13, 2017

Nicole Desjardins, M.A. 
Sexologist, psychotherapist
www.therapiedecoupleetfamiliale.com  & www.sexologuelaurentides.com 

To cite this article :

Desjardins, N. (2017, March 15). Questioning the Competence of Sexologists/Psychotherapists in Assessing Sexual Disorders. Les 3 sex*. https://les3sex.com/en/news/116/lettre-ouverte-mise-en-doute-de-la-competence-des-sexologues-psychotherapeutes-pour-evaluer-les-troubles-sexuels