Specialists Required for Effective Therapy
False Assumption: Only licensed mental health specialists can effectively deliver evidence-based psychotherapy for depression.
Written by FARAgent on February 11, 2026
For decades, mental health experts held that only licensed specialists could deliver effective psychotherapy for depression. This view took root in the mid-20th century, as professional guilds emphasized formal training and licensure to ensure competence. Psychologists and psychiatrists argued that lay providers lacked the skills to handle complex therapies, a stance that shaped guidelines and restricted access to care. By the 2000s, this assumption underpinned shortages in mental health services, leaving millions underserved.
The idea faced scrutiny in the 2020s with trials like SUMMIT, led by Dr. Daisy Singla at the Centre for Addiction and Mental Health. Her study trained non-specialists to provide evidence-based therapy to over 1,230 depressed pregnant and postpartum women, yielding results comparable to specialist care. Researcher Michael Inzlicht later pointed out how these findings undercut the "therapy elite," exposing untested beliefs that had limited scalable support. The harm was clear: specialist-only models had prolonged waits and denied treatment to vulnerable groups.
Growing evidence now suggests this assumption was flawed. Critics increasingly recognize that brief training can equip lay providers for effective delivery, potentially easing global shortages. Still, many professionals defend the specialist norm, and the debate continues to evolve.
People Involved
- Dr. Daisy Singla, a clinical psychologist and senior research scientist at the Centre for Addictions and Mental Health in Toronto, took on the role of challenger in the early 2020s. She led the SUMMIT trial and related global studies that trained nonspecialists to deliver psychotherapy for depression. Her work pointed to effective results without licensed specialists, much to the discomfort of therapy elites who held firm to old assumptions. [1]
- Michael Inzlicht, a researcher, stepped in after one of Singla's talks. He underscored how the findings undercut the elite's grip on mental health care. [1]
▶ Supporting Quotes (2)
“I attended a departmental colloquium earlier this month by the very impressive Dr. Daisy Singla, a clinical psychologist and senior research scientist at Toronto’s Centre for Addictions and Mental Health (CAMH).”— The Therapy Elite Won’t Like This
“I attended a departmental colloquium earlier this month by the very impressive Dr. Daisy Singla... I loved Dr. Singla’s talk and walked away having learned something important. Though perhaps not what she intended.”— The Therapy Elite Won’t Like This
Organizations Involved
The Centre for Addictions and Mental Health in Toronto stood behind this shift. It employed Dr. Daisy Singla and backed her trials that pushed for nonspecialist delivery of mental health care. [1] The organization supported research on scaling psychotherapy through trained lay providers, even as specialist norms held sway elsewhere. [2] Such institutional support helped sustain the challenge, while others clung to policies that favored licensed clinicians and reaped the benefits of restricted access.
▶ Supporting Quotes (2)
“Toronto’s Centre for Addictions and Mental Health (CAMH).”— The Therapy Elite Won’t Like This
“Dr. Daisy Singla, a clinical psychologist and senior research scientist at Toronto’s Centre for Addictions and Mental Health (CAMH).”— The Therapy Elite Won’t Like This
The Foundation
For years, therapy elites in North America and beyond assumed that only licensed mental health specialists could deliver effective psychotherapy for depression. This belief rested on the idea that formal training and licensure ensured competence in structured therapies like behavioral activation. [2] It seemed credible because no large trials had tested alternatives; experts pointed to unexamined norms as proof. [1] Growing evidence now suggests this foundation was flawed. The SUMMIT trial showed that brief workshops, role-playing, supervised internships, and ongoing oversight allowed nonspecialists to match specialist outcomes. [1][2] Increasingly, the assumption is seen as an untested barrier, though some still defend the need for elite credentials.
▶ Supporting Quotes (3)
“Patients were randomized to see either a specialist (licensed clinicians) or a nonspecialist (doulas, community health workers, peer supporters, or nonclinical hospital staff). These are not randos off the street, but hospital staff who have some perinatal experience but no formal mental-health training or licensure.”— The Therapy Elite Won’t Like This
“Therapy was delivered in-person or via videoconferencing with technology like Zoom.”— The Therapy Elite Won’t Like This
“These are not randos off the street, but hospital staff who have some perinatal experience but no formal mental-health training or licensure. Therapy was delivered in-person or via videoconferencing with technology like Zoom. The nonspecialists weren’t thrown in cold. They received structured training in behavioral activation following a standardized manual that included learning basics, observation, role-play, games, and homework. After this initial workshop, they entered an eight-week supervised internship, where they delivered behavioral activation to one or two real patients from start to finish while being monitored for competence. During the trial itself, they continued to receive weekly to biweekly supervision.”— The Therapy Elite Won’t Like This
How It Spread
The assumption spread through academic channels and professional norms in the late 20th and early 21st centuries. Therapy elites in universities and clinics prioritized licensed clinicians, dismissing scalable models with nonspecialists as inadequate. [2] Conferences and colloquia reinforced this view, until challengers like Dr. Daisy Singla presented counter-evidence in talks on scaling psychotherapies. [1] Her presentations, delivered in academic settings around Toronto and beyond, began to circulate ideas that questioned specialist exclusivity. Even so, funding incentives and social pressures kept the old belief alive among many experts.
▶ Supporting Quotes (2)
“Her talk, “Scaling up access to patient-centered psychotherapies,” focused on large-scale trials she’s run around the globe showing that non-specialists and video-conference delivery of mental health support are effective and scalable.”— The Therapy Elite Won’t Like This
“The Therapy Elite Won’t Like This”— The Therapy Elite Won’t Like This
Resulting Policies
Licensure laws across the United States and Canada enforced the specialist-only model for decades. These regulations limited who could provide psychotherapy, blocking broader access despite shortages in mental health care. [1] Policies required formal credentials for delivering evidence-based treatments, which hindered efforts to scale support through trained nonspecialists. [2] As a result, institutions built decisions around this assumption, from insurance reimbursements to clinic staffing, all while emerging trials suggested a more flexible approach could work just as well.
▶ Supporting Quotes (2)
“specialist (licensed clinicians)”— The Therapy Elite Won’t Like This
“patients were randomized to see either a specialist (licensed clinicians) or a nonspecialist (doulas, community health workers, peer supporters, or nonclinical hospital staff).”— The Therapy Elite Won’t Like This
Harm Caused
The specialist monopoly left gaps in care that hit vulnerable groups hard. In Toronto, more than 1,230 pregnant and postpartum women with depression faced restricted access until task-shifting trials intervened. [1][2] Shortages persisted nationwide, as the assumption blocked scalable models and prolonged waits for mental health support. [1] Broader underserved populations suffered similar limits, with resources tied up in elite delivery systems. Growing evidence suggests these harms stemmed from an increasingly flawed belief, though the full debate continues.
▶ Supporting Quotes (3)
“pulling in 1,230 pregnant or postpartum women between 2020 and 2023 who were suffering from depression.”— The Therapy Elite Won’t Like This
“Scaling up access to patient-centered psychotherapies”— The Therapy Elite Won’t Like This
“SUMMIT is a large, multisite randomized trial conducted across hospital networks in Canada and the United States, pulling in 1,230 pregnant or postpartum women between 2020 and 2023 who were suffering from depression.”— The Therapy Elite Won’t Like This
Downfall
The assumption began to crack in the 2020s with the SUMMIT trial, a large randomized controlled study published in Nature Medicine. Conducted in Toronto, it trained nonspecialists in behavioral activation therapy and found their results equaled those of specialists under supervision. [1][2] Videoconferencing proved effective too, exposing the specialist monopoly as unnecessary for scaling care. [2] Growing evidence from this and global studies suggests the old view was overstated, though not all experts concede the point yet. [1] Whistleblowers like Dr. Daisy Singla drove the shift, turning institutional confidence into quiet doubt.
▶ Supporting Quotes (2)
“The paper itself is impressive. It reports the results of the “Scaling up maternal mental healthcare by increasing access to treatment” (SUMMIT) trial. SUMMIT is a large, multisite randomized trial conducted across hospital networks in Canada and the United States”— The Therapy Elite Won’t Like This
“Her talk, “Scaling up access to patient-centered psychotherapies,” focused on large-scale trials she’s run around the globe showing that non-specialists and video-conference delivery of mental health support are effective and scalable. While she talked about a few papers with samples from Uganda and Bangladesh, I want to focus on one published in Nature Medicine a few months ago. The paper itself is impressive. It reports the results of the “Scaling up maternal mental healthcare by increasing access to treatment” (SUMMIT) trial.”— The Therapy Elite Won’t Like This
Sources
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[1]
The Therapy Elite Won’t Like Thisreputable_journalism
- [2]