What Training Is Required for Physical Therapists To Offer Mental Health Support?

By Joe Tatta, PT, DPT

A common question physical therapists may ask is: “What training is required to offer mental health support?” In this blog post, I’ll break down suggested training requirements, discuss the potential scope of practice limitations, licensure considerations, potential training programs, and how you can expand your practice to include mental health support while collaborating with other healthcare professionals.

For a comprehensive overview of the physical therapist’s role in mental health, refer to my earlier blog post, The Physical Therapist’s Role in Behavioral and Mental Health.

Understanding the Physical Therapist’s Scope of Practice & Limitations in Mental Health

As a physical therapist, your role and practice involves examining, evaluating, and testing patients/clients with mechanical, physiological and developmental impairments, functional limitations, and disabilities or other health and movement-related conditions in order to determine a diagnosis, prognosis and plan of treatment intervention, and to assess the ongoing effects of intervention. Understanding disability is key to understanding your role and scope of practice as a PT.

What is Disability?

The National Institutes of Health (NIH) defines disability as any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (participation restrictions).

The Americans with Disabilities Act (ADA) defines an individual with a disability as a person with a physical or mental impairment that substantially limits one or more major life activities.

Disabilities come in various forms, affecting different aspects of a person’s life, including:

• Vision

• Mobility

• Cognitive abilities

• Memory

• Learning

• Communication

• Hearing

• Mental health

• Social interactions

The World Health Organization identifies three key dimensions of disability:

1. Impairments in physical or mental functions, such as losing a limb, impaired vision, or memory loss.

2. Activity limitations, like challenges with walking, hearing, or solving problems.

3. Participation restrictions in daily activities, such as work, socializing, or accessing healthcare services.

Disability is a broad-encompassing term and results from the interaction between individuals with a health condition and/or a mental health condition. Disability is within the physical therapist’s scope of practice.

The American Physical Therapy Association also states that addressing mental health is within the physical therapist’s scope of practice. However, as discussed in a previous blog post here, the scope of practice for physical therapists is informed by three components:

1. Professional scope of practice

   2. Jurisdictional(i.e., state) scope of practice

   3. Personal scope of practice (what you are trained to do).

The key here is that physical therapists must be aware of all 3 parts of their scope of practice. Many Physical therapists receive basic or foundational training in mental health while in physical therapy school. This means training is essential to maximize your impact and stay within ethical boundaries.

Continuing Education and Specific Mental Health Training

The APTA Guide to Physical Therapy Practice 4.0 (Guide)is a helpful resource for understanding what types of interventions are needed to address mental health.

These interventions are used for self-management and health promotion and include:

• Motivational interviewing (a mental health therapy)

• Performance enhancement (think sports psychology applications)

• Health, wellness, and fitness programs (e.g., mindfulness, meditation).

• Cognitive and behavioral techniques to increase functioning and/or modulate pain.

• Psychosocial influences on treatment (e.g., behavior change techniques).

• Lifestyle intervention (e.g., stress management, sleep hygiene, nutritional recommendations, addressing environmental factors and exposures).

• Addressing risk factors for pathology or health conditions, impairments in body functions and structures, activity limitations, and participation restrictions.

Several training programs can help you incorporate mental health support without overstepping your professional boundaries. Here are a few suggested trainings to boost your knowledge and skills.

Cognitive Behavioral Therapy (CBT) for Chronic Pain: Similar to pain science education where you work with a client’s thoughts and beliefs, one of the most evidence-based methods for addressing the psychological aspects of chronic pain is CBT. Training in CBT for pain will give you the tools to help patients reframe pain-related thoughts, reduce fear and catastrophizing, and improve self-efficacy.

This training allows you to guide patients through mental and behavioral exercises that improve their pain management. For example, you can teach strategies to reduce avoidance behaviors or increase positive physical activity patterns.

Motivational Interviewing (MI): MI is widely used to help patients change maladaptive behaviors. PTs can use MI to encourage adherence to lifestyle-related behavior change such as physical activity, nutrition, and sleep. Training in MI will allow you to better navigate conversations about ambivalence toward treatment and elicit a patient’s intrinsic motivation to improve. 

This training helps you improve adherence to treatment programs and guide behavior change related to exercise and self-management without needing to delve deeply into mental health disorders.

Trauma-Informed Pain Care: Many patients, especially those with chronic pain, have histories of Post-traumatic Stress Disorder(PTSD)/trauma. Training in trauma-informed care helps PTs recognize trauma responses and create a safe therapeutic environment. You don’t treat trauma directly, but you avoid re-traumatizing patients and provide supportive care that acknowledges their emotional and psychological needs.

Trauma-informed care training will enable you to create an environment where patients feel safe, validated, and supported, ultimately improving treatment adherence and outcomes.

Mindfulness-Based Interventions: Mindfulness is not only a practice  – it is a state of awareness, a behavioral trait, an intervention, an act of self-care, and a way of living that can dramatically shift the nervous system toward homeostasis, or a state of internal equilibrium. Reduced pain, depression, anxiety, and distress are some commonly observed benefits of mindfulness interventions. 

Research shows even just a few minutes of practice has a substantial impact. And, exercises can be practiced anytime, anywhere. For these reasons, mindfulness-based interventions can be easily adapted into a variety of physical therapy practice settings.

There are many types of mindfulness-based interventions. Our team wrote a paper in the Journal of Physical Therapy (PTJ) about their usefulness in physical therapy practice.

Two of my favorite training resources are:

1. Mindfulness-Based Pain Relief Practitioner Certification Program

2. Acceptance and Commitment Therapy (ACT) for Chronic Pain.

 Psychologically Informed Physical Therapy (PIPT): PIPT explicitly integrates various psychological approaches into the physical therapy framework. This is highly recommended for PTs looking to address mental health more directly. It focuses on the psychosocial aspects of pain and recovery without veering into diagnostic roles.

 This training allows you to apply psychological principles, like fear-avoidance or anxiety management, in the context of physical therapy, creating a more holistic and effective treatment plan.

Licensure and Certification Requirements for Expanding Mental Health Practice

Physical therapist licensure is managed by individual state regulatory boards and is required to practice as a PT or work as a PTA in the United States. Licensure is required to practice as a physical therapist or as a physical therapist assistant in the United States. Always check with your state practice act for more information.

When it comes to formal licensure, generally states do not require additional mental health-specific licenses for physical therapists who treat patients with primary or comorbid mental health conditions or the integration of psychological approaches – also known as psychologically informed practice – into physical therapy practice. However, there are board certifications and additional training that can elevate your capacity to offer mental health support. The American Board of Physical Therapy Specialties (ABPTS) offers various certifications such as orthopedics, geriatrics, neurology, and pelvic health. While not specifically focused on mental health, these certifications encourage biopsychosocial approaches, which inherently integrate mental health considerations. The amount of training in mental health in each of these certifications is not specific to mental health.

Practice Limitations: What Can’t PTs Do in Mental Health?

While PTs can and should be involved in the prevention, screening, management, and co-management of patient mental health there are clear boundaries that must be appreciated.

PTs generally cannot:

• Advertise their services as psychotherapy

• Prescribe psychopharmacologic drugs, medications, or other agents.

Keep in mind, that the two bullet points above may not apply to PTs working within the federal system (i.e., military or VA). The recommended federal scope of practice for physical therapy includes primary care, diagnosis, and interventions such as specific pharmacy and therapeutic policy-approved medications.

It is wise to understand the boundaries of your scope and training. This ensures that you are practicing ethically and staying within your lane as a licensed healthcare professional. 

Expanding Your Practice by Collaborating with Mental Health Providers

Expanding your mental health expertise as a PT doesn’t mean working in isolation. One of the best ways to offer comprehensive care is by collaborating with licensed mental health providers such as psychologists, counselors, and psychiatrists. Here’s how these collaborations can benefit your practice:

• Co-treatment Models: In complex cases, such as chronic pain with co-morbid depression or anxiety, co-treatment between a PT and mental health provider can offer comprehensive care. This model allows you to focus on the physical aspects while the mental health provider addresses psychological barriers.

• Referral Networks: Building a strong referral network is crucial. When patients present with complex mental health needs outside your scope, referring them to trusted professionals enhances care quality. In turn, mental health providers may refer clients to you when physical issues are predominant.

• Interdisciplinary Care Teams: For larger practices or integrated health settings, working on an interdisciplinary team with psychologists, social workers, and medical providers offers the gold standard of patient care. By integrating your mental health training, you can advocate for biopsychosocial approaches in team meetings and patient care plans.

Conclusion: Training Opens the Door to Mental Health Support in PT

In conclusion, PTs are uniquely positioned to address the mental health needs of their patients, but requires specific training and knowledge to do so effectively. By staying within your scope of practice, seeking out specialized training like CBT, MI, mindfulness, trauma-informed care, and collaborating with mental health professionals, you can offer a holistic treatment approach that significantly improves patient outcomes.

Expanding into mental health as a PT not only enriches your practice but can also help bridge the gap between physical and mental health care, improving both patient satisfaction and clinical results. Now is the time to start investing in the right training and building the collaborative networks needed to meet the growing demand for mental health support in physical therapy.