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Psychology and psychotherapy in health care
A review of legal regulations in 17 European countriesLisbon, november 2011
N. Van Broeck, Catholic University of Louvain
BelgiumMember of EFPA Standing committee on psychotherapy
Member of the Working group on legal affaires
Former president of the BFP/FBP
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Problem?
• Psychologists in health care?
– Important place– Research shows positive effects of
delivered services on mental an physical health
– Underdeveloped legal framework
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Different countries – different regulations
– Legal regulation or not ?– Education and Training ? – Licencing?– Professional ethics?– Quality control ?
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Consequences of poor regulation:
• Confusion between professionals with different qualifications
• insufficient quality control of training• Insufficient quality control of services• Poor protection of clients• Poor protection of the professional
– Recognition– remuneration– mobility restricted
• Inadequate fit needs / services
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Legal regulation of Psychology and psychotherapy in health care
Lack / diversity
1. Definitions
2. Survey on legal regulations 2007
3. EFPA vision
4. Project of the EFPA Working Group on legal Affairs : Survey 2011/2012
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Definitions
Psychology in health care /Clinical psychology : •the development and application •of theories, methods and techniques of scientific psychology and related disciplines (f.i. neuro-sciences, genetics …) •in the assessment, prevention and intervention of health problems •that manifest themselves in psychological and/or physical symptoms •in persons of all ages
(Van Broeck, 2007, based on Perrez and Bauman, 1986).Lisbon, november 2011 Psychology and psychotherapy in health care: Legal
Regulations
domain of application of clinical psychology
By means of psychological knowledge and methods:
•education on the psychological aspects of health •prevention • treatment of health problems • rehabilitation after health problems and or traumatic life experiences
In the domain of physical and mental health
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
DefinitionsPsychotherapy:
Psychotherapy is a specific type of psychological treatment in which the professional applies a coherent whole of psychological interventions based on a scientifically validated theory on human psychological development, functioning, and dysfunctioning and on processes of change.
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
DefinitionsPsychotherapy:
The psychologist applying psychotherapy followed a specialized training in one or more of these scientifically validated theories and in the methods of change based upon it. He applies the theory and the methods in the context of a professional helping relationship in order to alleviate the psychological complaints, problems or disorders. The client or patient can be an individual, family or group.
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
2. Research 2006/2007
• Survey of legal regulations of psychology and psychotherapy in health care
• In 17 European countries
Van Broeck, N., & Lietaer, G. (2007). Psychologists and psychotherapists in Health care. A review of legal regulations in 17 European Countries. European Psychologist.
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Method: Countries• Selection of countries: 15 (situation EU in 2004)
+ 2
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
AustriaBelgiumDenmark FinlandFranceGermanyGreeceIreland
ItalyLuxemburgThe NetherlandsNorwayPortugalSpainSwedenSwitserlandUnited kingdom
Method: Parameters
• Law on psychologists in health care (clinical
psychologists, health care psychologists ..)?• If yes:
– Title protection ? • If yes: Criteria ?
– Practice? • Licencing ?• Registers ?• Ethical control ?
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Method: Parameters
Regulatory bodies ?• Decision ?• Execution / application ?• Ethical control?
Education training?• Duration ?• Level ?• Internship?• Supervision?
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Method: Parameters
Psychology and psychotherapy:
• If there is a law on psychotherapy– Specialization of profession of psychologists and
psychiatrists ? – Or – Multiprofessional activity= access for other professions ?
• If PT is considered a multiprofessional activity :– Minimum basic level of access to training– Duration of specialized training
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Related questions : not adressed
• Reimbursement ?– Public insurances– Private insurances
• Consequences of different models of regulation?
• Role of professional bodies / associations
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Results
• Law on Psychology in health care?• Law on psychotherapy?
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Table 1. Legal regulations of the title and the practice of psychologists in health care and the title and practice of psychotherapists in 17 European countries
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Country Law on the practice of psychologists (licensing and registry) in health care
Law on the title and the practice of psychotherapist
1 Austria X X (M)
2 Belgium / /
3 Denmark X /
4 Finland X X (M)
5 France X X (M)
6 Germany / X (S)
7 Greece X /
8 Ireland / /
9 Italy X X (S)
10 Luxemburg / /
11 Netherlands X X (M + S)
12 Norway X /
13 Portugal X /
14 Spain X /
15 Sweden X X (M)
16 Switserland / /
17 United Kingdom /* /
Total number of countries 11 7
• The majority of the countries opted for a legal regulation of clinical psychology: 11/17
– In 5/17: only clinical psychology– In 6 / 17: both clinical psychology and
psychotherapy are regulated
• In 1/17: law on psychotherapy but not on clinical psychology (Germany)
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
• The majority of the countries opted for a legal regulation of clinical psychology: 11/17
– In 5/17: only clinical psychology– In 6 / 17: both clinical psychology and
psychotherapy are regulated
• In 1/17: law on psychotherapy but not on clinical psychology (Germany)
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Results:
• Vision on psychotherapy?– Specialization of professions of psychologist or
psychiatrist
– Multiprofessional activity?
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Table 2. Legal regulation of psychotherapy as a specialization of the professions of psychiatrists and clinical psychologist or as a multiprofessional activity in the 7 countries with a legal regulation of this professional activity
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
country Psychotherapy as a specialization of the professions of psychiatrist
and clinical psychologist
Psychotherapy as a multiprofessional activity
Austria / X
Finland / X
France / X
Germany X* /
Italy X /
Netherlands* X X
Sweden / X
3 5
avril 08 Psychology and psychotherapy in health care
In 7 countries with law of PT:
• Specialization of professions of psychologist and psychiatrist:– 3/7
• Multiprofessinal activity: – 5/7
• In the Netherlands : both solutions
> When there is a law: mulitprofessional activity
Results: Education and training of psychologists in health care in countries with legal regulation
• In the 11 countries with legal regulation of psychologists in health care:
• Training: Masters degree in Psychological sciences: minimum 5 years
• Internship : – included in university training: 7/11– additional: 4/11
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Table 3. Training curriculum of psychologists in the 11 countries with a legal regulation of the title and the practice of psychology in the field of health care
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
countries University training Supervised practical training (internship) title duration
Included in the university training
Additional to the univ. training
Austria Bachelor (3) Masters (2) X, (1480 hours.) Clinical and health psychologist 5 + 1
Denmark Bachelor (3) Candidate (2) X (+2) Authorised psychologist 5 + 2
Finland Bachelor (3) Masters (2;06)
X (0:06) Psychologist 5;06
France Bachelor (3) Masters (2) X Psychologist 5
Greece Bachelor (2) Masters (2) X Psychologist 4?
Italy Bachelor (5) X (+1) Psychologist 5+1
The Netherlands
Bachelor (3) Masters (3) X (1) Health care psychologist, clinical psychologist
6
Norway Bachelor (3) Candidate (3) X Authorised psychologist 6
Portugal Bachelor (3) Master (2) X Psychologist 5
Spain Bachelor (2) Masters (2) X Psychologist 5
Sweden Bachelor Masters X (+1) Psychologist 5 + 1
Number of countries
7 4
Legally protected titles
• Psychologist• Authorized psychologist• Clinical psychologist• Health psychologist• Health care psychologist
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Results: Training of psychotherapists in the countries with legal regulation • Acces:
– Majority: masters level– Some bachelor– One (Sweden): secondary education
• Duration of specialisation: from 2 until 8– Longer specialisation when level of acces is lower
• Mean duration: 8 years after secondary
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Table 4. Training of Psychotherapists in the 7 countries with a legal regulation of the title and the practice of psychotherapists
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Minimal basic training Clini-cal
expe-
rience*
Specialized training in Psychotherapy
Country
secondary Bach. masters 1 2 3 1 2 / 1
Sweden second Basic PT training (bac level)
Specialisation (3 to 5 years)
Austria Bachelor Propae-deuse Specialisation (5 years)
Finland Bachelor Specialisation (5 years)
Germany Masters psychology, medicine 3 years part time or 5 full time
Italy Masters
Psychology / medicine
4 years part time
The
Netherlands
Masters medicine / clinical psychology or
other master
3 years part time or 5 full time
France Masters in medicine, psychology or psychoanalyst
?
Number of years of training in psychotherapy
Minimal level of academic training required to have access to the specialized training in psychotherapy
Results: Regulatory bodies
• Decisional power: Minister of public health (and social affairs/ welfare)
• Decisions based on advice of councils– The National Council of Medico-Legal Affairs– Danish Supervisory Board of Psychological Practice
• Councils: representatives of practioners, universities• Regional authorities: execution / application of
decisions (
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Regulatory bodies: other solutions
• Delegation of legal competence from the minister to a professional body: – Order of psychologists
• No law but royal decree: United Kingdom: ‘chartered clinical psychologist’
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Results: mandate of regulatory bodies
Advise the minister on :
• Duration and level of training• Accreditation of training institutes• Authorisation to carry title• Authorisation to practice (‘licencing’)• Criteria for ‘re-licencing’ • Procedures for handling complaints
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Law on psychologists in health care
11/17
Law on Psychotherapists
7/17
SpecialisationPsychologist/Psychiatrist?
3 /7
Multi-Professionnal
Activity5/7
Secondary
bachelor
master
If so
if so
Specialization `training in PT
0-3-5 y.
PT training 8y
PT training 5 y.
PT training 3 y.
Masters
Summary: In these 17 countries
• More countries with legal regulation of psychology in health care (11) than of psychotherapy (7)
• If legal regulation of PT: multiprofessional activity
• Basic training of psychologist in health care: 5 years univ.training + internship
• Training of PT: – If basic training low: longer PT training (8 y.)– If basic training Masters: 3 to 5
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
3. Vision of EFPA
• PT as specialisation of psychology or as multiprofessional activity?
• EFPA: – Psychotherapy is a Specialization of a basic profession
of psychologist or psychiatrist• Guarantee on the duration / content of training• Academic training = scientist /practitioner• Transparancy concering basic profession for the
consumer
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
3. Vision of EFPA
• EFPA Certificate of psychologist specialized in Psychotherapy
• Europsy-PT
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
EFPA Training standards Europsy-PT
1. Basic training in psychology at a university masters level : Europsy : (5 + 1)– Developmental, social and personality psychology, – Biological bases of behavior: neurosciences, – psychopathology and psychiatry, introduction in
psychopharmacology,– learning theory, psychodynamic psychology, – general and clinical psychological assessment and
psychodiagnostics, – basic counseling skills, introduction in psychotherapeutic methods – professional ethics, – methodology of scientific research and statistics (Superior Council
for Health in Belgium, 2005).
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
EFPA Training standards Europsy-PT
2. Specialization Training in Psychotherapy:
Three years if training if full time, equivalent if training is part time. – including supervision and supervised practice– theoretical & practical knowledge; – and personal development (e.g. personal training
therapy, learning therapy …)
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal
Regulations
EFPA Training standards
Specialization Training in Psychotherapy:Quantitative Standards:
• supervision : min 150 h.• supervised practice: min. 500 h. (This will include a minimum of 10 cases,
supervised over the entire therapeutic process by the same supervisor in anyone case. In certain therapeutic schools this may include some cases of supervised consultation.
• Theory, therapeutic methodology and techniques: min. 400 h
• Personal development / therapy : min. 100 h.
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
Lisbon, november 2011 Psychology and psychotherapy in health care: Legal Regulations
4. Survey 2011/2012
EFPA working group on legal affairs:• Rein Baneke (convenor) (The Netherlands)• Ole Tunold (Norway) • Remo Job (Italy)• Christof Kabas (Austria)• Miloslav Solc (Chech Republic)• Nady Van Broeck (Belgium)
• Robert Roe (EFPA President)
2011
Objectives: • Legal regulations of different specialization (Psy in
health, work and organization, education …)• Update / correct the info on countries already included
• Add other European countries– Countries represented in the EFPA standing committee on
Psychotherapy– Other EFPA member countries interested
> Online questionnaire– To the representatives of the collaborating countries
Countries: 35 EFPA member states
AustriaBelgiumBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungary
IcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMaltaThe NetherlandsNorwayPolandPortugalRussia
San MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandTurkeyUnited Kingdom
Generalpsycho-
logist
Clinicalpsycho-
logist
Work/Org.Psycho-
logist
School/Educ.
Psycho-logist
Otherpsycholo-
gistPsycho-
therapist
Title protection
Practice regulation
Education and training
specialization
Ethical control
Relicensing
Employment
Survey matrix
Results of new survey?
2013?
Thank you for your attention