Psychology and psychotherapy in health care

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


Different countries – different regulations

– Legal regulation or not ?– Education and Training ? – Licencing?– Professional ethics?– Quality control ?


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


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


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


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.


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.


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.


Method: Countries• Selection of countries: 15 (situation EU in 2004)

+ 2


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 ?


Method: Parameters

Regulatory bodies ?• Decision ?• Execution / application ?• Ethical control?

Education training?• Duration ?• Level ?• Internship?• Supervision?


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


Related questions : not adressed

• Reimbursement ?– Public insurances– Private insurances

• Consequences of different models of regulation?

• Role of professional bodies / associations


Results

• Law on Psychology in health care?• Law on psychotherapy?


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


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)


Results:

• Vision on psychotherapy?– Specialization of professions of psychologist or

psychiatrist

– Multiprofessional activity?


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


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


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


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


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


Table 4. Training of Psychotherapists in the 7 countries with a legal regulation of the title and the practice of psychotherapists


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 (


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’


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



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


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


3. Vision of EFPA

• EFPA Certificate of psychologist specialized in Psychotherapy

• Europsy-PT


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).


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.



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

Psychology and psychotherapy in health care

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