Psychology and psychotherapy
in health care
A review of legal regulations in 17
European countries
Lisbon, november 2011
N. Van Broeck, Catholic University of Louvain
Belgium
Member 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.
2.
3.
4.
Definitions
Survey on legal regulations 2007
EFPA vision
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
Definitions
Psychotherapy:
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
Definitions
Psychotherapy:
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
Austria
Belgium
Denmark
Finland
France
Germany
Greece
Ireland
Lisbon, november 2011
Italy
Luxemburg
The Netherlands
Norway
Portugal
Spain
Sweden
Switserland
United kingdom
Psychology and psychotherapy in health care: Legal
Regulations
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
Country
Law on the practice of psychologists
(licensing and registry) in health care
1
Austria
X
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
10
Luxemburg
/
11
Netherlands
X
12
Norway
X
/
13
Portugal
X
/
14
Spain
X
/
15
Sweden
X
16
Switserland
/
/
17
United Kingdom
/*
/
11
7
Total number of countries
Lisbon, november 2011
Law on the title and the practice of
psychotherapist
Psychology and psychotherapy in health care: Legal
Regulations
X
(M)
X
(S)
/
X
(M + S)
X
(M)
• 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
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
Lisbon, november 2011
Psychology and psychotherapy in health care: Legal
Regulations
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
avril 08
Psychology and psychotherapy in health care
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
countries
University training
Supervised practical training (internship)
Included in the
university training
title
duration
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)
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
Psychologist
5+1
Number of
countries
Lisbon, november 2011
X (+1)
X (+1)
7
4
Psychology and psychotherapy in health care: Legal
Regulations
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
Minimal basic training
Clini-cal
experience*
Specialized training in
Psychotherapy
/
1
Country
secondary
Bach.
masters
1
2
3
1
2
Sweden
second
Austria
Bachelor
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
?
Basic PT training (bac
level)
Specialisation (3 to 5 years)
Propae-deuse
Minimal level of academic training required to have access to the specialized training in psychotherapy
Number of years of training in psychotherapy
Lisbon, november 2011
Psychology and psychotherapy in health care: Legal
Regulations
Specialisation (5 years)
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
Law on
psychologists
in health care
11/17
Masters
Specialization `
training in PT
0-3-5 y.
Secondary
PT training 8y
bachelor
PT training 5 y.
master
PT training 3 y.
Specialisation
Psychologist/
Psychiatrist?
3 /7
Law on
Psychotherapists
7/17
Lisbon, november 2011
If so
MultiProfessionnal
Activity
5/7
if so
Psychology and psychotherapy in health care: Legal
Regulations
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
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)
Lisbon, november 2011
Psychology and psychotherapy in health care: Legal
Regulations
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
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Malta
The Netherlands
Norway
Poland
Portugal
Russia
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Turkey
United Kingdom
Survey matrix
General
psychologist
Title
protection
Practice regulation
Education and training
specialization
Ethical control
Relicensing
Employment
Clinical
psychologist
School/Educ
Work/Org.
.
Other
PsychoPsychopsycholo- Psychologist
logist
gist
therapist
Results of new survey?
2013?
Thank you for your
attention