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Autonomy of Psychotherapy;
Strasbourg Declaration - October 21st
1990
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Psychology has
progressively detached itself from its « mother »,
Philosophy.
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In 1990, Psychotherapy
took its flight, and distinguished
itself from Psychology
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Psychotherapy is an
independent scientific discipline, the practice of which
represents an independent and free profession.
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Training in psychotherapy
takes place at an advanced, qualified and scientific level.
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The multiplicity of
psychotherapeutic methods is assured and guaranteed.
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A full psychotherapeutic
training covers theory, self-experience, and practice under
supervision. Adequate knowledge of various psychotherapeutic
processes is acquired.
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5. Access to training is
through various preliminary qualifications, in particular
human and social sciences.
Strasbourg, October 21st, 1990
The European Certificate of Psychotherapy (ECP)
This Strasburg Declaration
led to the European Certificate of Psychotherapy (ECP).
The ECP was established in
1997, in Rome. It specifies the conditions for training: 3,200
hours in 7 years, including a prior training of 3 years in the
social sciences, following by a training in a scientifically
validated method for a minimum of 4 years.
A “grandparent procedure”
was applied, concerning Psychotherapists recognized by a
national commission of colleagues. Those who benefited from a
certificate from an EAPTI (European Accredited Psychotherapy
Training Institute) could apply directly. This recognition
was awarded after an in-depth study of their file, by the
Training Accreditation Committee
(TAC). To date, 50 psychotherapy training
institutes, teaching 14 methods, in 20 European countries have
received such accreditation.
Each candidate for the ECP is
examined by 3 different instances — national and
European:
1. The NAO
(National Awarding Organization);
2. The appropriate EWAO
(European Wide
Accrediting Organization);
3. The
Registration Committee -
6,000 ECPs in 51 countries within Europe
and the entire world have been awarded. Two thirds of the
ECPs have been awarded in the following countries:
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Germany |
1300 |
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Austria |
600 |
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France |
500 |
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Ireland |
400 |
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Netherlands |
300 |
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Russia |
200 |
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Poland |
200 |
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United Kingdom |
150 |
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Italy |
140 |
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Greece |
100 |
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Switzerland |
100 |
The European Parliament has
incorporated the main points of the ECP program into a
“platform” in the process of
elaboration by the European Commission.
Thus, the level of competence
of professional Psychotherapists is increased and has
become comparable from one country to another (Master’s
degree).
European Legislation
The legislation varies
greatly among the countries of the European Union. Today,
about ten countries have established a specific law. Some of
them (Germany, Italy, Sweden, Netherlands) have limited access
to the profession to Psychologists and
Medical Doctors; others
(Austria, Finland, etc.) have opened their training to
candidates from varying backgrounds.
Psychotherapy has developed
rapidly within a hundred countries on all continents.
It is diversified into a great number of practices.
Psychotherapy is at the crossroads between several disciplines:
medical, psychological and social.
It would therefore be unrealistic
to restrict it to one or another profession: Medical
Doctor, Psychologist, Social Worker, Sociologist, Philosopher,
Minister, etc.
To illustrate, I will briefly
describe three possible situations.
Any reductionist approach to
Psychotherapy is thus destined to be inefficient. The prevalence
of psychic difficulties According to international
studies, the percentage of people suffering,
at one time or another
in their life, from psychosocial troubles which require an
external assistance, varies between 7 % and 15 % of the general
population, representing for the 500
million residents of the European Union,
between 35 to 75 million people!
But few of these people with
problems will seek help from Psychotherapy — whether for
cultural or economic reasons.
We have conducted two national
surveys in France with
independent
organizations, which have shown that 8 % of the adult
population have undertaken
psychotherapy:
- 40 %
engaged in a Humanistic
Psychotherapy: Gestalt Therapy, Transactional Analysis, Person-Centered
Approach, Psycho-Organic Analysis… ;
- 30 %
a “psychodynamic” therapy, inspired by
Psychoanalysis;
- 20 %
a Cognitive-Behavioral therapy (CBT);
- 10 %
a Family therapy.
These psychotherapies lasted —
on the average — one year, at the rhythm of
one session of 50 minutes per week;
87 % of the clients
were satisfied, and only 4 % unsatisfied. (9 % did
not respond).
The need for Psychotherapy is increasing
Why is there a need for so many consultations –
preventative or curative? It appears that the causes are
not only individual (thus “medical”), but more,
sociological
and cultural.
Numerous problems have been
recently identified linked to the
severe crisis of the “post-industrial” society:
• economic crisis and
technological changes: global economy, migration of
populations, unemployment and exclusion, poverty, and
solitude… ;
• sociological crisis and
rapid evolution of lifestyles: travel, trans-cultural
shocks, racism, identity crises, housing developments and
lower class suburbs, with
conflicts between generations;
• informational crisis:
irruption of the medias into our private lives:
internet, television
and its daily menu of ecological catastrophes,
pollution, political and financial
scandals, moral issues caught up into
an insane “zapping,” alternating between: murders,
explosions, rapes and torture… and in parallel: love songs,
gorgeous starlets and sunny dreams.
• political crisis:
slow and delicate construction of Europe: ideological conflicts,
displaced populations,
linguistic conflicts, insecurity, violence,
terrorist attacks, genocides…
Thus, society is becoming more
and more complex and “depersonalized”. With the global economy,
we no longer know who decides what; we have
neither guide… nor enemy
identified; we feel lost
and impotent.
In fact, anxiety is the
corollary of progress. Technology produces garbage: not only
visible waste, but also collateral damage, psychological
and social. A global
approach is necessary to integrate the personal
psychological problems with social adaptation, with the
spiritual questioning about the meaning of existence
itself. We must consider the interrelationship between the
five principal dimensions of the human being: physical,
emotional, intellectual, social and spiritual.
Three Professions
To face these problems,
three main professions concerning psychosocial help have
developed in parallel: Psychology, Psychiatry and Psychotherapy.
1) Psychologists
have received a University diploma (after
5 years of studies). They have a good level of competence on a
theoretical level. They conduct tests, expert assessments, and
coordinate work meetings within institutions. There are
several specialities:
Industrial Psychologists, School
Psychologists, Legal Psychologists, and
Clinical
Psychologists. However, even these — who have been trained in
psychopathology
have still not been trained in psychotherapy
within the Universities! The
European Federation of Professional Psychologists
(EFPPA) requires that Psychologists continue to
take 3 more years of a complementary training, 2
years minimum of supervised practice,
and a personal psychotherapy.
2) Psychiatrists are
medical doctors specialized in mental illnesses and psychic
disturbances. They have completed about 10 years of studies in
psychiatric hospitals. They are allowed to prescribe
psychotropic drugs: tranquilizers, antidepressants,
antipsychotics… Such drugs are necessary for severe
cases (depression with risk of suicide, hallucinations,
delirium, etc.). In less severe cases, they may be
associated with a psychotherapy.
Besides drugs, the Psychiatrists may conduct a few interviews
with the patient. However, all Psychiatrists are not
necessarily Psychotherapists: that is a
complementary
specialization, not taught in the public Universities, but
acquired afterwards by certain
Psychiatrists from private
institutions. The Italian law demands
4 years of additional studies
— 2,000 hours — for a Psychiatrist (or for
a Psychologist) before they may use the title of “Psychotherapist.”
3) Psychotherapists
have themselves undergone a
psychoanalysis or psychotherapy, then they have been trained, in
specialized institutes, in one of the recognized
modalities of
psychotherapy. The European Certificate of Psychotherapy
represents 3,200 hours of training,
over 7 years.
Psychotherapy students are
recruited after a selection process – which focuses not
only on the level of education but on the equilibrium and
maturity of their
personality.
The training is theoretical, methodological, and practical.
Psychotherapists are not necessarily
Medical Doctors or Psychologists. In
many countries, more than
half come from other professions: Social Workers,
Nurses, Physical Therapists, Teachers, Sociologists,
Philosophers, Ministers, etc. They have all undergone a
personal psychotherapy, a long specific training in
psychotherapy, and are committed to continue with supervision,
throughout their career (Continuous
Professional Development – CPD1, as
well as to follow a Code of Professional Ethics.
Many Modalities
Some people criticize the
abundance of methods of psychotherapies. But this also
represents a wealth and freedom of choice. Must we
complain about the great variety of medicine, fruits, wine or
cheeses? In truth, we may name hardly 20 psychotherapies
which are commonly practiced in Europe, and which are
represented by a recognized professional association (EWAO). The
others are primarily variants. These twenty methods may
be grouped into 6 mainstreams:
1 • Psychodynamic Therapies,
inspired by Psychoanalysis. The
analysis is founded on free association, the
unconscious and especially sexual drives, the
determining effect of childhood
experiences and transference. The
analyses last many years (3 to 15), at a rhythm of
several sessions per week, and they aim for a restructuring of
the whole personality. Analysis represents from 10 to 30 % of
psychotherapies, depending on the country.
2 • Cognitive-Behavioural
Therapies (CBT) aim to de-condition
the patients from certain mental blocks, phobias or depressing
thoughts, to go beyond their obsesssions or post-traumatic
problems. These therapies are generally short-term (10 to
20 sessions) and centered especially on the healing of
symptoms. The CBTs today represent from 10 to 30 % of all
psychotherapies.
3 • Systemic Family Therapies:
there is no longer a ―designated
patient who analyses his or her problems, but the whole
family. These therapists help to clarify the
present relationship and the communication system
within the family, considered in its
totality. A variation on this is couple’s therapy. These
therapies are generally brief (several months). Their importance
is estimated around 10 to 15 %.
4 • Humanistic or Existential
Therapies — such as Gestalt Therapy,
Transactional Analysis, Ericksonian Hypnosis, and various
client-centered methods – as well as Body Psychotherapies. The
Humanistic Therapies are not limited to a verbal
exchange, but take into consideration the body, emotions, and
the environment. These Humanistic Therapies aim for a
creative adjustment of the entire personality to the
current conditions of life. They are usually of a medium
range (from 1 to 3 years, at a rhythm of one session per
week) and take place either in individual or small
group sessions. They represent a total of 40 % of all
psychotherapies.
5 • Transpersonal methods
(Holotropic breathing, Psychosynthesis,
etc.) emphasize the spiritual and energy dimensions; one may
also place the Trans-generational methods (total of 5 to 10 %,
depending on the country.)
6 • Eclectic or Integrative
Methods combine together techniques
from the different branches listed above, or attempt to
synthesize their theories.
The Law and the Need for Qualified
Professionals
The regulations for
Psychotherapy are quite varied from one country to
another. A law presently exists in 8 European countries. In some
countries, this profession implies a specific training which is
open to a number of original professions. In other
countries, training is only accessible to Medical Doctors and
Psychologists, and is added on to
their basic University training, and
everywhere, it is taught in private institutes. This is
due to the fact that a personal therapy and a
selection based on the equilibrium and maturity of the
personality is difficult to set up in the public
Universities.
Approximately 120,000
qualified professional Psychotherapists are in activity
in Europe…
Average Professional Density in Europe
(per 100,000 inhabitants)
Medical Doctors 200 /
(Psychiatrists) 15 /
Nurses 800 / Pharmacists 100 / Physical Therapists 100 / Lawyers
80 / Dentists 70 / Psychologists 70
Psychotherapists 30
The density of
Psychotherapists varies enormously from one country to
another: from 80 (per 100,000 inhabitants) in Austria,
Germany, Italy or Switzerland; to 10, even 5 in several
countries in Eastern or Southern Europe.
Estimation of the Professional Density
of Qualified Psychotherapists (per 100,000
inhabitants):
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Austria 80
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Germany 60
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Italy 60
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Switzerland 60
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Sweden 40
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Finland 40
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Netherlands 40
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Hungary 20
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France 20
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Portugal 15
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Malta 15
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United Kingdom 15
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Norway 12
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Ireland 12
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Latvia 12
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Spain 8
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Ukraine 2
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Russia 2
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Poland 2
Conclusions
If we consider that around
10 % of the population needs a Psychotherapy, and that a
Psychotherapist may care for around a hundred clients per
year, that would imply an optimal density of 100
qualified Psychotherapists per 100,000 inhabitants… which
means, for the European Union (500 million habitants): around
500,000 qualified Psychotherapists….
that is four times the estimated number today.
If we consider that a
Psychotherapist will exercise his/her
professional activity during 35 years,
this would imply a training each year
of 3 new professionals per 100,000 inhabitants,
representing, for the entire EU: approximately 15,000
Psychotherapy students, thus around 500 specialized
training institutes. This corresponds approximately to the
estimated number of institutes of training currently in
operation in Europe. It would be sufficient therefore for them
to meet all the quality criteria
defined by the Training Accreditation
Committee to be recognized as “EAPTIs.”
These objectives are not
unrealistic, and could be attained rather quickly after a
European directive
that would prescribe uniform requirements for the recognition of
this new profession
– which is much more than a simple specialization
of neighbouring professions.
Serge Ginger
Short Bibliography
• ELKAÏM Mony & al. (2003). A quel
psy se vouer ? Les principales approches. Le Seuil, Paris,
460 pages.
• GINGER Serge (2001). L’évolution de la
psychothérapie en Europe de l’Ouest, Conférence au Xe
Congrès de l’EAP à Moscou, juillet 2001.
• GINGER Serge (2003). The Evolution of
Psychotherapy in Western Europe Moscow, in International
Journal of Psychotherapy (IJP), vol. 8, Nr 2, July 2003.
• GINGER Serge (2006). Psychothérapie :
100 réponses pour en finir avec les idées reçues, Dunod,
Paris, 290 p.
• GINGER Serge (2006). The Evolution of
Psychotherapy in Europe, Tokyo, in
International Journal of Psychotherapy
(IJP), vol.11, Nr 2, July 2007 ; p. 61-71.
• GINGER Serge (2009). The Evolution of
Psychotherapy in Europe, Pékin, oct. 2008, in World
Journal of Psychotherapy (WJP), vol.2, Nr 1, March 2009 ; p.
126-132
• KOCHER G. & OGGIER W. (2004). Système de
santé en Suisse, Hans Huber, Berne, p. 263-276.
• PRITZ Alfred & al. (2002).
Globalized Psychotherapy, Facultas Universitätsverlag,
Vienna, 852 pages.
• WebSite EAP :
www.europsyche.org
• ZERBETTO Riccardo, TANTAM Dighby (2001) :
Survey of European Psychotherapy Training, in European
Journal of Psychotherapy, Counselling & Health, Vol. 4, Nr
3, Dec. 01
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