Psychology and psychotherapy in health care

1. 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 Psychology and psychotherapy in health care: Legal Regulations

2. Problem? • Psychologists in health care? • Important place • Research shows positive effects of delivered services on mental an physical health • Underdeveloped legal framework Psychology and psychotherapy in health care: Legal Regulations

3. Different countries – different regulations • Legal regulation or not ? • Education and Training ? • Licencing? • Professional ethics? • Quality control ? Psychology and psychotherapy in health care: Legal Regulations

4. 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 Psychology and psychotherapy in health care: Legal Regulations

5. Legal regulation of Psychology and psychotherapy in health care Lack / diversity Definitions Survey on legal regulations 2007 EFPA vision Project of the EFPA Working Group on legal Affairs : Survey 2011/2012 Psychology and psychotherapy in health care: Legal Regulations

6. 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). Psychology and psychotherapy in health care: Legal Regulations

7. 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 Psychology and psychotherapy in health care: Legal Regulations

8. 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. Psychology and psychotherapy in health care: Legal Regulations

9. 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. Psychology and psychotherapy in health care: Legal Regulations

10. 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. Psychology and psychotherapy in health care: Legal Regulations

11. Method: Countries • Selection of countries: 15 (situation EU in 2004) + 2 Psychology and psychotherapy in health care: Legal Regulations

12. 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 ? Psychology and psychotherapy in health care: Legal Regulations

13. Method: Parameters Regulatory bodies ? • Decision ? • Execution / application ? • Ethical control? Education training? • Duration ? • Level ? • Internship? • Supervision? Psychology and psychotherapy in health care: Legal Regulations

14. 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 Psychology and psychotherapy in health care: Legal Regulations

15. Related questions : not adressed • Reimbursement ? • Public insurances • Private insurances • Consequences of different models of regulation? • Role of professional bodies / associations Psychology and psychotherapy in health care: Legal Regulations

16. Results Law on Psychology in health care? Law on psychotherapy? Psychology and psychotherapy in health care: Legal Regulations

17. 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 Psychology and psychotherapy in health care: Legal Regulations

18. 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) Psychology and psychotherapy in health care: Legal Regulations

19. 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) Psychology and psychotherapy in health care: Legal Regulations

20. Results: • Vision on psychotherapy? • Specialization of professions of psychologist or psychiatrist • Multiprofessional activity? Psychology and psychotherapy in health care: Legal Regulations

21. 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 Psychology and psychotherapy in health care: Legal Regulations

22. 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 Psychology and psychotherapy in health care

23. 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 Psychology and psychotherapy in health care: Legal Regulations

24. 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 Psychology and psychotherapy in health care: Legal Regulations

25. Legally protected titles Psychologist Authorized psychologist Clinical psychologist Health psychologist Health care psychologist Psychology and psychotherapy in health care: Legal Regulations

26. 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 Psychology and psychotherapy in health care: Legal Regulations

27. Table 4. Training of Psychotherapists in the 7 countries with a legal regulation of the title and the practice of psychotherapists Psychology and psychotherapy in health care: Legal Regulations

28. 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 ( Psychology and psychotherapy in health care: Legal Regulations

29. 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’ Psychology and psychotherapy in health care: Legal Regulations

30. 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 Psychology and psychotherapy in health care: Legal Regulations

31. Law on psychologists in health care 11/17 Specialization ` training in PT 0-3-5 y. Masters Specialisation Psychologist/ Psychiatrist? 3 /7 Law on Psychotherapists 7/17 If so Secondary PT training 8y Multi- Professionnal Activity 5/7 if so bachelor PT training 5 y. master PT training 3 y. Psychology and psychotherapy in health care: Legal Regulations

32. 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 Psychology and psychotherapy in health care: Legal Regulations

33. Psychology and psychotherapy in health care: Legal Regulations

34. 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 Psychology and psychotherapy in health care: Legal Regulations

35. 3. Vision of EFPA • EFPA Certificate of psychologist specialized in Psychotherapy • Europsy-PT Psychology and psychotherapy in health care: Legal Regulations

36. 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). Psychology and psychotherapy in health care: Legal Regulations

37. 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 …) Psychology and psychotherapy in health care: Legal Regulations

38. 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. Psychology and psychotherapy in health care: Legal Regulations

39. 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) Psychology and psychotherapy in health care: Legal Regulations

40. 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

41. Countries: 35 EFPA member states

42. Survey matrix

43. Results of new survey? 2013?

44. Thank you for your attention