Mental health policy and practice across Europe: an overview

The treatment of mental disorders 133
of people with a depressive disorder have had any treatment (Lin and Parikh
1999; McConnell et al. 2002; Ialongo et al. 2004). Among the negative consequences
of the growth in antidepressant use are the increased prescribing
of these new drugs for people without any real indications – as some kind of
‘happiness pill’ – and perhaps too, the neglect of other modes of treatment
of depression, especially psychotherapy.
Psychotherapies
Psychotherapies are widely used and favoured by the public, but there are many
providers with quite diverse training – if indeed they have any at all – who claim
to be psychotherapists. In most countries, little has been done to regulate and
evaluate providers, which makes psychotherapy very much a public concern. Yet
public demand is very high: in general population surveys, most people declared
that, in the case of psychological or behavioural problems, they thought psychotherapy
to be the appropriate treatment (Angermeyer and Matschinger
1996; Jorm et al. 1997; Saragoussi et al. 2005). Many fewer people thought that
psychotropic drugs would work, and they expressed a fear of addiction to
medication (Angermeyer et al. 1993; Saragoussi et al. 2006).
In many countries there have been attempts to clarify the situation in order to
protect the public, especially from sects which claim to provide psychological
help. Paying for psychotherapies (either total or partial payment) through the
health care system is also an issue that has prompted some European countries
to establish guidelines for clinical indications, as well as for the qualifications of
providers (see Chapter 4).
The many faces of psychotherapy
To define psychotherapy is not an easy task. In general, it can be defined as a
psychological procedure, the aim of which is to achieve favourable psychological
changes in an individual or in a group of people by specific psychosocial
interaction that must be scientifically validated and acquired by a specific training.
This definition considers four different aspects of psychotherapy: the target,
the goal, the method and the training:
• the target is people with a mental health problem;
• the goal is to alleviate or cure the disorder;
• the psychological method used is based on the goal-oriented and systematic
application of a scientifically validated psychological theory; and
• sufficient training in the specific technique is a prerequisite to utilization of
that technique.
In its modern, scientific meaning psychotherapy has been used for more than
100 years in the treatment of mental health problems. One of its most prominent
pioneers was, without doubt, Sigmund Freud, the founder of psychoanalysis
in the early twentieth century. Since Freud’s day, hundreds of psychotherapy
techniques, based on a variety of theories, have been developed. In most of the