Mental health policy and practice across Europe: an overview

134 Mental health policy and practice
reviews and meta-analyses of psychotherapies, such as that recently conducted
for the French National Institute of Research (INSERM 2004), six major theoretical
frameworks of psychotherapy are usually identified for operational
purposes:
1 Analytic/psychodynamic approach.
2 Behavioural approach.
3 Cognitive-behavioural approach.
4 Humanistic (Rogerian) approach.
5 Systems theory approach (including most of the group and family therapies).
6 Problem/solution-oriented psychotherapies, which are not based on a specific
theory, but are standardized and research-based interventions for specific
disorders (such as schizophrenia, depression, eating disorders etc.).
In addition to this theoretical categorization, psychotherapies can also be
grouped according to their target, intensity or expected duration. Thus, we have
individual psychotherapies, family therapies and group therapies, as well as
long-term (with a duration of several years) and short (some six to ten visits)
therapies. The most intensive psychotherapy (psychoanalysis) can have five
visits weekly for years, while some supportive long-term therapies are conducted
with very infrequent visits.
In a survey to compare psychotherapies across Europe, conducted by the
European Commission, 195 psychotherapists in eight European countries
(Belgium, Italy, Poland, United Kingdom, Sweden, Portugal, France and
Switzerland), working in mental health outpatient centres, were approached to
fill in questionnaires (Power 1997). The results of this offer some interesting
insights, even though they may not be truly representative of these countries.
According to their own estimation, the respondents identified nine types of psychotherapy:
psychoanalysis, behavioural therapy, cognitive-behavioural therapy,
family therapy, brief psychodynamic therapy, group therapy, counselling,
humanistic therapy (Rogers, bio-energetic), marital/sex therapy, in addition to
an open category which included a variety of approaches. In some areas, subcategories
have to be specified; for example, the psychoanalytic category can be
subdivided into classical psychoanalysis and psychoanalytic psychotherapy.
Group therapy can be psychoanalytic, too, but can also be based on some other
psychological theory. This illustrates the diversity of techniques even when
using a relatively precise definition of psychotherapy, as in this survey (‘a therapeutic
approach and practice, either individual or group orientated, relating to a
specific, standardized technique which makes use of a programmed strategy in
terms of section planning and expected outcome definition’).
The providers of psychotherapy
Psychotherapy is not considered to be a purely medical treatment. Thus, the
provider of psychotherapy need not to be a medical doctor. In practice, psychotherapy
is provided by people from a variety of professional backgrounds.
The European survey revealed that the diversity of psychotherapies is paralleled
by an even larger diversity of providers, in terms of professional background: