Masaryk University Autumn 2012 Psychotherapy: Theory, practice and research 6^th January 2013 Psychotherapy politics in Belgium For beginning, I would like to define « psychotherapy ». According to me, there is not only one good definition of this topic. I have found an explanation that is similar with my own view, « no single definition of psychotherapy has won universal acceptance. Depending on one’s theoretical orientation, psychotherapy can be conceptualized as interpersonal persuasion, psychosocial education, professionally coached self-change, behavioral technology, a form of reparenting, the purchase of friendship, a contemporary variant of shamanism, health care, and many others. As Perry London (1986) once quipped, it is easier to practice psychotherapy than to explain or define it. »[1]. But my interest has been raised by a definition of Norcross , which is, for me, complete and represents the way that I see the psychotherapy. According to Norcross, « Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derives from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable. »[2].[a1] The psychotherapy is based on a help and interpersonal relationship. As for all the relationship, the therapist and the patient have to define the relation for determine which communication they have to use; this definition can be made by their own behaviors. In the psychotherapy, the interaction between the therapist and his patient involve the therapeutic changes. But the importance and the role of this relation depend on the type of therapy, this is important to determine this one for each therapeutic system. For instance, this relationship has a little importance in behavior therapy[a2] in contrast of psychoanalysis within this one brings the content of the therapy. Before to describe the situation in my country, I would like to insist on different notions in the profession “psy” which are frequently confused. This distinction is important because these concepts have not the same situation in the country. A psychiatrist is a doctor who has followed a formation (seven years in medicine and five years in specialization), he can prescribe drug to his patients. A psychologist is someone who has followed a university formation (five years) but the field of the psychology is wide so there are a lot of specializations. For instance, a psychologist can work in a hospital but also in a company. And for last concept, everyone can claim itself psychotherapist[a3] , a formation is not request. A last distinction that I would like to emphasize is between psychotherapists and psychoanalysts. A psychoanalyst is someone who practices psychoanalysis, which is a kind of psychotherapy. My home country, Belgium, is one of the countries in Europe without a regulation about the exercise of the psychotherapy, conversely to psychiatrists and psychologists, which are protected by law and supervised by the government. Psychotherapist is widely debated in our society. Behind this profession there is a practical rather than a degree or a diploma. They are three different situations cover by the word « psychotherapist »: 1. The psychotherapist is a psychologist or a psychiatrist who is practicing psychotherapy. 2. The psychotherapist has followed a formation within a school but it is not recognize by the government. 3. The psychotherapist is self-proclaimed psychotherapist based on readings, theory or his own experiences that making him able to help others. Since 1998, there is a debate on the regulation of the profession « psy » and different propositions and pilot study had been proposed. The project of a law and so, this debate, has been developed in result of the insecurity of the patient; the government have to protect them against incompetent therapists. Because at present time in Belgium everyone can declare itself psychotherapist, the patient can be face up to and confide in bad therapists like crooks, gurus, or sects and a lot of abuses on patients are observed. So a law for the security may be necessary in this discipline. Unfortunately, the government cannot respond to the numerous complaints that it receives because it is unable to refer to tittles legally protected. Different proposals have been elaborated and these can be gathered in two main tendencies: for the first one, these professions have to be classified as health profession (royal decree 78) and for the second one not. I will explain the most important projects. In the first tendency different project have been developed like Bob Cools, “Mayeur, Lambert, Burgeon” and Rudy Demotte. The royal decree 78 regulates the medical profession. So with the projects of the first tendency, the « psy » professions are placed on the same level than nurses and psychotherapists. The current framework of the law is the Royal Decree 78 called “Arreté royal sur l’exercice de l’art de guerrir”[3] which legislates medical and paramedical professions. In 2001, this one had been modified and psychosocial professions had been introduced in this decree, this Royal decree is now calling “Arreté royal à l’exercice des professions de soin de santé”[4]. In this decree, the illegal exercising of the medicine is defined as “the performing usual (for those not holding a degree of Doctor of Medicine) any act aimed at the respect of a human being, or a review of the health status or screening illness or disability or the diagnosis or treatment of the execution of a medical condition, physical or mental, real or perceived, or vaccination.”[5] So in this project, the psychotherapy practiced by non-medical people is illegal if it is about proven mental disorders. But the law will not integrate all the therapy, for instance couples therapy or therapy for the treatment of ill-being or self-esteem will not concern by this law. This project was made inapplicable by the extension of the sector of the mental health.[a4] The first attempt is the law “Alvoet-Tavernier” in 2001, his aim is the guaranty of the quality and the protection of the patient. They wanted to turn the paramedical profession of mental health to paramedical by the obligation to work with the prescription of a doctor. But this project had been removed by the mobilization of the sector of the mental health. This is after this first proposition, in opposition with this one, that the Platform of psychotherapist had been created. It includes psychologists, psychotherapists, psychoanalysts, psychiatrists, and counselors wanting to defend the vision of their profession. The three federations representing the three main orientations in the country are present it this platform: la « Fédération Francophone Belge de Psychothérapie Psychanalytique »[6] (FFBPP), la « Fédération belge de Psychothérapie Humaniste »[7] (FPH) et de l’Association regroupant les psychothérapeutes systémiciens » [8] (ABIPFS). Bob Cools, doctor in psychology, developed a proposal in accordance with Alvoet, which includes two levels of practice in psychotherapy: - psychotherapy (practiced by psychologists and psychiatrists) - counseling (practiced by people who have follow no-university higher education) Like the majority in Flanders, Bob Cools is a cognitive-comportementalist. So according to him, psychotherapy is validated by scientific studies based on statistics and doctors of psychology or psychiatrists should teach psychotherapy. “Mayeur-Lambert-Buregeon” is a project of “framework law” which goes beyond the protection of the patient; this project aims to recognize the specificity of the profession of mental health by the creation of a specific chapter within the Royal Decree 78. It pushes the separation between mental health and physical medicine, the mental health will have a epistemological definition different than the one of the medicine. This project de-paramedicalises professions of the mental health. The current proposition of the Minister of Health, Rudy Demotte, is inspired of this “Mayeur-Lambert-Buregeon” project. In these proposals, the field of the psychoanalysis is reduced on clear psychotherapy. The psychoanalysts are against these new propositions for a matter of common status, for these people the field of the psychoanalysis is larger than the mental health. All the Belgian psychoanalysis associations had getting together and being organized in the “Fédération des associations belges de psychoanalyses”[9] (FABEP). This federation had been created with the objective of a common position for all the psychoanalysts against the politics. The psychoanalysts are opposed to and differ from the platform of the psychotherapists who want a law of a paramedicalisation and they claim a status, a profession (psychotherapist) as part of the mental health. The FABEP had two positions: 1. Psychoanalysts don’t want a law. 2. If there will be a law, the psychoanalyst from known associations will be qualified for practicing the psychotherapy. This federation organized different petitions and different claims to the Minister but these one was staying without respond. They had decide to create a case file called “Situation de la psychanalise en Belgique” which have for aim to inform all the people from the specificity of psychoanalyze. The conception of each association about mental health and psychotherapy are gathered in three different positions within the FABEP: 1. Position of the “Ecole belge de Psychanalyse”. They agree with the position of psychoanalyze in the field of the mental health and the assimilation between psychoanalyze and psychotherapy. They are not opposed with a law if this one leaves the formation to the different associations. 2. Position of the “Ecole de la cause Freudienne”. They agree with the position of psychoanalyze in the field of the mental health but with a condition, the psychoanalysts have to have a different workmate of the psychotherapists. 3. This is the majority position. The field of psychoanalyze is larger than the psychotherapy, they don’t want the law within which the psychoanalyze is gather with the mental health. In spite of these different positions, all the members of the FABEP agree with the fact that this federation is necessary to protect the specificity and the interest of the psychoanalysis in the future debate. My country is separated in two main part: the Wallonia, French part, in the South and the Flanders, dutch part, in the North (there is also a third part in the South-East, German part). These different parts has different viewpoint about the debate. The Dutch want a law of exercise within which the “psy” professions are classified as health profession. For this part of the country, the movement cognitive-comportementalism is the only kind of therapy with evidence; it is the only effective therapy. They pass over the study that shows that there is not therapy whit effectiveness higher than the other one. On the francophone side, it’s more complicated, the different minister have different viewpoint. A “coordination psy” has been established including all the different orientation and diploma in the “psy” profession. This movement is managed by a platform that coordinate the participants. The ministers want a unanimous movement in the society. A big advance in this debate is the current recognition of three associations of the platform by the SFP (“Service Public Federal”[10]) as professional federation representative the profession of psychotherapist. It is a big advance because it is the first time in Belgium that an official and federal instance recognizes the profession. These three associations have an aggregation since 2011 until 2016. Before to do this essay, I didn’t realize that the situation in my country is so complicated. But now, I can observe that my viewpoint is really consistent with my part of the country (French part); I think that for change the present situation we must to have a solid movement with the same idea but without pass over the others views. I think that we have to consider all the different view for have a strong and complete idea. If a proposal of a law is accepted, two situations will be possible: 1. The different institutes of formation for the psychotherapist which is respecting some criteria could be recognized by the government. People who have followed their formation in this institution could be accepted as psychotherapist. 2. If the title of psychotherapists will be only for the university, the situation will be similar to the situation of the France. The professional will use an other title near to psychotherapist but not the same, « psychopraticien »[11], because they don’t respect all the criteria. Before to conclude my essay, I would like to briefly describe in few words the different approches of psychotherapy in my country. In Belgium, we don’t have our own approaches, there are a variety of psychotherapeutic approaches and the choice of the kind of therapy depend on the expectations of the patient and on the framework of the situation, it can be individual, group or familial view. So they are several forms of the psychotherapy but these have some common elements. Psychotherapy looks for differential effectiveness of some therapy with specific disorders. I will describe the three main kinds of psychotherapy in Belgium: psychoanalysis, cognitive-behavior therapy and systemic therapy. Psychoanalysis is born with Sigmund Freud. According to him, the individual have to realize that his way to think is influenced by his past and his rejected ideas. The therapist is somebody who creates a situation within the individual can understand itself and be aware of his life. In this kind of therapy, the way to think is emphasized. The main concept in the cognitive-behavior therapy is that our behavior is influenced by our thoughts and our feelings. This therapy is used the most of time for helping people with a specific problem like phobias, depression, anxiety, etc. This is a short-term therapy during while the client learns how to identify the disturbing thoughts and how to change it because these thoughts have negative influence on the behavior. Systemic therapy considers the interpersonal relationship of the patient (individual or group) in the diagnostic. So this therapy don’t consider people on a individual level but on relationship level, people deals with all the interaction on a group. To conclude this essay, the situation of the psychotherapy in Belgium is really in late comparing with the others European countries[a5] . Even if there was a lot of proposal of law proposed, anyone had been accepted and so, there is still no law on the regulation of the psychotherapy. Everyone can claim itself psychotherapist, this fact reduce the security of the patient against his therapist. REFERENCES : · Books Prochaska, J. O., Norcross, J. C. (1994). Systems of psychotherapy: A transtheoretical analysis (3rd ed.). US: Thomson Brooks/Cole Publishing Co. Haley, J. (1992). Stratégies de la psychotherapie (Dupuis G., Trans.). Toulouse, France : Eres. (Originalwork published 1963). Ford, D. H., Urban, H. B. (1998). Contemporary models of psychotherapy : A comparative analysis (2^nd ed.). New York, NY : John Wiley & sons, Inc. Gross, S. (2008). Les psychanalystes belves devant la loi. Topique, 101, 61-66. · Web http://www.lacanw.be/archives/FABEP/061026%20situation%20de%20la%20psychanalyse%20en%20Belgique.pdf http://www.mieux-etre.org/Psychotherapie-ou-en-sommes-nous.html http://www.mieux-etre.org/Situation-du-titre-de.html http://www.psy-therapie.be/le-monde-psy.html http://psychology.about.com/od/psychotherapy/a/cbt.htm ________________________________ [1] Prochaska, J. O., Norcross, J. C. (1994). Systems of psychotherapy: A transtheoretical analysis (3rd ed.). US: Thomson Brooks/Cole Publishing Co. P.5. [2] Prochaska, J. O., Norcross, J. C. (1994). Systems of psychotherapy: A transtheoretical analysis (3rd ed.). US: Thomson Brooks/Cole Publishing Co. P.6. [3] This is the official name in French. It means “Royal decree on the exercise of the art of healing” [4] This is the official name in French. It means “ Royal decree on the exercise of the health care professions” [5] This is a traduction of Gross S.,“Les psychanalystes Belges devant la loi”, Topique, 101, p.61. “l'accomplissement habituel (par les personnes non détentrices d'un diplôme de docteur en médecine) de tout acte ayant pour objet, à l'égard d'un être humain, soit l'examen de l'état de santé, soit le dépistage de maladies ou déficiences, soit l'établissement du diagnostic ou l'exécution du traitement d'un état pathologique, physique ou psychique, réel ou supposé, soit la vaccination.” [6] Federation Francophone Belgian Psychoanalytic Psychotherapy [7] Belgian Federation of Humanist Psychotherapy [8] Association involving systemic therapists and psychotherapists [9] “Federation of the Belgian association of psychoanalysis” [10] Federal public service [11] There is not an english traduction for this word “psychopraticien”. ________________________________ [a1]This is not APA citation style, but i will accept it. [a2]It used to be in this way. Actually nowadays the therapeutic relationship is considered to be a common factor in therapy and every psychotherapy approach try to focus on it, but in different ways. [a3]Really i am suprised? [a4]What is the situation in the sector of education , e.g. treating of comduct disorders in childhood and adolescence is considered to in or out of domain of medical proffesions? [a5]It would improve your essay, if you will compare situation in your country with guidelines of European Association for Psychotherapy (http://www.europsyche.org/). I appreciate precisely description of situation in your country. There are parts of your text, that should be exluded : 1. first two paragraph, you are not using further information from them ; 2. short general discription of three psychotherapy approaches at the end ;+ I evaluate your text as C.