Developments in European Psychotherapy and Counselling Standards

By Dr. Michael Fitzgerald

As concern grew amongst psychotherapists and counsellors that changes in the European Community regulations for the professions in 1992 might adversely affect them, so their organisations began to consider a European Association to look after both the interests of the profession and the public. It was feared that the European Commission and its committees could pass legislation issued by interested parties that would be enforceable throughout the European community with very little national consultation. Never­theless, it was also felt that the European Directives would give oppor­tunities for the psychotherapy profession to take the initiative, to become recognised and competent authorities, and therefore to be in a position to advise the European Commission and National Governments.

It became clear that it was necessary for both National and European Associations to monitor the following elements of the EC structure includ­ing:

1. The European Parliament and its Committee on the Environment, Public Health and Consumer Protection, its Committee on Economics and Monetary Affairs, its Committee on Legal Affairs and its Committee on Drug Abuse.
2. The EC Commission.
3. The Council of Ministers.
4. The Economic and Social Committee and a number of Directorate Generals including DG12 Employment, Labour Relations and Social Affairs; DG11 the Internal Market; DG12 Science Research and Develop­ment; DG3 Freedom of Movement of Doctors, etc.

We soon realised that professions with greater financial resources than our own had independent offices monitoring these departments in Brussels. An example of the kind of document that comes from the Commission of the EC was the proposal for a Council Directive on the Liability of Suppliers of Services published in Brussels in December 1990. This had relevance for psychotherapists in that it shifted the onus of proof of safety and responsibility from the recipient or patient to the provider of services. In 1988 a Higher Education Diploma Directive was published which focused on the mutual recognition of diplomas within the EC. This directive related to article three of the Treaty of Rome which defines one of the objectives of the community as “the abolition to obstacles to freedom of movement for per­sons, services and capital”. In the definition of a Higher Education Diploma the Council did accept equivalent trainings to their formal ones. They also discussed the fact that the differences in length of training may be compen­sated for by evidence of professional experience, i.e. actual involvement in the pursuit of the profession in a member state. The length of professional experience required may not exceed four years. Some people who go to another state may have to go through an adaptation period or aptitude test.

Each country in Europe will have a competent authority which will look at credentials and diplomas of migrants to see if they meet the requirements of that country. It is hoped that, here in Ireland, the Irish Standing Confer­ence for Psychotherapy will be recognised as this competent authority. There is also a differentiation between independent private practice and practising in a hospital setting where one is usually a member of a team and where there is supervision of treatment. The notion of acquired rights is also quite important in Europe and therefore people who are in established private practice would be seen as having acquired rights which would be recog­nised.

There is great variation in Europe about how psychotherapy and coun­selling is organised. There is an official register of psychotherapists in Holland since 1986 and only those on this register are allowed to practise psychotherapy in public hospitals. In Germany psychotherapy is covered by the compulsory health insurance scheme, but those psychotherapists avail­ing of this must be qualified medical practitioners or psychologists. There are approximately 4,000 medical psychotherapists in Germany, 3,200 psychological psychotherapists and 750 therapists dealing with children and young people who may also be professional educationalists.

In France there is no regulation and no definition of what a psycho­therapist is. The situation in the United Kingdom is similar to that in Ireland: there is no statutory recognition of psychotherapy other than when it is carried out by medical practitioners.

In 1990 the Executive Committee of the Dutch Association for Psycho­therapy took the initiative in founding a European Association for Psycho­therapy (EAP). I was invited to the first meeting held in Amsterdam in December 1990 and at least one member from each of the other European countries was also invited. A Steering Committee was formed to look at issues of training and regulation of psychotherapy in Europe. Since then regular meetings have taken place in either Amsterdam or Brussels and have been very valuable to psychotherapists in this country. I invited Dorothy Gunne to attend these meetings as she represents a different strand of psychotherapy from myself. Dr. B. Martindale stated in February 1994 that “The Dutch initiative is foundering and is now confined to a few individ­uals”.

A second organisation also called The European Association for Psycho­therapy was set up in Austria. This organisation supports the Strasbourg Declaration on Psychotherapy 1990 which states in accordance with the aims of the World Health Organisation, the non-discrimination accords valid in the framework of the European Area, and the principle of freedom of move­ment of persons and services, and is in agreement on the following points:

1. Psychotherapy is an independent scientific discipline, the practice of which amounts to an independent and free profession.
2. Training in psychotherapy takes place takes place at an advanced, quali­fied and scientific level.
3. The multiplicity of methods of psychotherapy is assured and guaranteed.
4. In a process of psychotherapy, training is carried out in full and includes theory, self-experience and practice under supervision. Adequate know­ledge is gained of further processes of psychotherapy.
5. Access to training is through various preliminary qualifications, in parti­cular in human and social sciences.

Of course having two European Organisations with the same name is a problem and this is reflected in a statement by Dr. Alfred Pritz, Executive Officer EAP (Austria) in March 1994:

‘The EAP is keen to ensure that a truly co-operative effort across the whole of Europe will secure the future of the profession of psychotherapy in Europe. Psychotherapy is formally established as an independent profession in Austria and Switzerland where national umbrella organisations regulate the profession. A similar situation exists in the United Kingdom although no psychotherapy law has been adopted as of yet. The Austrian, Swiss and British umbrella organisations are now working actively together through the European Association for Psychotherapy and a start has been made on agreeing minimal training standards in psychotherapy in Europe. We are also working closely with the European Commission and some interesting developments have been achieved. We believe that it is essential for us all to work together (with Brussels based EAP) and we would welcome opening lines of communication directly with your organisation to overcome the potential danger of fragmentation of the field.”

This new movement is gathering pace and has involved many individuals from Eastern Europe. It will probably be a broadly based organisation and this is probably shown by the fact that its annual meeting in 1994 will be held in London on June 24/26 with the British Association of Counselling, United Kingdom Council for Psychotherapists, and European Association for Counselling.

In 1990 I believed that if our profession was to develop in Ireland it would be necessary for the major strands of psychotherapy to come together. I decided, therefore, to set up an Irish Standing Conference on Psychotherapy. The current strands of psychotherapy represented by the Standing Confer­ence are: Analytical Psychotherapy, Family Therapy, Constructivist Psycho­therapy, Behavioural and Cognitive Psychotherapy, Humanistic Psycho­therapy. We organise national meetings and have also had discussions with the Department of Health about the development of psychotherapy in Ireland.

In February 1991 I received an invitation to attend a meeting in London to establish a European Federation of Specialists in Psychoanalytic Psycho­therapy. Its aim was to promote development and research and to train therapists to a high standard. At a later stage I invited Tom McGrath to be an alternative representative from Ireland. More recently Dr. Louise Tansey and Dr. Mary Smith have agreed to represent the child section of this Federation which is setting high standards for individual group and child psycho­therapy and establishing training guidelines. The EFPP now has members from most of the EC countries and European Free Trade Countries. New training guidelines will come into force in 1995 and I believe that this will lead to increased harmonization of psychoanalytic psychotherapy training within Europe.

(Dr. Michael Fitzgerald is the only Psychoanalyst recognised by the International Psychoanalytical Association in the Republic of Ireland).