Report 2010: 9 R

Improving the quality of psychotherapy programmes

The Government has asked the Swedish National Agency for Higher Education to investigate the prerequisites for improvement of the quality of programmes in psychotherapy.

This task has been entrusted by the National Agency to a panel of experts with extensive knowledge of and experience from various fields of psychotherapy including training, research and clinical practice. Various psychotherapeutic approaches have been represented in the panel.

During the inquiry the National Agency invited representatives of the different course providers to a meeting to discuss factors of particular relevance to them. The National Agency has together with the panel of experts also conducted hearings with both representatives of all the course providers as well as representatives of different stakeholders.

This report presents the premises on which the study was based as well as the National Agency's recommendations for the improvement of programmes in psychotherapy.

The conditions on which programmes in psychotherapy may be offered and therefore also qualifications awarded have changed considerably over the last decade. New legislation, the Act on Professional Practice in the Field of Health Care (1998:531) came into force on 1 January 1999. This act laid down for instance that certification for professional practice as a psychotherapist could only be issued to those who had been awarded a qualification in psychotherapy by an appropriately entitled course provider. Previously the Board of Health and Social Welfare had since 1985 also been making the same appraisals of programmes in psychotherapy to enable certification. The act has meant that since 1999 the National Agency for Higher Education has audited the quality of a large number of individual course providers who have applied to entitlement to award psychotherapy qualifications. Universities wanting to be able to award qualifications in psychotherapy have also applied to this entitlement.

During 2006/2007 the National Agency conducted a quality evaluation of all the psychotherapy programmes in Sweden. The programme offered by Stockholm University was not, however, included in this evaluation as it did not start until the autumn of 2006. All of the programmes evaluated led to the award of a qualification in psychotherapy and therefore entitlement to certification for professional practice in the health services. For this reason the same quality standards applied to all the programmes irrespective of whether they were offered by a government funded or independent course provider. The final result of the evaluation was that only eleven of the programmes were considered to meet the quality standards that had been laid down. This evaluation provided the point of departure for this study. Its report contains a brief description of the observations made during the evaluation.

The study also offers a brief background to psychotherapy training and a description of the current state of the programmes.

The task also included undertaking a survey of programmes in Europe. From the summary produced it can be concluded that there is a great deal of variation in the practice and training of psychotherapists in different European countries. Legislative and regulatory differences, a multitude of different approaches and different educational requirements mean that currently there is no predominant model on which the training of psychotherapists in Sweden could be based. The conclusion is that programmes in psychotherapy in Sweden must comply with Swedish legislation and our own experience and circumstances.

Previous evaluations, experience from all of the psychotherapy programmes and their circumstances as well as ideas about the future of psychotherapy provide the basis for the proposals submitted by the National Agency. These can briefly be summarised as follows:

• Programmes in psychotherapy must offer specialist training based on the knowledge required for the degrees of MSc in psychology, Msc in medicine specialising in psychiatry, a post graduate diploma in specialist nursing specialising in mental health nursing or a BSc in social work.
• Programmes in psychotherapy must comprise 180 credits by integrating and assuring the quality of the clinical practice element, which they do not currently incorporate. Special agreements should be made about clinical practice between the course providers and care providers. These agreements should be subject to further consideration.
• Basic training in psychotherapy should be integrated into all the programmes that can qualify students for the award of a qualification in psychotherapy. This would enable the removal of basic training in psychotherapy as a specific entry requirement for psychotherapy programmes. One or more of the higher education institutions concerned should be given the task of reviewing how basic training in psychotherapy could be introduced into the programmes concerned.
• The students' own therapy should continue to form part of these programmes, but the extent and form can be modified and adapted to the conceptual framework of the different approaches.
• Independent course providers of programmes in psychotherapy should be able to offer them on the same terms as other independent course providers with contractual regulation of their rights and obligations.