Interim report on

Project: Securing psychoanalysis in the public health sector

Applicants: The five Nordic psychoanalytic societies

Sverre Varvin

Oslo 14.12.09

Aim of project 

To secure psychoanalysis and psychoanalytic derived treatments as part of the public health services.

Organisation and work plan

This project is a collaborative project between: The Danish Psychoanalytic Society, the Finnish Psychoanalytic Society, the Norwegian Psychoanalytic Society, the Swedish psychoanalytic Society and the Swedish Psychoanalytic Association.

The five (soon four as the two Swedish societies will merge next year) agreed on the following steps on this project:

  1. Discuss the common and different problems in the Nordic countries.
  2. Built up arguments to be used in relations to the governments in order to convince of the benefits of psychoanalysis.
  3. Develop strategies on how to relate to the governments in order to secure funding of psychoanalytic treatments and justification of psychoanalytic knowledge as important for the treatment of any mental illnesses.
  4. To develop a network for psychoanalytic research in the Nordic countries that both can develop research on psychoanalysis and disseminate research findings for the benefit of clinicians and for the justification of psychoanalytic treatments.

To achieve these aims, three inter-Nordic working groups were set up:

  1. Working party for psychoanalytic research aims at dissemination of research findings and establishing connections with other existing networks for psychotherapy in the Nordic countries and elsewhere (e.g. IPA research committees).
  2. Workingparty for relations to the public health authorities aims at building up arguments and developing strategies in order to secure funding of psychoanalytic treatments and justification of psychoanalytic knowledge as important for the treatment of any mental illnesses.
  3. Working party for outreach and continuous psychoanalytic educationaims at dissemination of psychoanalytic knowledge to the general public as well as at developing strategies for raising interest in young psychiatrists and psychologists for a proper psychoanalytic education.

Each working party will met in person and by Skype during the project period. The groups will prepare material for a working conference to take place in Sweden autumn 2010. The result from this conference will be:

  1. A “White book” containing background material and strategies related to the different areas of the working parties
  2. Publications aimed at informing public health authorities
  3. Publications aimed for the general public.

What has been done so far

1. Working party for psychoanalytic research
     Chairs: Bent Rosenbaum (DK) and Andrzej Werbart (SE)

A first DPPT Nordic meeting was held in Stockholm, Sweden, 20 August 2009 at the Swedish Psychoanalytical Society. The four participants were Johannes Lehtonen (SF), Steinar Lorentzen (NO), Bent Rosenbaum (DK) and Andrzej Werbart (SE).

The working party decided

  1. To start a work on collecting information from all members of the Nordic societies on research activities, research networks where psychoanalysts participate and research publications by psychoanalysts.
  2. To collect and summaries research findings in international publications concerned with evidence for psychoanalytic treatments with focus on meta-analyses and reviews.

Sweden

Members of SPS (Swedish psychoanalytical society) and SPA (Swedish psychoanalytical association) take part in several Swedish networks for psychotherapy, psychotherapy education and research such as

  • National Federation Centre for Psychotherapy (RPC),
  • Foundation for Psychotherapy (Psykoterapistiftelsen),
  • Swedish Working Party for Psychotherapy Research,
  • Swedish Working Party for Psychotherapy Education and Research Courses (SAPFO).

At present 8 psychoanalysts are professors or emeritus professors and further 8 associate professors at universities in Stockholm. Several psychoanalysts are conducting psychoanalytic or psychotherapy research projects. Some examples:

  • A naturalistic study of interaction effects in psychotherapy in public services,
  • A randomized controlled trial of mother-infant psychoanalytic treatment,
  • Dream research,
  • Eating disorders,
  • Holocaust and Genocide Studies,
  • Private theories of pathogenesis and cure in patients in psychoanalysis and their analysts,
  • Psychotherapy and antidepressant medication,
  • Saving and Empowering Young Lives in Europe,
  • Suicide prevention and suicidal behaviour,
  • Young Adult Psychotherapy Project

PhD students conduct further studies. Several psychoanalytically oriented research projects are conducted by non-analysts.

Norway

Members of the Norwegian society are taking parts in research networks and many do active research on psychoanalysis (outcome and process among others). There has been a process –outcome study organised within the frames of the psychoanalytic institute. Erik Stänicke (advanced candidate) now publishes parts of results of these in a PhD thesis.

Several members are at present involved in research and research networks among others on the following themes:

  • Treatment of severely traumatised patients

  • Group analysis

  • Neurobiology

  • Therapeutic competence

  • Psychoanalytic case study

  • Dreams of traumatised persons

  • Outcome of psychotherapy.

Finland

At the universities, among the psychiatric and psychology professors, many of them used to be psychoanalysts, at the moment there are c. 8 persons, who have that kind of a position at the university, and some of them are emeritus professors. We have established four years ago a university consortia consisting of these persons and of some others. These consortia aims at encourage people to start and keep on in research and writing academic papers.

In Finland we have a wide research going on, financed by National Insurance pension, The Helsinki Psychotherapy Study, which researches four different kinds of psychotherapies, one of them is psychoanalysis. The outcome results are only partly published nothing about psychoanalysis yet. There are also some other academic researches going on in the field of psychoanalysis.

Denmark

At the University of Copenhagen a ”Centre for Psychoanalysis” is established under the leadership of Judy Gammelgaard.

There are several psychoanalytic research projects:

  • General and developmental role of the unconscious in the formation of the psyche

  • Psychoanalysis and art: a psychoanalytic reading of Marcel Proust ”A la recherche.”

  • Neuro-affective development, drive destiny and psychic illness

  • Infantile sexuality and sexual traumas

  • There are also 4 PhD projects at this centre.

  • Adjunkt-projekt ved adjunkt Katrine Zeuthen: Forholdet mellem udviklingen af den infantile seksualitet og seksuelle traumer.

Other researches:

  • RCT: Psychoanalytic therapy and CBT with Bulimia Nervosa
  • Trauma and dream
  • Trauma and psychotherapy
  • Supportive psychodynamic psychotherapy with persons with first episode Schizophrenia.

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The working party on research is working to compile relevant research literature especially on outcome that can be utilised among others in outreach activities and relations to public health authorities.

2. Working party for relations to the public health authorities Chair: Kari Høydahl, Norway

This working party aims at the following:

  1. Universities: Investigate the place of psychoanalysis in psychiatry in the Nordic countries. How many professors/teachers are psychoanalysts or psychoanalytically oriented. Psychoanalytically based teaching activities at universities. The role and place of psychoanalysis in other disciplines (literary science etc).
  2. The role of psychoanalytic research in relation to psychiatric/psychological research.
  3. Psychiatric hospitals/outpatient clinics: the role/place of psychoanalytic therapies and thinking. What is the possibilities
  4. Establish networks with other organisations and institutes related to psychoanalysis/psychoanalytic psychotherapy
  5. Develop common strategies in relation to authorities to bring evidence for psychoanalytic therapies and especially influence treatment recommendations/guidelines developed by health authorities

This work has started in all countries.

Sweden

The situation in Sweden merits special attention as it has been especially problematic there with attacks on psychoanalytic/psychodynamic educations, a development one can fear will happen in other Nordic countries.

This working party consists of the joint SPS (Swedish psychoanalytic society) and SPA (Swedish psychoanalytic association) Negotiation Committee.

The Negotiation Committee participates in the network Consultation Forum for Psychotherapy, an instance for negotiations between all arrangers of psychotherapy education in Sweden.

The Negotiation Committee was engaged in arduous negotiations with the Stockholm County Council about financial support for the candidates’ training cases. The last year was marked by big changes within Swedish psychiatry.

  • The Institute of Psychotherapy in Stockholm was closed down and the previously integrated research, educational and clinical activities were split up.

  • The Swedish National Board of Health and Welfare compiled guidelines for treatment of depression and anxiety disorders, recommending CBT as the treatment of choice.

  • The Swedish National Agency for Higher Education withdrew the examination right from several arrangers of psychotherapy education, inclusive of SPS and SPA. The consequence is that the candidates after psychoanalytic education no longer receive certificate as licensed psychotherapist.

  • The agreement between Stockholm County Council and SPS and SPA about financial support for the candidates’ training cases was cancelled and the phasing out is still unclear.

  • Stockholm County Council carries out purchasing of psychiatric in- and out-patient units.

Norway

Psychoanalytic training and training in psychodynamic psychotherapy are still supported by the Norwegian government. The Norwegian group has been alerted by the Swedish experience and is now cooperating with psychodynamic therapy institutes in order to approach public health authorities with scientific data on psychoanalytic treatments. Whenever guidelines are produced for comments the institutes are active in producing corrections and comments assuring that research data on psychoanalytic therapies are included; so far with some success.

Finland

In the Finnish Society we have a Group for outreach and public relations. This group aims in keeping relations to media and public. For years we had public meetings, “Studia Psychoanalytica”, 4 – 8 times a year, where our members gave a talk or a presentation and there were discussions from the floor. Earlier times, in those meetings were c. 200 people, later c. 50, even less. At the moment we have had a pause for two years. 

In some universities our members have some teaching, for example at the Helsinki University, at the Psychology Department, a psychoanalyst gives part of the programme in the psychotherapy field. But it is clear that our connections with the academic world have decreased and we hope that our new consortia can help here.

Denmark

Psychoanalytic Debate

The Danish Society has since 1991 with the intent to create a dialogue with people from other disciplines about psychoanalytic ideas arranged public lectures. Psychoanalytic Debate is an open forum for discussion of psychoanalysis in relation to clinical subjects and to more general areas as humaniora, art and society in general.

Psychoanalytic Consultation

The society has an open consultation, 2 members and 2 candidates have their phone-numbers and mail-addresses on our web-site and can be contacted directly. The Consultation is open for all who seeks treatment or should like to know more about what psychoanalysis is. The Consultation offers 1-3 session at a low price. The consultant will refer to a candidate/analyst with a vacancy for analysis, or to another form of treatment if that is found more relevant.

3. Working party for outreach and continuous psychoanalytic education Chair: Hanne Bygholm, Norway

This working party works with revitalising psychoanalytic societies and institutes in order to strengthen the following aims:

a) Make them a place for development of psychoanalytic theory and practice and make them relevant in relation to the health services and other disciplines

b) Make societies and institutes more attractive for professional development for younger generations

Sweden

This working party consists of SPS's Information Committee and SPA's External Committee, often working together when organizing external events for general public. Examples of events 2009:

  • The course of lectures, “What is psychoanalysis? Psychoanalysis from cradle to grave” organized together with the Worker’s Educational Association (ABF) in Stockholm continued for 10th year.

  • The course of Freud seminars in Gothenburg.

  • Movie breakfast and movie evenings for general public followed by discussion with psychoanalysts.

  • 2009-01-31, panel discussion at the Boulvard Theater in Stockholm after the show “Freud’s cigar”.

  • 2009-04-25, panel discussion at the City Theater in Stockholm after the performance “Do I comfort you now?”

  • 2009-05-14, seminar at the Axess TV about the serial Be’tipul.

  • 2009-05-15, educational day in Gothenburg, “Talking with children – does it help?”

  • 2009-05-26, “How do psychodynamic psychotherapists think and act?” panel discussion at the Worker’s Educational Association (ABF) in Stockholm about the serial “In treatment”.

  • 2009-10-09, “Myth, dream, drama in ancient Greece and the therapy office of today”, educational day at the Worker’s Educational Association (ABF) in Stockholm.

  • 2009-10-23, educational day in Lund, “Our time’s depression – educational day in about not being able to mourn”.

A Think Tank for future psychoanalytic education started 2008 with representatives from SPS and SPA (Alexandra Billinghurst, Siv Boalt Boëthius, Gunnar Karlsson, Johan Schubert, Andrzej Werbart). The aim was to generate innovative ideas about the future psychoanalytic education and broaden contacts with universities (see Appendix 2).

Members of the Think Tank met representatives for several university departments:

  • Centre for Studies in Practical Knowledge, Södertörn University, Stockholm

  • Department of Literature and History of Ideas, Stockholm University

  • Department of Psychology, Stockholm University

  • Department of Education, Stockholm

Finland

Our society is quite big, also quite active society. Because at the moment about 40% of our members are living outside Helsinki, in our scientific meeting there are fewer participants in relation to our amount of members. But when we have our own Congress every other year, about 70 % of the members attend. We have members in Helsinki, Tampere, Turku, Jyväskylä, Kuopio, Oulu and in some other smaller cities. These members are very active in the psychotherapeutic associations in these cities. It is difficult to say how many of our members are fully privately practicing, how many also hold positions in the society; we have the impression that almost all of them have some private practice. There are c. 25 child psychoanalyst + 10 child psychoanalytic candidates.  

Denmark

Psychoanalytic Outreach Courses

Since 2001 the Society has arranged postgraduate courses for psychologists and psychiatrists that can be used in the postgraduate qualification for becoming specialists in psychotherapy.

“Psychoanalytic Perspectives” is a course that is a more general introduction to modern psychoanalysis and key psychoanalytic concepts. As the teachings of psychoanalytic ideas in the public educational systems decline this course is a possibility to spread information about the actuality of psychoanalysis.

“Psychopathology in psychoanalytic Perspectives”. The focus of this course is to present the psychoanalytic understanding of psychopathology – which is becoming less and less known in psychiatry – and these ideas are related to the diagnostic systems of ICD10 and DSMIV.

“Course on Ethics” A course more directed towards the post‐grauduate needs of psychologists – the focus is primarily on the ethics of the therapist‐client relationship including the frame seen from a psychoanalytic perspective –at the same time the social context and the law is taking into account.

“Theory of the Supervision Process” The course can be used by psychodynamic therapists who want to qualify as supervisors. It is primarily a course on theory, but clinical supervision of supervision can be taken in according to the participants needs. (e.g. confidentiality /third-party rapports)

These 4 different courses are repeated – and renewed – and can be supplemented by other courses. The members of the Society and senior candidates are teachers.

These courses have during the years resulted in people deciding to take a psychoanalytic education.

Norway

Introductory courses for psychologists and psychiatrist

These have been going for many years and are now well established and are arranged in cooperation with the Psychologists association and the Medical association. These courses are part of the formal training to become psychiatrist and clinical psychologist. The participants work for two years in groups, which also give opportunity for in-depth studies for two years. These courses have recruited several candidates for training.

  1. The society has worked actively with the internal life in the society/institute. A committee has made suggestions how to organise scientific meetings, groups etc in order to create a more creative atmosphere.
  2. The society supports economically scientific work and writing project of members and candidates
  3. Public lectures on psychoanalytic perspectives on contemporary social matters in The House of Literature, Oslo
  4. Public film presentation, lecture and discussion in Cinemateket (House of Films)
  5. Conferences arranged with other psychodynamic associations on psychoanalytical issues.
  6. Publication of the society’s Bulletin: Katexis, providing interviews, discussions and information.

Respectfully submitted

 

Sverre Varvin (Chair) 

 

 

 

 

 

 

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