á jour 2012.02.07
This is a sketch of the place of psychoanalysis in the Finnish health care system as well as in some institutions which influence health care. The following aspects will be described: the number of psychoanalysts and psychotherapists, the subsidization of psychoanalysis and psychotherapy, the place of psychodynamic thinking in the national health care system, and the relation between psychoanalysis and the University.
The training of psychoanalysts began in Finland in 1965. Since then, the number of psychoanalysts has been steadily rising. Today, we have about 230 trained IPA psychoanalysts. There is also a Finnish IFPS society (Therapeia), with about 120 trained psychoanalysts. In Finland we have 5,5 million inhabitants.
The number of Finnish psychotherapists has also been rising, especially during last years. In 2008 we had 4.458 registered psychotherapists. Of these 67 % were psychoanalytically oriented, 20 % were cognitive behavioral psychotherapists, 5 % were cognitive-analytical therapists, 3 % were gestalt therapists. The number of registered psychotherapists has risen around 8 % a year for the last five years.
The societal subsidization of psychotherapy and psychoanalysis has grown steadily. The most important subsidiary source (see below) has been more than doubled during the last ten years (in 2009 it was 23 million euro).
There are five possible sources for financial support for psychotherapy and psychoanalysis in Finland. (1) In case your work ability is decreased or challenged you may get rehabilitation support for psychotherapy. The support is limited: you may get two sessions a week for two years. In some instances you may get one session a week for a third year. This is the most important subsidiary source for psychotherapy and psychoanalysis in Finland. (2) In case your psychoanalyst or psychotherapist is a physician, you may get your treatment supported from the National health insurance. They pay about half of the fee for about 4-6 years, after that their support gradually decreases. (3) In some parts of Finland the National health services may buy psychotherapies from the private sector. This concerns especially treatments of children and younger adolescents. In case the patient is an adult, the length of the treatment is about the same as in the first group: two sessions a week for two or three years. (4) Handicapped children, adolescents and young adults may get their treatments financed. In these cases there are no limits for frequency or length of treatment, so also regular psychoanalyses may be fully subsidized. The handicap is often physical, but may be also psychical. (5) In case you have a private health insurance (which is not that usual in Finland), you may get a psychotherapy (two sessions a week) financed.
As can be seen, here are relatively many psychoanalysts and psychotherapists in Finland. The numbers have risen steadily, also in recent years. There are also fairly good possibilities to get at least some part of your psychoanalysis or psychotherapy subsidized. The political back-up for these subsidizations seem (at least for the time being) unchallenged.
How much is psychoanalytical thinking represented in the national health care, i.e., in the basic health care and in the psychiatric and child psychiatric services? This is not that easy to estimate. The general view, however, is that psychodynamic thinking has receded into the background. There has been a shift to diagnostic thinking. The treatments in the general health care services are more time-limited than before – which at least partly is a result of the increasing number of patients. The general recommendations for treatments – which are based on double-blind surveys – have been more bended towards cognitive-behavioral therapy than before. In the national health care services the place of psychoanalysis has thus diminished.
The greatest concern has, however, been the relation between psychoanalysis and the University. In the Finnish academic psychiatry psychoanalysis have had a very central position. In the 1970´s five professors of psychiatry were psychoanalysts. Today, there are none. Some professors in psychiatry, however, have been trained as psychoanalytical psychotherapists. In child and adolescent psychiatry psychoanalytical thinking is better represented. In Finnish academic psychology psychoanalysis has never been that central, but its presence has also there slowly decreased during the last two decades. Among students in psychology, however, the interest in psychoanalysis seems to be fairly vital. There is some interest in psychoanalysis in the social sciences, history, literature and philosophy, but also in these fields there seems to be a slow decrease of academic presence.
In summary, during the last decades there has been a rise of numbers of psychoanalysts and psychotherapists in Finland. There has also been a rise of financial support for these treatments. Probably there is a relation between these facts. Since the pressure in the national health care services has grown, the private sector is a tempting alternative for psychotherapeutically trained professionals (especially as the societal subsidization seems – for the time being – to remain unchallenged). There is thus a political back-up for psychoanalytical or psychoanalytically informed treatments. There seems, however, to be some risks present. The greatest risk is the decreased presence of psychoanalysis in the University. If psychoanalysis is not represented in higher education, the political back-up will probably slowly decrease. In case subsidization decreases, professionals probably will be less eager to train as psychoanalysts or psychotherapists. If that happens, the conditions for a flourishing psychoanalytical culture will at least be limited. From the beginning of 2012, psychotherapeutic trainings need to be organized by the University, or in conjunction with a university (formerly, they have usually been supplied by private organizations). We still do not know what this change will lead to. We also do not know if the psychoanalytic training in the future will be organized in conjunction with a university. Alternatively, only registered psychotherapists could apply for psychoanalytic training (which would be supplied solely by the Institute of the Finnish Psychoanalytic Society).