Information about the national audits of psychotherapy training institutes in Sweden 2007-08
The National Agency for Higher Education in Sweden (HSV) started in 2001 a general program for audits of all major university training programs. About 150 audits of the exams of different professional trainings have taken place during these six years. The content and structure of the training institutes for psychotherapy have been audited twice, in 2003 and in 2007. The three main aims of the audit were to (a) contribute to the training institute`s own quality assurance, (b) examine whether the training program corresponds to the aims and regulations stipulated by the law for higher education as well as the Higher Education Ordinance, and (c) give information to students, among others, regarding choice of psychotherapy training program.
The audit was based on 14 criteria including:
• The organisation and framework of the training program
• Long-term planning and stability of the institute`s work with training programs
• Academic level of teachers and supervisors (at least some should have a PhD exam)
• Provision of a creative and critical environment
• Number of clinical cases and supervision
• Type and amount of literature
• International contacts
• The examination papers should give an opportunity to focus on specific areas of interest
• Opportunities for students to evaluate their training
• Formal channels for the students to bring complaints about the training program
The first round included 22 training programs. Initially none of the institutes were fully accepted, but after one year of work with many of the criteria used for the audit 18 of these programs reached a standard that, according to the HSV was accepted as a base for authorization as psychotherapist. Five different orientations of psychotherapy were audited, training programs based on psychodynamic psychotherapy being one of these.
In 2007 eighteen training institutes were evaluated and only four were fully accepted (with only minor comments). All of these were university-affiliated programs. Another four were given recommendations for changes that could be reached within a year. This implies that the majority of the training programs were not accepted and they have been given time to react to the critique until May 2008. In this last audit it was clear that the implications of the Bologna process had some significance.
Although this result has created major problems for many of these institutes, it is interesting to note that two of the four fully accepted training programs include programs in child and adolescent psychotherapy in Sweden (The Erica Foundation in Stockholm and one of the three psychotherapy programs in Gothenburg University). This indicates that the standard of the training programs focusing on child and adolescent psychotherapy is high. The two other programs that were fully accepted are the Karolinska Institute and Lund University.
The network for psychotherapy training institutes in Sweden
At a meeting in October 2007 the problems involved for the future training in psychodynamic psychotherapy were discussed, due to the fact that many of the programs not accepted were psychodynamically oriented and included the two psychoanalytic training programs in Sweden as well as the only Swedish group-analytic training. The main problems are:
• A diminishing number of trained psychotherapists with a psychodynamic orientation in the near future, as we are facing a situation characterised by a large number of people who will retire.
• Difficulties for many trained psychotherapists in the public sector to work with individual psychodynamic psychotherapy, especially in the larger cities.
• As the demand for cognitively (CBT) trained psychotherapists is very pronounced, many employers will only pay for this kind of training and not for any other e.g. psychodynamic psychotherapy.
• There is a clear risk that academic qualifications will have a higher impact than clinical experience, leading to that well experienced clinicians will not be able to compete with less experienced, but academically trained psychotherapists when it comes to employment in the public sector.
Concluding remarks
One conclusion is the importance of being aware of that similar national or international audits are likely to be performed also in other countries. Important elements in these are the public sectors´, especially psychiatric services in the public sector, rapidly increasing demands for fast, effective and less costly psychotherapeutic methods as well as the Bologna process in the European academic world that was introduced in 2007.
The Bologna process implies that the educational structure of the universities will be changed. It will be easier to compare university degrees between different countries and it will be easier for the students to move between different places of study. It also implies that university training programs should adapt to the demands in society. This, of course raises many questions.
Another conclusion is that it is a primary concern to stimulate clinically based research e.g. research projects that combine the everyday psychotherapeutic work in ordinary clinics and the resources trained researchers can provide, i.e. effectiveness studies. The need for experienced clinicians who also are trained in research is very clear.
We think that the EFPP can and should play an important role in this development. It involves being well informed about the authorities involved in these processes and their activities in order to understand the context we will be working in. It is also necessary to continue developing training programs that maintain a high quality and to integrate clinically based research in the daily practice as clinician.
Stockholm March 25th 2008
Britta Blomberg, Siv Boalt Boëthius, Juanita Forssell, Pia Litzell Berg, Anna Malmquist-Saracino and Sigmund Soback
Delegates for the EFPP, Sweden
