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By way of introduction, on April 9th, you will participate in the II National Conference on Psychotherapy, which will take place in Barcelona. What is the purpose of this meeting?
It is an opportunity to exchange views and discuss the current situation of psychotherapy and its future prospects. The recent establishment of the Division of Psychotherapy of the Spanish Psychological Association (COP) is a milestone for the development of psychotherapy. This has been followed by a decade of momentum and accreditation of activity in psychotherapy through the Europsy Certificate of Specialist in Psychotherapy, which currently has on its European register more than 3,300 Spanish certified psychologists publicly accessible on the Web. All of this merits a conference of meetings, as mentioned above, to put psychotherapy in Spain into perspective within the European context.
As we have said, throughout the conference various round tables will be held with the main theme of psychotherapy. As an expert in the field, could you point out the additional benefits that psychotherapy can provide in comparison with other types of intervention?
Psychotherapy is the treatment of choice in major health problems. This is clear from the scientific literature and is covered in government treatment guidelines. Thus it is the most efficient option, for example, for anxiety disorders and depression, with psychiatric drugs being used as a complement to psychotherapy for major depression, but not for mild or moderate cases. Thus the pre-eminence of psychotherapy is evident in health care due to its importance in emotional disorders, problems in childhood and adolescence, and generally in most areas that affect the behaviour and its interpersonal implications. It is worth mentioning that not only is psychotherapy more effective than psychotropic drugs but it is also less iatrogenic, which is especially important for people with various pathologies or generally people on medication because the interaction of psychotropic drugs with this medication significantly increases the potential iatrogenesis. In addition the cost of the treatment should be noted. Although drug therapy may have a lower direct cost than psychotherapy, this is not necessarily the case in the long term, as several studies have shown.
What role does psychotherapy currently hold in our country? Do you think it is given the importance it deserves?
The presence and recognition of psychotherapy in Spain are increasing, both among citizens and health professionals. The knowledge that psychological problems should be addressed precisely from a psychological and nonmedical perspective is increasing all the time. This does not mean we should dismiss the medical approach but rather we should delimit it to the appropriate areas of intervention and, of course, combined treatment whenever this is indicated. With respect to your second question, the answer is that psychotherapy is not given the importance it deserves. Psychotherapeutic care in Spain is usually a private matter, not an issue of public health. With few exceptions, the public health system does not meet the necessary conditions, the scope, resources, etc., to provide psychotherapeutic services with a guarantee of their effectiveness. This is a serious problem because it discriminates against citizens in their ability to benefit from it. Citizens should have the right to receive, through the public health system, treatments that have been proven to be the most effective and efficient for their problems, which does not happen at present in most cases, especially, as mentioned above, for emotional problems and their wider effect on health.
In your opinion, what actions should be taken to spread psychotherapy and to enhance its scientific, technical and professional development?
Reaching the general population with clear information on this issue is essential. Psychological problems require a different approach to other normal medical problems. An addiction or depression is not resolved by taking pills, although this may be useful occasionally. This type of message should be reiterated continuously, in order to increase awareness among citizens. From a scientific and technical standpoint it is very clear. The effectiveness of psychotherapeutic procedures has been thoroughly demonstrated, as recognized by the scientific community. Whether these treatments are available or not for the citizen is not a scientific but a political issue. It is the health authorities who must answer to this incongruity. This is even more the case, when the cost-effectiveness of psychotherapy has been demonstrated in public systems such as the German or the British health services, which offer it to citizens using different models. Finally, from the professional perspective, it is imperative to be strict in the application of psychotherapeutic procedures that have proven effective. It is not so much about the therapeutic orientations but the empirical demonstration of their effectiveness. The diversity of approaches is positive because the problems are diverse, as are the different perspectives from which they can be addressed. This diversity enriches, as long as the procedures are scientifically backed, including clinical studies. Adding, not subtracting, but following the clinical standards and guidelines.
Today, there is much debate about which professionals can obtain accreditation as psychotherapists. Specifically, to paraphrase the question on this subject proposed for the round table in which you will participate, why should the psychotherapist be a psychologist? How can we ensure the quality of intervention of the psychology professional in this area?
It seems patently obvious, of course, that it is best that psychotherapy be practised by a psychologist. Who better than a psychologist? The issue is that other professionals, especially doctors, also practise psychotherapy. Clearly, a psychologist has better training, more appropriate I would say, than a medical doctor for addressing psychological problems. However, the history of psychotherapy has a number of distinguished cases of psychotherapist doctors such as Joseph Wolpe or Aaron T. Beck, for example. So, in my opinion, and with the appropriate exceptions, it should be the psychologist who practises psychotherapy. The quality of the intervention must be ensured by appropriate training, theory and practice in the basics of psychotherapy, i.e. in psychology, and in the specific intervention tools that have empirically demonstrated their effectiveness. This is a dynamic, unfinished process that must govern all professional life, since science and technology, precisely because of their experimental roots, are subject to new insights and improvements. I would also emphasize the psychotherapist’s competence in interpersonal skills. These skills play a central role since the therapeutic relationship is the vehicle through which the therapeutic procedures are applied; its quality is essential to ensure effectiveness.
More specifically, your presentation revolves around training and accreditation. Could you give us more detail on what your presentation involves and what topics you will address?
Well, I'll touch on three points: what is required in order to practise as a psychotherapist, how the knowledge is acquired and which accreditation standards are the most appropriate. Regarding the first point, as we have already mentioned, the starting point must be the study of psychology, with an undergraduate degree, and a postgraduate degree in psychotherapy. In the studies, there should be special focus on the interpersonal skills of the psychotherapist that require special training. These are therapeutic competencies that transcend the techniques, such as empathy, acceptance, warmth, etc. Continuing education should also be included. Practical training in hours of real and supervised activity is fundamental. The second point focuses on the methods for acquiring knowledge and skills. Theoretical and especially practical knowledge from studying cases with their corresponding modalities (pictures, audio-visual, etc.). Supervision as a standardized learning procedure and guarantee of the integrity of the psychotherapeutic procedures. The methods to be used include both classroom activities and the use of information technology and communication. Finally, the third aspect will focus on the systems of accreditation. The quantitative and qualitative criteria for the accreditation of reference in Spain will be compared: the Specialist in Clinical Psychology, the general health psychologist and the EuroPsy in Psychotherapy. In addition to the European projection of the EFPA accreditation, its openness and the requirement for continuing education are also emphasized.
Today, you are the President of the National Accreditation Committee of the EuroPsy Specialist in Psychotherapy. In line with the previous question, do you think the EFPA regulations for granting the certificate adequately ensure the quality of the psychotherapeutic practice of psychologists? What does it mean to hold this accreditation?
The EuroPsy Specialist Certificate in Psychotherapy is a guarantee of quality for citizens. The psychologists who have this certificate have been accredited to a collegial body fulfilling the European standards for the practice of psychotherapy. These standards are valid, therefore, at European level and include a transnational European register, with access via the Web. I would like to emphasize that in addition to the criteria and standards of accreditation, this is a process that is carried out with full guarantees from the national and European collegial associations.
In your opinion, what are the basic differences between the EFPA certificate and other certificates that are issued accrediting psychotherapeutic training by associations such as the Spanish Federation of Psychotherapy (FEAP) in Spain?
Although both certificates, the EFPA and the FEAP (what confusing acronyms!), are for accreditation in psychotherapy and have a European reference, there are notable differences between the two. I will highlight the main one. The EFPA certificate is the EuroPsy, that is, it is a European recognition of the training of an undergraduate degree in psychology and a postgraduate degree in psychotherapy. This means, in sum, two certificates, one as a psychologist and one as a psychotherapist. The FEAP accreditation is not specifically psychological. It has associates who are not psychologists, such as doctors, and it even admits other university degrees. The reference and control of the EFPA certificate is the Spanish Psychological Association and in the case of the FEAP the reference and control is each of the more than 50 associations that comprise the FEAP, each applying these common criteria. The FEAP certificate is not a European certificate in itself. The people who have it can request its European equivalent and be included in a register of the EAP. On the contrary, the certificate of the EFPA is European in itself.
Finally, would you like to add any other comments?
Yes, a couple of things. The first is the advantage taken by EFPA when it established European standards prior to the adoption of laws on this matter. This approach places the onus of the regulation of activities on the professional organizations, in our case at the highest level, the Spanish Psychological Association, which has important implications for the public service. In Spain all psychologists that practise psychotherapy can apply for this recognition, whether or not they belong to a scientific and/or professional association. The second is the need to disseminate the register of psychologists who hold the certificate. We encourage the general public and those in need of professional services to visit the website.
Consejo General de la Psicologia de Espana.
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