A recent article in Eesti Ekspress about the mental health landscape also touched briefly on psychotherapists. The reader may have been left with a misleading impression, which can create uncertainty for those who have started their recovery process in the psychotherapist's office. Some clarifications of the facts are given below.

Who is a psychotherapist?

Two professional umbrella organizations at European level have been working on this question for some time. One of them is the European Association for Psychotherapy (EAP), which represents the free and independent practice of psychotherapy in Europe and adheres to high standards of competence and professionalism. EAP brings together 128 organizations from 41 European countries and over 120 000 psychotherapists. In Estonia, the Estonian Psychotherapists Association (EPTA) has a long-standing cooperation with EAP.

The other umbrella organisation is EFPA (European Federation for Psychological Association), which represents the interests of psychologists. It has 37 full members (one organisation from each country), with the Estonian Association for Psychologists (EPL) as an Estonian member.

A comparative article by Aherne et al. 2018 ^[2] concluded that the two organizations' visions of who is a competent psychotherapist largely overlap. However, perceptions of the higher education (or degree) background prior to psychotherapy training are the source of the differences. The EAP represents the view that psychotherapy is an independent profession ^[3] in the same way that psychology and psychiatry are, and that psychotherapists can be trained from a variety of higher education backgrounds (predominantly in the social sciences or humanitarian).

However, the EFPA, the organization representing psychologists, considers that psychotherapists can only be psychologists with a university degree and additional training in psychotherapy.

What is the situation in Estonia?

Both psychotherapists themselves and their clients are uncomfortable with the fact that a separate profession of psychotherapist has not yet been established in the Estonian Qualifications Authority. At present, clinical psychologists and psychiatrists can apply for additional specialization in psychotherapy to their basic qualifications. In the absence of a occupational standard, it has been suggested that there is no such profession as psychotherapist.

Many psychotherapists in Estonia, through their professional associations, are grouped together under EPTA, which monitors and supervises EAP psychotherapy standards. EPTA lists 60 psychotherapists working in prevention, treatment and rehabilitation across the mental health landscape.

Thus, psychotherapists are there and are doing serious work

to alleviate people's suffering.

In the absence of a professional standard, Estonian psychotherapists can prove their qualifications by applying for the European Certificate of Psychotherapy (ECP), which defines the core competences of European psychotherapists. The ECP has formulated the highest professional standards for psychotherapists (foundations for education, training and clinical practice).

According to this, qualification implies a minimum of four years of training, including theory, methodology, clinical supervised practice, with personal therapy as an important component. Often, the study takes longer than four years, as the demands are very high and the process of personal growth of the future psychotherapist cannot be put under pressure.

The personal aptitude for the job and the capacity for self-reflection are decisive factors in starting and successfully completing the training. This means that not everyone can become a psychotherapist.

In Europe, psychotherapists are mainly trained in private institutes, although in some countries training is also available at university at master's degree level. Certification and the training process have been developed over decades by international associations of psychotherapeutic disciplines and are subject to thorough preparation and quality control.

Participants are expected to pay the full cost of their studies. Other costs will be added if the study is taken abroad.

About psychotherapy

Psychotherapy is a comprehensive, goal-oriented and systematic treatment or therapeutic intervention aimed at alleviating or eliminating established psychological symptoms, modifying disturbed behavioural and thought patterns, promoting the patient/client's maturity, development, personal growth, mental health and well-being, and alleviating emotional and psychological distress. Psychotherapy can be short or long term.

The term "psychotherapy" brings together a variety of non-medical and non-pharmacological approaches and methods. Each modality of psychotherapy (psychodynamic, humanistic, systemic, existential, behavioral) is based on a theory, a methodology and a research foundation.

Some approaches focus on treating and reducing symptoms, addressing behavior and cognition. Other approaches focus on changing personality and fostering emotional development, taking into account the inner world and social influences of which the person may not be aware. Different psychotherapeutic approaches recognize the complexity of human experience, supporting clients in understanding and resolving deep and often unconscious emotional inner conflicts in the context in which they occur.

Some psychotherapies are more manualized, others less. We believe that the diversity of approaches is the richness of psychotherapy, which can benefit many, according to their problem or preferences. ^[4]

The therapeutic effect of psychotherapy

There have been many large-scale and comprehensive studies on the effectiveness of psychotherapy, confirming its efficacy in the treatment of a wide range of mental disorders. It has been found that the success of treatment does not depend so much on the therapeutic approach and method chosen, but that the relationship between the psychotherapist and the client and the interaction between them is the most important element.

B. E. Wambold ^[5] stresses that effective psychotherapists have a knowledge of different ways of relating and responding, based on scientific foundations, which is skilfully applied in complex and affective situations as a therapeutic method. He adds that psychotherapy has been scientifically proven to be as effective as medication, with the difference that psychotherapy is longer lasting and has fewer side effects. Mental health is a key component of overall health to which psychotherapy disciplines are constantly contributing. The diversity of people's lives and mental health needs cannot be covered by a single approach or therapeutic modality, and the richness of psychotherapeutic modalities reflects the diversity of societal values, perspectives and perceptions.

In order to alleviate people's pain and suffering, improve mental health and overall well-being, it is necessary that psychotherapeutic options are accessible, applicable and continuously developed. To achieve this goal, we need shared understanding and greater cooperation.

[1] Data collected by EPTA for 2023.

[2] Aherne, D., Smith, L., Whelan, N., Hickey, L., Kirwan, C. & Coffey, A. M. (2018). Comparing competencies of a psychotherapist with those of a psychologist specialising in psychotherapy. European Journal of Psychotherapy & Counselling, 20:3, 294-311, DOI: 10.1080/13642537.2018.1495244

[3] European Psychtherapy Act (2018). https://www.europsyche.org/about-psychotherapy/european-psychotherapy-act/

The Strasbourg Declaration (21 October 1990) states that psychotherapy is a scientific discipline in its own right, the practice of which constitutes a separate profession. Access to training is open to people with various prior qualifications (in particular in the humanities and social sciences).

[4] Norcross, J. C., & Wampold, B. E. (2018). A new therapy for each patient: Evidence-based relationships and responsiveness. Journal of Clinical Psychology, 74(11), 1889-1906. https://doi.org/10.1002/jclp.22678

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172

Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303–315. https://doi.org/10.1037/pst0000193

[5] Wampold, B. E., Imel, Z. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge