Psychotherapy - a profession that has evolved from market demand?

Psychotherapy is an issue we come across more and more in today's world. There is more and louder talk about mental health problems among young people, and we are inclined to express our feelings openly and to speak directly about topics related to depression. We are increasingly willing to go to a specialist to talk. No wonder, since psychotherapy is not without reason simply called talk therapy to support people struggling with various problems.

Psychotherapy itself, however, is a rather general formulation that still raises many doubts in Poland. Although it is an existing and recognised profession in Poland, which has its own number among the classification of professions and specialities (as of 2022, it is code: 229905), there are still many doubts. And this is mainly due to the action of the Ministry of Health in Poland, which in 2022 announced a plan to create a new speciality - psychotherapy. This plan was intended to regulate the market situation in Poland, as the profession of psychotherapist has so far lacked any specific regulation. This is how the discussion about who can be a psychotherapist, when to become one and whether it is a profession that needs to be distinguished was born.

History of psychotherapy. "It is necessary to treat the spirit because the spirit is diseased here".

In the beginning there was psychology, which was the core of the treatment of human emotional problems. As far back as ancient Greece, any difficulty with emotions was described as a medical condition linked to the human psyche. It was then when the first ways of treating depression in a rather peculiar way by bathing or bloodletting a person as a method of dealing with psychosis developed. But mental problems were noticed at the time.

Moments after the fall of the Roman Empire, i.e. as early as the Middle Ages, all mental illness began to be seen as part of the influence of 'evil spirits' or 'supernatural powers'. To drive them out of a person, torture was used. Demons could not be expelled and everything was blamed on demonic possession. In the 16th century, however, Paracelsus became an early pioneer in the field of mental illness. He was the first to debunk the belief that mental illnesses are the result of contact with demons or even Satan himself. Instead, he recognised that their basis may be hereditary and that some patients have a predisposition to depression or other conditions. He was also one of the first known medical practitioners to comprehend the nature of psychosomatic illnesses as we know them today.He is the author of the significant words: "You should apply treatment not as in an ordinary illness, but you should treat the spirit. Because the spirit is diseased here".
The real breakthrough came in 1853, when Walter Cooper Dendy first introduced the term 'psychotherapy'. Sigmund Freud undertook a major development of psychoanalysis at the turn of the 20th century, putting an enormous amount of work into the study of dreams, the unconscious and sexuality. Freud used hypnosis early in his career to penetrate the minds of his patients; he eventually discovered the famously more effective techniques of 'dream interpretation' and 'free association'. He believed that treatment would be successful by listening to the patient and providing interpretations to help bring memories to the fore. Freud believed that this would result in a reduction of symptoms.

Around 1950, a trend developed in American psychology towards more patient-oriented methods of treatment and therapy. This gave rise to, for example, behavioural psychology, whose way of combining therapy with an emphasis on the patient's feelings and thoughts allowed it to evolve into cognitive behavioural therapy, which is still extremely popular today.

The Law on the Psychology Profession in Poland, or how is a psychologist classified since 2001?

In 2001, the Act on the Psychologist Profession and the Professional Self-Government of Psychologists in Poland, was passed, which did not come into force until 2006.  Since then, in order to legally practice the profession of psychologist in Poland, one must:

• obtain an entry in the list of psychologists of the Regional Chamber of Psychologists;
• become a member of the professional self-government formed by all psychologists and trainee psychologists.

However, in order for registration as a psychologist to take place, an additional four conditions must be met according to the law:

1. obtain a Master's degree in psychology at a Polish university or obtain an education abroad equivalent to that in Poland;
2. have full legal capacity;
3. have a good command of Polish, both spoken and written, to the extent necessary for the performance of their profession;
4. complete a postgraduate professional internship, under the professional supervision of a licensed psychologist.

What can a psychologist do according to the law and the law in Poland?

In order to determine what competences a psychologist has under the law in Poland, it is necessary to go back again to the 2001 Act. The profession of psychology is a so-called profession of public trust: the activities of the person with this title have an impact on another person, his or her mental health and the changes that take place in his or her life.

The profession of psychologist in Poland can be practised by any person who meets the requirements indicated above. There is no control here, it is considered an independent profession. At the same time, the Act points out that the performance of a psychologist's work consists in the provision of services, in particular:

1. psychological diagnosis,
2. feedback,
3. adjudication, insofar as separate provisions so provide,
4. psychotherapy,
5. provision of psychological assistance.

The 2001 Act defines what psychological services consist of and how they should be performed in Poland. It also includes the duties of a psychologist, which include:

• Obligation to obtain informed consent from persons receiving psychological services. 
• Obligation to obtain approval of the planned activities and to inform the client of the purpose of the proceedings, the course of the proceedings, the results and how they will be made available. 
• Obligation to keep information obtained from the client confidential (with the exception, however, of situations where there is a threat to the life or health of the client or other persons).

What else under the Act can a psychologist do? Or, more precisely, what is he or she obliged to do? First and foremost, to continuing professional development in the form of postgraduate training. In addition to this, he or she can practice privately if he or she holds a licence to practice and is registered in the National Register of Judges and the Register of Private Psychological Practices.

The chamber of psychologists that didn't come into being, or how unions and associations 'took over' the chamber function

The professional self-government of psychologists has never been established, despite the efforts made over the past years by the individuals or associations involved. At the same time, there have been several attempts to repeal the current law, which has also met with opposition from the psychological community.

It is impossible to estimate exactly, but there are a huge number of psychologists in Poland. They work in the private or public sector. However, there is no Chamber of Psychologists in our country, as there is in some other countries. However, there are various professional associations and unions in Poland that bring together psychologists and work for professional development, ethics and standards in psychological practice.

Is it worth signing up to such associations? It is true that one can encounter different opinions. Some are for yes, others for no. However, it all depends on who and what they really want to achieve. However, it should not be forgotten that it is the trade unions that are striving to ensure that the psychology community can integrate with each other, regardless of what parts of the country people come from. It is the trade unions that are fighting to ensure that every psychologist - especially those working in the public sector - can be paid a decent wage. It is thanks to them that various types of training are available, which are able to positively influence their professional competences. The trade unions also provide appropriate legal assistance in the event of conflicts arising. They have therefore taken over the function of the Chamber, which by law should function to support psychologists in Poland. De facto, however... To date, there is no indication that it has been officially established. Change is unlikely in 2023, despite many efforts. Will this change in 2024? It is not known.

Psychotherapist, a profession born out of a loophole in the law?

There is a lot of talk at the moment that the amendment of the mental health legislation in Poland is a way to take some of the competences away from psychiatrists. There are claims that the introduction of a law regulating the profession of psychotherapist has to do with gaps in the law, as well as the lack of qualified and experienced professionals in our country.The first voices on the subject were raised in 2022, when the Ministry of Health announced that it planned to create a separate medical specialisation from psychotherapy. At the time, it was said that it would only be available to people who had graduated in medicine, nursing (at master's level), psychology, pedagogy, sociology or re-socialisation.

In 2010, it was recognised by the Regulation of the Minister of Labour and Social Policy of 27 April 2010. (Journal of Laws No. 82, item 537 of 17 May 2010) that psychotherapy is an existing profession in Poland, included in the category of 'Health care professionals not elsewhere classified'. At that time, the training minimums for psychotherapy were agreed on, among other things, and the requirements for practitioners were defined. At the moment, the Regulation of the Minister of Labour and Social Policy of 7 August 2014 on the classification of professions and specialities for the needs of the labour market and the scope of its application (Journal of Laws 2014, item 1145, as amended) is the applicable Regulation in the aforementioned matter.

Pursuant to the Regulation of the Minister of Health of 19 June 2019 on guaranteed services in the field of psychiatric care and addiction treatment (Journal of Laws 2019, item 1285, as amended), a psychotherapy practitioner is considered to be a person who fulfils all of the following conditions:

a)  holds a professional title of a doctor or a professional title of a master's degree in nursing, or a master's degree after graduation in psychology, pedagogy, re-socialisation, sociology, or meets the conditions specified in Article 63(1) of the Act of 8 June 2001 on the profession of psychologist and the professional self-government of psychologists (Journal of Laws of 2019, item 1026),

b) completed a postgraduate training course in psychotherapeutic interventions applied to health disorders carried out with scientifically proven methods, in particular psychodynamic, cognitive behavioural or systemic therapy, of at least 1200 hours or, before 2007, completed a postgraduate training course in psychotherapeutic interventions applied to health disorders of the duration specified in the training programme,

c)  holds a certificate attesting to having undergone the training referred to in point (b), culminating in an examination conducted by a board external to the training body and not composed of representatives of the training body, in particular set up by associations which issue certificates for psychotherapists, hereinafter referred to as "psychotherapist certificate";

Until now, the situation of psychotherapists was regulated at most by ministerial decrees, which listed, among other things, who could practise the profession within the scope of services financed by the National Health Fund. According to the Ministry, the specialisation was supposed to increase the availability of psychotherapy in Poland. But did it really?

Psychotherapist and legislation to be updated - September 2023

The Act on the Psychologist Profession and the Professional Self-Government of Psychologists in Poland referred to in this article has been in force in Poland for more than 20 years. Over the years, there have been industry consultations and discussions with, among others, the Ministry of Family Affairs, Labour and Social Policy, with the aim of relaunching the work related to the regulation of the psychological profession in Poland. Many years of efforts led to the establishment of the Parliamentary Group for the Statutory Regulation of the Psychology Profession in September 2020 on the initiative of the National Union of Psychologists (OZP) as a social party. And although a new bill was tabled in 2021, there are still no new regulations introduced.

Why is it so problematic in Poland to determine who - in principle - can be a psychologist? Because there are no unambiguous laws clearly regulating this issue. No implementing regulations were ever introduced for the current law, nor was a self-governing body of psychologists established, the document said. For this reason, there are often problematic situations in Poland. Cabinets that are out of control are being opened. Patients are treated by people without knowledge, which translates into a deterioration of their mental state, often also a loss of confidence in the psychological profession. The lack of participation in supervision or any kind of control leads to pathology and the destruction of the psychological environment.

In 2023, the Parliament adopted an amendment to the Law on Mental Health Protection in Poland. This bill will enter into force on 1 January 2024, while regulating the conditions and rules for the practice of certain medical professions, including psychotherapists. It introduced a new field of specialisation training - psychotherapy.

The most important regulatory changes

The year 2024 will bring important changes to the field of psychotherapy in Poland. The amendment to the Mental Health Act, included in the Law on Certain Health Professions, introduces significant changes that will affect the future of this key area of healthcare. For many, this is a milestone in the development of psychotherapy in the country.

One of the key aspects of the new legislation is the introduction of a definition of psychotherapy for the first time and the definition of the competencies that a psychotherapist should have. This certainly means clearer guidelines for practitioners in the field and may help to ensure a higher standard of care for patients.

Despite the changes, some psychotherapists are still pushing for a separate law regulating the profession of psychotherapist. Work on such a project is being carried out by the Polish Psychotherapy Council. However, already from January 2024, the new legislation should contribute to the regulation of the field, although opinions on this are divided.

The war over standards in Psychotherapy: Controversy over new regulations

However, the new legislation is not without controversy. One of the most important points of contention is the statutory sanctioning of the practice of psychotherapy regardless of the field of study of the master's degree. This means that a person with a master's degree in any field can apply to become a psychotherapist and practice in that role. This presents a challenge to traditional training pathways and to psychotherapists with more classical training.

It is worth noting that the proponents of this legislation argue that opening up the profession to people with different educational backgrounds can contribute to greater diversity and flexibility in psychotherapy. This could help tailor therapy to the specific needs of patients, as well as increase the availability of psychotherapeutic support.

Nevertheless, supporters of traditional psychotherapy schools fear that such liberalisation of the profession could lead to lower levels of professionalism and patient safety. In their eyes, psychotherapy is a field that requires specialised education and lengthy training, and the new regulations could undermine these standards.

Transformation in Psychotherapy: An era of new opportunities and challenges is upon us

A key aim of the new legislation is to improve the quality of patient care, ensure appropriate standards in psychotherapy practice and bring the law in line with the real needs of patients. Whether this will succeed or bring turmoil to the world of psychotherapy remains to be seen. One thing is certain, 2024 brings fundamental changes to the field and could open up new opportunities, as well as challenges, for all those interested in psychotherapy.

Psychotherapist vs. post-September 2023 regulations to take effect from January 2024

The law in force since 2024 introduces a definition of psychotherapy for the first time. According to it, psychotherapy is intentional and planned psychological interactions aimed at alleviating or removing the symptoms of a disorder and improving mental and social functioning, supporting the individual's or family's aspirations for health and development, directed at people with mental disorders.

The new regulations standardise many issues related to psychiatry and psychotherapy. Among other things, it talks about who can practise the profession, what qualifications are needed and what the rights of the individual are. For example, there is the right to write prescriptions for psychotropic drugs, which until now were mainly held by psychiatrists, but a small proportion could even be written by family doctors. A lot of things have now been clarified here, but associations claim that the new law is very restrictive and de facto causes more confusion than real solutions to problems.

Today, in light of the solution entering into force in 2024, psychotherapy within the framework of care referred to in paragraph 1 is provided:

1) a person certified as a psychotherapist who fulfils all of the following conditions:

• holds a professional title of a doctor or a professional title of a master's degree or meets the conditions specified in Article 63(1) of the Act of 8 June 2001 on the profession of psychologist and the professional self-government of psychologists (Journal of Laws of 2019, item 1026),
• documents: completion of a postgraduate training of at least 1,200 hours in psychotherapeutic interventions applicable to the treatment of health disorders, delivered by methods of scientifically proven effectiveness, in particular humanistic-experiential or integrative, or cognitive-behavioural, or psychoanalytic, or psychodynamic, or systemic therapy, including self- or experiential psychotherapy, psychotherapy supervision and internships, or completed before 31 December 2028. commenced before 1 January 2024. postgraduate training in psychotherapeutic interventions applicable to the treatment of health disorders carried out with scientifically proven methods, in particular humanistic-experiential or integrative, or cognitive-behavioural, or psychoanalytic, or psychodynamic, or systemic therapies, and completion, after starting the training, of self-directed psychotherapy, self-experience, psychotherapy supervision or internships, which, taken together with the training, amount to at least 1,200 hours, or completion before 2012 of postgraduate training in psychotherapeutic interventions applicable to the treatment of health disorders for the duration of the training programme,
• passed a certification examination conducted by a board external to the training body and not composed of representatives of the training body, in particular one established by the associations that certify psychotherapists, or

1. a person who has obtained the title of specialist in the field of child and adolescent psychotherapy or a person who has a decision of the minister responsible for health on recognition of scientific or professional achievements as equivalent to the completion of the specialisation training programme in this field, in accordance with Article 28(1) of the Act of 24 February 2017 on obtaining the title of specialist in fields applicable to health care (Journal of Laws of 2023, item 506), or
2. a person who has obtained the title of specialist in psychotherapy or a person who has a decision of the minister responsible for health on recognition of scientific or professional achievements as equivalent to the completion of the specialisation training programme in this field, in accordance with Article 28(1) of the Act of 24 February 2017 on obtaining the title of specialist in fields applicable to health care, or

In addition, the law stipulates that a person who applies for certification as a psychotherapist who meets all of the following conditions:

a) has the professional title of doctor or the professional title of Master's degree, or meets the conditions set out in Article 63(1) of the Act of 8 June 2001 on the profession of psychologist and the professional self-government of psychologists,

b) he/she is in possession of a trainee status as referred to in point 1(b), first or second indent, and either holds a certificate issued by the entity providing this training that he/she has completed at least the second year of that training, or satisfies the condition referred to in point 1(b), first or second indent,

c) participates in psychotherapy supervision and is certified as such by a psychotherapy supervisor, or

The legislation singled out the following professionals and doctors associated with psychiatry and therapeutics:

• psychologist, and therefore the lowest level of 'initiation', the person in this role is not a doctor, does not write prescriptions and is only required to have a basic knowledge of therapy;
• psychotherapist is the next level, where expertise in conducting cognitive behavioural therapies is already required, this is a medical position;
• a psychiatrist, i.e. a person authorised to provide drug therapy, to write prescriptions for psychotropic drugs, who may also provide cognitive behavioural therapies.

In addition, it is worth noting that within the scope of Article 5 (3) of the aforementioned Act, there are other statutory possibilities authorising the performance of psychotherapy within the care described in Article 5 (1) of the aforementioned Act (in addition to the specified in Article 5 (3) pt. 1 of the aforementioned Act the performance of psychotherapy by a person certified as a psychotherapist and additionally fulfilling the three conditions described in art. 5 para. 3 pt. 1 points a-c).

However, there is no shortage of voices saying that the introduction of a law on the profession of psychotherapist is necessary. The situation is changing day by day, which raises concerns for both patients and therapists. Not only due to the shortage of specialists, but also due to the practices of many pseudo-psychotherapists who do not guarantee the safety of those receiving psychological help. Often, the work in this field is not undertaken by qualified people who have finished their studies - both private and public, but accredited and checked - but by courses that are offered by unknown, untested companies.

Psychotherapy and the National Health Fund

It is worth bearing in mind that there are 3 types of psychotherapy available under the National Health Service:

 

• Individual psychotherapy - involves a free conversation between the patient and the psychotherapist, without the involvement of a third party. Allows one to get to the causes that cause mental health disorders.
• Family psychotherapy - involves working through problems in family functioning that negatively affect the mental health of the family member concerned.
• Group psychotherapy - consists of regular meetings between a group of patients and a psychotherapist. The working methods are adapted to the nature of the group. At the start, rules of cooperation are established, such as freedom of expression or discretion.

Can anyone become a psychotherapist?

Psychology degrees are among the most popular in the country.  In 2023, 40,642 people enrolled for it nationwide. So there is no shortage of applicants to pursue this profession. However, can anyone be a psychotherapist?

The law, which comes into force in 2024, is to specify that anyone who has completed postgraduate studies in psychotherapeutic interactions - including humanistic, integrative, cognitive-behavioural, psychoanalytic, psychodynamic or systemic therapy methods of 1,200 hours or has commenced postgraduate training - before the resolution comes into use - may take the specialist examination.

In addition, it is important to note that under the law entering into force from 2024, in addition to those who have obtained specialisation under the new pathway (as defined in the regulation of the Minister of Health), psychotherapy will be able - according to this law - to be conducted by a person who is certified as a psychotherapist and who fulfils all of the following conditions:

a) holds a medical or master's degree,
b) documents completion of postgraduate training in psychotherapeutic interventions (at least 1,200 hours, in-house psychotherapy, self-experience, supervision, internships) or completion of such training commenced before 1 January 2024 and completed by 31 December 2028, or completion of training before 2012 for the duration of the training programme)
c) passed the certification exam.
At the same time, psychotherapy will also be allowed to be conducted by a person who applies for a psychotherapist certificate and who meets the following conditions together:
a) holds a medical or master's degree 
b) has the status of a postgraduate trainee and a certificate issued by the provider of that training that he or she has completed at least the second year of that training

Accreditation, certification, recommendations, or how it is with the training body's referral system

The referral system of psychotherapy training units currently plays a major role in regulating this field. Prospective therapists meticulously choose units that have special certifications or recommendations from associations or societies that 'regulate' this unique profession. Does this ensure that trainees acquire professional knowledge and skills?

This system is not an integral and absolutely inseparable part of the psychotherapeutic training process and can serve as a guarantee of quality and top professionalism. Training bodies must meet precise educational standards and have reputable teaching staff. Unfortunately, this is not always the case and every institution tries to lobby that it is its accreditation that is necessary for the profession. Currently, there are as many psychotherapeutic streams in Poland as there are associations accrediting them. Importantly, some of these units are accredited by other associations that accredit/certify them on a European or worldwide scale.

Some psychological communities believe that an amendment to the existing law is not enough and that a separate document regulating the work of Polish psychotherapists is necessary. For the time being there is no sign of such a revolution, but one thing is certain - changes are necessary in the Polish mental health system.

WSB-NLU School of Cognitive Behavioural Psychotherapy and current legislation

On 1 January 2024, an amendment to Article 5 of the Mental Health Act of 19 August 1994 will enter into force, according to which a legal definition of the term 'psychotherapy' and the requirements for practitioners of psychotherapy will be introduced.
 According to Article 5(3) of the amended Act, psychotherapy is provided by a person certified as a psychotherapist who fulfils all of the following conditions:

• has the professional title of a doctor or the professional title of a master's degree or meets the conditions specified in Article 63(1) of the Act of 8 June 2001 46 on the profession of psychologist and the professional self-government of psychologists (Journal of Laws of 2019, item 1026),  
• document the completion of a postgraduate training of at least 1200 hours in psychotherapeutic interventions applicable to the treatment of health disorders, carried out by methods of scientifically proven effectiveness, in particular humanistic-experiential or integrative, or cognitive-behavioural, or psychoanalytic, or psychodynamic, or systemic therapy, including self- or experiential psychotherapy, psychotherapy supervision and internships,
• has passed a certification examination conducted by a commission external to the training provider, which does not include representatives of the training provider, in particular one set up by associations that certify psychotherapists.

The university has been certified by the Professional School of Health Sciences Ltd. in London to conduct the examination (in Polish) and issue the psychotherapist certificate.
 
Accordingly, graduation from the WSB-NLU School of Research and Behavioural Psychotherapy will qualify you to become a qualified psychotherapist.