Psychotherapy regulation and mental health care in Scandinavia: The contribution of psychotherapy as an autonomous profession and scientific discipline to the shift from a biomedical to biopsychosocial approach

Abstract

This article is based on a qualitative study examining the development of psychotherapy regulation and mental health care in European countries. It focuses on the Scandinavian countries because they are considered to be highly developed welfare states with a long tradition of egalitarian health and welfare policies. Over recent decades, these countries have prioritised improvements in mental health and services, including psychotherapy regulation. The focus has shifted from psychiatric institutional care to outpatient, community-based care and social participation.

Sweden was the first European country to pass a psychotherapy law, in 1985, and Finland followed in 1994. This has contributed significantly that these two countries are more developed in terms of psychotherapy than Denmark, Iceland and Norway, where it is considered a multiprofessional activity. The legalisation of psychotherapy as an independent profession, and the academisation of psychotherapy as an autonomous scientific discipline are two interlinked, mutually reinforcing processes that are crucial for the development of psychotherapy.

Strategies for developing mental healthcare in Scandinavia indicate a shift from a biomedical/disease-based approach to a biopsychosocial one. However, despite the implementation of many effective strategies and practices to reduce medicalisation and coercive psychiatric measures, data on psychopharmaceutical consumption, overdiagnosis and resistance to medication-free treatment, suggest that the biomedical model still dominates also in Scandinavian countries.

Psychotherapy has the potential not only to soften the biomedical approach, but also to contribute significantly to a fundamental shift in paradigm towards a biopsychosocial approach. Efforts by psychotherapists in Scandinavia and many other European countries to establish psychotherapy as an independent profession and scientific discipline are crucial to its future development. Without professional and academic autonomy, psychotherapists will continue to be marginalised, rather than participate on equal footing with other mental health professionals in developing a biopsychosocial approach.