Werden Psychotherapeuten,Psychiater oder die Psychotherapie stigmatisiert?

Background

In the last decades much has been found out about the stigmatization of persons with mental illnesses. Recently, a potential stigmatization of psychologists, psychiatrists and psychotherapy has been debated.

Aim

The question should be answered whether there is any scientific evidence for stigmatization of psychologists, psychiatrists and psychotherapy by using the conceptualization of stigma as brought forward by Link and Phelan (Ann Rev Sociol 2001; 27:363–385).

Material and methods

For the systematic literature search in 2013 a databank search was carried out in Web of Science using the search terms stigma or discrimination or stereotypes or prejudice AND psychiatrist or psychotherapist or psychotherapy or mental health professional. A total of 2013 publications were identified which were systematically arranged according to the title and abstract with respect to the relevance for the question whether psychotherapy or associated professional groups are stigmatized. Only four of the articles were considered to be relevant. After advice from experts six further relevant articles could be found which did not appear in the databank search.

Results

The review found evidence for both positive and negative stereotypes but not for other components of the stigmatization process.

Conclusion

At present there is no evidence for a stigma related to psychotherapy or to the professions of psychotherapists and psychiatrists.     

The public's perception of psychotherapy and counseling: Differential views on the effectiveness of psychologists,psychiatrists, and other providers

This study examined the public's perceptions relative to the effectiveness of psychotherapy and counseling, expectations of treatment efficacy for different psychotherapy and counseling providers (i.e., clinical psychologists, counseling psychologists, counselors, general medical practitioners, marital and family therapists, psychiatrists, self-help groups, and social workers), professional characteristics, and factors that may influence treatment utilization in an adult population. The sample viewed psychotherapy or counseling as moderately effective and perceived psychotherapy/counseling to be effective for 26 to 50 percent of all cases. The perceived amount of time necessary for noticeable improvement in psychotherapy or counseling was approximately four months, and the expected necessary length of treatment was approximately eight months. Participants stated they were moderately willing to seek psychotherapy or counseling if they were to experience a mental problem, and reported discernible differences among the eight psychotherapy/counseling providers in terms of treatment efficacy. Differences were also found in the relative perception of providers' personal/professional qualities and characteristics.     

Therapists' judgments of mentally healthy beliefs for women and men

Clinical and counseling literature indicates that practicing psychologists often observe different mental health standards for women and men. Most of this research has examined mental health in terms of personality attributes, and as such there is a noticeable lack of research concerned with mentally healthybeliefs. The present research was concerned with the investigation of a possible gender bias in therapists' mental health standards, defined in terms of personal beliefs. For this purpose, the Irrational Beliefs Test (IBT; Jones, 1969) was completed three different times by a group of licensed psychologists in private practice, measuring their beliefs of how (1) a mentally healthy sex-unspecified adult, (2) a mentally healthy male adult, and (3) a mentally healthy female adult would respond to the IBT. The results indicated that both women and men therapists associated unique beliefs with women's and men's mental health.The late Dr. Frank B. Lambert studied the philosophical foundations of psychotherapy theory and was concerned about value issues in the practice of psychotherapy. He was pursuing his Ph.D. in counseling psychology at the time of his untimely death.Portions of these data were presented at the 1985 annual meeting of the American Psychological Association, Los Angeles, California. Graditude is extended to Lucia Gilbert and Mark R. Leary for their helpful comments on an earlier version of this article.     

Psychology Internships in the Treatment of Severe Mental Illness: Implications for Training in Academic Medical Centers

Despite an increasing focus over the past 2 decades by federal and state governments on the care of persons with severe mental illness, psychologists remain underrepresented among behavioral health professionals working with this population. Within the discipline there is growing concern about the need to adequately train, recruit, and retain psychologists in this specialty. This is a particular concern in academic medical settings where the overall severity of illness among those receiving psychiatric services continues to increase. The purpose of this qualitative research study was to intensively examine the experience of predoctoral interns engaged in treating individuals with severe mental illness in an academic medical center in order to identify the professional developmental experiences and training needs of those learning to care for this population. This analysis, conducted with semistructured interviews at four points during the internship year, yielded a series of recommendations for improving internship training and recruiting psychologists to this specialty.     

“Part of me feels like there must be something missing”: a phenomenological exploration of practising psychotherapy as a clinical psychologist

The experience of practising psychotherapy as a clinical psychologist was explored through a small number of in-depth interviews. Using Interpretative Phenomenological Analysis, three main themes were identified: “Feeling there’s something missing”, “Being able to get in there emotionally” and “Needing somewhere to go for support”. This study suggests that training for psychotherapy work can be experienced as piecemeal and fragmented, contributing to professional self-doubt, with clinical psychologists seeking more structured, cohesive training in this area. It also suggests that engagement in personal therapy can contribute to greater emotional capacity as a psychotherapy practitioner, although clinical psychologists can fear engaging in something that is unfamiliar. In addition, the psychologists highlighted the felt necessity of safe and satisfying supervision for resilient practice.     

A call for dialogue: psychotherapists and psychologists specialising in psychotherapy

The development of psychotherapy as an independent discipline in many countries in Europe has stimulated debate within the field of psychology as to what constitutes psychotherapy as a specialism of psychology. The authors, both clinical psychologists who pursued further training in psychotherapy, offer a reflection in this paper on the historical battle between psychiatry and psychology for ‘ownership’ of psychotherapy, describe recent developments in Europe to clarify this specialism within psychology and discuss the distinctive contributions that psychologists offer in developing psychotherapy as a specialism within the discipline. The aim of the paper is to begin a dialogue both within the profession of psychology and outside the profession, with our psychotherapy colleagues, that can develop into an interdisciplinary discourse and a more mutually respectful professional environment.     

Mirror mirror on the ward: who is the unfairest of them all? Reflections on reflective practice groups in acute psychiatric settings

Consultant psychiatrists in medical psychotherapy, adult psychotherapists, child and adolescent psychotherapists and clinical psychologists increasingly complement their direct therapeutic activity with applications of their psychotherapeutic thinking in acute mental health work through facilitating reflective practice groups for staff working in mental health teams. The authors offer their reflections on facilitating National Health Service reflective practice groups using the metaphor of a mirrored dialogue between patient and professional, and professional and institution as a basis for informing the development of reflective practice for colleagues. Their reflections are based on working on three acute in-patient wards, in a crisis resolution team and in community mental health teams. They describe the practicalities of setting up and facilitating reflective practice groups, and offer insights into some of the issues that arise in reflective practice groups. They conclude that these groups are mutually beneficial in forging links between psychotherapy professionals and professionals working in other disciplines and areas of mental health. Facilitating these groups often requires a challenging adaptation of technique, which will not suit all psychotherapists, as well as a wider understanding of organisational dynamics and the interplay between clinicians and management.     

Trauma,protest, and therapeutic culture in Algeria since the 1980s

This article focuses on the shift in sensitivities that took place between the 1980s and 2019 toward psychological suffering in Algeria. Promoters of psychotherapy showed an increase in receptivity—via the media, public authorities, and the general population—to their practices and discourses during this period. Based on professional literature, interviews with psychologists, psychiatrists, and psychoanalysts, and newspaper articles and essays, this article considers the following aspects: the use of psychotherapy, the authority of psychoanalytic/psychopathological analyses, and the ethics of relation in politics. Taking a social and cultural history of politics approach, it traces the discontinuous politicization of psychotherapy over the course of events (namely the uprising of 1988, the civil war of the 1990s, and the 2019 popular movement) and examines the interactions between the state, popular mobilizations, and the psychotherapists. The civil war of the 1990s coincided with the normalization of “trauma” on a global scale, and procedures for the prevention of posttraumatic stress disorder were put in place in Algeria from 1997 onwards. In this process of legitimizing psychological suffering and its treatment, the promoters of psychotherapy who belonged to the less visible margins gained authority. The year-long protest movement (2019) against the regime performed the ethics of relation, focusing on human relations, reflexivity, and living together. Promoters of psychotherapy identified consistently with the political subjectivities produced within the 2019 popular movement characterized by massive pacifist marches against the regime.     

California psychologists' religiosity and psychotherapy

Forty-seven randomly selected California clinical psychologists were surveyed to examine the effect religious or spiritual orientation has on the practice of psychotherapy. This included an assessment of ideology, attitudes toward religiosity, affiliation with organized religion, dimensions of religiousness, and use of clinical interventions of a religious nature. The majority of these psychologists were found to address religious and spiritual issues in their personal lives, to respect the function religion serves in peoples' lives, and to address religious and spiritual issues in professional practice. The majority of these psychologists use interventions of a religious nature. Very limited training occurs respective of religious and spiritual concerns; 81% reported that religious or spiritual issues were rarely or never discussed in the course of their graduate education and training.This paper was presented at the annual meeting of the American Psychological Association in Los Angeles in August 1985.     

Legislative warriors: American psychiatrists,psychologists, and competing claims over psychotherapy in the 1950s

American psychiatrists and psychologists have long been close colleagues and fierce rivals. There is no better illustration of this polarized relationship than the chronic tug-of-war over psychotherapy. Both groups laid claim to psychotherapy-whatever it was and however it was practiced. Psychiatrists attempted to monopolize psychotherapy despite its ambiguous status as an essential component of the healing arts. After the war, psychologists pressed for a share on the basis of their qualifications and competence, but struggled to overcome the limitations imposed by medical envy. This story lays bare the crucial function of tools and techniques for defining the identity and the boundaries of a science-based profession.     

Psychological treatments

Psychology has recently identified itself as a health care profession and codified this change in the bylaws of the American Psychological Association. Although psychologists make a number of contributions to the nation's health--and mental health--the most identifiable activity focuses on treating physical or psychological pathology with psychological interventions. Recently, health care policymakers have established that evidence supporting the efficacy of these interventions is more than sufficient for their inclusion in health care systems around the world. To promote faster and more widespread dissemination of these interventions specifically targeting problems severe enough to be included in health care systems and to solidify the identification of psychology as a health care profession, perhaps it is time for a change in terminology. It is proposed that psychologists label these procedures psychological treatments so as to differentiate them from more generic psychotherapy, which is often used outside of the scope of health care systems.     

Some normative data on mental health professionals' attitudes about racial minorities and women

Although codes of ethics of the mental health professions and the recently developed race- and gender-specific models of counseling and psychotherapy stipulate positive and accepting attitudes toward racial minorities and women, formal assessment of these attitudes has been hindered by the absence of appropriate measurement tools and generalizable data. This study provides some normative data by reporting responses of 705 psychologists and social workers to the Quick Discrimination Index, a psychometrically sound 23-item self-report measure previously administered to several different professional groups. Analysis indicated psychologists and social workers reported particularly positive attitudes toward racial minorities and women but expressed the same racial and sex contradictions, ambivalences, and vulnerabilities reported by the general public.     

Comparing competencies of a psychotherapist with those of a psychologist specialising in psychotherapy

This paper contributes to a recent call for dialogue between the different professional groups representing psychotherapy in Europe. At present, two core psychotherapy groups exist in Europe, namely the EAP, representing psychotherapy, and EFPA, representing psychologists specialising in psychotherapy. This article compares and contrasts two competency frameworks representative of these bodies, which capture the skills, knowledge, reasoning and values of the respective professions. The shared and divergent competencies are identified and discussed, followed by suggestions for potential changes in future European competency frameworks. By doing this, we not only respond to the recent call for dialogue but also promote collaboration and discussion between the professional groups representing psychotherapeutic practice both in Europe and beyond.     

Psychologists versus psychologists: evaluating the claims of psychologists who publicly criticize their profession

Since the 1990s, 7 psychologists have written books for a public audience expressing great dissatisfaction with mental health practitioners. These critics represent 4 English-speaking countries: Australia, Canada, the United Kingdom, and the United States. Those psychologists make 3 basic arguments: (a) any improvements attributed to psychotherapy are due to placebo effect, (b) psychological assessments have little value, and (c) clinicians do not meet the legal standards to qualify as experts in a court of law. The present author examines these arguments and concludes that these concerns are unfounded. The exception is that several forensic psychologists had been using tests that were invalid for legal purposes, but this situation has shown gradual improvement in the past 15 years.     

Usage légal du titre de « psychothérapeute » : stratégies des acteurs concernés

The law proposal of the deputy Bernard Accoyer adopted by the National Assembly the 13th of March 1999, after many debates, finally led to a law article on use of psychotherapist title. Several consultation meetings with professional organizations in the Health Ministry took place about its future application decree, nevertheless without a consensus because of the contradictory interests for people practising psychotherapy. Are concerned two regulated professions — psychologists and physicians — and two types of non-regulated activities, psychoanalysts and “psychotherapists” which are not physicians and not psychologists. These last ones defend in France, as it's the fact in some other european countries, the creation of the independant profession of “psychotherapist”; a minority part of psychoanalysts societies support them, leant upon the principle of practice liberty. The opinion differences are focused on the training criteria in psychopathology required by the law, some organizations disputing that this training be a university monopoly. Another ambiguity deals with the law gives a miss about the actual psychotherapy training, the Senate having chosen for the minimum requirement of a psychopathology training. The subject of this paper is to come back on the strategies and the identity stakes of actors mobilized during the different drafts of this law proposal and to prepare the ground about the ideological positions underlying by these strategies.     

Psychologist suicide: Incidence, impact, and suggestions for prevention, intervention, and postvention

Psychologist practitioners are not immune to some mental health problems, including suicidality, for which they provide services. In the aftermath of two recent psychologist suicides, the American Psychological Association's Advisory Committee on Colleague Assistance (ACCA) initiated the formation of a conjoint ad hoc committee consisting of members from ACCA, the American Psychological Association (APA) Practice Directorate, and the Section on Clinical Emergencies and Crises (Section VII of APA's Division 12) to investigate the incidence of psychologist suicide and its impact on colleagues, students or interns, patients or clients, and the profession. The committee reviewed the extant empirical literature on suicide rates for psychologists, evaluated unpublished data on psychologist suicide provided by the National Institute of Occupational Safety and Health (NIOSH), interviewed colleague survivors, reviewed published case reports of the impact of therapist suicides, and linked their findings to the literature on professional distress, impairment, and self-care. The committee concluded that there is evidence suggestive of an elevated risk of suicide for psychologists in past decades. It further concluded that there is a need for further research to confirm if there is a heightened risk of suicide for psychologists in the present day, and to determine factors that might contribute to such risk. Accounts from colleague-survivors suggest that the impact of a psychologist's suicide can affect many people including family, colleagues, students, and patients or clients. This article offers suggestions for possible preventive approaches, for intervention with potentially at-risk colleagues, and for postvention efforts in the wake of a colleague suicide.