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Letters of Psychotherapy the NORDIC PSYCHIATRIST THE NORDIC PSYCHIATRIST Issue 1 2017 Letters of Psychotherapy THE NORDIC PSYCHIATRIST Letters of psychiatry Psychotherapy is one of the most used treatment methods in modern psychiatry. Treatment through verbal communication has been used through the centuries as medics, philosophers, and spiritual practitioners have used psychological methods to heal others. The term psychotherapy derives from ancient Greek “psyche”, meaning spirit or soul and “therapeia” meaning healing or medical treat- ment. A modern definition of psychotherapy would be "treatment of disorders of the mind or person- ality by psychological methods”. Not too long ago, a clinician in psychiatry was expected to choose sides regarding how he or she conceptualised psychiatry, both in terms of diagnosis and treatment. The two standpoints were either the “biological one” – or the “psychotherapeutic one”. The latter was synonymous with the practice of insight-oriented therapies, with the focus on revealing or interpreting unconscious processes. The relief of symptoms was not the main focus of the treatment, but to unveil the unconscious conflict. For years, psychodynamic therapy was the only therapy of choice. With time new methods arose, and were scientifically evaluated. As the concept of evidence entered the stage, psychodynamic practi- tioners were challenged by therapists using cognitive-behavioural and systemic techniques. Over the last decades, numerous therapies have been introduced. Initially, psychotherapy was performed by doctors. Over the years, psychologists have become more or less synonymous with psychotherapy. Today, fewer doctors are trained as psychotherapists, and it is often debated to which degree psychotherapy should be a part of specialist training in psychiatry. Earlier assumed harmless, the potential side effects of psychotherapy are nowadays highlighted in a new way, comparing them with drug therapy. The way psychotherapy is regulated varies much from one country to another. There is a broad spectrum of psychotherapies to chose from. In this issue, our aim is to provide you with an overview of the ones most often used. Many therapies today are referred to as different abbrevia- tions of “letters”. We asked practitioners to write a letter to a colleague explaining the therapy they perform. As always, you will in this issue read about the recently published articles in the Nordic Journal of Psychiatry, and get a report from what is going on in the Nordic Psychiatric Associations. It is with great joy I present this very informative issue of The Nordic Psychiatrist to you! Hans-Peter Mofors, Editor THE NORDIC PSYCHIATRIST 3 Talking to the Patient Andres Lehmets Psychiatry stems from different ideologies. Biological psychiatry has its roots deep in the medical model. There is a pill for ev- ery disease and evidence-based treatment models provide clear guidelines for treatment and cure. Psychotherapeutic approaches are much less organised – psychodynamic thinking has been grad- ually surrendering its positions to other therapies and psychothera- py is no longer the monopoly of psychiatrists. I started my career during the years of the years of Soviet Em- pire. The society ruled over the individual and psychiatric diagno- sis lead to restrictions rather than understanding. Freud represented the decadence of the West, the closest that “psychotherapy” came to was hypnosis. All this changed when the iron curtain opened. In a few years time different training opportunities were opened, mostly with the help of colleagues from Nordic countries. Psy- chotherapy became available for the treatment of mental disorders and also outside medical quarters – as a tool of empowerment and for improving self-esteem. UEMS sees psychotherapy as an integral part of training in psy- chiatry. This is also the common practice in most European coun- tries, but at the same time there are differences in the substance and format. It is often the case that more thorough training is pro- vided outside the academic medical setting, by psychotherapeutic institutes and associations. Neither is there a common certificate Andres Lehmets of psychotherapist that would enable cross-border recognition as MD, Chairman, Nordic Psychiatric Associations there is for medical specialities. Over the last decades the understanding about the interaction of the mind and body has developed substantially. This has also helped to understand psychotherapy and do develop further more Psychotherapeutic understanding of mental disor- structured and evidence-based psychological interventions. But ders is essential for assessment and treatment of pa- this has also raised issues on reimbursement of several, particu- tients with mental disorders. Establishing and main- larly long-term therapies that used to be a well-accepted golden taining the therapeutic alliance is the basis of any standard in the past. psychiatric treatment, not only psychotherapy. Modern technologies open new possibilities for psychotherapy The talking cure is here to stay. and counseling. Internet-based techniques can make them more accessible, but they will probably never fully substitute the tradi- tional contact between the patient and the therapist. It is the hu- man contact that has made psychotherapy work. 4 THE NORDIC PSYCHIATRIST THE NORDIC PSYCHIATRIST Issue 1 2017 Contents THE NORDIC PSYCHIATRIST Letters of Editor Psychotherapy Hans-Peter Mofors 3 Talking to the Patient Andres Lehmets 4 A rough blueprint for national treatment guidelines PSYCHOTHERAPY Rolf Sandell 6 Cognitive Behavioral Therapy today Guðlaug Thorsteinsdottir 8 The Nordic Psychiatrist is published twice a year by Taylor & Francis Conversation therapy in old Icelandic writings on behalf of the Joint Committee of the Óttar Gudmundsson 9 Nordic Psychiatric Associations. The journal is distributed to all members of the Dangers in psychoanalysis national Nordic psychiatry associations. Óttar Gudmundsson 11 The limited evidence for effectiveness of psychotherapy Joar Øveraas Halvorsen 12 Systemic family therapy in Latvia Ilona Buša 14 Systemic family therapy in Lithuania: Editorial Committee from its beginning up to now Hans-Peter Mofors, MD. Laura Tamulevice 16 Psykiatri Nordväst, Stockholm [email protected] Encountering religious and spiritual themes in psychotherapy Óttar Gudmundsson, MD. Peppi Sievers 18 Psychiatrist. Landspitalinn, University Hospital, Reykjavik Does psychological treatment of convicted Iceland offenders of child sexual abuse reduce recidivism? Marianne Kastrup, MD., PhD. Jarna Soilevuo Grønnerød, Cato Grønnerød 20 Specialist in psychiatry The role of psychotherapy in modern psychiatry Hanna Tytärniemi, MD. Halldora Olafsdottir 21 MD, psychiatrist Questions about psychotherapy Anne Kristine Bergem, MD. Ramune Mazaliauskiene 22 Psychiatrist Motivational Interviewing: Ramunè Mazaliauskienè, MD. Lithuanian University of Health Sciences, Improving your conversation skills Psychiatric clinic Darius Jokubonis, Cornelis de Jong 26 Open dialogue Advertising Per Sonnerfeldt, Taylor & Francis Ramunè Mazaliauskienè 29 PO Box 3255, SE-103 65 Stockholm Drottensgatan 2 Open dialogue in Latvia SE-222 23 Lund, Sweden Maris Taube, Douglas Ziedonis Tel: +46-(0)46-13 07 90 32 Fax: +46-(0)46-13 07 82 Cell phone: +46-(0)70-7320145 We need to talk about harm [email protected] Jørgen Flor 33 General information Letters of therapy Taylor & Francis ACT: a travel to the LETTERS OF THERAPY PO Box 3255 place that matters 34 SE-103 65 Stockholm, Sweden Anger management 35 • Basic Body Awareness Therapy (BBAT) 36 • ISSN 2001-2454 Compassion Focussed Therapy 37 • Dialectical Behaviour Therapy 38 • Psychiatric Riding Therapy 39 • Group psychotherapy 41 • Layout & Design Illness management and recovery (IMR) 42 • Existential Therapy 43 • Åtta.45 Tryckeri Ateljén Internet-delivered computer-assisted psychotherapies deliver low-threshold support in Finland 44 • Cover photo Mentalisation-based treatment 45 • Solja Niemelä Psychoanalytic psychotherapy 46 • Mindfulness in Lithuania: Gaining momentum 47 • Copyeditor Solution-focused therapy 50 • How do I treat clients with psychological Hans Ågren trauma and PTSD? 51 • “e-Mental Health: the future is now” 53 • Why is CBT recommended? 54 • Printer Åtta.45 Tryckeri AB, Highlights from the Nordic Journal of Psychiatry Järfälla, Sweden Martin Balslev Jørgensen 56 NORDIC JOURNAL THE NORDIC PSYCHIATRIST THE NORDIC PSYCHIATRIST© 2017 Taylor & Francis AB 5 A rough blueprint for national treatment guidelines Rolf Sandell Despite the beliefs of a number of sceptics we know now that psychotherapy, in general, is an efficacious type of treatment, as shown in RCTs, and also an effective type of treatment, as shown in naturalistic studies. Thus, the average outcome of the active treatment has been found significantly superior to the average outcome in some control no-treatment condition. But that does not necessarily mean that the difference is large or that the outcome of the active treatment is clinically significant. Let us look more closely at the findings. In fact, the rate of non-response to psychotherapy, what- taken as valid, that is 5-10%. Further, roughly 10% (at ever the method or the ”brand,” hovers around 50%. A an average; 0 – 58% in different studies, according to naturalistic study in the US a few years ago, with almost a meta-analysis published this year) do not show up to 7000 cases with almost 700 therapists of various orienta- start a treatment that has been agreed on, and rough- tions, found that
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