Bernardo Nardi and Emidio Arimatea Psychiatric Unit, Neuroscience Department, Polytechnic University of Marche, Ancona, Italy

Transcription

1 European Psychotherapy/Vol. 10 No european Bernardo Nardi and Emidio Arimatea Psychiatric Unit, Neuroscience Department, Polytechnic University of Marche, Ancona, Italy Psychotherapy training in Italy A BSTRACT In Italy there are two ways of becoming a psychotherapist: schools specialized in for doctors of medicine or psychology and post-graduate schools specialized in psychiatry reserved for doctors of medicine. The former course has been established by private schools (using different theoretical approaches) recognized by the Ministry of University Education and Scientific-Technological Research ( Ministero dell Istruzione Università e Ricerca scientifica e tecnonologica, MIUR), the second one by university schools of medicine. Teachers must be professors from Italian and foreign universities or have some specific and proven experience as psychotherapist. Private schools with the same theoretical approach can associate and constitute national and international societies in order to train and qualify teachers and supervisors. Specialized courses take at least four years comprising 2000 or more hours of theoretical and practical education. In order to gain diagnostic and intervention experience, trainees must attend at least 100 hours of apprenticeship in institutions and public or private services accredited by MIUR. According to the applicable law personal of each trainee is not compulsory but many schools expect the trainee to complete this course before graduating. Although by passing the final examination the candidate gains some qualification as a psychotherapist, he/she has not completed his/her training; in fact, when taking into consideration client and therapist subjectivity, technical abilities are not sufficient to be able to effectively help patients. Key words: Italian schools, training 81

2 european European Psychotherapy/Vol. 10 No Legal issues related to in Italy In Italy the Ministry of University Education and Scientific-Technological Research ( Ministero dell'istruzione Università e Ricerca scientifica e tecnologica, MIUR) governs the acknowledgment and activities of the schools and post-graduate specialized courses qualifying trainees for the profession of a psychotherapist. In Italy there are two ways of becoming a psychotherapist: schools specialized in for doctors of medicine or psychology and post-graduate schools specialized in psychiatry reserved for doctors of medicine. A great number of applicants for have undergone specialized trainings. In these courses both psychologists and doctors of medicine who have a qualifying degree and are enrolled in the List of Psychologists or Doctors of Medicine are admitted. To obtain the qualification, doctors of medicine have to finish a 3-month apprenticeship and pass the state examination, while psychologists need to complete a 12-month apprenticeship and pass the state examination. There are both public and private schools specialized in. The D.P.R. law no. 162 dated 10 March 1982 governs the public specialized schools to which candidates may be admitted after a public competition. These schools have been originated by universities and acknowledged by law at a time when the occupational title of a psychologist has not yet been officially recognized. Since 1989 law no. 56 (art. 3) has governed the profession and activity of a psychologist and defined all qualifications required to practice. Furthermore, law no. 56 (art. 35) allowed the official acknowledgment of those psychologists and doctors of medicine who had proven to practice. The private specialized schools are governed by law D.M. no. 509 of Here, candidates are admitted through selection rather than a public competition. Since 2008 the degree of these schools has been equalized to the public university degree. In Italy there is no specific law defining the activity of psychotherapists. The key qualification of a school is to be recognized by MIUR, while the Ministry of Health acts only as a consultant. To be recognized, each school must send its internal code, documents concerning its theoretical and methodological approach, references concerning such an approach, the agreement with public or private services where trainees can do their apprenticeship, information about the owners or official holders of the school as well as of the availability of qualified teachers and professionals and of the presence of adequate structures and equipment required to effectively hold courses. A MIUR technical and consulting commission reviews 82

3 European Psychotherapy/Vol. 10 No european whether the school is qualified for teaching and observes all applicable laws and regulations. This commission consists of up to 15 members qualified in the field of : among those, 5 are experts chosen by MIUR, 5 are professors chosen by the National University Council (CUN), 3 are persons chosen by the National Council of the Orders of Psychologists, and 3 are persons chosen by the National Federation of the Orders of Doctors of Medicine. Methods and techniques of approved in Italy The Italian MIUR website lists 332 schools specialized in. There are only 12 public university schools having four different curricula: clinical psychology, evolutionary psychology, social psychology, and health psychology. As opposed to the private ones, the university schools follow a theoretical integrate strategy rather than only a specific therapeutic approach. On the contrary, the private schools teach many different theoretic and methodological approaches such as psychodynamic, cognitive-behavioral or systemic methods. In addition, the various private schools differ regarding the object of the training, which can be an individual or a family or a period of life (i.e. infancy, adolescence, adult age). Most of the private schools join the non-profit National Coordination of Psychotherapy Schools ( Coordinamento Nazionale Scuole di Psicoterapia, CNSP), which aims at qualifying these schools. Furthermore, many schools are associations that intend to develop and spread a specific theory or approach. Twenty three of these associations are combined in the Italian Federation of Psychotherapy Associations ( Federazione Italiana delle Associazioni di Psicoterapia, FIAP), which is a member of the European Association for Psychotherapy, EAP. FIAP is a federation joined by many professional organizations with different theoretical and practical approaches, which agrees with the Strasbourg Declaration on Psychotherapy of The aim of this Declaration is to promote coherent and independent training in Europe. Currently, the following psychotherapeutic approaches are represented by FIAP: 1) psychodynamic approaches (Adler, Freud, group analysis, Jung, Lacan, new Freudian, and translational approaches), 2) cognitive approaches (cognitive-behavioral, cognitive rationalist and post-rationalist and constructivist approaches), 3) somatic approaches (bio-energetic and Reichian approaches), 4) systemic approaches, 5) humanist approaches (person-centered, phenomenological existentialist, Gestalt, and psychosynthesis approaches), and 6) other approaches (for those organizations that do not feel represented by the above mentioned approaches). One example of approaches not represented by FIAP is hypnotherapy. 83

4 european European Psychotherapy/Vol. 10 No Structure of training in Italy In Italy specialized psychotherapeutic courses are required to last at least four years. Theoretical lessons and clinical practice must comprise at least 500 hours each year, of which at least 100 hours must be spent for apprenticeship in accredited public or private institutions and services. During their training the trainees can match the specificity of their theoretical approach with the requirement to help patients, thus gaining experience in clinical diagnosis and intervention in critical situation. Each training consists of two parts, theory and practice. In every school there is a council of teachers, a scientific committee of three experts (with at least one external university professor). According to the applicable general regulations, the council of teachers will decide on an internal rule comprising the characteristics of the course and the theoretical and practical guidelines; therefore, the training can be modified according to this rule (law D.M. no. 509 of 11 December 1998, art. 7a). The course may be reduced to 500 hours per annum (2000 hours in total) if the trainee proved to have just received theoretical and practical post-graduate training. For example, a doctor of medicine specialized in psychiatry who has just qualified as a psychotherapist can improve his/her practice in a school with the number of hours reduced as mentioned above, while this is not the case for doctors of medicine with other special qualifications. The training common to all schools must comprise: a) general psychology, developmental psychology, psychopathology, clinical diagnosis, and a general overview of the major approaches, b) a specific in-depth training regarding the theoretical approach of the school, c) a practical training and supervision according to the specific approach of the school, and d) an apprenticeship in public or private qualified institutions and services to put the theoretical knowledge into practice. Both theoretical and practical are taught by professors from Italian and foreign universities or by experts who are qualified in the field of prescribed by the rule of the respective school. Therefore, the same teacher, having completed a qualified and specific training, can teach in several schools of the same approach or in schools having very different approaches. In the latter case he/she can also address other approaches. As mentioned above, many associations in Italy have been established to develop and spread specific approaches, thus qualifying the member schools and governing the 84

5 European Psychotherapy/Vol. 10 No european qualifications of teachers, supervisors, and trainers. The non-university experts have been qualified by these associations prior to the schools. For example, teachers from cognitive-behavioral schools are recognized and qualified by the Italian Cognitive-Behavioral Therapy Society (Società Italiana di Terapia Cognitivo-Comportamentale, SITCC). They must have been members of the Society for at least six years, have scientific and/or teaching expertise in the field of cognitive and behavioral, and have been co-trainers for at least three years. Their application and curriculum (including the positive evaluation of the trainer whose con-trainer the candidate was) are evaluated by a specific commission. Every association has its own criteria, but the requirement concerning qualified clinical experience and a scientific curriculum applies to both trainers and supervisors. In each school the council of teachers has large discretionary powers regarding the choice of both teachers and activities (i.e. whether the course is to last 4 or 5 years or how to manage the theoretical and practical activities). Furthermore, as the applicable law does not require a personal therapy of the trainees, in some schools personal therapy is compulsory and must last a defined number of hours, while in other schools it is only recommended. In Italy psychotherapies (also the short ones) are not covered by the national health system and must therefore be paid by the patient. This means further expenses also for the trainees. Supervision is done during the training, and its length will be decided by the council of the school, which keeps a specific individual record book where the acquired educational level is registered. This book allows both the trainee and the council to monitor the activities that have been actually done and are necessary to sit for the annual and final examinations. The book describes the trainee s personal educational level including specific activities to achieve adequate expertise during training. Every year, the council of the school will send a report to MIUR concerning both the scientific-educational activity of the previous year and the program for the following year. Such a report is evaluated by the technical consulting commission. The council will determine the formalities of the annual and final examinations. What is common to all schools is the fact that the final examination consists both of written and oral tests. For example, trainees must present a written graduation thesis concerning a theoretical issue indicating the educational level acquired, while in the oral examination they must discuss some clinical cases treated under supervision. On the basis of these objective evaluations, the trainees will have finally graduated as psychotherapists. Discussion Although by passing the final examination the candidate gains some qualification as a psychotherapist, he/she has not completed his/her training; in fact, when taking into considera- 85

6 european European Psychotherapy/Vol. 10 No tion client and therapist subjectivity, technical abilities are not sufficient to be able to effectively help patients (NARDI, 2000). In fact, psychotherapeutic practice must focus on personal rather than conscious aspects to reach a more adaptive comprehension of the symptoms and individual functioning. In, scientific and technical learning should be done by learning practice from a master: in-depth knowledge of the theoretical principles and the technical assessment is necessary but not sufficient if a trainer is to avoid the risk for the trainee to become an expert of a certain method while not being able to explore the problems of his/her patient. For example, psychotherapists must reach a complex balance between emotion (such as subjective experience and consequent relational styles) and rationality (technical-practical abilities). According to the applicable law personal of each trainee is not compulsory but many schools expect the trainee to complete this course before graduating. Thus, the therapist can recognize his/her emotions und distinguish between them with respect to the emotional activation of the patient. In some cases the training comprises several sessions including role plays in which trainees play the role of the therapist or of the patient. During these role plays the initial request of help can be focused on in its internal significance as an expression of the subject s manner of self-referring experience. The trainee learns to distinguish between theories and explanations on the psychotherapeutic profession and the immediate experience made during therapy (i.e. what is the effect of being the therapist of a patient who feels the effect of having a problem ). Furthermore, the trainee must be aware of his/her attitude towards a problem or a symptom. This aspect is not related to a specific theoretical approach but depends on personal functioning. When symptoms are focused on as an objective aspect which is external to the client, competitive and challenging behaviors can be established. On the contrary, when symptoms are considered as an aspect of the patient who is asking for help, they become a knowledge factor for the subject s functioning (NARDI AND BELLANTUONO, 2008; NARDI, 2009). It is important to consider that symptoms represent an adaptive effort, a point of unstable balance, when a perturbing experience is incoherent and inconsistent with the sense of the self. On the contrary, if the therapist is only an expert trainer, he/she cannot focus on the internal subjective processes and the therapy becomes impersonal and standardized. These methodological aspects regarding the therapist s knowledge of the self will complete the education of the trainee who must learn to focus on and control his/her emotions during clinical practice. 86

7 European Psychotherapy/Vol. 10 No european References CNSP Coordinamento Nazionale Scuole di Psicoterapia. Piazza Vittorio Emanuele II, Roma (Italy). FIAP Federazione Italiana delle Associazioni di Psicoterapia. Via di Santa Maria Mediatrice 22/G Roma (Italy). MIUR Ministero dell Istruzione, dell Università e della Ricerca. Piazza Kennedy Roma (Italy). Nardi, B. (2000) Report on psychotherapeutic landscape in Italy. European Psychotherapy, 1(1), Nardi B. (2010) Guidelines on the construction of a post-rationalist therapeutic approach. European Psychotherapy, 9(1), Nardi B., Bellantuono C. (2008) A new adaptive and evolutionary conceptualization of the Personal Meaning Organization (P.M.O.) framework. European Psychotherapy, 8(1), Table I. How and training is practiced in Italy Psychotherapy trainings Who can be a psychotherapist Public university trainings Private trainings Graduated in Psychology (A level) 12 Public university trainings. 332 Private trainings. after a training of Integrated theoretical approach. All theoretical approaches or Studies in: clinical psychology, (mainly psychodynamic, cog- Graduated in medicine after a evolutionary psychology, social nitive-behavioral, and systemic training of psychology, and health psycho- approaches). or logy. Clinical work on: individuals or Graduated in medicine after a Duration: at least 4 years. families, evolutionary age, specialized psychiatric university Annual activities: 400 hours of adolescent or adult age. training theoretical lessons and tutorials Duration: at least 4 years. or and 400 hours of apprentice- Annual activity: 500 hours Psychotherapists practicing psy- ship. (at least 100 hours of chotherapy according to law no. apprenticeship). 56 art. 35,

8 european European Psychotherapy/Vol. 10 No Q UESTIONNAIRE Which qualification is necessary to enter training? To enter training a university degree in medicine or psychology and enrollment in the List of Psychologists / Medical Doctors is necessary. Is a university degree obligatory? If so, which subject(s)? A university degree in medicine or psychology is obligatory. Is a university degree in psychology a possible or mandatory requirement for the training? For training a university degree in psychology is a mandatory requirement. Is a university degree in medicine a possible or mandatory requirement for the training? For the training a university degree in medicine is a mandatory requirement. Doctors of medicine specialized in psychiatry may qualify as psychotherapists and improve their practice in a school with a reduced number of hours; thus, their university degree is a possible requirement. Which directions and methods of are approved? All of these directions and methods of are approved. (x) psychodynamic (x) psychoanalysis (x) behavioral therapy (x) person-centered therapy by Carl Rogers (x) gestalt therapy (x) systemic therapy (x) hypnotherapy (x) pesso therapy PBSP How many hours of theoretical lessons does the training comprise? Theoretical lessons comprise at least 1600 hours (400 every year). How many hours of self-awareness or training analysis does the training comprise? As the law in force does not require a personal therapy of the trainees, in some schools personal therapy is compulsory and comprises a defined number of hours, while in other schools it is only recommended. How many hours of therapy (as a therapist) does the training comprise? In training at least 400 hours of practice are mandatory (100 every year). 88

9 European Psychotherapy/Vol. 10 No european How many hours of supervision does the training comprise? Usually, supervision is performed during the training and its duration is determined by the council of the school. How many months of practice in a psychiatric clinic does the training comprise? A total at least of 400 hours must be spent for an apprenticeship in accredited public or private institutions and services. Practice in a psychiatric clinic is not mandatory. How many months of practice in a psychosomatic clinic or surgery does the training comprise? For psychologists training is humanistic rather than medical. Only post-degree schools specialized in psychiatry require many months of practice in a psychiatric unit (also including psychosomatic patients) for their trainees to become psychiatrists and psychotherapists. How many years does the training take at least? The training takes at least four years. Are the final examinations oral or written? The final examinations are usually both written and oral. Which certificates including authorizations are granted with the final examinations? Depending on the objective evaluations made at the end of the course the trainees graduate as psychotherapists. Is covered by health insurance? How many hours of for each patient are covered by health insurance? In Italy, (including short-term types) is not covered by health insurance provided by the national health system. What qualification is needed to be a training instructor? Both theory and practice of training are performed by professors from Italian and foreign universities or by experts qualified in the field of as specified in the rule of the schools. What qualification is needed to be a supervisor? The qualification needed to be a supervisor is the same as for training instructors, but differs among schools. 89

10 european European Psychotherapy/Vol. 10 No What qualification is needed to be a self-awareness instructor? The qualification needed to be a self-awareness instructor is determined by the council of the school or by its internal code. Are there any certifications for training institutes? What requirements have to be fulfilled? The key qualification schools should possess is to be recognized by the Ministry of Education, University and Scientific and Technological Research ( Ministero dell'istruzione Università e Ricerca scientifica e tecnologica, MIUR). A MIUR technical and advisory commission decides whether the school is suitable for teaching and checks whether all legal requirements are observed. Is there a governmental curriculum for training? Would it be possible for us to gain access to this curriculum? To be recognized, each school must send to the MIUR its internal code, documents concerning its theoretical and methodological approach, bibliography with respect to such an approach, the agreement with public or private services where trainees can do their apprenticeship, documents regarding the owners or regular holders of the school, the availability of qualified teachers and professionals and the presence of adequate structures and equipment necessary to efficaciously perform courses. Are there any national associations? Would you give us their addresses? Most of the private schools join the non-profit National Co-ordination of Psychotherapy Schools ( Coordinamento Nazionale Scuole di Psicoterapia, CNSP), which aims at qualifying these schools. Furthermore, many schools constitute associations the goal of which is to develop and spread a specific theory or approach. Twenty three of such associations combine into the Italian Federation of Psychotherapy Associations ( Federazione Italiana delle Associazioni di Psicoterapia, FIAP), which is a member of the European Association for Psychotherapy, EAP. CNSP Coordinamento Nazionale Scuole di Psicoterapia. Piazza Vittorio Emanuele II, Roma (Italy). FIAP Federazione Italiana delle Associazioni di Psicoterapia. Via di Santa Maria Mediatrice 22/G Roma (Italy). Which governmental department is responsible for and training? Would you be so kind to give us its address? The MIUR regulates acknowledgment and activity of the schools and post-degree specialization courses qualifying their trainees for the profession of a psychotherapist. MIUR Ministero dell Istruzione, dell Università e della Ricerca. Piazza Kennedy Roma (Italy). 90

11 European Psychotherapy/Vol. 10 No european Correspondence address: Prof. Dr. Bernardo Nardi Sezione di Psichiatria, Dipartimento di Neuroscienze Facoltà di Medicina e Chirurgia dell Università Politecnica delle Marche Via Tronto 10/A Torrette Ancona (Italy) b.nardi@univpm.it 91

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