Psychotherapies are widely used
treatments in healthcare practice
for mental disorders in adults,
adolescents, and children. They
are used alongside drug therapy
for some severe disorders (schizophrenia,
bipolar disorder, etc.) and as an
alternative to drug therapy for
other, less severe disorders, or
for those in which drug therapies
are not used (for example, personality
disorders).
In France, psychotherapies are
generally recommended to patients
by medical psychiatrists, psychologists,
general practitioners, or other
healthcare professionals, although
spontaneous requests also occur.
The percentage of these latter cannot
be quantified because there are
no data available on this subject.
Psychotherapies are usually practised
on an outpatient basis in the setting
of care from psychiatrists and psychologists
and on an institutional basis by
different parties (nurses, psychologists,
etc.), often under the responsibility
of a psychiatrist. Psychotherapies
are not included in the listing
of technical procedures in French
healthcare regulations, with the
exception of group therapies. A
category "psychiatric consultation",
which does not specify the type
of care administered by the psychiatrist
in the consultation, does, however,
exist.
On an international scale and
according to published scientific
works, psychotherapies are performed
by psychiatrists and psychologists,
and to a lesser extent in the United
Kingdom and United States by specialist
nurses (nurse therapists), social
workers, or specialised counsellors
and by students as part of psychotherapy
research projects, under close supervision.
Finally, in some research work,
reference is made to general practitioners
who have received brief training
in applying methods that have already
been tested and are suitable for
general medical practice in healthcare
or prevention.
Like other treatments, much scientific
work has been conducted on the different
psychotherapy methods. Some of this
work has sought to evaluate the
effectiveness of the practices under
different conditions.
In the mental health plan implemented
by the Minister of Health in 2001,
the Direction générale de la santé
(DGS; general health directorate)
approached INSERM to produce a current
overview of the international literature
on aspects of evaluating the effectiveness
of different psychotherapeutic approaches.
Two French associations, Unafam1
and Fnap-psy,2 worked
with the DGS in this approach. With
the agreement of these partners,
the scope of the expert assessment
covered three major psychotherapeutic
approaches—the psychodynamic (psychoanalytical)
approach, the cognitive-behavioural
approach, and family and couple
therapy—often used to care for defined
disorders of adults, adolescents,
or children.
To respond to this request, INSERM
convened an expert group in a collective
expert evaluation procedure. The
group consists of psychiatrists,
psychologists, epidemiologists,
and bio-statisticians. This expert
group structured the analysis of
the international literature around
the following questions.
How can we envisage evaluation
of psychotherapies in terms of efficacy?
What are the different types
of studies that enable assessment
of the efficacy of the psychotherapies?
What are the methodological difficulties
encountered in such an evaluation?
What are the historical stages
of the assessment of efficacy of
the psychotherapies?
What are the theoretical references
for the psychodynamic (psychoanalytical),
cognitive-behavioural, and family
approaches?
What information is present in
the literature about assessment
of the efficacy of the psychodynamic
(psychoanalytical), cognitive-behavioural,
and family approaches?
What information is present in
the literature about the comparative
assessment of the efficacy of these
different psychotherapeutic approaches?
What information is present in
the literature about evaluation
of the efficacy of these three psychotherapeutic
approaches for different diseases?
What information is present in
the literature about evaluation
of the efficacy of these psychotherapies
in children and adolescents?
We collated more than 1,000 articles
from an independent interrogation
of the international databases conducted
by the collective expert evaluation
centre. The experts were asked to
supplement this bibliography within
their own field of competence and
within the scope of the objectives
of the expert assessment. The experts
presented a critical analysis and
review of the published work on
international and national scales
on the different features of the
scope of the assessment during 11
working meetings that were organised
between the months of May 2002 and
December 2003.
Open/Download Report
© 2001, INSERM
