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
