British Journal of Clinical Psychology (1992), 31, 419-428 0 1992 The British Psychological Society
Printed in Great Britain
419 [35]
Clinical psychology training in Europe Frank M. McPherson* Tayside Area Clinical Psychology Department, Royal Dundee Liff Hospital, Dundee O D 2 5NF, Scotland, UK
Clinical psychology training in the United Kingdom (UK) and in the remainder of Europe differs in several respects; in particular, the latter allows for greater variability and clinical specialization with much more training taking place postqualification than in the UK; differences in content and in the balance between the supply of, and demand for, clinical psychologists also exist. These differences reflect employment arrangements and, to a lesser extent, the structure of higher education and legal regulation. Various current and predicted changes in health-care systems and in the legal and educational context will probably lead to training in the LJK and elsewhere in Europe becoming more similar in the years after 1992.
The aims of this article are to describe some of the main similarities and differences between clinical psychology training in the UK and in the rest of Europe, to consider how training has been affected by its educational, employment and legal context, and to identify some possible future influences on training. There have been no systematic surveys of clinical psychology training in Europe. The data on which this article is based are therefore : statements of training standards and accreditation criteria produced by national associations of professional psychology ; descriptions of training programmes at various centres ; evidence presented to a task force of the European Federation of Professional Psychologists Associations (EFPPA) ; documents of the World Health Organization, Council of Europe and the European Community ; published articles ; and personal communications to, and (uncontrolled) observations by, the author. Three limitations to this article should be noted. Firstly, the effects on clinical psychology in Eastern Europe of the current social and political upheavals merit separate consideration ; the ‘ Europe ’ referred to in the article will thus include only the Western European and Nordic States. Secondly, it is not intended to describe in detail the content of training in the different States. Such catalogues are soon out of date and are also potentially misleading, in the absence of agreed definitions of terms such as ‘supervised experience’ and ‘year of study’ and of an international system of on-site inspection and peer review to ensure that what is described in each syllabus is reflected in practice. Instead, some generalizations will be attempted. Inevitably, these will ignore many of the significant differences which exist in clinical psychology training, not only between, but often also within, the various European States.
* Requests for reprints. 17-2
[36] 420
Frank M . McPherson
Thirdly, the article will be written from a UK perspective and many of the contrasts and comparisons drawn will be between the UK and the remainder of Europe. This is only partly attributable to the narrow concerns and interests of the author; it also reflects his judgement that greater variation in training and practice exists between the UK and Continental Europe than exists within most of the latter.
The context of training This section will outline the main features of the educational, employment and legal context within which clinical psychology training takes place.
Structure of higher education The structure of higher education in the UK and Ireland (and in the USA) distinguishes between three phases : undergraduate, postgraduate and postqualification (undergraduate, graduate and postgraduate in US parlance). The first (undergraduate) degree course in psychology is construed as an education in the scientific discipline, whereas the training necessary to become qualified as a clinical psychologist is exclusively the concern of the second (postgraduate) phase. Elsewhere in Europe, these undergraduate and postgraduate phases are usually combined and the potential clinical psychologist embarks on a single degree course, at the completion of which s/he is regarded as a qualified professional psychologist. Usually, the early semesters are devoted to the basic science of psychology while, in the latter years, some measure of specialization occurs, with students able to choose subjects relevant to either ‘academic/research ’ or ‘professional applied ’ psychology.
Employment of clinical psychologists For the past 45 years, the National Health Service (NHS) has been much the largest employer of clinical psychologists in the UK. The clinical policies, organizational and managerial arrangements, professional norms, entry requirements and conditions of employment of the NHS have been the major influence on the profession (McPherson, 1983a, 6). Elsewhere in Europe, by contrast, the employment arrangements are very much more diverse. A higher proportion of clinical psychologists are in independent, feefor-service practice. Those who are salaried have a much wider range of employers, such as State agencies, regional and municipal authorities, private hospitals and institutions and charities.
Legal regulation Several European States have no form of legal regulation; these include some with well-developed professions of clinical psychology, e.g. the former German Federal Republic (BRD), Denmark, Ireland, Finland and Belgium. Where regulation does exist, the usual form is a certification law, which protects the title obtained on completion of the university degree. Laws of this type exist in Spain, Portugal, Italy,
Clinical pyhology training in Europe
421 [37]
France, Austria, Norway, Iceland and The Netherlands. In addition, some States have licensing laws which regulate the practice of clinical psychology and/or of psychotherapy, e.g. Austria, Italy, The Netherlands and Sweden (McPherson, 1986). In most States, professional regulation is the responsibility of a Government department and there are big variations in the influence of the profession upon the content and administration of any laws. Spain and the UK are unusual in that the national association of psychologists has been given legal authority by the State to regulate qualifications and practice, although the powers of the Colegio are much greater than those of the British Psychological Society (BPS).
Similarities and differences in training This section will identify similarities and differences in training which exist, in particular between the UK and elsewhere in Europe.
Length of training to qualification In the UK, the minimum period of education and training necessary for registration with the BPS as a chartered clinical psychologist and, from 1993, for employment in the NHS is six years - three undergraduate and three postgraduate years. This is roughly similar to the minimum periods of study and training in Europe, at the end of which graduates are regarded as qualified professional psychologists : e.g. approximately five years in Spain, Sweden and Denmark; six years in Italy, the BRD and Finland; and six and a half years in Norway. As noted above, comparisons are difficult. The implications for training of a ‘year of study’ vary considerably because of differences in the numbers of contact hours within the year and in the form of teaching. Moreover, in the UK, many potential clinical psychologists spend several years obtaining relevant experience before being selected for training. In most of Europe, students enjoy some freedom to determine when to take their exams, so that the actual period of study and training is often two or more years longer than the minimum prescribed.
Basic science preparation Clinical training throughout Europe seems always to be preceded by the systematic study of the scientific discipline of psychology. In the UI
Printed in Great Britain
419 [35]
Clinical psychology training in Europe Frank M. McPherson* Tayside Area Clinical Psychology Department, Royal Dundee Liff Hospital, Dundee O D 2 5NF, Scotland, UK
Clinical psychology training in the United Kingdom (UK) and in the remainder of Europe differs in several respects; in particular, the latter allows for greater variability and clinical specialization with much more training taking place postqualification than in the UK; differences in content and in the balance between the supply of, and demand for, clinical psychologists also exist. These differences reflect employment arrangements and, to a lesser extent, the structure of higher education and legal regulation. Various current and predicted changes in health-care systems and in the legal and educational context will probably lead to training in the LJK and elsewhere in Europe becoming more similar in the years after 1992.
The aims of this article are to describe some of the main similarities and differences between clinical psychology training in the UK and in the rest of Europe, to consider how training has been affected by its educational, employment and legal context, and to identify some possible future influences on training. There have been no systematic surveys of clinical psychology training in Europe. The data on which this article is based are therefore : statements of training standards and accreditation criteria produced by national associations of professional psychology ; descriptions of training programmes at various centres ; evidence presented to a task force of the European Federation of Professional Psychologists Associations (EFPPA) ; documents of the World Health Organization, Council of Europe and the European Community ; published articles ; and personal communications to, and (uncontrolled) observations by, the author. Three limitations to this article should be noted. Firstly, the effects on clinical psychology in Eastern Europe of the current social and political upheavals merit separate consideration ; the ‘ Europe ’ referred to in the article will thus include only the Western European and Nordic States. Secondly, it is not intended to describe in detail the content of training in the different States. Such catalogues are soon out of date and are also potentially misleading, in the absence of agreed definitions of terms such as ‘supervised experience’ and ‘year of study’ and of an international system of on-site inspection and peer review to ensure that what is described in each syllabus is reflected in practice. Instead, some generalizations will be attempted. Inevitably, these will ignore many of the significant differences which exist in clinical psychology training, not only between, but often also within, the various European States.
* Requests for reprints. 17-2
[36] 420
Frank M . McPherson
Thirdly, the article will be written from a UK perspective and many of the contrasts and comparisons drawn will be between the UK and the remainder of Europe. This is only partly attributable to the narrow concerns and interests of the author; it also reflects his judgement that greater variation in training and practice exists between the UK and Continental Europe than exists within most of the latter.
The context of training This section will outline the main features of the educational, employment and legal context within which clinical psychology training takes place.
Structure of higher education The structure of higher education in the UK and Ireland (and in the USA) distinguishes between three phases : undergraduate, postgraduate and postqualification (undergraduate, graduate and postgraduate in US parlance). The first (undergraduate) degree course in psychology is construed as an education in the scientific discipline, whereas the training necessary to become qualified as a clinical psychologist is exclusively the concern of the second (postgraduate) phase. Elsewhere in Europe, these undergraduate and postgraduate phases are usually combined and the potential clinical psychologist embarks on a single degree course, at the completion of which s/he is regarded as a qualified professional psychologist. Usually, the early semesters are devoted to the basic science of psychology while, in the latter years, some measure of specialization occurs, with students able to choose subjects relevant to either ‘academic/research ’ or ‘professional applied ’ psychology.
Employment of clinical psychologists For the past 45 years, the National Health Service (NHS) has been much the largest employer of clinical psychologists in the UK. The clinical policies, organizational and managerial arrangements, professional norms, entry requirements and conditions of employment of the NHS have been the major influence on the profession (McPherson, 1983a, 6). Elsewhere in Europe, by contrast, the employment arrangements are very much more diverse. A higher proportion of clinical psychologists are in independent, feefor-service practice. Those who are salaried have a much wider range of employers, such as State agencies, regional and municipal authorities, private hospitals and institutions and charities.
Legal regulation Several European States have no form of legal regulation; these include some with well-developed professions of clinical psychology, e.g. the former German Federal Republic (BRD), Denmark, Ireland, Finland and Belgium. Where regulation does exist, the usual form is a certification law, which protects the title obtained on completion of the university degree. Laws of this type exist in Spain, Portugal, Italy,
Clinical pyhology training in Europe
421 [37]
France, Austria, Norway, Iceland and The Netherlands. In addition, some States have licensing laws which regulate the practice of clinical psychology and/or of psychotherapy, e.g. Austria, Italy, The Netherlands and Sweden (McPherson, 1986). In most States, professional regulation is the responsibility of a Government department and there are big variations in the influence of the profession upon the content and administration of any laws. Spain and the UK are unusual in that the national association of psychologists has been given legal authority by the State to regulate qualifications and practice, although the powers of the Colegio are much greater than those of the British Psychological Society (BPS).
Similarities and differences in training This section will identify similarities and differences in training which exist, in particular between the UK and elsewhere in Europe.
Length of training to qualification In the UK, the minimum period of education and training necessary for registration with the BPS as a chartered clinical psychologist and, from 1993, for employment in the NHS is six years - three undergraduate and three postgraduate years. This is roughly similar to the minimum periods of study and training in Europe, at the end of which graduates are regarded as qualified professional psychologists : e.g. approximately five years in Spain, Sweden and Denmark; six years in Italy, the BRD and Finland; and six and a half years in Norway. As noted above, comparisons are difficult. The implications for training of a ‘year of study’ vary considerably because of differences in the numbers of contact hours within the year and in the form of teaching. Moreover, in the UK, many potential clinical psychologists spend several years obtaining relevant experience before being selected for training. In most of Europe, students enjoy some freedom to determine when to take their exams, so that the actual period of study and training is often two or more years longer than the minimum prescribed.
Basic science preparation Clinical training throughout Europe seems always to be preceded by the systematic study of the scientific discipline of psychology. In the UI
