CBT in Denmark Historical development of behavioural and cognitive therapy in Denmark: In Denmark interest in behavioural approaches began late and developed only slowly. This failure to thrive may to a large extent have been due to the continuing absence of an academic base for research, theoretical development and training. In the department of psychology at the University of Copenhagen experimental phenomenology was, until the late 1960s-early '70s, the predominant school of thought. Though fine and original contributions to general psychology were made from this centre, only limited time was given to the development of other fields or approaches. Though a more pluralistic climate developed from around 1970, student interests centred mainly on, among others, Freudian and Marxist schools of thought. Fields such as the experimental psychology of learning were not prominent and little applied research was completed. During this period the field of clinical psychology, as applied in e.g. adult and child psychiatry, remained almost exclusively psychoanalytic in orientation. Thus, behavioural psychology had only a few, though very committed, advocates in academic positions - among these were Melvin Lyon at the University of Copenhagen, Mogens Brun at the Royal Highschool of Educational studies and Thomas Nielsen at the University of Århus – and their teaching positions were in general psychology, rather than clinical. In addition to these, a small number of individual clinicians and students were inspired by the literature on behaviour therapy and in 1975 the Danish Association for Behaviour Therapy was founded (with psychologist Preben Wagner as its first president). In the absence of a major centre of research or clinical excellence, members were encouraged to form local groups for study of basic literature and for mutual supervision of clinical work. During the following years the DABT organized a number of workshops with prominent foreign practitioners and theoreticians in behaviour therapy – from the U.K. Victor Meyer was a regular visitor and his emphasis on individual case analysis became a major influence on many clinicians in the DABT. During the same period several visits by Fred Kanfer provided further theoretical and clinical inspiration at an advanced level. A number of workshops by other outstanding foreign clinicians and researchers followed, all crucially important in providing models of excellence in CBT; these included Ron Ramsay, Peter McLean, Charles Ferster, David Lane, Robert Sharpe, Sheldon Rose, Richard Stuart, Joseph LoPiccolo, Fanny Duckert, Ivar Hand, Lawrence Burns, Ivar Løvaas, Martin Seligman, and several others. During the 1980s individual clinicians in psychiatry, school psychology and special education were increasingly applying behaviour therapy in their work with clients. However, behavioural psychology was still controversial and the widespread misunderstandings of the approach provided an ongoing challenge for practitioners. Little clinical research was conducted on issues directly related to theory or practice in behaviour therapy; an exception was a study on effects of controlled drinking as a treatment goal with alcoholics; the study was done in the early eighties at the St Hans Hospital by Per Vendsborg and Karin Sønderbo. In general, however, the lack of an applied research tradition was still evident and progress was can be attributed to the work and teaching of individual clinicians. The increasing emphasis on cognitive concepts in the field during the '80s appeared to stimulate new interest and perhaps facilitated the already slowly increasing interest and acceptance among a slightly larger number of practitioners. Like several organisations abroad, the DABT updated its name and became the Danish Association for Behavioural and Cognitive Therapies ( S.A.K.T.). As in other countries this development was the cause of theoretical controversy within the field, but this was limited and fairly short-lived - perhaps due in equal measure to the small number of people involved and the pragmatic, rather than philosophically committed, position of many clinicians. (Some observers might attribute the smoothness of this transition to the easy-going attitude said to be typical of the Danish national character.) Denmark joined the European Association in 1979. During an international meeting a decade later, the president of DABCT Irene Oestrich offered Copenhagen as the host of the world Congress scheduled for 1995. Irene has been a founding member of the Danish association, was well known in DK as an author and workshop leader in CBT. She was determined that the congress should accommodate both behavioural and cognitive approaches at a time where separate events were increasingly being planned. Working closely with the behavioural and cognitive scientific committees (chaired by L-G. Öst and David M.Clark, respectively) Irene and the organising committee secured a memorable World Congress in Copenhagen in July 1995. Over a thousand 1000 delegates from 39 countries attended the event. As intended, the programme included both behavioural and cognitive contributions - prominent among these were presentations by founding fathers of the field such as Joseph Wolpe and A.T.Beck. The congress was considered highly successful by delegates and participating organisations. Interestingly, the number of Danish delegates was very modest - indeed, twice as many colleagues attended from e.g. Sweden or the U.K. and even Australians vastly outnumbered the locals! However, in the following year’s interest in CBT among Danish mental health professionals has increased considerably and the DABCT has more than tripled its membership in the last 8 years. Reasons for this may include the success of the World Congress as well as the zeitgeist of increased focus on evidence-based treatments. A crucial role has been played by a more local phenomenon, namely the great organisational, educational and diplomatic talents of the next DABCT president, psychologist Lennart Holm. During those years a model of basic and advanced training courses were developed, combining workshops and group supervision. In these activities we have been fortunate in having the help of prominent foreign colleagues. During the same period a group at the University of Århus and Risskov University Hospital (including Merethe Mørch, Nicole Rosenberg, Esben Hougaard and others) had launched training programmes and authored several books on CBT, providing much-needed literature in Danish. Current state. The training courses are now available in several parts of the country have been completed mainly by psychologists and psychiatrists, but also by nurses, social workers and physicians in general practice. In several psychiatric hospitals staff have been trained in CBT and an recent multi-authored book on Cognitive Behavioural Milieu Therapy has been published recently. At the large psychiatric Sankt Hans Hospital a Centre of Cognitive Therapy has been established with Irene Oestrich as director. An ongoing research project on the treatment of low self-esteem in psychiatric patients is been undertaken in collaboration with Nick Tarrier and colleagues at the University of Manchester. Another piece of applied research undertaken on the treatment of hypochondriasis, comparing cognitive-behavioural treatment (based on Paul Salkovskis' work) with standard psychiatric care. This project is done jointly by a large private CBT-clinic and a department of liaison psychiatry at a Copenhagen hospital. In April 2003 Denmark once more hosted of an international event, this time the Nordic Congress in CBT, with a program covering a wide range of topics and presenters including Art and Christine Nezu, Ed. Craighead, Lars Göran Ôst, Erikur Arnasson, Terro Timonen and many others. In the light of the many other positive developments already mentioned it seems that cognitive-behavioural therapy has, at long last, gained a permanent recognition and a growing position in this country. The current activities reflect the growing impact CBT is having on adult psychiatry (and in the private practice sector). A correspond in child psychiatri is yet to take place. However, the DABCT has recently successfully held its first training course on CBT with children, again combining workshops by foreign and national authorities (incl. Phil Kendall, Tom Ollendick, Will Yule, Tammie Ronen, Tony Attwood and others) with group supervision by experienced local clinicians. In the year of 2002 we completed the first training program on supervision. The course was established in collaboration between Irene Oestrich and Lennart Holm from the eastern part of Denmark and Nicole Rosenberg from the western part of the country. Training supervisors as well as therapist are of crucial importance for the future development in the field and DACBT has training as one of our main task. We will continue to expand our training opportunities for clinicians and other mental health professionals, in line with the requirement for further professional development as deemed by the Psychological Association and the Psychiatric Society. Psychologists and psychiatrists qualified to carry out psychotherapy. In order to become approved as specialist in psychotherapy one needs 600 hours of practical works (including therapy hours, evaluation etc.), 200 hours of supervision 100 hours of personal training or therapy and 300 hours of theory and method within different themes (incl. psychopathology, theory on psychotherapy etc.). The supervision has to include minimum 125 hours from the tradition one wishes to specialise in and 50 hours from a different school of thought. The training can begin after one has acquired the status of authorised psychologist, which takes a minimum 2 years of working as a psychologist, while receiving supervision and participating in ongoing professional development. Qualification of supervisors: The training can begin when one has specialised in psychotherapy and worked minimum 5 years after authorisation. The training includes minimum 120 hours of providing supervision to other psychologists or psychiatrists within a 2 years period. The training also includes 40 hours of supervision on ones own supervision and 30 hours of teaching on theory and methods on supervisionprocesses. Psychiatrists receive a basic psychotherapy training which includes 60 sessions of therapy and 60 sessions of supervision. This training can be followed by a specialisation in psychotherapy, which includes 60 hours of theory, and between 60 and 90 hours of supervision depending on whether it is individual or group therapy. The program also includes personal therapy and some theory and supervision from another psychotherapy tradition than the one one’s specialised in. DACBTs basic training program is approved by the Danish Psychological Association to accredit for 66 hours of theory and 30 hours of supervision or personal training. And our advanced course is also accridited. In the beginning there were some discussion regarding the idea of “personal therapy” per se in order to be approved as a therapist. The tradition of therapist receiving personal therapy has never been prominent within our field. One could argue, as we did, that in order to secure the integrity and the ethical position of the therapist, video supervision would be a more suitable method, rather than requiring therapist working out personal issues. The Psychiatric Association has been less flexible on this issue and they still require feedback on personal style and supervision to be separated. We are now in the process having the supervisor training approved by the Psychological Association and the Psychiatric Association. DACBT currently has 350 members and we run a one year basic introductory course in CBT, a series of advanced courses and a supervisor training course well as we also run a number of open workshops with internationally recognised workshop leaders. Antonia Sumbundu has chaired the association since spring 2002, when the office moved to St. Hans Hospital in Roskilde.
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