Poland

Country

• Population 38 million people
• Health care expenditure as a percentage of GDP: 7% of the gross domestic product (2008)

Psychotherapy in the health care system

• At present the Polish psychotherapy services offered within the national health fund cover cognitive-behavioural therapy, integrative psychotherapy (incl. person-centered therapy, psychodynamic therapy, gestalt) as well as family therapy.
• Individual and/or group therapy is practiced within a full range of inpatient and outpatient care and day center units.
• Psychotherapy is recommended for adjustment-, affective-, anxiety-, eating-, sexual-, sleep-, personality-, psychotic- and somatic disorders as well as behavioral and emotional disorders in children and adolescents. Inpatient care for persons with mental disorder is offered by psychiatric hospitals and rehabilitation centers.
• Psychotherapy is covered not only by the statutory health insurance but also private health insurance.
• Private practice psychotherapy is becoming more and more popular when patients have to pay, but they can choose their therapist and have no limitations on the number of sessions.

Psychotherapeutic Professionals

• Intensive works have been carried out in Poland on the law governing psychotherapy as a profession.
• The law is being prepared by the Ministry of Health in consultation with Polish psychotherapeutic associations.
• The law is to safeguard the patient’s rights and regulate the qualifications of psychotherapists.
• The postgraduate training courses are to be run by the Psychotherapy Associations whose members are obliged to conform to codes of ethics.
• Already organized courses involve 4 year studies, involving 1200 hrs of formal education, internship, clinical work under supervision as well as own psychotherapy experience. The courses are open to any person with humanistic or scientific degree.
• The law is to allow a variety of recommended approaches to be practiced (not finally decided as yet). It is hoped to regulate that the most efficient methods of psychotherapy are used and evidence based practice is promoted.
• At present Polish psychotherapists have no chambers, but form associations specific to different approaches to psychotherapy. However only 3 of such associations are officially recognized by the National Health Fund: the Association of Psychologists, the Association of Psychiatrists (both representing integrative psychotherapy) and the Polish Association of Cognitive-Behavioural therapy.

Psychotherapy for Depression

• Poles have an average level of depression on a national scale as compared to other countries. There is approx. 10% of population suffering from depressive states.
• Women suffer from depression twice as often as men. More often it is now young and so called successful people that experience symptoms of depression.
• Strong competitive environment and pressure of success create a demanding life style. The modern civilization problems to which Poland is now having to face.
• Patients with depression are treated on an in or out patient basis (incl. day centres).
• Psychotherapy is more commonly practiced for depression. In some cases patients are treated pharmacologically only. In cases of severe depression a combination of both is recommended.
• Depression is still not well understood by Poles. For the past few years national awareness campaigns about depression have been organized.
• 23 February is a depression awareness day in Poland. People are being educated, free medical advice is made available, well known personalities get involved often presenting themselves as examples, so the social stigma is reduced.

Desirable Changes to Health Policy

• The most important task is to introduce the law governing the psychotherapy. A reform of the regulation system should lead to:
• the reduction of the presence of unprofessional therapists,
• replacing it with evidence based approaches.
• It would improve access to recognized psychotherapy services and
• It may result in reducing of the high amount of drugs taken.

Additional Information

• In Poland new, more proactive approaches to psychotherapy are becoming popular and recognized, such as cognitive-behavioral therapy or motivational enhancement therapy.
• Such approaches not only deal with patient’s weaknesses but build on patient’s strengths, self esteem and self efficacy.

Author
Iga Jaraczewska, clinical psychologist, psychotherapist, clinical supervisor of Polish Association of Cognitive-Behavioural Therapy, chair of Polish Association of Motivational Interviewing  

The text above is an excerpt from the paper "Psychotherapy in Europe – Disease Management Strategies for Depression. National Concepts of Psychotherapeutic Care".

You can download the paper here.