Psychoanalytical Psychotherapy in Latvia

Good afternoon!

Before I get into my presentation I would like to indicate that there will be two speakers from Latvia this afternoon. I and my colleague, Dr. Zaiga Blaua, have the honor of representing the national group, which is the only officially recognized, state certified, psychotherapists organization – Latvian Association of Psychotherapy. (The full name of this organization is – Latvian Association of Psychodynamic Psychiatry, Psychosomatic medicine and Psychotherapy).

The aim of this organization ever since its founding ten years ago has been the creation of a training environment for and the development of the psychoanalytical psychotherapy.

The another society which also offers services in psychotherapy in Latvia and whose representative will speak here today is a more diverse group with more ambiguous aims and, as I understand, holds a membership only in EAP. The professional standards of this group have been formulated on a different bases than those of LAP. This group will be represented here by Dr. Plume.

As I said earlier, by historical necessity, the profession of psychotherapy in Latvia has developed mainly as an outgrowth of psychoanalytical psychotherapy and for the following basic reasons:

Immediately following the independence, the need for psychotherapy in Latvia was recognised first and foremost by medical doctors. They were acutely aware, that due to the fact that before 90-ies there were very few psychologists and no social workers in the Soviet system (that is as we understand the definition of these professions today) – the founding and the development of the psychotherapy as the profession will fall on the shoulders of he medical doctors. Besides in medical psychotherapy the understanding of person’s psychodynamic processes and the relationship between somatic and psychic functioning begins with the deepest understanding of psychodynamic/psychoanalytic phenomena.

As to why at that stage no other colleagues from other professions were pursuing active interest in psychoterapy, can be answered as follows:

In the Soviet system which in Latvia spanned over 45 years, the department of psychology at the University of Latvia was closed and so the studies of psychology as a social science did not exist (in early 90-ties there were 5 – 8 colleagues with degree of psychology after graduating from the universities in Soviet Russia).
With regard to social workers – it was absolutely a new term and this new activity had to start its development from ground zero. As far as the medical nurses were concerned – there were no medical nurses with a university education up to that point.

Currently the section for Psychoanalytical psychotherapy is the largest segment in the Latvian Association for Psychotherapy (LAP). There are, however, other segments although smaller – The Family systemic therapy, group therapy and, the less active, Children and Adolescents section.

The main duty of LAP – empowered by the state – is to work out the certification rules, standards and the administration of the process of certification itself in the country. It also has to assist in initiating and formulating new legislation as it relates to the nation’s psychotherapy.

Until now 24 full members have fulfilled the certification rules and have received professional certificates – 22 medical doctors and 2 psychologists.
There is now also quite a large group of psychologists, who have received their education during the last 10 years. Some of them are interested in psychotherapy.
We are also in good contact with the Association of clinical psychology, but here we have experienced some problems too – for example, this year clinical psychologists flatly refuse to be identified as a category of health care profession (of in Medicine involved or a “treating person”).We think that these are normal problems in a young and growing society and they will be worked out in time.

Another problem is that the psychodynamic concept and psychotherapy in practice have not been given the appropriate place in the treatment of the emotional and somatic disturbances.
Consequently the treatment is not (with very few exceptions) reimbursed by the state nor the insurance companies. It has something to do with the poor financial state of country and the fact that the state has allocated too small a portion of the national budget to medicine – one of the worst in Europe, but looking more deeply – there is a wanting cultural attitude. There are no deep roots in the society with respect to treating personality disorders and nurturing the emotional life of the patients. This attitude has also contributed to the current low prestige of health care system.

About systematic education

• The first systematic education in individual psychodynamic psychotherapy in Latvia started in 1991 as the project of Eskilstuna (Sweden) college of health and caring sciences.
• As the continuation of this initial activity, in 1997 in Riga was started the 3-years education project in psychodynamic psychotherapy organized by the Karolinska institutet and lead by the head of the department of Psychotherapy Karin Gyllenskold.
• In August 2001 the third part of this process was started, which is being lead by Tomas Videgard (Stockholm, SAPU).

So, Sweden has made a great and essential contribution in the mental health care development of specialists in Latvia un has create the strong group of specialists in psychodynamic psychotherapy.

Another important educational project – in group analysis and group psychotherapy – comes from the Institute of group analysis in Oslo (Norway) (from1994), which is lead by specialists from Norway in collaboration with the colleagues from the Netherland.

Starting with 1994 postgraduate education in psychotherapy (based on psychodynamic basis) is available at Riga Stradina University.

About certification standards

1. theory – 350 theoretical hours are needed (240 before the start of clinical work)
2. clinical experience – not less than two years
3. supervisions – 60 hours
4. to present and defend two clinical cases from which at least one should be long – term case
5. personal experience – at least 100 hours in individual or 240 hours in group therapy

A very successful program was started in Riga this year in the training in personal psychoanalytical psychotherapy with Michael Shebek. We are very happy about the way this program is progressing.

About collaboration with EFPP

We are happy to be the associate members of EFPP. Still – our aim is to became a full member. It means that we are very interested in discussing the procedures for equaling and achieving the necessary criteria and standards of those of full members.

Similarly we would be very interested in the common research projects with EFPP recognizing that only through research we can improve the situation of psychotherapy on all levels.

Thank you very much.

October 2001