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  • Approximately 16,5 million inhabitants, with a population density of 490 persons per square kilometer
  • Expenditure on health was 79 000 million Euro in 2008, which is 13.3% of the gross domestic product
  • In 2005 14,2 billion Euro’s was spend on mental disorders, including dementia and mental retardation.


Psychotherapy in the health care system

  • Psychotherapeutic treatments in the Netheralnds are defined as interventions in which the core element of treatment consisted of verbal communication between a therapist and a patient.
  • The Dutch mental health care system is divided in three different levels with the provision of care organized from mild and general to heavy and specialized disorders. In the first level of care patients with mild and general disorders are treated by a general practitioner or (first level) psychologist. If the disorders are beyond the capacities of the first level patients are referred to the second layer or care in which more specialized mental health professionals provide diagnostics and treatment according to multidisciplinary guidelines. If this still doesn’t offer desired results the patient is referred to the third level to receive even more specialized help. Psychotherapeutic techniques are used in treatments on all the different levels of mental health care. Psychotherapist can therefore work in all three different levels of care, treating outpatients with mild depressive symptoms to inpatients with schizophrenia.
  • Psychotherapeutic interventions provided include client centered therapy, relationship or family therapy, Problem Solving Treatment, short term treatments, cognitive behavioural therapy, behavioural therapy, interpersonal therapy and psychodynamic therapy.
  • The primary source of psychotherapy financing in descending order are social insurance, out of pocket expenditure by patient or family and private insurances.


Psychotherapeutic Professionals

  • Health Care Psychologists (“GZ psychologen”) are registered in a national register of health professionals and are allowed to deliver psychological treatments as an independent therapist.
  • Apart from the GZ psychologists, there are psychotherapists. The title ‘Psychotherapist’ is protected by law; all psychotherapists are registered under the Individual Health Care Professions Act. This Act concerns the quality of care guaranteed by legally protected professional titles and provides a register of health care professionals (the BIG-register). Only those listed in this register may carry the legally protected title of psychotherapist.
  • The postgraduate training takes approximately 4 years and is accessible for people holding master degrees in psychology, medicine or educational studies for child psychotherapy training.
  • There are only 5 schools providing the training which enables one to register in the BIG-register. There are other schools (e.g. Dutch Academy for Psychotherapy) which provide psychotherapy training but are not credited for the BIG register. They often are however recognized by the European Association for Psychotherapy and provide a ‘diploma’ called European Certificate for Psychotherapy. People graduating from this training are not legally allowed to carry the name ‘psychotherapist’ in the Netherlands.
  • Clinical Psychologists have the highest level of education, and are also trained in management and research skills.


Psychotherapy for Depression

  • The "GGZ richtlijnen voor depressie" is an evidence- and consensus-based clinical practice guideline for patients with depression. In cases of depression psychotherapy or pharmacotherapeutic treatments like cognitive behavioural therapy, behavioural therapy and interpersonal therapy are recommended. The guidelines work according to the principles of stepped-care.


Desirable Changes to Health Policy
If you were responsible for health policy in your country, what would your first decision be regarding psychotherapeutic care?

  • Introduce stepped-care principles in all treatment guidelines.
  • Focus more on self-management skills.
  • More strict adherence to evidence based practices.


Additional Information:   None.


Prof Dr. Pim Cuijpers, Head of the Department of Clinical Psychology at the VU Universiteit Amsterdam

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.