FRANCE
Historical background for psychotherapy research in France :
Psychotherapy and France share a part of a quite long history.
The roots of the modern era of psychotherapy, in France, send back to the 18th century, when
Franz Anton Mesmer began famous for delivering an ancestor of hypnotic interventions, the
« Mesmerism », which was supposed to transmit a specific fluid (« animal magnetism »), in
order to treat various diseases.
Because of Mesmer’s successes, the king decided to create a scientific committee including
Benjamin Franklin, realizing one of the first empirical study of « psychotherapeutic »
intervention, which leads to the demonstration of the implication of a psychological process in
the « treatment » of a disease: the role of suggestion and imagination.
At the same time, « Moral Treatment Movement », initiated by the pioneering work of
Philippe Pinel, introduced a non-medical, individualized and compassionate regimen in the
treatment delivered to patient. The history of psychotherapy practice and research in France
moved forward with Janet and Charcot, inspiring the study of functional nervous disorders,
the study of hypnosis, and the developement of psychoanalysis (Cautin in Norcross, 2011).
Nowadays, psychoanalytic traditions continue to exert a strong influence in France, even if a
more recent shift to behavioral-cognitive interventions is quite important. The most influent
psychotherapeutic traditions are well represented in France (Psychoanalysis and
Psychodynamic related therapies, Cognitive-behavioral therapies, Person centered therapy,
Gestalt, family and systemic therapies, Ericksonian therapy, brief strategic therapy…), with
many privates institutes of training, and researches related to these different schools of
psychotherapy.
Research activities in France:
Psychotherapy research in France have been traditionally driven in university and hospital
research center, and/or promoted by the principals schools and associations of psychotherapy.
The fields of research are pretty large, including lifespan and specific ages (child, adolescent
and adults), systems (family and couples), different orientations and timeframes (brief and
longer therapies), and different sociological, cultural, ethnological and economical aspects of
psychotherapy.
Recently, The National Institute for Health and Medical Research (INSERM, 2004), produced
a rapport following the demand of the General Direction for Health and the request of two
important patient associations. The goal was to review the literature on psychotherapy
effectiveness, for three principal interventions: psychodynamic interventions, cognitivebehavioral interventions, and family and couple therapy, across a large array of psychological
disorders.
This rapport suggested the superiority of CBT on other interventions, leading to criticism on
the scientific methodology of the expertise, and bringing a high level of tension between the
different psychotherapeutic communities. These conflicts sensitized so much psychotherapists
to topics related to evaluation and effectiveness/efficacy, that evocating these important
aspects of our work, is sometimes difficult nowadays.
More recently, a principal source of uncertainty regarding psychotherapy research, has been
related to changes in the regulatory law (Jardé Law), supervising the organization of research
implying patients (for a recent discussion around this law at the French Senate, please see
https://www.senat.fr/espace_presse/actualites/201604/cadre_legislatif_et_reglementaire_des_
essais_cliniques.html). The stakes are quite important, because the new nomenclature of
trials, could lead to complicated situations in the organization of research. For example, the
students at university might necessitate a timely consuming process of rendering a proposal
for a later committee audition, even for small studies related to their research projects,
questioning the feasibility of students tasks in the course of the year’s university calendar.
One other topic of psychotherapy related both to practice and research, is the main access to
treatment, its regulation, and its funding. In France, only psychotherapy delivered from a
Psychiatrist in private practice, or at a center for care, and only in this last context, for
psychologists (Hospital, medico-psychological center), can be funded or allow for a refund. In
the case of consultation with Psychologist, in private practice, for example, patients have to
go « out of their pocket », which limits access to treatment, even if it has been documented for
decade that the psychotherapeutic treatments reduce the cost of care at the nation level; and
moreover psychiatrist waitlists are quite large, in general. This limits also the possibility to get
research and data from psychotherapy in naturalistic conditions. One other paradox in this
situation, is related to the regulation of the psychotherapy profession, to protect the patient.
The title of « Psychotherapist » have recently been recognized by regulatory law, protecting
the patient from self-proclaimed « psychotherapist practicing », without any official
qualifications, but at the same time, the possibility to enter treatment with recognized
psychotherapist, is limited by the financial aspects previously evocated.
Recent and on-going discussions on this topic, and new agreements between private assurance
companies about funding psychological treatment would hopefully lead to a greater access to
care and to the possibility to get more data from treatment in naturalistic conditions.
Especially, some political propositions point to the possibility that psychologists could be
seen as a first line of treatment and that the funding could be covered by the national
insurance system (For more information see proposition 25 : http://www.assembleenationale.fr/14/rap-info/i1662.asp). This, in our sense, is an additive argument to the value of
psychotherapy research in the debate about funding ( by referring to accountable practice).
We are pretty convinced that, on this particular topic, data, not only collected in clinical trials
(evidence based practice), but also in psychotherapy naturalistic conditions (practice base
evidence), could facilitate and orient future politics of health. Bringing back in return to the
possibilities of innovative research.
Enlightening some Initiatives
We would like to shed a light on specific initiatives, that are directly related to psychotherapy
« hot topics » and to the development of research from the « ground », particularly aimed at
articulating practice and research.
A network for Practice based research:
A first French network of practice based research (RRFPP, Thurin & Falissard, 2008), funded
by the INSERM and the General Direction For Health, can help clinicians in the acquisition
of a better knowledge related to psychotherapy, abroad contexts of exercise, and to the
development of competencies in assessing psychotherapeutic processes in naturalistic
conditions (for the website :http://www.techniques-psychotherapiques.org) . Three mains topics have
been originally considered (Autism, Borderline personality Disorder and Depression in Alzheimer
disease) and there is an invitation to connect with the network. The website is also a documentary
repository with extended article analysis.
A university Center for research and Practice :
The « Centre Pierre Janet » at the University of Lorraine, has been created by the Professor
Cyril Tarquinio (for more informations see http://centrepierrejanet.event.univlorraine.fr/janet_accueil.php). This new center will be the first French university center
dedicated to deliver consultation and to the development of psychotherapy research , allowing
the use of logistics and methodological resources to new research projects. There is a strong
original focus on EMDR research, and at the same time the vision of the center is large and
integrative.
----------------------------------------------------------------------------------------------------------------Our current work : Practice based Research - Validation and dissemination of Feedback
Informed Treatment.
At the University of Bordeaux, we are currently doing research about feedback effects in
psychotherapy, with, as a first step, the French adaptation and validation of a complete
Routine Outcome monitoring system (PCOMS, ORS/SRS, Miller and al. 2006 ), allowing
clinicians to track their outcomes in their current practice. The main goal these last years, has
been to present and develop Practice Base Evidence research, with Routine Outcome
Monitoring (ROM), in congress and workshop, in order to prepare future Feedback research
and train for the practice. We are looking for exchanging and collaborating with
psychotherapists measuring their outcomes, especially in French European community and
abroad, in order to better understand feedback effects and psychotherapy processes efficacy.
Author Contact:
Christophe Cazauvieilh,
Clinical Psychologist,
5 rue du chai des Farines, 33000 Bordeaux /France
Email: [email protected]
References
Cautin, R, L. A century of psychotherapy, 1860-1960. In Norcross, J. C., VandenBos, G. R.,
Freedheim, D. K., & American Psychological Association. (2011). History of psychotherapy:
Continuity and change. Washington, DC: American Psychological Association.
Inserm (dir.). Psychothérapie : Trois approches évaluées. Rapport. Paris : Les éditions Inserm,
2004, XII- 553 p. - (Expertise collective). - http://hdl.handle.net/10608/146 - See more at:
http://www.ipubli.inserm.fr/handle/10608/57
Miller, S.D., Duncan, B.L., Sorrell, R., Brown, G.S., & Chalk, M.B. (2006). Using outcome
to inform therapy practice. Journal of Brief Therapy ,5(1) , 5-22.
Website
Falissard, B & Thurin, J-M – website accessed on 30/09/2016
http://www.techniquespsychotherapiques.org
Tarquinio,C–websiteaccessedon30/09/2016
http://centrepierrejanet.event.univ-lorraine.fr/janet_accueil.php