Sweden steps away from CBT monopoly, opening the door to more reflective therapies.

After years of complaining that cognitive behavioral therapy receives all the public funding, it seems that therapists who work in a more reflective, less educational paradigm are about to get a break – in Sweden at least.

Sweden’s government has put substantial funds into CBT provision and CBT training. Now, it looks like the government’s National Board of Health and Welfare, has accepted that psychodynamic therapies are as effective as CBT at treating depression – might lead to the introduction of government support for psychodynamic therapies.

Also in the US substantial funds have gone into CBT, and there is a similar dispute from psychodynamic therapists who claim that practice-based research shows that all therapies work equally well in the field – therefore they should all get funding, not just CBT.

The shift in Swedish policy is in part due to the work of Rolf Holmqvist, professor of clinical psychology at Linköping University, whose research suggests that just about every form of talking therapy is equally effective when used in the field. 

In an interview Rolf Holmquist states the following: 

RH: 'In our study we used the CORE-OM system for rating therapy outcomes [as opposed to the Beck Depression Index, designed by Aaron Beck, who’s also the founder of Cognitive Behavioural Therapy]. We started by examining outcomes in primary care centers. In Sweden, there is perhaps one such centre for every 10,000 people. And at every centrer, there is one or two people providing psychological treatment. We asked therapists to ask their patients to rate their state on the CORE-OM outcome measure, so we could follow the progress of their treatment, which was typically rather short – on the average six sessions. We compared a number of things, particularly how different treatment orientations succeeded – particularly CBT and psychodynamic. We found exactly the same results, for both depression and anxiety. They all got good results, with about half of patients recovering. Even supportive therapy, which is the Cinderella of therapies because it seems too simple, got quite good results.'

One could object that the study only looked at very short therapies. It might be said that the positive effect does not have as much to do with the actual therapy, as with the well known fact among clinicians that just the fact of starting therapy leads to an improvement, has a therapeutic effect.

The study also underlines the relevance of not just randomized studies, but practice based studies.  I would add that case studies where the particularity of each patient is studied has proven great support for more reflective theories. It is impossible to grasp the particularity of this work in randomized studies, but a growing openness to these kind of studies lends support for reflective therapies. We could say that for treatment to work, the patient needs to have a choice, and the therapist needs to have a choice. There is no one size fits all. Monopolies dry op creativity, also in the world of therapy.

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