Clinical Psychology in Europe, History of

I Lunt, University of London, London, UK

2001 Elsevier Ltd. All rights reserved.
This article is reproduced from the previous edition, volume 3, pp. 20252029, 2001, Elsevier Ltd.

Abstract

Although psychology as a discipline is held to have originated in Europe with Wundts laboratory in Leipzig in 1879, clinical
psychology emerged in Europe substantially after the World War II in the 1940 and 1950s when Europe was rebuilding itself
and its health and welfare systems. Europe is characterized by the diversity of its 48 or so countries which have different
histories and social, intellectual, and cultural traditions which have affected the development of the profession and practice of
clinical psychology. Nevertheless, since the 1950s with the increasing professionalization of clinical psychology, leading to
increased length of education and training, the development of ethics codes, growing regulation, and legislation in relation to
the profession, and in 1981 the formation of the federation EFPPA (European Federation of Professional Psychologists
Associations), there has been a gradual move toward more common standards and an attempt to develop a European
framework for different areas of training and practice. This trend is likely to develop well into the mid-twenty-rst century
with a greater unication of Europe.

Introduction assessment and treatment of people who see themselves as having

Europe is characterized by its social, linguistic, and cultural
diversity (e.g., Drenth et al., 1990; Poortinga, 1996), which is
rooted in very different histories and traditions of the 48 or so
countries. Even the geographical or political extent of Europe is
a matter for some debate, though it is assumed that the growth
of the European Union (currently 15 states, all of them in
western Europe) will clarify this in future years. Although
psychology as a discipline originated with Wundts laboratory
in Leipzig, Germany, in 1879, the profession of clinical
psychology was considerably slower to develop in Europe than
in the USA (Sexton and Misiak, 1976; Eysenck, 1990; Sexton
and Hogan, 1992).
The major inuence for the development of clinical
psychology in many western European countries was the
rebuilding of Europe after World War II in the 1940s and 1950s
and the development of mental health facilities by European
states, as the challenge of mental problems and mental health
presented itself to health authorities (Lunt, 2000). In eastern
European countries clinical psychology developed much later
as these countries emerged in the 1980s from political regimes
which were critical of the discipline (e.g., Pawlik, 1996). It is
only relatively recently that these countries have begun to
develop a profession of clinical psychology.
psychological problems, such as those with mental health difcul-
ties, but they also work with the handicapped, families, those with
learning difculties, and, more widely, with staff and organisations.
Llewelyn, 1994
There are some differences in the practice of clinical
psychology, from countries where the majority are employed
by the state such as the United Kingdom where most clinical
psychologists work for the National Health Service (NHS) and
there is relatively little private practice, to countries such as
Switzerland and Germany where many clinical psychologists
work in private practice, with charges reimbursed by medical
insurance companies. Furthermore, there are differences in the
dominant activity of clinical psychologists: in many European
countries the main activity is psychotherapy, whereas in others
there is a broader role which includes assessment and other
forms of intervention, and also a role in training and consulting
with other staff. While the dominant paradigm informing
clinical psychology in the United Kingdom is cognitive
behavior therapy, other European countries such as France and
Italy historically have been more inuenced by psychoanalytic
ideas. Although all European countries have been inuenced
by the USA, this inuence has been perhaps most striking in the
Scandinavian countries which embraced the scientist practi-
tioner approach to practice from an early stage.

The Field of Clinical Psychology

Although there are differences between countries, it is possible
to provide a general denition of the eld which would be
agreeable to all European countries; clinical psychologists may
be dened as psychologists who
apply psychology in a clinical context, usually a hospital, medical or
community setting, with people (patients or staff) who consider
themselves to be in need of a psychological perspective on their lives.
In practice, the majority of clinical psychologists contribute to the
Europe
As mentioned, the political face of Europe is developing and
changing rapidly (see Lunt, 1998). Many of the central and
eastern European countries have applied for membership of
the European Union, and are working toward criteria which
will enable them to join. This will mean an expanded and
changed Europe in the not too distant future, bringing together
the early members of the European Union and nonmember
states; many of the latter in Eastern Europe and formerly
belonging to the Soviet Union. The countries of Europe

International Encyclopedia of the Social & Behavioral Sciences, 2nd edition, Volume 3 http://dx.doi.org/10.1016/B978-0-08-097086-8.03026-9 873
874 Clinical Psychology in Europe, History of
constitute a very diverse group that may nevertheless be
grouped into broad regions with some commonality in their
organization and practice of clinical psychology. For these
purposes, at a very broad level it is possible to identify a Nordic
group of countries with considerable commonalities in their
practice (the Scandinavian countries), Great Britain which has
much in common with education and training in the USA and
other parts of the English-speaking world, the German
speaking countries, a southern European group, and an eastern
European group. Of course, within these regions, the countries
are characterized by their individuality and their diversity, and
the different histories that have had a profound inuence on
the development of clinical psychology.
The Early Years of Clinical Psychology
There are a number of models in the eld of clinical
psychology, a eld which emerged in European countries
substantially after World War II (see above). It emerged as
a recognizable profession at different times in different coun-
tries. In the United Kingdom the two World Wars provided
a signicant impetus to the emergence of this profession,
initially through the need to develop psychological tests to
recruit suitable personnel, and later in 1948 with the formation
of the NHS that provided a considerable impetus to the
development of this new profession. In these early days, the
role of the clinical psychologist was largely one of laboratory
technicians administering psychometric and other tests, usually
for medical practitioners (Eysenck, 1990). However, in the
United Kingdom, the development of behavior therapy, in
particular under the inuence of Hans Eysenck who established
clinical psychology as a profession in England in 1949, led to
clinical psychologists developing a therapeutic role, and by the
1960s they had become clinical practitioners in their own right.
In the Nordic countries, also, clinical psychology emerged
substantially after World War II, in the 1940s and early 1950s;
the Norwegian Psychological Association was founded in 1934,
the Danish Psychological Association in 1947, the Swedish
Psychological Association in 1955, and the Finnish Union of
Psychologists in 1957. The formation of these Psychological
Associations reected the emergence in these countries of
a profession of psychology, mainly clinical psychology, which
progressed through similar broad major phases as the UK; that
is, a phase focusing on diagnostic examination and testing of
individual patients, a phase focusing on therapeutic work
involving mainly psychotherapy, and a phase focusing on
indirect work with other professional groups through tech-
niques such as consultation and training.
In Spain, on the other hand, clinical psychology has had
a shorter history (Belloch and Olabarria, 1994) and is said to
have emerged in the 1970s along with fundamental changes in
Spanish society. Similarly in Italy, clinical psychology as
a professional application emerged substantially in the 1960s
and there remain some tensions over the autonomy and role of
clinical psychologists and their relationship with medical
practitioners, especially psychiatrists. The Association of Greek
Psychologists, founded in 1963, reects the existence of
professional psychology in Greece, although at that time and
until very recently, all clinical psychologists received their
training overseas, and the profession was very much dominated
by the medical profession.
As mentioned above, clinical psychology emerged much
later in Eastern European countries, and it was not until the
1980s that psychotherapy was fully recognized as a profession
(Pawlik, 1996). Until recently, nearly all psychologists were
employed in state institutions, though in recent years there has
been a growth in demand which has resulted in a growth in
private practice.
In all European countries, clinical psychologists represent
the largest group of psychologists, and experienced a rapid
growth in their number between the 1960s and the 1990s with
the expansion of mental health provision and the growing
awareness of the contribution of clinical psychology to a wide
and diverse range of areas of work (EFPPA, 1997). Indeed, the
31 Member Associations of EFPPA (see below) represent
150 000 psychologists, the majority of whom are clinical
psychologists.
Since the 1990s, in many European countries the emergence
of the specialty of health psychology, with a focus on prevention
rather than treatment, and the promotion of health rather than
a more therapeutic or curative function, has led to attempts to
dene and differentiate a new eld of psychological activity
within the mental health eld. This has been supported by the
WHO commitment to Health for All by the Year 2000; EFPPA
has had three Task Forces, focusing respectively on clinical
psychology, health psychology, and psychotherapy, which have
drawn up a model dening overlap and separate areas of activity
within the health eld, with corresponding commonalities and
differences in education and training (EFPPA, 1997).
Training of Clinical Psychologists
Education and training of clinical psychologists varies in
European countries though, again, there are major regional
groupings. Across Europe, as in other regions of the world, the
education and training period has increased, with moves in
some European countries for doctorate training for clinical
psychologists, and more demanding requirements in all
countries for the internship period. In the United Kingdom,
there is a strong commitment to a scientist-practitioner model:
the clinical psychologist is rst and foremost an applied
scientist or scientist-practitioner who seeks to use scientic
knowledge to a benecial end (Marzillier and Hall, 1990). This
commitment also characterizes the Nordic countries which
have been inuenced substantially by the USA, and also by the
UK. These countries would sign up to the denition that:
clinical psychologists share several common attributes. They are
psychologists because they have been trained to use the guidelines of
knowledge of psychology in their professional work. They are
clinicians because they attempt to understand people in their natural
complexity and in their continuous adaptive transformations . they
are scientists because they utilize the scientic methods to achieve
objectivity and precision in their professional work. Finally, they are
professionals because they render important human services by
helping individuals, social groups, and communities to solve
psychological problems and improve the quality of life.
Kendall and Norton-Ford, 1982: p. 4

This model is also espoused by Spanish clinical psychology
where Belloch and Olabarria (1994) state that clinical
psychology training is very similar to that proposed in the
1940s, in the famous Boulder Conference, organised by the
APA. In France, where there is a strong clinical psychoanalytic
tradition, there is less of a commitment to the Boulder model,
and more of a philosophical or hermeneutic tradition in rela-
tion to education and practice.
However, since 1957 when the Treaty of Rome provided the
foundation for the European Community (later Union), there
have been requirements on individual countries (states) to
provide procedures for the mutual recognition of psycholo-
gists qualications across national boundaries (see
McPherson, 1988). Wider moves within the European Union
such as the Bologna Agreement, which was signed by 29
Ministers in 1999 and commits them to greater convergence in
terms of university degree structures, mean that even within
Europe there is likely to be greater similarity in terms of
structures of education and training for clinical psychologists.
Professionalization of Clinical Psychology
The period since the 1950s has seen a greater professionaliza-
tion of clinical psychology in all European countries, with the
development of codes of ethics (Lindsay, 1996) and increased
regulation and laws for clinical psychologists (Lunt, 2000)
across European countries. These political and professional
developments have been supported by EFPPA which has
brought together clinical psychologists from all over Europe to
work on the professional aspects of practice at a European level
and to support individual European countries seeking to
develop their ethical codes, laws protecting the title of
psychologist, and education and training in clinical
psychology.
Organization of Clinical Psychology
It is also possible to trace the history of clinical psychology
through its organization in Europe (Gilgen and Gilgen, 1987;
Lunt, 1998). Many European countries founded scientic
societies for psychologists in the early twentieth century whose
purpose was to foster research and psychological science. At the
time of World War II, separate professional associations to
meet the needs of professional psychologists, often mainly
clinical psychologists, were founded in a number of European
countries. These associations had, as a focus, issues concerning
professional practice and emerged in some countries as Trade
Unions, negotiating salaries and terms and conditions of work
for clinical psychologists as well as wider professional issues
such as regulation, legislation, and ethical codes. In 1981, at
a time when the provisions of the European Community
demanded that European member states encourage mobility of
professionals across Europe, the European Federation of
Professional Psychologists Associations was formed to bring
together professional associations in Europe and to collaborate
on matters of common professional concern.
EFPPA currently has 31 member associations representing
all the countries of the EU, all other countries in western
Clinical Psychology in Europe, History of 875
Europe, and a growing number of member associations from
central and eastern Europe. The federation provides a unique
opportunity for comparison between the practices of different
European countries and a forum for discussion and debate of
important issues. The formation of EFPPA in 1981, when
matters of mobility and mutual recognition were becoming
more pressing, was due to a realization by psychologists and
psychology associations of member states that a federation
would provide a professionally and politically useful way to
move forward and to begin to develop common policies in this
area. Clinical psychologists, in particular, were faced with the
growing prospects of mobility between countries in the Euro-
pean Union, and the implications of the Treaty of Rome that
provided the foundation for the European Community in
1957.
As a federation of Professional Psychology Associations
representing around 150 000 professional psychologists in
Europe, EFPPA spends most of its efforts on clinical psychology
and clinical psychologists, also the largest group of psycholo-
gists within Europe (as in the rest of the world). In many
countries psychology has become one of, if not the, most
popular subjects to study at university. The majority of students
studying psychology aspire to become clinical psychologists,
and for this reason, in many European countries, there is an
oversupply of qualied practitioners. Many countries now
operate a so-called numerus clausus, either at the start of the
psychology study, or during the study. This controls the
numbers in training. In the United Kingdom, where specialist
training in clinical psychology is funded by the NHS where
the vast majority of clinical psychologists work the number of
trainee posts is strictly limited and is planned according to
stafng needs in the different regions of the country. In other
countries, where there is a tradition of predominantly private
practice in clinical psychology, there are large numbers of
qualied psychologists unable to nd work. In all European
countries, the ratio of female to male students is between 6:1
and 3:1, leaving the profession in danger of becoming an
almost feminized profession in the future (Schorr and Saari,
1995). There has also been some difculty in many countries
in recruiting students from the range of ethnic groups repre-
sented in Europes increasingly multiethnic population. This
clearly has implications for the clinical treatment of different
client groups.
The Future
As new elds of practice in the health eld evolve, in particular
health psychology, there are pressures on clinical psychology.
For example, in some countries it has been said that there may
no longer be a eld of clinical psychology, since there are strong
moves toward a broader eld of health psychology and
a greater focus on preventive work. These newer areas, such as
health psychology, neuropsychology, and forensic psychology,
are leading to greater specialization within and outside clinical
psychology. Although European countries differ in the extent
and nature of their specialisms within the health eld, there is
an increasing trend for specialization and demands for higher
qualications. In one respect, psychologists working within the
health system could be said to be becoming more generic,
876 Clinical Psychology in Europe, History of
while on the other hand there are increasing specializations
within this eld of work.
Summary
The brief 50-year history of clinical psychology in Europe has
seen an enormous increase in numbers both of students and of
practitioners, such that the majority of psychologists are now
clinical psychologists. This rapid professionalization has been
accompanied by higher qualications, greater regulation, the
development of ethical codes, and all the characteristics of
traditional professions. However, as the number of clinical
psychologists increases, and the question of mobility across
Europe becomes more pressing, there will be increasing
attempts to develop more common frameworks and standards
for education and practice; the challenge will be to achieve
a balance between allowing individual countries their own
autonomy which reects their differing history and culture
(subsidiarity as it is called), and developing more common
agreed frameworks of practice which reect a possible future
federalization of Europe.
See also: Clinical Psychology in North America, History of;
Freud, Sigmund (18561939); Psychoanalysis, History of;
Psychotherapy, History of: Psychiatric Aspects; Training in
Clinical Psychology in the United States: Practitioner Model;
Training in Clinical Psychology in the United States:
ScientistPractitioner Model.
Bibliography
Belloch, A., Olabarria, B., 1994. Clinical psychology: current status and future pros-
pects. Applied Psychology: An International Review 43 (2), 193211.
Drenth, P.J.D., Sergeant, J.A., Takens, R.J., 1990. European Perspectives in
Psychology, vol. 2. Wiley, Chichester, UK.
EFPPA, 1997. Report to the General Assembly of EFPPA of Clinical Psychology Task
Force. Available from EFPPA secretariat.
Eysenck, H., 1990. Clinical psychology in Europe and in the US: development and
future. In: Drenth, P.J.D., Sergeant, J.A., Takens, R.J. (Eds.), European
Perspectives in Psychology, vol. 2. Wiley, Chichester, UK.
Gilgen, A.R., Gilgen, C.K. (Eds.), 1987. International Handbook of Psychology.
Greenwood Press, New York.
Kendall, P.C., Norton-Ford, J.D., 1982. Clinical Psychology. Scientic and Professional
Dimensions. Wiley, New York.
Llewelyn, S.P., 1994. Assessment and therapy in clinical psychology. In: Spurgeon, P.,
Davies, R., Chapman, A. (Eds.), Elements of Applied Psychology. Harwood
Academic Publishers, Chur, Switzerland.
Lindsay, G., 1996. Developing an ethical psychological practice. In: Georgas, J.,
Manthouli, M., Besevegis, E., Kokkevi, A. (Eds.), Contemporary Psychology in
Europe. Hogrefe & Huber, Gttingen.
Lunt, I., 1998. Psychology in Europe: challenges and opportunities. The European
Psychologist 3 (2), 93101.
Lunt, I., 2000. Psychology as a profession. In: Pawlik, K., Rosenzweig, M. (Eds.), The
International Handbook of Psychology. Sage, London.
Marzillier, J., Hall, J., 1990. What Is Clinical Psychology?, second ed. Oxford University
Press, Oxford, UK.
McPherson, F., 1988. Psychologists and the EEC. The Psychologist 9, 353355.
Pawlik, J., 1996. The situation of the psychologists in Eastern European countries
today. In: Georgas, J., Manthouli, M., Besevegis, E., Kokkevi, A. (Eds.), Contem-
porary Psychology in Europe. Hogrefe & Huber, Gttingen.
Poortinga, Y., 1996. Cultural diversity in Europe: extrapolations from cross-cultural
research for professional psychology. In: Georgas, J., Manthouli, M.,
Besevegis, E., Kokkevi, A. (Eds.), Contemporary Psychology in Europe. Hogrefe &
Huber, Gttingen.
Pilgrim, D., Treacher, A., 1992. Clinical Psychology Observed. Routledge, London.
Schorr, A., Saari, S. (Eds.), 1995. Psychology in Europe. Hogrefe, Gttingen.
Sexton, V.S., Hogan, J.D. (Eds.), 1992. International Psychology. Views from Around
the World. University of Nebraska Press, Lincoln & London.
Sexton, V.S., Misiak, H. (Eds.), 1976. Psychology Around the World. Brooks/Cole,
Monterey, CA.