Relational Psychotherapy in Sweden

At  the 2011 IARPP conference in Madrid, I visited a very interesting panel called “Every Culture Creates the Psychoanalysis it needs: Culture and the Transformation of Psychoanalysis,” where panelists from all over the world presented the historical development and the present situation for psychoanalysis in general and for the relational turn in particular.

One of the panelists was Swedish professor, Rolf Holmqvist, from the University of Linköping. He described the present conditions for Psychodynamic Psychotherapy and Psychoanalysis in our  country in accordance with the situation and view of the Swedish health care system. Professor Holmqvist also said that the Swedish psychoanalysts´ organization is not authorized to issue diplomas anymore and the result is that no new psychoanalysts can be registered in Sweden. He also said that the analysts in Sweden, in common, have showed little or no interest in relational psychoanalysis. He reported about the situation in psychiatric health care where most economic resources go to CBT- therapy.

In my opinion, professor Holmqvist gave us a rather pessimistic view, certainly a correct one from his position as a professor at the University and as a representative of the public sector. He also gave us a correct description concerning psychoanalysis.  However, if we turn to psychotherapy we find a much more optimistic situation. Here I would like to add some things to this picture to make it more complete. In this report I will try to describe the present situation of relational psychotherapy in Sweden.

In Sweden, we are about 9,000,000 people. There are about 5,000 psychotherapists. We have an organization for relational psychotherapists with about 130 members, SFRP, Swedish Association for Relational Psychotherapy, founded in 2002. In comparison to the small population, this is not so bad!  Most of our members are clinicians. Few are researchers or connected to a University. Nevertheless, at the University of Linköping, there are training programs for relational psychotherapists, so that will probably change. In Stockholm we have the SAPU Institute (The Stockholm Academy for Psychotherapy Training), which started the first Relational Training Program in Sweden many years ago and is currently developing affect phobia therapy and a more integrative perspective towards CBT, to mention some work in progress. Every year about twenty new students begin a three year postgraduate training program at SAPU. These trainings lead to authorization as a psychotherapist.

Our association, SFRP, is not an IARPP local chapter according to the rules for being a local chapter, but we follow closely what is going on in IARPP and feel ideologically connected, though we also develop and add theory in accordance with our psychotherapeutic culture and needs.  Theoretically one could say that we started in the beginning of this century from a  base of Self Psychology, ORT, and Attachment Theory.  In addition,  many of us were studying Mitchell and all others in the Relational group. Gradually, we have been studying more Affect Regulation theory and there is also more influence from neuroscience than earlier. Affect focused therapy forms have attracted considerable interest among relationally oriented therapists. CBT-methods as Compassion Focused Therapy and mindfulness-based therapy influence some of us. There has been an ongoing discussion for years at our meetings on the theme --“What is relational psychotherapy?” concerning both theory and clinical practice. We find this vital and aids in the development of  our clinical work.

From the beginning our members have paid a low annual fee, but sufficiently high to cover for our costs at meetings. At least twice every term we meet and listen to lectures with authors of new relational literature, study therapy session-films and have discussions on special subjects concerning the relational perspective. SFRP is often a co-organizer together with SAPU when arranging conferences with international lecturers. To mention some names:  Paul Wachtel, Leigh Mc Cullough, Susie Orbach and Bruce Wampold have visited us during the recent years.

As a local chapter representative I and some colleagues have made a survey about joining IARPP as a formal local chapter and we found that there was  low interest. One reason that many of our members don´t want to be members and join IARPP is that they think they already get what they need from SFRP. I realized when talking to local chapter colleagues in other countries, that we are privileged as most psychotherapists can afford our fees and charges for local conferences. The need for contributions one could get as a Local Chapter is not so urgent, and the concerns about the bureaucracy of getting help to start one prevail. Some of us frequently visit the IARPP annual conferences, whereupon we write our own summaries that we present to our colleagues at our meetings. Some of those who are IARPP-members, by now 26 persons, say they have the opportunity to participate or follow the web colloquia, which is really a rich source of knowledge and experience.

There is also a growing interest in psychotherapy research among psychotherapists here in Sweden and, as Professor Holmqvist also mentioned at the Madrid panel, the health authorities  only want to make use of evidence-based methods, and most research of that kind is in CBT. That may be one reason why therapists get more engaged in research studies and evidence-based methods. But, to quote the Madrid Panel, it may also be that there is a different tradition as there are few psychoanalysts among us, and more  psychologists, social workers, physiotherapists and others who have become psychotherapists, probably out of what our culture needs.  That is a psychotherapy for everybody, not so much only for an educated middle class, as in the early days.

When I was writing this I came to think about how well the relational perspectives suit our culture and connect ideologically to the old democratic roots and equality-based traditions in our country. The equal but asymmetric encounter with “the other,” the possibility to negotiate, to feel intersubjectively involved, not objectified, alludes very much  to our unique ,“Folkbildning” -- adult educational traditions rooted in the 19th Century’s demand from social movements to participate in the development of society. (These thoughts might be developed in another article.)

I think and hope that we all create, consciously and unconsciously, the pychotherapy and psychoanalysis we need in harmony with, or opposition to, our different traditions. I have learned from meeting colleagues at the IARPP congresses, that the similarities and differences in our cultural contexts help me to understand my own work better, how I create and transform relational practice in relation to my own and my clients´ cultural context.

Anna Christina Sundgren, M.A., Psychotherapist, former Chair of SFRP, Swedish Association for Relational Psychotherapy and member of IARPP Local Chapter Committee

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