1. The word "European" - in this context - covers, not only the 27 members of the European Union, but also the other members of the European Economic Area, [1] and any other country that allies itself under the general heading of being "European", especially with respect to the profession of psychotherapy; thus psychotherapists in Switzerland, Russia and the Ukraine have currently chosen to be seen within this 'European' heading. [2] However, to date, those psychotherapists working in Turkey, Syria, Israel, Palestine and various North Africa countries, irrespective of their education, training or origin, have not generally seen themselves yet to be working within such a "European" context, (though some in Israel may consider themselves to do so), mainly for historical, geographical, cultural and political reasons. With the entry of other cultures, there is also the potential for a hegemony of 'European' values. [3]
  2. "Psychotherapy" [4] is defined as a professional activity usually carried out or practiced by psychotherapists and some other professionals (viz: psychiatrists, clinical psychologists, (sometimes) social workers & psychiatric nurses, and also trained and experienced 'lay' people, etc.). There are many different definitions: two or three are given in Appendix 1. It is also defined much more widely (with 20 different definitions) in Appendix 2.[5] These different definitions are very important as each one can provide a totally different background, or ethos, to the work of psychotherapy.
  3. The word "Psychotherapist" (in this document) refers to anyone who practices psychotherapy professionally. This can, and frequently does, include qualified clinical psychologists, psychiatrists, counsellors, nurses, social workers, ministers, as well as ‘lay’ people, etc.; most of whom have undertaken an extensive professional training in psychotherapy, and/or who have been practicing psychotherapy professionally, either as part of their paid employment, voluntarily, or privately. Historically, some people have had a considerable training in psychotherapy (and thus can consider themselves as 'psychotherapists'), and others (often already trained professionals in another related field) have had less specific training in psychotherapy: they may not therefore technically 'be' a "psychotherapist", though they may 'do' psychotherapy very professionally.
  4. The "professional practice" of psychotherapy implies that the person undertaking it has the usual degree of personal maturity, impartiality, ethical behaviour, proper attitude, competency, and informed knowledge and experience that one might be reasonably expected from any practicing professional:
    1. This means that they have usually engaged in an extended amount of tertiary education and professional training and qualification. In many cases, and increasingly so, this professional training and qualification is considered to be, at least, the equivalent of a university master’s degree. The professional training also includes experiential training and extended supervised practice. This professional training (including the relevant 1st degree) extends over a total about 7 years of education and training after the age of 18. There is a clear assessment or examination at the end of the professional training, resulting in a qualification, certificate or diploma. These professional qualifications are designed to fit within the European Commission's European Qualifications Framework (EQF) at Level 7 (see here).
    2. It also implies that, post-qualification, the professional psychotherapist is working in a safe and healthy fashion, in a professional manner, within the regulations of the country, paying appropriate fees and taxes, registered with or accredited by appropriate professional bodies (where they exist), practicing according to an established and accessible code of ethics, working within (fitness to) practice standards, and being generally accountable, keeping proper records, as well as being open to conforming to an appropriate complaints or disciplinary procedure.
    3. It further implies that the professional psychotherapist is usually involving themselves in on-going professional and peer activities; staying informed about developments in the ‘field’; doing additional training where appropriate (as for a new speciality, or with a different client group); and engaging in some degree of continuous professional development.
    4. This 'professional practice' also implies that, at qualification or immediately post-qualification, the professional psychotherapist has the possibility of joining an appropriate national and/or European professional association in psychotherapy (for a list of these see the member organisations on the EAP website).
  5. 'State-regulation': In any particular European country, the provision or accessibility of psychotherapy usually includes a combination of the above definitions, and psychotherapy may or may not be ‘state-regulated’. [6] There is currently a very wide differentiation as to the degree of state involvement across the 40 or so countries in Europe where psychotherapy is practiced, although there is an increasing trend towards some form of state-regulation, registration, state involvement, or state-recognition. [7], [8]
  6. 'Professional Association' In many European countries, there is, at least, one professional association of psychotherapy for practitioners in that country, and, separately, many of the 'mainstreams' and 'modalities' of psychotherapy also have a European-wide professional association for their practitioners. These professional associations provide a degree of recognition (accreditation) and internal regulation (including ethics committees to hear complaints), as well as supporting the practitioner professionally, running conferences and seminars, producing journals, etc. They are increasingly connected with (a member organisation of) the EAP, and largely support the 1990 Strasbourg Declaration on Psychotherapy[9], and many of the above perspectives.
  7. 'Mainstreams', 'modalities' and 'methods': There are very many different ways of defining and classifying all the different psychotherapies (sometimes estimated to include between 400-600 different types). Within the EAP's European Wide Organisations Committee (EWOC), we have decided upon the following definitions:
    There are significantly different philosophical and practical approaches within psychotherapy that are grouped together into 'mainstreams'. This list of the various mainstreams includes: Psychoanalytic Psychotherapy; Psychodynamic Psychotherapy; Cognitive-Behavioural Psychotherapy; Humanistic Psychotherapy; Systemic Psychotherapy (including Family Psychotherapy); Body-Oriented Psychotherapy; Hypno-Psychotherapy; Transpersonal & Existential Psychotherapy; and Integrative Psychotherapy. In Europe, some countries only recognise 3 or 4 of these mainstreams.
    Within these mainstreams, there are different 'modalities': for example: the mainstream of psychoanalysis, containes several different 'modalities' of psychoanalysis; Freudian psychoanalysis; Analytical Psychology (Jungian psychoanalysis); Lacanian psychoanalysis; Adlerian psychoanalysis; Kleinian psychoanalysis; etc.
    Most of the modalities recognise that they have a similar basic philosophical way of working as the other psychotherapy modalities in the same mainstream, and that they have significantly different perspectives to those in other mainstreams. Some modalities also relate to the philosophies in more than one mainstream, so there is not a simple one-to-one mapping. Some countries do not have a word in their language for 'modalities' and therefore use the word 'approach' or 'method'.
    'Methods' are now generally taken to mean different techniques, interventions or ways of working that - by themselves - do not constitute a full psychotherapy modality: one such technique, recently popularised, is EMDR; another is Mindfulness Practice. A method can develop of grow, with extra components, into a modality: for example, hypnotherapy is a method, sometimes used by other psychotherapists, which has expanded into the modality, or even the mainstream of Hypno-psychotherapy.
  8. 'Competency': There are subtle but significant differences between the definitions of 'competence', 'competencies', 'competency', 'skill', 'craft' and 'capability'. These are defined in more detail in the Glossary (see Appendix 7).
  9. "Problems of Competence" indicate an interference in professional functioning; can be observed though maladaptive patterns of behaviour or performance, or via critical incidents; may occur when performance fails to meet expected benchmarks, repeated patterns of mistakes occur, or as acquired incompetence or impairment in the form of outdated knowledge and techniques, or diminished functioning; can be categorised based on: - origin (situational, developmental, problematic personality and interpersonal dynamics); - severity and chronicity (length of time); - potential for remediation; - manifestation: may be exhibited when individuals; - do not have adequate training, education, or experience opportunities. People with 'problems of competence' are unable to acquire professional skills and reach an accepted level of competency (performance problem); - are unable or unwilling to acquire and integrate professional standards into their behaviour; - or fail to respond to feedback or remediation efforts; - or do not continuously grow, change, or make progress.
  10. "Occupational Standards" (sometimes called 'National Occupational Standards' or 'Professional Competencies') are defined in order to act as an aid and support to the information, knowledge and understanding held by the general population: this includes medical practitioners; specialists; mental health commissioners; politicians and civil servants; trainers and education providers in all forms of psychological therapies; clinical and health managers and supervisors; psychological practitioners; service users; carers; and to wider communities nationally and internationally. They provide an essential ‘benchmark’ that articulates what can be expected from all professionals (in this instance: psychotherapists; psychotherapists of different traditions, and in different settings), and they can be used as a starting point from which to develop any future services and practice.
    1. "Benchmarks" or "Performance Indicators" reflect the standards for measurement of performance that can be used for comparison and to identify where needs for improvement exist. They can identify a ‘task’ or ‘performance indicator’, which can be used to capture a minimal level of each competency for each stage of professional development.
    2. "Levels" reflect the level of competencies within a particular profession: e.g. a support worker will have different (and probably fewer) competencies - and thus be at a lower 'level' - than a skilled professional, and different from from a specialist, or a director of services for that profession.
  11. "Quality" is much more difficult to assess as there are no commonly agreed scientific criteria for quality assessment in psychotherapy - yet. Quality involves - essentially - a collective set (a combination) of personal or professional preferences and/or judgements without any clearly defined criteria. There are very different definitions of quality. It is hoped that - through a combination of professional training, professional competencies, patient/client satisfaction questionnaires, successful outcome studies, continuous professional development, etc. - quality is eventually achieved.
  12. Glossary of Terms: There are many different and specialist 'terms' of reference within psychotherapy. Many people may have heard of "transference" and "counter-transference"; we often use the word "intervention"; but some words are less common like "introjection". These terms are originally from within psychoanalysis and psychodynamic psychotherapy. Gestalt psychotherapy and Psychodrama use the concept of an "empty chair"; Body Psychotherapists speak of "grounding"; etc. We therefore considered that there has to be a Glossary of Terms, as an Appendix: and this is in the process of being developed (see Appendix 7).

[1] There are currently 50 sovereign states in Europe, with 5 countries (Azerbaijan, Georgia, Kazakhstan, Russia and Turkey) being considered as also belonging to Asia; there are also about 7 non-sovereign territories and regions and 4 partly recognized with (at least) 2 unrecognized republics, territories or regions.
[2] The national organizations for psychotherapy in these countries have become National Umbrella Organisations (NUO), or National Awarding Organisations (NAO), within the European Association of Psychotherapy (EAP).
[3] This is a potential 'minefield'. The last 2,000-3,000 years of European history has seen a wide diversity of waves of immigration, major and minor wars, varying religious beliefs, different languages and ethnicities, the rise and fall of several empires, and massive social, political, cultural and economic changes: all complicated by the use of many different languages. What may be clear, natural and self-evident to one person can easily be misunderstood, or be alien, heretical, offensive, or even a taboo to their neighbour. Multiculturalism and plurality can also be seen to be almost as oppressive as tradition, dogma, repression or control. Psychotherapy, as a profession, is almost uniquely suited to be a forum to help explore some these residual social difficulties and tensions, especially if psychotherapy is being practiced without any particular allegiance or mind-set. Cultural and social sensitivity is a large part of a professional psychotherapist’s training. It is also enshrined in the EAP's Statement of Ethical Principles; see Appendix 6.
[4] See the EAP 2009 Definition of Psychotherapy: Template for a Psychotherapy Law: EAP website: ; or Appendix 5.
[5] See Young, C. (2011). "20 Different Definitions of Psychotherapy." International Journal of Psychotherapy, Vol. 15, No. 1, February 2011; or a synopsis in Appendix 2.
[6] It is noted that currently there are about 8 European countries where there is a law, or a form of state-regulation, about psychotherapy (These are: Austria, Finland, Germany, Italy, Lichtenstein, Netherlands, Sweden and the UK (but only for the title ‘Child Psychotherapist’ in the NHS)). Some of these laws or regulations are fairly 'open', and some of them view 'psychotherapy' as an activity that, in that country, should only be done by psychologists and psychiatrists, or it restricts the title of 'psychotherapist' and or the activity of 'psychotherapy' only to those people with specific psychological or medical or certain other qualifications. (Austrian Health Institute) However, it should be noted that some of these 'national' laws or restrictions may contravene the principle of the free movement of labour across the European Union, or may contravene the European Directive 2005/36/EU, so it might just be a matter of time before they are challenged successfully in the courts. There have already been a couple of successful cases challenging these laws in Italy & Germany.
[7] See EAP Conference proceedings on "The legal status of psychotherapists from a professionals and clients’ protection point of view in the European Union": Vienna, February, 2010, Downloadable from
[8] Ginger, S. (2011). The European Certificate of Psychotherapy (ECP) and the Training of Psychotherapists. International Journal of Psychotherapy, Vol. 15, No. 1, February 2011.
[9] 1990 Strasbourg Definition of Psychotherapy: see EAP website:; or Appendix 1.
[10] Sperry, L. (2010). Core Competencies in Counseling and Psychotherapy. New York: Routledge, pp. 4-6.

Working Group on Professional Competencies: