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Until recently, Quebec was the first to have regulated the practice of psychotherapy through law adopted in 2009. The law emerged following 30 years of efforts and inter-professional discussions that led to a consensus by an expert committee presided by Dr Jean-Bernard Trudeau in 2005. In this essay, Dr Jean-Bernard Trudeau, general practitioner, and two psychiatrist and psychologist colleagues, who have participated to the expert committee or have been involved more recently in the implementation of law no 21 in Quebec, relate the main landmarks and moments in the regulation of the practice in psychotherapy following this inter-professional consensus that was translated in the law 21. They relate particularly the last ten years that have led to the adoption of law 21 in 2009, following two parliamentary commission after the Trudeau report. They underline how the practice of psychotherapy is integrated in the professional system and submitted to strict regulation. It includes regulations for obtaining the license of psychotherapist and for maintaining competence. Guidelines emerging from continuous inter-professional discussions for the application of the law and of its regulation in the public and private sectors are produced by the Quebec Professions Office. The definition of psychotherapy that was reached by consensus is not limited to the treatment of mental disorders and is distinguished from other intervention in the area of human relations. Continuous training is mandatory and is implemented on one hand by the Order of the psychologists for the psychologists and other professionals practicing psychotherapy and on the other hand the College of physicians for physician practicing psychotherapy. The authors finally described the interdisciplinary advisory council for the practice of psychotherapy that the legislator has foreseen as an external mechanism to insure the conformity of regulation with the spirit of the law and to give opinions to the various professional orders.

Keywords: psychothérapie, traitement psychologique, évaluation initiale rigoureuse, formation continue obligatoire, conseil consultatif interdisciplinaire, psychotherapy, psychological treatment, rigorous initial evaluation, mandatory continuous education, interdisciplinary advisory board

Objectives To explore the level of satisfaction among residents regarding their training in psychotherapies, the interest they have in these therapies, and their wishes in the area of training.Methods A survey including both a quantitative and qualitative methodology was undertaken among 869 residents out of 1,334 enrolled in the psychiatric residency program. In the 2009-2010 academic year. The survey included five themes of study: theoretical academic training, psychoanalysis, training in institutes outside the university, supervision, wishes in the area of training. This article presents results from the qualitative sociological survey using a semi-guided interview with 27 residents. Their conceptions and practice in the field of psychotherapy, and its place in psychiatric practice were questioned in-depth.Results The vast majority of residents were interested in psychotherapy, but simultaneously dissatisfied with the training they had received. Almost half opted for various sorts of extra-curricular training, costly in time and money. The psychotherapeutic orientations among these residents were varied, and a plurality of methods and theoretical approaches was advocated both for reasons of having a wider viewpoint and good practice in psychiatry, and because the residents considered this plurality to be an essential component in their training. They saw psychotherapy as a medical practice, and considered that it is the responsibility of the psychiatric discipline to provide training in psychotherapies.Conclusion The absence of any real training in psychotherapies for residents in psychiatry is damaging for care quality in psychiatry. The recent creation of a protected title of psychotherapist for psychiatrists without the need of additional training suggests an urgent need to develop a training course. A proposal by the authors should be discussed in light of reflections and proposals already underway in other countries.

Keywords: formation, psychothérapie, psychiatres, France, training, psychotherapy, psychiatrists, France

The article gives an overview of psychological psychotherapy in Switzerland. We describe the legal status of psychological psychotherapists, their position and role within the Swiss health-care system, the professional context they practice in, the format of psychotherapy training, various employment models of psychological psychotherapists, as well as the currently insufficient reimbursement situation of psychological psychotherapy. Reimbursement by mandatory health insurance is highlighted as the most important current challenge psychological psychotherapists face in Switzerland, on their way to be fully acknowledged as independent providers of psychotherapy.

Keywords: psychothérapie, Suisse, psychotherapy, Switzerland

SummaryThe analysis presented in this paper consists of a questioning of the "character" of psychotherapy. Elements which make it possible to partially establish this character were isolated from twenty-five interviews carried out with therapists. Two main groups of elements were constituted in this way. The first group can be linked to the various theories claiming that psychotherapy is the "product of a society", at the basis of which we can trace a logic of production which can be formulated in terms of work and of supply and demand. The second group throws light on the nature of the "product" achieved in the framework of this relationship; it is a category which makes it possible to isolate from reality that which constitutes the element around which the situation can be constructed - the individual. This group can be associated with the theories claiming that psychotherapy is a mechanism of the production of society. In conclusion, this analysis is the starting point for reflections on the entrenchment of psychotherapy in a system of social relationships and on the theoretical and methodological problems raised by the analysis of this phenomenon from the point of view of its social qualities.

Introduction In Quebec, mental disorders affect one in five people in their lifetime. Anxiety and depressive disorders are the main common or moderate mental health disorders. They affect both the individuals with the disorder and the people around them and have substantial economic impact. Psychotropic drugs are the treatment option most often proposed to patients presenting with moderate mental health disorders. Psychotherapy is nevertheless a treatment that should be given consideration.Physical and financial access to psychotherapy remains limited because only one third of professionals qualified to offer it practise in the public sector, and the coverage and reimbursement policy for this service is very restricted. In order to improve such coverage, the Ministère de la Santé et des Services sociaux (MSSS) mandated the Institut national d'excellence en santé et en services sociaux (INESSS) to assess the evidence on the effectiveness of psychotherapy compared with those of pharmacotherapy for the treatment of adults with anxiety and depressive disorders.Methods An update of a review of recent and good quality literature was conducted through a review of systematic reviews dealing with psychotherapy compared to pharmacotherapy in the treatment of anxiety and depression in adults. The period covered included 2009 to 2013. The literature search strategy, modelled on that of the reference review, was applied to Medline, Cochrane Library, CINAHL, Web of Science and health technology assessment agencies. Exploration of the grey literature focused on information available on the websites of various health assessment organizations.Results The level of scientific evidence overall was judged to be of moderate to high quality. In general, the data showed no significant difference between psychotherapy and pharmacotherapy in terms of symptoms reduction in patients with moderate anxiety or depressive disorders, indicating comparable effectiveness of these two modes of treatment. However, the benefits of psychotherapy lasted longer after the end of treatment than those of medication. Psychotherapy therefore offers better protection against relapse. Furthermore, the combination of psychotherapy and pharmacotherapy is more effective than psychotherapy alone in severe or chronic cases.Conclusion Psychotherapy appears to be as effective as pharmacotherapy in the treatment of adult patients with moderate anxiety and/or depressive disorders. Moreover, the beneficial effects of psychotherapy last longer after the end of treatment with a lower likelihood of relapse.

Keywords: efficacité, psychothérapie, pharmacothérapie, troubles anxieux et dépressifs, effectiveness, psychotherapy, pharmacotherapy, anxiety and depressive disorders

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

SUMMARYThis article deals with the notion of supportive psychotherapy. This overall approach is often discredited even if, in the mental health network, it is widely used. Therefore, it appears important to analyze this approach and to define the idea of support in psychotherapy; this article reviews secondly when it is opportune to offer such an approach, what are the techniques related to this approach and finally, what are the results we can hope for? This article wants to initiate a reflexion while integrating some readings on the matter and using a clinical experience evolved from a practice in sector psychiatry.

Objective This article is an overview of the creation and development of www.psychopap.com, a website designed to provide psychotherapy-related material to patients and clinicians. This website, unveiled in 2019, is affiliated with the Hôpital en santé mentale Albert-Prévost.Methods To illustrate the pertinence of this initiative, the article briefly reviews current literature on self-therapy and psychotherapy training before presenting the main components of www.psychopap.com.Results Literature shows that psychotherapy is a well-accepted and efficient treatment but that limited resources hinder its use. Self-therapy, mainly delivered through technology, has been described as an interesting way to improve access to psychotherapy for patients. Moreover, technology can also play an important role in psychotherapy training, with many e-programs showing promise. In the light of those results, www.psychopap.com offers self-therapy resources (brochures, infographics) for patients as well as training material for future or budding therapists (introduction guides, testimonials from therapists, videos, lists of textbooks, and courses).Conclusion This article discusses how www.psychopap.com can contribute to the knowledge transfer in order to improve access to psychotherapy for patients and to offer learning possibilities to trainees in psychiatry and other clinicians. In the current healthcare system, innovative ways of delivering and teaching psychotherapy are crucial to improve access.

Keywords: Hôpital en santé mentale Albert-Prévost, psychothérapies, modèles d'apprentissage, autothérapie, autosoin, transfert des connaissances, enseignement, technologies, Hôpital en santé mentale Albert-Prévost, psychotherapy, learning models, self-therapy, self-help, knowledge transfer, teaching, technology