INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 65 (4) 2015 SEGERCRANTZ GROUP PSYCHOTHERAPY IN FINLAND
Group Psychotherapy in Finland ULRIKA SEGERCRANTZ, M.A.
ABSTRACT This article describes the development of group psychotherapy in Finland as a treatment in the 1950s, 1960s, and 1970s. Different theoretical preferences split the training programs into two; both are now trying to survive in a psychotherapeutically changing landscape. All training programs have been transferred to the universities, but a lack of interest in, and knowledge about, group psychotherapy has resulted in fewer students choosing this program. This may result, in the future, in even less knowledge of, and research in, group dynamics in Finland.
One can easily understand that crises often are the source of
creativity and also create a need for new tools to work with and to relate to new phenomena. This is how it was in Europe after the Second World War and also in Finland after the Finnish wars against Russia 1939–1945. The young doctors and psychiatrists had a need to expand and introduce new ideas on how to treat traumatized patients, which numbered too many after the wars. During the war and in the 1950s, psychiatry was not very advanced in Finland, and many ideas about treatment had their roots in Germany’s definitive methods, with an idealized picture of human resources and possibilities. The common assumption was that patients only need discipline, and the traumatized were often seen as weak. The word trauma was not even used in the 1930s and 1940s in Finland, and soldiers had very limited pos-
Ulrika Segercrantz is a psychotherapist, group psychoanalyst, supervisor, and trainer in Helsinki, Finland.
535
536 SEGERCRANTZ
sibility for compensation from the state for lost health or other related problems. Bringing new ideas from the rest of the world changed the picture slowly to a broader understanding of the forces in human behavior (Kivimäki, 2013). The times after crises are often filled with hope and positive thinking, and this may have resulted in the more humanistic approach starting to emerge. Maybe Finland’s hunger for new thoughts also was due to its relatively isolated northern position, mainly surrounded by water, with a powerful neighbor in the east. Finland is a small country with only about five million people, yet there are two group psychotherapy training programs, one based on Bion and the Tavistock tradition and the other on Foulkes’s group analytic model. HISTORY OF GROUP PSYCHOTHERAPY IN FINLAND
The interest in working with groups began in the 1950s, with Finnish colleagues bringing new ideas from all over Europe. The first experiments with groups started in mental hospitals. At the end of the 1950s, psychotherapy groups were finally introduced as part of the treatment in Kellokoski hospital (Kaila, 1998). At that time, group theory and a broader way of thinking still did not have strong support. However, Henrik Carpelan, a Finnish psychoanalyst, brought Tavistock methods to Finland and began to teach an understanding of group dynamics in the mental hospital of Lapinlahti in Helsinki starting in the late 1960s (Arppo, Pölönen, & Sitolahti, 1996; Pölönen & Sitolahti, 2006). Finally, when the Finnish Group Psychotherapy Association, today named Finnish Group Psychotherapy, was born in the 1970s, group psychotherapy was accepted as a psychotherapy treatment among others. And when at about the same time, Bion’s Experiences in Groups (in Finnish, Kokemuksia ryhmistä; 1979) and other articles were translated into Finnish, it became possible to start the first Finnish group psychotherapy training with a Bionian approach, which is still very strong in Finland in both group and individual psychotherapy (Arhovaara, 2009). The other branch of group psychotherapy in Finland, group analysis, celebrated its 35th anniversary in Finland in 2014, although the beginning activities were quite modest and the de-
GROUP PSYCHOTHERAPY IN FINLAND 537
velopment went through many phases. It was not until recently that group analysis in Finland became well organized and found its place. Group analysis in Finland started with a one-week seminar held in Jyväskylä in 1979 and was attended by some 20 persons (Salminen, 1997). The idea behind this seminar came from the Finnish psychiatrist Anneli Sorri, whose main consultant was Alice Ricciardi von Platen from Rome. She in her turn had been attending the groups of S. H. Foulkes and Malcolm Pines, arranged by the Group Analytic Society of London. These seminars continued for some years, but without any wider context. There was, however, also a need and an idea within Finnish group analytic circles about a course that could meet on a continuous basis over a longer period of time. But it was not until November 1993 that the first basic course in group analytic training was arranged by the Finnish Mental Health Association (Arhovaara, 2009). The original trainers were Marja-Liisa Lassila, Heidi Lindroos, Raili Rinne, Heimo Salminen, and Ulrika Segercrantz, all group psychoanalysts from the group psychotherapy training program of the Finnish Group Psychotherapy Association. They wanted to promote the Foulkesian way of thinking about group psychotherapy. As a result, the training of group psychotherapists was split between Bion and Foulkes. As in the other group psychotherapy organization founded in the 1970s, there was now a need to find a forum for graduated group analysts as well. The thought was to have a forum where graduates could meet to keep up with professional ideas and to arrange seminars. In October 1998, a meeting was held with the purpose of establishing an association, but the definitive decision was only made as late as January 8, 2003. Up until that point, group analytic training took place apart from the association’s activities and was arranged in cooperation with the Finnish Mental Health Association. TODAY
Psychotherapy training in Finland today is undergoing big changes. Since 2012, there have been negotiations with the medical and psychological university faculties about moving all psycho-
538 SEGERCRANTZ
therapy training to the universities, in cooperation with pre-existing societies. The Finnish Group Analytic Association now cooperates with the University of Helsinki and the University of Oulu in northern Finland. The other organization, Finnish Group Psychotherapy, has had an arrangement with the University of Tampere in central Finland, and training will mainly be based in Helsinki, the capital. The process is not yet complete and many questions remain. The first training programs offered did not have enough participants in either association, so the programs did not begin in 2014. The next training was meant to start in 2015, and it will be interesting to see if there are enough students to make it viable. Budgetary concerns require a minimum number to attend each course. In addition, the cognitive psychotherapy model has taken over in Finland, as in other European countries, and the analytic approach is much less popular. Engaging in any psychotherapy that lasts longer than a year has also been difficult since the economic depression in Finland in the 1990s, when the structures of Finnish society took a new turn (Segercrantz, 2009). THE TRAINING PROGRAMS
The group psychotherapy programs are block trainings (Group Analytic Association) or weekly one-day seminars (Finnish Group Psychotherapy Association). In both trainings, there are theory, clinical seminars, supervision of the trainees’ groups, and an own group psychotherapy experience as a member among others. In a fashion somewhat typical for Finnish group psychotherapy training, consultants and visiting teachers from other countries offer personalized programs. There are, however, similar standards and regulations for all psychotherapy training programs, created by national consensus. For dynamic approaches, this means about 350 theory hours of training, at least 120 hours of reviewing literature and writing essays, 120 hours or more of supervision, and about 300 hours as group leader in the trainee’s own groups. Additionally, from 80 to 250 hours of personal group psychotherapy experience are
GROUP PSYCHOTHERAPY IN FINLAND 539
required, and the training generally lasts from 3 to 4 years. The exact number varies from one psychotherapy training program to another. The largest distinction between the two group training programs in Finland is the application of different theories. Other differences between programs are the inclusion of live infant observation (Finnish Group Psychotherapy), which means time spending observing changes in behavior in the communication between mothers and their infants. The training program of Finnish Group Psychotherapy also includes time as a group observer, which means observing in a patient group with a graduated group psychotherapist, but without talking or having any obligations. This is meant as an opportunity to experience the heaviness of being the object of the projections in a group. The Group Analytic Association, on the other hand, wants to promote the experience of large groups as one component of their training. The anxiety that rises in large groups is seen as a learning experience and also provides an opportunity to become familiar with questions in society from a larger perspective. A training program designed for future individual psychotherapy trainers has been discussed in Turku in western Finland, but has not yet begun. There are no similar plans at the moment for group psychotherapy trainers. Group psychotherapy research in Finland is not as prominent as it could be, but some research was completed. In the 20th century, the following reports included group analytic references: Näätänen, Grandell, Kähönen, and Miikkulainen (2002), Salmela, Näätänen, Tolvanen, and Nurmi (2011), and research by Kähönen, Näätänen, Tolvanen, and Salmela-Aro (2012). The aim is to provide more possibilities to engage students in research when the university is involved in the training program, because more information and evidence-based research is needed to promote group psychotherapy as a functioning model for many psychological problems in Finnish society. The new training programs in the universities will probably be more focused on the tools needed to complete group psychotherapy research.
540 SEGERCRANTZ
GROUP PSYCHOTHERAPY AND FINNISH SOCIETY
The role of groups is important in Finland where the distances are big and resources are limited. The group context could be very important for the Finnish people, as a treatment and also as a forum for learning social skills, accepting differences, discussing war and other traumas, and other social difficulties. This could take place in arranged large groups led by trained group analysts. Groups are needed in Finnish society to promote dialogue between people who are not used to talking to each other in this kind of setting. Although young people are very good at social media, there is a lack of ability among many to mentalize, to reflect, and to be in the here-and-now (Segercrantz, 2009). For this reason, it is important to keep up the work with groups in Finland, although politicians may disagree for economic reasons. Nevertheless, group psychotherapy is accepted as one therapeutic modality among others in a country where health care is available for all Finns. The Social Insurance Institution pays for a part of the costs. Most psychotherapy groups are conducted in private practice, but groups are also utilized in hospitals and outpatient clinics. There are still problems, however, because doctors are sometimes reluctant to refer patients to groups. FINAL THOUGHTS
The individual approach and, at least for the moment, cognitive therapies dominate the mental health landscape. The future will reveal whether there are enough students who seek training in group psychotherapy. If so, there will be good training arranged in at least three of the universities in Finland, providing a perfect base for group psychotherapy to continue and thrive. If not, psychotherapy training at universities will become very one-sided and biased, missing the important possibility given by groups to meet challenges never met in individual psychotherapies.
GROUP PSYCHOTHERAPY IN FINLAND 541
REFERENCES Arhovaara, S. (2009). Ryhmäanalyysin tulo Suomeen [How group analysis came to Finland]. In H. Lindroos & U. Segercrantz (Eds.), Yksilöksi ryhmässä [Becoming an individual in groups] (pp. 249-261). Helsinki, Finland: Gaudeamus, Palmenia-sarja. Arppo, M., Pölönen, R., & Sitolahti, T. (1996). Esipuhe teoksessa; Ryhmäpsykoterapian perusteet [The basics of group psychotherapy]. Helsinki, Finland: Yliopistopaino. Bion, W. R. (1979). Kokemuksia ryhmistä [Experiences in groups and other papers] (L. Syrjälä, Trans.). Espoo, Finland: Oy Weilin&Göös. Kähönen, K., Näätänen, P., Tolvanen, A., & Salmela-Aro, K. (2012). Affects during burnout intervention, changes in goal-related affects. Scandinavian Journal of Psychology, 53, 523-527. Kaila, H. (1998). Terapiaa ryhmätyönä [Therapy is groupwork]. Historiaa Suomesta, Ryhmätyö ry. Helsinki, Finland: Seurakuntaopisto, Mielterveyden Keskusliitto. Kivimäki, Ville (2013). Murtuneet mielet [Cracked minds]. Helsinki: WSOY. Näätänen, P., Grandell T., Kähönen K., & Miikkulainen, R. (2002). Aleksityymisten ja somaattisesti oireilevien työuupuneiden ryhmähoito [Burnout patients with alexithymic and somatization symptoms in group psychotherapy]. Helsinki, Finland: Occupational Healthservice Medivire OY. Balanssi. Pölönen, R., & Sitolahti, T. (2006). Ryhmä hoitaa [The group cares]. Helsinki, Finland: Yliopistopaino. Salmela, K., Näätänen, A. P., Tolvanen, A., & Nurmi, J.-E. (2011). Decrease in burnout during a group psychotherapy intervention. European Journal of Work and Organizational Psychology, 20, 451-466. Salminen, H. (1997). Ryhmäanalyysin perusteet [The basics of group analysis]. Jyväskylä, Finland: SMS-Tuotanto OY/SMS-Julkaisut. Gummerus Kirjapaino. Segercrantz, U. (2009). Ryhmäanalyysin haasteet [The challenges of group analysis]. In H. Lindroos & U. Segercrantz (Eds.), Yksilöksi ryhmässä [Becoming an individual in groups] (pp. 11-22). Helsinki, Finland: Gaudeamus, Palmenia-sarja. Sandkilsvagen 64 06880 Karrby Finland E-mail: [email protected]
Group Psychotherapy in Finland ULRIKA SEGERCRANTZ, M.A.
ABSTRACT This article describes the development of group psychotherapy in Finland as a treatment in the 1950s, 1960s, and 1970s. Different theoretical preferences split the training programs into two; both are now trying to survive in a psychotherapeutically changing landscape. All training programs have been transferred to the universities, but a lack of interest in, and knowledge about, group psychotherapy has resulted in fewer students choosing this program. This may result, in the future, in even less knowledge of, and research in, group dynamics in Finland.
One can easily understand that crises often are the source of
creativity and also create a need for new tools to work with and to relate to new phenomena. This is how it was in Europe after the Second World War and also in Finland after the Finnish wars against Russia 1939–1945. The young doctors and psychiatrists had a need to expand and introduce new ideas on how to treat traumatized patients, which numbered too many after the wars. During the war and in the 1950s, psychiatry was not very advanced in Finland, and many ideas about treatment had their roots in Germany’s definitive methods, with an idealized picture of human resources and possibilities. The common assumption was that patients only need discipline, and the traumatized were often seen as weak. The word trauma was not even used in the 1930s and 1940s in Finland, and soldiers had very limited pos-
Ulrika Segercrantz is a psychotherapist, group psychoanalyst, supervisor, and trainer in Helsinki, Finland.
535
536 SEGERCRANTZ
sibility for compensation from the state for lost health or other related problems. Bringing new ideas from the rest of the world changed the picture slowly to a broader understanding of the forces in human behavior (Kivimäki, 2013). The times after crises are often filled with hope and positive thinking, and this may have resulted in the more humanistic approach starting to emerge. Maybe Finland’s hunger for new thoughts also was due to its relatively isolated northern position, mainly surrounded by water, with a powerful neighbor in the east. Finland is a small country with only about five million people, yet there are two group psychotherapy training programs, one based on Bion and the Tavistock tradition and the other on Foulkes’s group analytic model. HISTORY OF GROUP PSYCHOTHERAPY IN FINLAND
The interest in working with groups began in the 1950s, with Finnish colleagues bringing new ideas from all over Europe. The first experiments with groups started in mental hospitals. At the end of the 1950s, psychotherapy groups were finally introduced as part of the treatment in Kellokoski hospital (Kaila, 1998). At that time, group theory and a broader way of thinking still did not have strong support. However, Henrik Carpelan, a Finnish psychoanalyst, brought Tavistock methods to Finland and began to teach an understanding of group dynamics in the mental hospital of Lapinlahti in Helsinki starting in the late 1960s (Arppo, Pölönen, & Sitolahti, 1996; Pölönen & Sitolahti, 2006). Finally, when the Finnish Group Psychotherapy Association, today named Finnish Group Psychotherapy, was born in the 1970s, group psychotherapy was accepted as a psychotherapy treatment among others. And when at about the same time, Bion’s Experiences in Groups (in Finnish, Kokemuksia ryhmistä; 1979) and other articles were translated into Finnish, it became possible to start the first Finnish group psychotherapy training with a Bionian approach, which is still very strong in Finland in both group and individual psychotherapy (Arhovaara, 2009). The other branch of group psychotherapy in Finland, group analysis, celebrated its 35th anniversary in Finland in 2014, although the beginning activities were quite modest and the de-
GROUP PSYCHOTHERAPY IN FINLAND 537
velopment went through many phases. It was not until recently that group analysis in Finland became well organized and found its place. Group analysis in Finland started with a one-week seminar held in Jyväskylä in 1979 and was attended by some 20 persons (Salminen, 1997). The idea behind this seminar came from the Finnish psychiatrist Anneli Sorri, whose main consultant was Alice Ricciardi von Platen from Rome. She in her turn had been attending the groups of S. H. Foulkes and Malcolm Pines, arranged by the Group Analytic Society of London. These seminars continued for some years, but without any wider context. There was, however, also a need and an idea within Finnish group analytic circles about a course that could meet on a continuous basis over a longer period of time. But it was not until November 1993 that the first basic course in group analytic training was arranged by the Finnish Mental Health Association (Arhovaara, 2009). The original trainers were Marja-Liisa Lassila, Heidi Lindroos, Raili Rinne, Heimo Salminen, and Ulrika Segercrantz, all group psychoanalysts from the group psychotherapy training program of the Finnish Group Psychotherapy Association. They wanted to promote the Foulkesian way of thinking about group psychotherapy. As a result, the training of group psychotherapists was split between Bion and Foulkes. As in the other group psychotherapy organization founded in the 1970s, there was now a need to find a forum for graduated group analysts as well. The thought was to have a forum where graduates could meet to keep up with professional ideas and to arrange seminars. In October 1998, a meeting was held with the purpose of establishing an association, but the definitive decision was only made as late as January 8, 2003. Up until that point, group analytic training took place apart from the association’s activities and was arranged in cooperation with the Finnish Mental Health Association. TODAY
Psychotherapy training in Finland today is undergoing big changes. Since 2012, there have been negotiations with the medical and psychological university faculties about moving all psycho-
538 SEGERCRANTZ
therapy training to the universities, in cooperation with pre-existing societies. The Finnish Group Analytic Association now cooperates with the University of Helsinki and the University of Oulu in northern Finland. The other organization, Finnish Group Psychotherapy, has had an arrangement with the University of Tampere in central Finland, and training will mainly be based in Helsinki, the capital. The process is not yet complete and many questions remain. The first training programs offered did not have enough participants in either association, so the programs did not begin in 2014. The next training was meant to start in 2015, and it will be interesting to see if there are enough students to make it viable. Budgetary concerns require a minimum number to attend each course. In addition, the cognitive psychotherapy model has taken over in Finland, as in other European countries, and the analytic approach is much less popular. Engaging in any psychotherapy that lasts longer than a year has also been difficult since the economic depression in Finland in the 1990s, when the structures of Finnish society took a new turn (Segercrantz, 2009). THE TRAINING PROGRAMS
The group psychotherapy programs are block trainings (Group Analytic Association) or weekly one-day seminars (Finnish Group Psychotherapy Association). In both trainings, there are theory, clinical seminars, supervision of the trainees’ groups, and an own group psychotherapy experience as a member among others. In a fashion somewhat typical for Finnish group psychotherapy training, consultants and visiting teachers from other countries offer personalized programs. There are, however, similar standards and regulations for all psychotherapy training programs, created by national consensus. For dynamic approaches, this means about 350 theory hours of training, at least 120 hours of reviewing literature and writing essays, 120 hours or more of supervision, and about 300 hours as group leader in the trainee’s own groups. Additionally, from 80 to 250 hours of personal group psychotherapy experience are
GROUP PSYCHOTHERAPY IN FINLAND 539
required, and the training generally lasts from 3 to 4 years. The exact number varies from one psychotherapy training program to another. The largest distinction between the two group training programs in Finland is the application of different theories. Other differences between programs are the inclusion of live infant observation (Finnish Group Psychotherapy), which means time spending observing changes in behavior in the communication between mothers and their infants. The training program of Finnish Group Psychotherapy also includes time as a group observer, which means observing in a patient group with a graduated group psychotherapist, but without talking or having any obligations. This is meant as an opportunity to experience the heaviness of being the object of the projections in a group. The Group Analytic Association, on the other hand, wants to promote the experience of large groups as one component of their training. The anxiety that rises in large groups is seen as a learning experience and also provides an opportunity to become familiar with questions in society from a larger perspective. A training program designed for future individual psychotherapy trainers has been discussed in Turku in western Finland, but has not yet begun. There are no similar plans at the moment for group psychotherapy trainers. Group psychotherapy research in Finland is not as prominent as it could be, but some research was completed. In the 20th century, the following reports included group analytic references: Näätänen, Grandell, Kähönen, and Miikkulainen (2002), Salmela, Näätänen, Tolvanen, and Nurmi (2011), and research by Kähönen, Näätänen, Tolvanen, and Salmela-Aro (2012). The aim is to provide more possibilities to engage students in research when the university is involved in the training program, because more information and evidence-based research is needed to promote group psychotherapy as a functioning model for many psychological problems in Finnish society. The new training programs in the universities will probably be more focused on the tools needed to complete group psychotherapy research.
540 SEGERCRANTZ
GROUP PSYCHOTHERAPY AND FINNISH SOCIETY
The role of groups is important in Finland where the distances are big and resources are limited. The group context could be very important for the Finnish people, as a treatment and also as a forum for learning social skills, accepting differences, discussing war and other traumas, and other social difficulties. This could take place in arranged large groups led by trained group analysts. Groups are needed in Finnish society to promote dialogue between people who are not used to talking to each other in this kind of setting. Although young people are very good at social media, there is a lack of ability among many to mentalize, to reflect, and to be in the here-and-now (Segercrantz, 2009). For this reason, it is important to keep up the work with groups in Finland, although politicians may disagree for economic reasons. Nevertheless, group psychotherapy is accepted as one therapeutic modality among others in a country where health care is available for all Finns. The Social Insurance Institution pays for a part of the costs. Most psychotherapy groups are conducted in private practice, but groups are also utilized in hospitals and outpatient clinics. There are still problems, however, because doctors are sometimes reluctant to refer patients to groups. FINAL THOUGHTS
The individual approach and, at least for the moment, cognitive therapies dominate the mental health landscape. The future will reveal whether there are enough students who seek training in group psychotherapy. If so, there will be good training arranged in at least three of the universities in Finland, providing a perfect base for group psychotherapy to continue and thrive. If not, psychotherapy training at universities will become very one-sided and biased, missing the important possibility given by groups to meet challenges never met in individual psychotherapies.
GROUP PSYCHOTHERAPY IN FINLAND 541
REFERENCES Arhovaara, S. (2009). Ryhmäanalyysin tulo Suomeen [How group analysis came to Finland]. In H. Lindroos & U. Segercrantz (Eds.), Yksilöksi ryhmässä [Becoming an individual in groups] (pp. 249-261). Helsinki, Finland: Gaudeamus, Palmenia-sarja. Arppo, M., Pölönen, R., & Sitolahti, T. (1996). Esipuhe teoksessa; Ryhmäpsykoterapian perusteet [The basics of group psychotherapy]. Helsinki, Finland: Yliopistopaino. Bion, W. R. (1979). Kokemuksia ryhmistä [Experiences in groups and other papers] (L. Syrjälä, Trans.). Espoo, Finland: Oy Weilin&Göös. Kähönen, K., Näätänen, P., Tolvanen, A., & Salmela-Aro, K. (2012). Affects during burnout intervention, changes in goal-related affects. Scandinavian Journal of Psychology, 53, 523-527. Kaila, H. (1998). Terapiaa ryhmätyönä [Therapy is groupwork]. Historiaa Suomesta, Ryhmätyö ry. Helsinki, Finland: Seurakuntaopisto, Mielterveyden Keskusliitto. Kivimäki, Ville (2013). Murtuneet mielet [Cracked minds]. Helsinki: WSOY. Näätänen, P., Grandell T., Kähönen K., & Miikkulainen, R. (2002). Aleksityymisten ja somaattisesti oireilevien työuupuneiden ryhmähoito [Burnout patients with alexithymic and somatization symptoms in group psychotherapy]. Helsinki, Finland: Occupational Healthservice Medivire OY. Balanssi. Pölönen, R., & Sitolahti, T. (2006). Ryhmä hoitaa [The group cares]. Helsinki, Finland: Yliopistopaino. Salmela, K., Näätänen, A. P., Tolvanen, A., & Nurmi, J.-E. (2011). Decrease in burnout during a group psychotherapy intervention. European Journal of Work and Organizational Psychology, 20, 451-466. Salminen, H. (1997). Ryhmäanalyysin perusteet [The basics of group analysis]. Jyväskylä, Finland: SMS-Tuotanto OY/SMS-Julkaisut. Gummerus Kirjapaino. Segercrantz, U. (2009). Ryhmäanalyysin haasteet [The challenges of group analysis]. In H. Lindroos & U. Segercrantz (Eds.), Yksilöksi ryhmässä [Becoming an individual in groups] (pp. 11-22). Helsinki, Finland: Gaudeamus, Palmenia-sarja. Sandkilsvagen 64 06880 Karrby Finland E-mail: [email protected]
