Models of practice and training in psychotherapy: cross-national perspectives from Italy and Canada

Submitted: October 20, 2023
Accepted: February 22, 2024
Published: March 14, 2024
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Supplementary Material: 153
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Internationally, there is ongoing concern about accessibility to mental health care and training. The goal of this study was to explore commonalities and differences within models of clinical psychology and psychotherapy in Ontario, Canada, and Lombardia, Italy, respectively, to inform improvements to the accessibility of mental health care and training. Using key informant sampling, we recruited ten students and professionals in Italy and Canada who study or work in psychology for semi-structured interviews. We analyzed the interview content using an inductive approach for thematic analysis within countries and meta-theme analysis across countries. The findings indicated three cross-national meta-themes: the need to integrate evidence with practice, the limited accessibility of training for students and treatment for patients, and the importance of the quality of training programs. Despite some differences regarding the amount of scientific training, personal therapy for trainees, and the prominence of cultural diversity training, Canadian and Italian psychology professionals and students shared experiences of psychotherapy practice and clinical psychology training. The three cross-national meta-themes indicate which issues in training and practice may be relevant worldwide and where to focus resources. The findings can inform international collaborations regarding training model structures that may increase access to psychology training and may increase consensus on professional recognition standards to improve mobility for professionals. These changes could reduce barriers to mental healthcare services for patients.

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Anderson, C. (2010). Presenting and evaluating qualitative research. American Journal of Pharmaceutical Education, 74(8), 141. doi: 10.5688/aj7408141. DOI: https://doi.org/10.5688/aj7408141
Association of Psychology Postdoctoral and Internship Centers. (2022). Canadian Statistics – 2022 – Phase I. Available from: https://appic.org/Internships/Match/Match-Statistics/Canadian-Statistics-2022-Phase-I.
Barbato, A., Vallarino, M., Rapisarda, F., Lora, A., Parabiaghi, A., D’Avanzo, B., & Lesage, A. (2016). Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy. International Journal of Social Psychiatry, 62(4), 334-344. doi: 10.1177/0020764016631368. DOI: https://doi.org/10.1177/0020764016631368
Belar, C. D., & Perry, N. W. (1992). The national conference on scientist-practitioner education and training for the professional practice of psychology. American Psychologist, 47(1), 71-75. doi: 10.1037/0003-066X.47.1.71. DOI: https://doi.org/10.1037//0003-066X.47.1.71
Benzi, I.M., Compare, A., Tona, A.L., Di Nuovo, S., Lazzari, D., Lingiardi, V., Lo Coco, G., & Parolin, L. (2023). PsyCARE study: assessing impact, cost-effectiveness, and transdiagnostic factors of the Italian ministry of health’s “psychological bonus” policy. BMC Psychology, 11, 306. doi: 10.1186/s40359-023-01345-6. DOI: https://doi.org/10.1186/s40359-023-01345-6
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi: 10.1191/1478088706qp063oa. DOI: https://doi.org/10.1191/1478088706qp063oa
Brien, S., Grenier, L., Kapral, M., Kurdyak, P., & Vigod, S. (2015). Taking stock: a report on the quality of mental health and addictions services in Ontario. An HQO/ICES Report. Available from: https://www.hqontario.ca/Portals/0/Documents/pr/theme-report-taking-stock-en.pdf.
Buckman, J. R., & Barker, C. (2010). Therapeutic orientation preferences in trainee clinical psychologists: Personality or training? Psychotherapy Research, 20(3), 247-258. doi: 10.1080/10503300903352693. DOI: https://doi.org/10.1080/10503300903352693
Canadian Psychological Association. (2020). CPA Statement against anti-Black racism and discrimination. Available from: https://cpa.ca/cpa-statement-on-anti-black-racism/.
Canadian Psychological Association. (2023) Accreditation standards for doctoral and residency programs in professional psychology (6th Rev.). Available from: https://cpa.ca/docs/File/Accreditation/CPA%202023%20Accreditation%20Standards_EWeb.pdf
Canadian Psychological Association and Council of Professional Associations of Psychologists. (2020). Strong majority want improved access to psychologists: Ontario. Available from: https://cpa.ca/docs/File/Media/Ont%20Access%20to%20Services%20CPA%20CPAP%20Nanos%20Survey.pdf.
Caputo, A., Langher, V., Mastrantonio, F., Cescut, A., Vicanolo, F., & Piccinini, N. (2021). Why do Italian psychology graduates dream of becoming psychotherapists? A study on decision-making in undertaking psychotherapy. Interdisciplinaria, 38(1), 181-202. doi: 10.16888/interd.2021.38.1.12. DOI: https://doi.org/10.16888/interd.2021.38.1.12
Castelnuovo, G., Di Nuovo, S., Lingiardi, V., Madeddu, F., Castelnuovo, G., Di Nuovo, S., Lingiardi, V., Madeddu, F., & Salvatore, S. (2023). Psychology profession, clinical psychology, psychotherapy. Specificities and boundaries. Rivista Di Psicologia Clinica, (1). doi: 10.3280/rpc1-2023oa16357. DOI: https://doi.org/10.3280/rpc1-2023oa16357
College of Psychologists of Ontario. (n.d.). Supervised practice: psychologist. Available from: https://cpo.on.ca/applicants/how-to-apply/supervised-practice-psychologist/
College of Psychologists of Ontario. (1991). Psychology Act, 1991, S.O. 1991, c. 38. Available from: https://www.ontario.ca/laws/statute/91p38.
College of Psychologists of Ontario. (2022). 2021-2022 annual report. Available from: https://cpo.on.ca/wp-content/uploads/Annual-Report-2021-2022.pdf.
Crepet, A., Rita, F., Reid, A., Van den Boogaard, Deiana, P., Quaranta, G., Barbieri, A., Bongiorno, F., & Di Carlon, S. (2017). Mental health and trauma in asylum seekers landing in Sicily in 2015: A descriptive study of neglected invisible wounds. Conflict and Health, 11, 1. doi: 10.1186/s13031-017-0103-3. DOI: https://doi.org/10.1186/s13031-017-0103-3
Cuellar, A. E., & Haas-Wilson, D. (2009). Competition and the mental health system. The American Journal of Psychiatry, 166(3), 278-283. doi: 10.1176/appi.ajp.2008.08091383. DOI: https://doi.org/10.1176/appi.ajp.2008.08091383
Dobson, K. S. (2016). Clinical psychology in Canada: challenges and opportunities. Canadian Psychology, 57(3), 211-219. doi: 10.1037/cap0000061. DOI: https://doi.org/10.1037/cap0000061
EuroPsy. (2021). Regulations. Available from: https://www.europsy.eu/quality-and-standards/regulations.
Falender, C., Goodyear, R., Duan, C., Al-Darmaki, F., Bang, K., Ciftci, A., Gonzalez, V.R., de Pilar Grazioso, M., Humeidan, M., Jia, X., Kagnici, D.Y., & Partridge, S. (2021). Lens on international clinical supervision: Lessons learned from a cross-national comparison of supervision. Journal of Contemporary Psychotherapy, 51(3), 181-189. doi: 10.1007/s10879-021-09497-5. DOI: https://doi.org/10.1007/s10879-021-09497-5
Gee, D. G., DeYoung, K. A., McLaughlin, K. A., Tillman, R. M., Barch, D. M., Forbes, E. E., Kruger, R. F., Strauman, T. J., Weierich, M. R., & Shackman, A. J. (2022). Training the next generation of clinical psychological scientists: a data-driven call to action. Annual Review of Clinical Psychology, 18(1), 43-70. doi: 10.1146/annurev-clinpsy-081219-092500. DOI: https://doi.org/10.1146/annurev-clinpsy-081219-092500
Gemignani, M., & Giliberto, M. (2005). Counseling and psychotherapy in Italy: a profession in constant change. Journal of Mental Health Counseling, 27(2), 168-184. doi: 10.17744/mehc.27.2.j5pgfrwhk91hqu9q. DOI: https://doi.org/10.17744/mehc.27.2.j5pgfrwhk91hqu9q
Government of Ontario. (2023). Psychologists in Canada. Available from: https://www.jobbank.gc.ca/marketreport/outlook-occupation/2218/ca.
Hall, J. E., & Lunt, I. (2005). Global mobility for psychologists: the role of psychology organizations in the United States, Canada, Europe, and other regions. American Psychologist, 60(7), 712-726. doi: 10.1037/0003-066X.60.7.712. DOI: https://doi.org/10.1037/0003-066X.60.7.712
Humbke, K. L., Brown, D. L., Welder, A. N., Fillion, D. T., Dobson, K. S., & Arnett, J. L. (2004). A survey of hospital psychology in Canada. Canadian Psychology, 45(1), 31-41. doi: 10.1037/h0086969. DOI: https://doi.org/10.1037/h0086969
Hutman, H., Lichtenberg, J. W., Goodyear, R. K., Overland, E. A., & Tracey, T. J. G. (2016). “Counselling psychology’s genotypic and phenotypic features across national boundaries”: Erratum. Counselling Psychology Quarterly, 29(2). doi: 10.1080/09515070.2016.1174396. DOI: https://doi.org/10.1080/09515070.2015.1128400
International Union of Psychological Science. (n.d.). Universal declaration of ethical principles for psychologists. Available from: https://www.iupsys.net/about/declarations/universal-declaration-of-ethical-principles-for-psychologists/
Johnson, J. L., Adkins, D., & Chauvin, S. (2020). A review of the quality indicators of rigor in qualitative research. American Journal of Pharmaceutical Education, 84(1), 138-146. doi: 10.5688/ajpe7120. DOI: https://doi.org/10.5688/ajpe7120
Jones, J. L., & Mehr, S. L. (2007). Foundations and assumptions of the scientist-practitioner model. American Behavioral Scientist, 50(6), 766-771. doi: 10.1177/0002764206296454. DOI: https://doi.org/10.1177/0002764206296454
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormei, J., Ustun, T. B., & Wang, P. S. (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiologia e Psichiatria Sociale, 18(1), 23-33. doi: 10.1017/s1121189x00001421. DOI: https://doi.org/10.1017/S1121189X00001421
Kim, H. S., Yoon, S., Son, G., Hong, E., Clinton, A., Grus, C. L., Murphy, D., Siegel, A. M., Karayianni, E., Ezenwa, M. O., Zara, G., Gutiérrez, G., Balva, D., Chey, J., & Choi, K.-H. (2022). Regulations governing psychologists: an international survey. Professional Psychology: Research and Practice, 53(6), 541-552. doi: 10.1037/pro0000470. DOI: https://doi.org/10.1037/pro0000470
Kurdyak, P., Zaheer, J., Carvalho, A., de Oliveira, C., Lebenbaum, M., Witton, A. S., Fefergard, M., Sterglopoulos, V., & Mulsant, B. H. (2020). Physician-based availability of psychotherapy in Ontario: A population-based retrospective cohort study. CMAJ Open, 8(1), E105-E115. doi: 10.9778/cmajo.20190094. DOI: https://doi.org/10.9778/cmajo.20190094
Levitt, H. M., Bamberg, M., Creswell, J. W., Frost, D. M., Josselson, R., & Suárez-Orozco, C. (2018). Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: the APA Publications and Communications Board task force report. American Psychologist, 73(1), 26-46. doi: 10.1037/amp0000151. DOI: https://doi.org/10.1037/amp0000151
Maffei, C., Del Corno, F., Dazzi, N., Cioffi, A., & Strepparava, M. G. (2015). Private psychotherapy training in Italy: a systematic analysis. European Journal of Psychotherapy and Counselling, 17(3), 240-257. doi: 10.1080/13642537.2015.1059866. DOI: https://doi.org/10.1080/13642537.2015.1059866
Manfrida, G., Giachi, E., & Eisenberg, E. (2013). Steps to a therapy of human relationships: the evolution of family therapy in Italy. Contemporary Family Therapy, 35(2), 376-387. doi: 10.1007/s10591-013-9269-z. DOI: https://doi.org/10.1007/s10591-013-9269-z
McMahon, A., & Hevey, D. (2017). “It has taken me a long time to get to this point of quiet confidence”: What contributes to therapeutic confidence for clinical psychologists? Clinical Psychologist, 21(3), 195-205. doi: 10.1111/cp.12077. DOI: https://doi.org/10.1111/cp.12077
Mental Health Commission of Canada. (n.d.). Anti-stigma. Available from: https://mentalhealthcommission.ca/what-we-do/anti-stigma/.
Mental Health Commission of Canada (2017). Expanding Access to Counselling, Psychotherapy, and Psychological Services. Available from: https://mentalhealthcommission.ca/expanding-access-to-counselling-psychotherapy-and-psychological-services/.
Mental Health Commission of Canada. (2023). Mental health strategy for Canada. Available from: https://mentalhealthcommission.ca/what-we-do/mental-health-strategy-for-canada/
Messina, I., Gullo, S., Gelo, O. C. G., Giordano, C., & Salcuni, S. (2019). An overview of the Italian contribution to the international multisite SPRISTAD study on psychotherapy training. Research in Psychotherapy; Psychopathology, Process and Outcome, 22(3), 418. doi: 10.4081/ripppo.2019.418. DOI: https://doi.org/10.4081/ripppo.2019.418
Mikail, S. F., & Nicholson, I. R. (2019). The national summit on the future of professional psychology training: overview and recommendations. Canadian Psychology, 60(4), 228-241. doi: 10.1037/cap0000192. DOI: https://doi.org/10.1037/cap0000192
Moroz, N., Moroz, I., & D’Angelo, M. S. (2020). Mental health services in Canada: barriers and cost-effective solutions to increase access. Healthcare Management Forum, 33(6), 282-287. doi: 10.1177/0840470420933911. DOI: https://doi.org/10.1177/0840470420933911
Munizza, C., Argentero, P., Coppo, A., Tibaldi, G., Di Giannantonio, M., Picci, R. L., & Rucci, P. (2013). Public beliefs and attitudes towards depression in Italy: A national survey. PLoS One, 8(5), e63806 . doi: 10.1371/journal.pone.0063806. DOI: https://doi.org/10.1371/journal.pone.0063806
Napoli, G., Autuori, S., & Ephraim, K. S. (2023). Attitudes of Italian mental health nurses towards mental illness and recovery: a cross-sectional study. AIMS Public Health, 10(2), 333-347. doi: 10.3934/publichealth.2023025. DOI: https://doi.org/10.3934/publichealth.2023025
Nicholson, I. R. (2022). Canadian models of professional training: Past and future. Canadian Psychology, 63(2), 261-277. doi: 10.1037/cap0000325. DOI: https://doi.org/10.1037/cap0000325
Nicholson, I. R., Velikonja, D., & Bisnaire, L. (2004). Hospital psychology in Canada: issues and strategies. Healthcare Management Forum, 17(2), 30-35. doi: 10.1016/S0840-4704(10)60325-0. DOI: https://doi.org/10.1016/S0840-4704(10)60325-0
Norcross, J. C., Rocha, M. N., & Chrysler, A. A. (2023). Psychologists conducting psychotherapy in 2022: Contemporary practices and historical patterns of the Society for the Advancement of Psychotherapy. Psychotherapy, 60(4), 587-592. doi: 10.1037/pst0000493. DOI: https://doi.org/10.1037/pst0000493
Ontario Public Service Employees Union. (2014). Cuts and privatization not the way to quality mental health care. Available from: https://opseu.org/news/cuts-and-privatization-not-the-way-to-quality-mental-health-care/10522/.
Ontario Public Service Employees Union. (2022). Ottawa hospital cuts psychologist services for patients. Available from: https://opseu.org/news/ottawa-hospital-cuts-psychologist-services-for-patients/180532/.
Ordine degli Psicologi della Lombardia. (n.d.). Consulta dei profili professionali. Available from: https://www.opl.it/consulta-dei-profili-professionali.php. [Material in Italian].
Ordine degli Psicologi della Lombardia. (2021). Razzismo e inconscio: riflessioni psicologiche in occasione della Giornata della Memoria. Available from: https://www.opl.it/evento/25-01-2021-Razzismo-e-inconscio-riflessioni-psicologiche-in-occasione-della-Giornata-della-Memoria.php. [Material in Italian].
Orlinsky, D. E., Messina, I., Hartmann, A., Willutzki, U., Heinonen, E., Ronnestad, M. H., Loffler-Stastka, H., & Schroder, T. (2023). Ninety psychotherapy training programs across the globe: Variations and commonalities in an international context. Counselling and Psychotherapy Research. doi: 10.1002/capr.12690. DOI: https://doi.org/10.1002/capr.12690
Queens University. (n.d.). Clinical program. Available from: https://www.queensu.ca/psychology/graduate/graduate-programs/clinical-program.
Robinson, E. M., & Tagher, C. G. (2017). The companion dissertation: enriching the doctoral experience. Journal of Nursing Education, 56(9), 564-566. doi: 10.3928/01484834-20170817-10. DOI: https://doi.org/10.3928/01484834-20170817-10
Sandhu, H. S., Arora, A., Brasch, J., & Streiner, D. L. (2019). Mental health stigma: explicit and implicit attitudes of Canadian undergraduate students, medical school students, and psychiatrists. Canadian Journal of Psychiatry, 64(3), 209-217. doi: 10.1177/0706743718792193. DOI: https://doi.org/10.1177/0706743718792193
Schubert, S., Buus, N., Monrouxe, L. V., & Hunt, C. (2023). The development of professional identity in clinical psychologists: a scoping review. Medical Education, 57(7), 612-626. doi: 10.1111/medu.15082. DOI: https://doi.org/10.1111/medu.15082
Spinogatti, F., Civenti, G., Conti, V., & Lora, A. (2015). Ethnic differences in the utilization of mental health services in Lombardy (Italy): an epidemiological analysis. Social Psychiatry and Psychiatric Epidemiology, 50(1), 59-65. doi: 10.1007/s00127-014-0922-0. DOI: https://doi.org/10.1007/s00127-014-0922-0
Statistics Canada. (2018). Mental health care needs, 2018. Available from: https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00011-eng.htm.
Statistics Canada. (2022). Tuition fees for degree programs, 2022/2023. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/220907/dq220907b-eng.htm.
Task Force. (2018). Psychology’s response to the truth and reconciliation commission of Canada’s report. Available from: https://cpa.ca/docs/File/Task_Forces/TRC%20Task%20Force%20Report_FINAL.pdf.
Tomai, M., Esposito, F., & Rosa, V. (2017). Psychologists in Italian hospital settings: an exploratory analysis of hospital physicians’ representations and demands of psychological intervention. Interdisciplinaria, 34(1), 5-23. doi: 10.16888/interd.2017.34.1.1. DOI: https://doi.org/10.16888/interd.2017.34.1.1
University of Ottawa. (n.d.). Clinical program statistics. Available from: https://www.uottawa.ca/faculty-social-sciences/psychology/graduate/clinical-psychology-statistics.
Vasiliadis, H. M., Spagnolo, J., & Lesage, A. (2021). Public funding of evidence-based psychotherapy for common mental disorders: increasing calls for action in Canadian provinces. Healthcare Policy, 16(3), 16-25. doi: 10.12927/hcpol.2021.26437. DOI: https://doi.org/10.12927/hcpol.2021.26437
Votta-Bleeker, L., Tiessen, M., & Murdoch, M. (2016). A snapshot of Canada’s psychology graduates: initial analysis of the 2015 psychology graduates survey. Canadian Psychology, 57(3), 172-180. doi: 10.1037/cap0000059. DOI: https://doi.org/10.1037/cap0000059
Western University. (n.d.). Clinical: prospective students. Available from: https://www.psychology.uwo.ca/research/clinical/prospective_students.html
World Health Organization. (2022). World mental health report: transforming health for all. Available from: https://www.who.int/publications/i/item/9789240049338.
Wutich, A., Beresford, M., SturtzSreetharan, C., Brewis, A., Trainer, S., & Hardin, J. (2021). Metatheme analysis: a qualitative method for cross-cultural research. International Journal of Qualitative Methods, 20. doi: 10.1177/16094069211019907. DOI: https://doi.org/10.1177/16094069211019907

How to Cite

Klimkowski, V., McRae, S., Blick, A., Beaulieu, L., Handley, J. R. S., Hopley, A. A., Hyde, C. A., Jain, D. M., Kolodziejczyk, S., Laliberté, J., Lévesque, A., Masri, L. M., Monet, A. M., Nediu, R. S., Valihrach, R., & Tasca, G. (2024). Models of practice and training in psychotherapy: cross-national perspectives from Italy and Canada. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(1). https://doi.org/10.4081/ripppo.2024.732