Psychotherapy in Sweden: historical background, current status, and future projections.

From medieval times, care of the emotionally disturbed in Sweden has shifted between moralistic and enlightened approaches. In this century through the 1960s, organic methods have predominated, with emphasis on description and precise diagnosis. Psychodynamic treatment has been only reluctantly accepted until the past decade, with child psychiatrists and psychologists at the forefront. Norway has typically been most progressive in the establishment of psychoanalytic and other psychodynamic movements in Scandinavia, with Sweden following and Denmark often lagging behind. In 1970, Norway became the first Scandinavian country to require training in psychotherapy for psychiatrists. Sweden remained more conservative for years, both in adherence to the organic model at one extreme, and in supporting one of the most orthodox psychoanalytic movements in the world, at the other. During the 1970s, however, it became increasingly more common for psychiatrists in Sweden to seek training in psychotherapy through a variety of organizations, established since the early 1930s and operating independently of each other. In 1978, a uniform state program in psychotherapy was developed with theoretical and practical requirements, and is scheduled in the near future to become obligatory for psychiatrists, psychologists, and various other mental health professionals. The paramedical personnel has become increasingly more involved in mental health care during the past decade. In delivery of care, the "sectorization" principle has become central, and is likely to set the tone for the future. With the entire country divided into local catchment areas, the direction will be toward psychodynamic approaches integrated with traditional organic models, open care, decentralization, planned prophylaxis, and full collaboration of all mental health professionals and social agencies.