In my work I often get asked whether I am a psychologist, a psychotherapist, or a psychiatrist. And aren’t they basically all the same? ☺ It is perfectly understandable to not know what the exact differences between these mental health professionals are in terms of qualifications, duties and professional responsibilities. I thought it would be a good opportunity to shed some light onto this topic and to open up about my journey in navigating some professional hurdles in Finland, and how I ended up training as a psychotherapist in Finnish.
A psychiatrist is a medical doctor who has completed specialist training (about 6 years) in mental health disorders. In simplistic terms, a psychiatrist’s primary focus is on finding a diagnosis for the patient and treating the symptoms with medication as necessary. A psychiatrist can act as a gatekeeper for further specialized treatment and investigation by a multidisciplinary mental health team.
To get referred to a psychiatrist in the public sector, you would have to see a doctor in your health centre (terveysasema), who can make the referral. It is also possible to make an appointment directly with a private sector psychiatrist.
A clinical psychologist will usually have a master’s in psychology, if not a doctorate, and is allowed to do extensive psychological and personality assessments, as well as therapeutic work. Doctors are responsible for giving diagnoses, but they are not allowed to do personality assessments as they do not receive the extensive training required to carry these out.
A neuropsychologist is a psychologist who has gone on to study neuropsychology. Some of the conditions they routinely deal with include developmental disorders like autism, learning and attention disorders (such as attention deficit disorder/ADHD), and disorders affecting the brain like epilepsy, traumatic brain injury, cancer, stroke and dementia.
A neuropsychiatrist is a psychiatrist who has completed sub-specialization in neuropsychiatry (i.e. in both neurological and psychiatric disorders), and they are the only doctors allowed to make a neuropsychiatric diagnosis. In a neuropsychiatric clinic in the public and private health care sector, you will usually find both a neuropsychologist and a neuropsychiatrist.
A therapist is someone who focuses on supporting the mental health of a client. A variety of therapies are available for the treatment of mental health disorders – from somatic therapy, to art and music therapy, to name a few. The term “therapist” is not protected, which means that this profession is not regulated by a health authority in Finland. The title of psychotherapist on the other hand, is “protected” because there are strict regulations, standards and requirements around how to become a psychotherapist, equivalent to the process of attaining a title as a nurse, psychologist, or doctor etc.
My own professional journey in Finland
I studied medicine in the UK and completed 2 years of my medical residency in the Northeast of England (a very friendly and lovely place, very close to my heart!). I then set off to New Zealand for half a year to work in Accident and Emergency. It was after this that I moved to Finland, because of my Finnish husband.
I encountered a massive cultural and language shock when moving to Finland. I had to pass a language test (YKI 3) to be able to get my medical license, after which I still (very much!) felt completely inept at communicating in Finnish, let alone practice medicine!
I feel it is necessary to be real here. I had not anticipated that the hardest part of integrating into Finnish society would be the overwhelming disappointment at both my lack of Finnish skills and lack of connection with the Finnish community.
Luckily however, the Employment Office (työvoimatoimisto) offered me a place on a Medical Finnish course for foreign doctors. As part of this course, I did a clinical placement as an assistant doctor in a health centre. I eventually decided to pursue psychiatry, which felt closer to my heart, and where I hoped I would meet more like-minded colleagues.
I worked in psychiatry for 3 years both in clinics and on the wards. During my clinical work in psychiatry, I came across Dialectical Behaviour Therapy (DBT), which is the gold standard treatment for treating suicidal clients with borderline personality disorder. DBT is also used for depression, anxiety, substance abuse, eating disorders and ADHD. I gained competency in doing individual and group DBT, after which I started working at Compass Psychology since August 2023.
I have now started studying psychotherapy with the University of Helsinki. This will enable me to provide psychotherapy and to treat more difficult conditions, such as OCD, trauma disorders and psychosomatic disorders.
Psychotherapy is an evidence-based and effective treatment modality for mental health disorders which aims to enhance, maintain, or regain a person’s social functionality.
In Finland, psychotherapy can be:
1) Rehabilitative psychotherapy (kuntoutuspsykoterapia), which is subsidised by the social security insurance institution (Kela)
2) Service voucher psychotherapy. If you are not eligible to receive Kela subsidized psychotherapy, the public health care service of some municipalities can cover or help cover the cost of psychotherapy, through a service voucher (palveluseteli)
3) Paid for and organised privately
Kela-subsidized psychotherapy
You can be eligible to receive psychotherapy subsidized by Kela if you are between 16-67 years old and:
- Your ability to work and study is threatened by a mental health disorder
- You have received a minimum of 3 months of appropriate treatment after diagnosis of a mental health disorder
- A psychiatrist has deemed that rehabilitative psychotherapy is necessary to support or improve your ability to work or study
Rehabilitative psychotherapy can be provided as individual-, group-, family- or couple’s psychotherapy, and also as art therapy.
The Kela subsidy is provided for one year at a time and can be continued for a maximum of 3 years. This subsidy can be provided for up to 80 sessions per year (or 200 sessions in 3 years). Kela can pay a maximum of 57.60 euros per session for individual therapy (yksilöterapia).
How to get a referral for psychotherapy
The first port of call is through the public service, ie your health care centre, occupational health services, or student health care services.
They must assess and treat you over a period of 3 months, and if this treatment is not effective, you can be referred to a psychiatrist working in the public health sector (erikoissairaanhoito) or see a private psychiatrist of your own choice.
The psychiatrist will write a doctor’s certificate (B-lausunto) for rehabilitative psychotherapy “kuntoutuspsykoterapia” if you are eligible, and you will also have to submit an application for the same to Kela.
If it is concluded by your public health care doctor that your overall functioning is so low that getting through the day is difficult, and you are under the age of 65, then you can be referred for “intensive medical rehabilitative psychotherapy” (vaativa lääkinnällinen kuntoutuspsykoterapia) as part of your rehabilitation plan (kuntoutussuunnitelma).
Once a client is given the clinical recommendation to start psychotherapy, the client will have to find a licensed psychotherapist. Clients are usually directed to the Minduu page to find a psychotherapist, and contact them for an initial phone consultation.
Training clients
A part of my psychotherapy training involves having training clients and discussing these cases with my psychotherapy trainers. These discussions take place in a very careful and regulated manner, where no identifying information is shared. Training clients are fully informed of all the procedures involved and must give informed consent before we can start. Sessions with training clients are recorded in accordance with the EU GDPR laws. These recordings are stored in a safe manner, with absolutely no possibility of being uploaded to the cloud for example. The recordings are deleted as soon as they have been discussed in supervision. If a client is interested in becoming a training client, the requirement is that we would need to work together regularly (e.g. weekly for the first 10-12 weeks). Regular sessions at Compass Psychology are typically 100€/ 45 minutes. For training clients, I would be able to offer 70€/ 50 min. Feel free to email me at Jenine@compasspsychology.fi if you have any questions!
Resources:
https://www.kela.fi/rehabilitative-psychotherapy
https://www.kela.fi/news/two-ways-to-seek-therapy-1
Mielenterveystalo.fi – contains free self-help programs and internet therapies