Вы находитесь на странице: 1из 8

Integration in Psychotherapy: An Approach From

Argentina
lvarez
Hector Fernandez-A

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Fundacion Aigle

This article presents the distinctive features of psychotherapy in Argentina.


An overview of the major changes it has faced in the past 10 years is
provided. The development of psychotherapy models and significant aspects
of the integration movement are highlighted. The article also outlines the
formal aspects and training of psythotherapists and the main publications in
Argentina. Original contributions of the national culture are offered.
Keywords:

psychotherapy, Argentina, integration

DISTINCTIVE FEATURES OF PSYCHOTHERAPY IN


ARGENTINA
It is a fairly well-known fact that Argentina is one of the countries with
the highest consumption of psychotherapy in the world. There is no official
data, but there is wide agreement on the subject and it is plain to whomever
visits the country for the first time. In Buenos Aires and other large cities,
in particular, the visitor senses that it is a common practice, and he soon meets
people who mention their contact with psychotherapy. Taxi drivers, bookshop
attendants, bank employees, teachers, and many others talk about it quite
naturally. It is no novelty either. For several decades now, Argentineans have
seen therapy as a commonplace tool in everyday life and have contributed to
its promotion. They do this not only to help people who face serious psychological disturbances, but also as a way to improve the quality of life. People
often approach therapy in order to enhance their personal development.
This has brought about some very interesting effects and consequences:

lvarez, Fundacion Aigle.


Hector Fernandez-A
Correspondence concerning this article should be addressed to Hector Fernandez lvarez, Virrey Olaguer y Feliu 2679, (C1426EBE) Buenos Aires, Argentina. E-mail:
A
hfa@aigle.org.ar
79
Journal of Psychotherapy Integration
2008, Vol. 18, No. 1, 79 86

Copyright 2008 by the American Psychological Association


1053-0479/08/$12.00 DOI: 10.1037/1053-0479.18.1.79

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

80

lvarez
Fernandez-A

(a) In response to such wide demand, there was an accelerated process


of training of large numbers of professionals in the field, especially
clinical psychologists. At one point, the number of psychologists per
inhabitant was among the highest in the world. Recent data show
that there are some 40,000 psychologists in the country: this means
949 inhabitants per psychologist or 105 psychologists per 100,000
inhabitants (Alonso & Eagly, 1999).
(b) In addition, Argentina was a major exporter of therapists, especially to Latin America during the 1970s and beginning of the
1980s. This was mainly due to the fact that a vast number of
psychotherapists opposed to the military regime left the country.
Brazil, Venezuela, Mexico, and Spain were among the countries
that received the largest numbers of professionals. Many of them
chose to get established in their new homes (such as Goldenberg,
Rodrigue, and Grinberg) and fostered interesting developments
in their adopted countries.
(c) A further relevant point is that several Argentine therapists
played a significant role in international spheres, either on account of their theoretical production or their active participation
in top-level scientific and professional organizations. The International Psychoanalytic Association, the International Association of Group Therapy, and the International Family Therapy
Association are among the institutions where these therapists
attained distinguished positions.
In recent years, the consumption of psychotherapy has kept growing
along lines similar to an overall trend witnessed in many countries. That
notwithstanding, in the past 10 years psychotherapy practice has faced two
new circumstances that have caused profound changes in its work. On one
side, the use of psychopharmacology, widely spread over this decade, has
meant tough competition for psychological treatments. Pharmaceutical
companies launched an active campaign to promote psychoactive drugs,
not only among psychiatrists but also in the field of general medicine.
Today, we witness an unprecedented situation: in their first interview, a
large number of our patients tell us that they have used or are currently
usingthis kind of medication. The use of pharmacological medication by
itself or combined with psychotherapy proves beneficial in many clinical
situations. There is growing concern among professionals, however, about
an excessive use of this medication. It is becoming increasingly common to
see patients who have been using these drugs for long periods of time.
Psychotherapy is often hindered by the complex nature of associated
clinical conditions, often as a result of frustration ensuing from illusory

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Special Section: Argentina

81

expectations of results to be obtained and by dependence caused by


medication.
An additional new development affecting psychotherapy is the emergence of companies that regulate health services. In Argentina, there are
two types of organization: Social Medical Care and Prepaid Health Insurance. In recent years, there has been a gradual merging of both of them.
Social Medical Care is composed of institutions formed by workers grouped in
unions or trade. Health Insurance companies are private enterprises offering health services under a free-contract policy. A significant proportion of
psychotherapy sessions is now conducted by therapists hired by these
organizations. This is an expanding phenomenon with a strong impact on
therapeutic practice. Among the main effects has been their function as a
third party, mediating in the patient-therapist relationship and stipulating
the number of sessions and other aspects of the therapeutic process, usually
based on a policy of cutting down costs. Besides that, the massive concentration of services involved has contributed to significantly reduce professional fees.
An additional factor has brought about important changes in mental
health care services with grave consequences for psychotherapy consumption. It is one of the results of the difficult economic conditions
that have had a detrimental impact on the overall conditions of the
population. Individuals and organizations alike can tap fewer resources
to face health care costs. This has not meant a decrease in the demand
for these services. Quite the opposite. It has had two effects, however,
that hinder our task: on one hand, many persons come to consultation
immersed in a dreadful socioeconomic situation (lower salaries, unemployment, worsening of work conditions), which only makes psychotherapy more difficult. On the other hand, it has lowered the standard
of therapists fees, which makes it more difficult to attract new trainees
to the field and diminished the already scarce resources devoted to
education and training.
It must be said that these circumstances have also brought about some
very positive changes. First, it has prompted therapists to find ways of
renewing traditional procedures. New proposals have emerged and crucial
changes are envisaged in the techniques used up to now. Argentine therapists today are miles away from the stereotype forged several decades ago.
The search for a higher level of efficiency fosters optimization of their
practice and spurs creativity as well as a significant increase in the drive
toward research. At present, Argentina has become one of the countries
where research has acquired a noticeable impulse. This has also favored
dialogue between therapists from various orientations thus promoting
greater integration.

82

lvarez
Fernandez-A

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

MODELS IN PSYCHOTHERAPY: THE ROAD TO


INTEGRATION
Much has been written about the strong impact of psychoanalysis in
Argentina. Its early roots in the country were favored by the fact that
several psychoanalysts from Central Europe immigrated into Argentina at
the end of the thirties. A very rich cultural life, well-established universities, and an active movement in the arts and sciences met them. It all
contributed to an open attitude in the face of new ideas. The characteristics
of the population also helped along this line since it was a heterogeneous
and cosmopolitan society, with a high proportion of European immigrants
(Vezzetti, 1996). The Argentine Psychoanalytic Association was founded
in 1942 and was soon incorporated into the corresponding international
organization. Its official periodical, Revista de Psicoanalisis (Journal of
Psychoanalysis), was launched in 1943 and has been published regularly
since then. Although it did have to surmount some initial resistance,
psychoanalysis managed to become the hegemonic model of psychological
therapy for a long period of time. As a result, it superseded other lines
with timid developments. And though there were some interesting contributions in humanistic therapy, psychodrama, Gestalt therapy and other
approaches, they were all overcome by the weight of psychoanalysis. Two
simultaneous events altered this scenario in the 1970s.
On one hand, within the very field of psychoanalysis, the traditional
rule of the ideas of Freud and Klein was challenged at first, and later
overcome, by the emergence of a strong movement set on promoting the
contribution of Lacan. Why did his work root so deeply in Argentina?
There is surely no single reason. The powerful influence of French culture
among intellectual circles in Buenos Aires must have been a crucial factor.
The obscure, hermetic characteristics of that doctrine probably played a
role too, especially in a period when freedom of speech was seriously
restricted. Centers for the study of this line of thought sprouted, until it
managed to prevail in numerous schools of psychology and health care
centers. This caused a profound debate within the psychoanalytic world
fostering rifts in a previously compact circle. Other factors contributed in
the same direction and after few years the scenario of psychoanalysis in
Argentina turned into a wide array of organizations with deeply diverse
interests and programs.
During the same period, a large group of therapists (most of whom had
previously been psychoanalysts) chose the systemic model in therapy.
Several circles adopted the therapeutic model of the Palo Alto School.
Others working along similar lines joined them, until they became a
significant alternative option to psychoanalysis. Numerous systemic thera-

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Special Section: Argentina

83

pists from Argentina also left the country; in this case, they went to the
United States of America where they made relevant contributions. Such was
the case for Minuchin, Slutzky, and Madanes, among others. Their links with
Argentina remained active and soon there were many new centers of systemic
therapy in our country. Eventually, and due to this process, the world of
psychotherapy opened up and other lines of thought were more warmly
welcomed. In the past 20 years, cognitive therapy has become one of the
strongest alternatives. Its growth was very fast and several organizations are
currently using different variations of this approach. There is also a very active
national association linked to the international group of cognitive therapy,
which includes a vast number of professionals.
This has coincided with the advent of an enthusiastic movement of
integration proposals. The integrative approach gathered momentum at
the beginning of the nineties with the steep decline of orthodox models.
From various angles, professionals and consumers alike were concerned
with finding more effective procedures. A rapid shift in the demand toward
more eclectic methods resulted in an array of proposals ranging from
technical eclecticism to various models of integration. This process was
facilitated by the regular visit to the country of well-known professionals who
led workshops and seminars such as Wachtel, Safran, Goldfried, Beutler,
Feixas, and Goncalves, among others. In 1994, SEPI held its annual conference in Buenos Aires, the first time ever in a Latin American country.

SIGNIFICANT ASPECTS OF INTEGRATION IN


PSYCHOTHERAPY
There are two vital components of psychotherapy in Argentina. An
external observer is likely to feel rather surprised by them. Both have
operated as catalysts contributing to strengthening the forces of integration
in this field. In the first place, psychotherapy is established in our society as
a familiar occurrence. It is a service that covers a wide array of demands
and reaches all segments of the population. This includes the least economically favored groups, although the limited availability of resources
restricts its reach and frequency. Research on the practice of psychotherapy
provides clear information on this situation (Fernandez-Alvarez, Scherb,
Bregman, & Garca, 1995). It also represents a good source of information on
other aspects, such as levels of consumer satisfaction and the most common
uses. These studies provide a sample of the characteristics of peoples expectations regarding psychological treatments.
A second notable fact becomes evident upon observation of how
professionals perform their work. This trend, which is less obvious on

lvarez
Fernandez-A

84

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

the surface of everyday life, points to the existence of a close connection


between clinical work and academic activities. Therapists usually couple
their theoretical concerns and work in universities with daily practice in
clinical centers. As a consequence, despite very limited resources, research
is widely informed by clinical work. Studies are usually developed on
naturalistic samples, stressing their ecological validity.

FORMAL ASPECTS AND TRAINING OF THERAPISTS


In Argentina, mostly medical doctors and psychologists legally practice
psychotherapy. The latter obtained formal permission in 1985, through a
law that modified a previous regulation restricting this function to
medical professionals. Currently, every medical doctor may practice
psychotherapy with no specialization required. This is also the case with
psychologists, who can provide psychotherapy upon completion of their
graduate studies. Graduate studies in psycho-pedagogy are also admitted for the practice of psychotherapy, although as yet there are no legal
regulations on the subject.
Although it is not a compulsory requirement, specialized training is in
fact considered essential to access significant positions in the labor market.
Many of the more prestigious academic and clinical centers over the
country provide graduate studies for the education and training of therapists in various approaches and methods. Having said that, we must note
that there still are no regulations on a national level for the accreditation
of psychotherapists and the regulation of their practice in its various fields
of specialization. This is a matter of concern for government agencies and
professional associations.
Training programs for therapists are widely varied. Many centers
specialize in the training of candidates in specific models, although there is
an increasing range of opportunities for whoever seeks training within the
perspective of integration. Fundacion Aigle has played a crucial role along
this line. Its graduate programs are taught in several cities in connection
with agreements with various universities. These training arrangements
include as well complementary agreements with institutions in other countries.

PUBLICATIONS
For many years, the main source for works on psychotherapy in the
Spanish language was books published in Argentina. Naturally, works on

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Special Section: Argentina

85

psychoanalysis were at the top of the list, but there were many writings by
authors representing other lines of thought as well. Among the latest major
projects was the Spanish edition of Stracheys version of Freuds complete
works. Unfavorable economic conditions halted this production, though
there is still significant activity carried out in the field.
Several specialized journals were published in Argentina, the oldest
being Psicoterapia (Psychotherapy). It was launched in Cordoba in 1936,
but unfortunately, it was short lived. Many of the journals encountered
similar problems for publication and were often discontinued or abandoned. At present, various journals come out on a regular basis and are
concerned with the promotion of specific approaches or methods: Sistemas
Familiares [Family Systems], Psicoanalisis [Psychoanalysis], and journals of
the Association of Argentine School of Psychotherapy for Graduate Professionals and of the Association of Psychology and Group Psychotherapy,
among others. The integrative approach is strong in Revista Argentina de
Clnica Psicologica [Argentine Journal of Clinical Psychology] and it was
inspired by the Acta Psiquiatrica and Psicologica de America latina [Latin
American Annals of Psychiatry and Psychology], a remarkable publication
directed by Guillermo Vidal over several decades.
Vidal was one of the most interesting personalities in the field of
mental health in our country. An open minded and refined person, he
represented the spirit of integration from the very start and became a
fervent defender of the concept of integration in psychotherapy when it
emerged explicitly in our country. His work was gathered in several publications and was eventually included in a major project, Enciclopedia de
Psiquiatra [Encyclopedia of Psychiatry] (Vidal, Alarcon, and Lolas
Stepke, 1995).

PSYCHOTHERAPY AND NATIONAL CULTURE


Our review shows quite clearly that ideas originally developed by the
leading schools of thought in foreign countries nurtured the development
of psychotherapy in Argentina, especially ideas from the United States and
Europe. In no way does this mean that there has been no important local
contribution. First, even if Argentine therapists did feed on developments
in practice abroad, they usually developed new and unique versions of
these practices in their own work. This is so in the more traditional
approaches, such as psychoanalysis, as well as in the more innovative
integrative approaches in recent years. A pioneer within the psychoanalytic
movement who well illustrates this state of affairs is Enrique PichonRivie`re (1977). He joined this movement from its inception, but the evo-

lvarez
Fernandez-A

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

86

lution of his work led him toward a project of integration. His work
developed toward the interface between psychoanalysis and social psychology. He envisaged an interesting project involving the community; unfortunately it did not reach a high level of formalization, which hindered its
further development.
Finally, it would be unfair to end this review without mentioning a field
where the integration of psychotherapy is at work in our country, under
conditions that are quite a far cry from traditional practice. We are referring to projects carried out in various regions, particularly in the south of
the country, where psychotherapists work side by side with healers and
practitioners of traditional healing methods. In some of the Patagonian
provinces (mostly Ro Negro and Neuquen) public health care centers
apply programs that incorporate the cultural framework of indigenous
groups. An active collaboration between local healers and psychotherapists
has contributed to enhancing patients confidence in the help they are
offered (Arrue and Kalinsky, 1991). This illustrates just one more way in
which integrative thinking continues in our country and another model for
integration that it will be useful to explore further in coming years.

REFERENCES
Alonso, M. M., & Eagly, A. (1999). Psicologa en las Americas [Psychology in the Americas].
Buenos Aires, Sociedad Interamericana de Psicologa.
Arrue, W., & Kalinsky, B. (1991). De la medica y el terapeuta [The doctor and the
therapist]. Buenos Aires, Centro Ed. de America Latina.
Fernandez-Alvarez, H., Scherb, E., Bregman, C., & Garca, F. (1995). Creencias sobre la
extension y eficacia de la psicoterapia en la poblacion de la ciudad de Buenos Aires
[Beliefs about psychotherapy extension and efficacy among the population of the city of
Buenos Aires]. En J. P. Jimenez, C. Buguna, y A. Beldar (Eds.), Investigacion en
psicoterapia. Procesos y resultados (pp. 89 107). Santiago de Chile: Corporacion de
Promocion Universitaria.
Pichon-Riviere, E. (1977). El proceso grupal. Del psicoanalisis a la psicologa social [The
group process. From psychoanalysis to social psychology]. Buenos Aires: Nueva Vision.
Vezzetti, H. (1996). Aventuras de Freud en el pas de los argentinos [Freuds adventures in the
country of the Argentines]. Buenos Aires: Paidos.
Vidal, G., Alarcon, R., & Lolas Stepke, F. (Eds.). (1995). Enciclopedia Iberoamericana de
Psiquiatra [Iberoamerican Encyclopedia of Psychiatry]. Buenos Aires: Panamericana.