The Bulletin of National Defence University of Ukraine

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  • Vol. 20, No. 6, 2025

  • Towards a unified psychotherapy in the 21st century: Paradigm shifts, educational reforms, and global challenges in the German-speaking world and beyond

  • Received 27.05.2025,
  • Revised 30.10.2025,
  • Accepted 27.11.2025
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Vol. 20, No. 6, 2025
  • psychotherapy integration; ICD-11; Artificial Intelligence; intermodal competences; evidence-based practice
  • https://doi.org/10.33099/2617-6858-25-20-6-13-28
  • Pages 13-28

In light of profound global crises and evolving health policies, psychotherapy is undergoing a crucial transformation that increasingly requires integrated and evidence-based professional training systems. The purpose of this article was therefore to analyse the paradigm shift toward unified psychotherapy, examining educational reforms in the German-speaking world as a central case study within a broader international context. The investigation was based on a comprehensive analysis of scientific literature, policy documents, and international competency frameworks. Through the analysis of scholarly sources and normative documents, the study examined educational reforms in Germany and Austria that reflected a transition from fragmented, modality-oriented learning toward university-based, integrative pathways focused on intermodal competences, empirical literacy, and deferred specialisation. The theoretical foundations of this movement were described, presenting research on common factors such as therapeutic alliance, empathy, and resource activation as critical for therapeutic success beyond technique-specific effects. Furthermore, the international policy landscape was examined, with comparative examples from the United Kingdom, Norway, and Ukraine illustrating the adaptability of diverse integration strategies, while key challenges such as the adoption of AI-driven supervision systems and the complex diagnostic shift to the ICD-11 dimensional model were also highlighted. Finally, the potential benefits of unification, including a strengthened professional identity, enhanced cross-border mobility, and improved quality assurance, were weighed against significant risks such as theoretical dilution, identity conflicts, and under-resourced implementation. The results of this analysis could be used by policymakers, educational institutions, and professional associations to guide the strategic development of evidence-based, internationally coherent, and ethically sound curricula for psychotherapy training

References

  1. Bach, B., et al. (2022). The ICD-11 classification of personality disorders: A European perspective on challenges and opportunities. Borderline Personality Disorder and Emotion Dysregulation, 9, article number 12. doi: 10.1186/s40479-022-00182-0.
  2. Baier-Mosch, F., Weiher, G.M., & Kananian, S. (2025). Determining what is common: A theoretical account of common factors in psychotherapy through the lens of self-determination theory. Journal of Contemporary Psychotherapy, 55, 269-281. doi: 10.1007/s10879-025-09664-y.
  3. Bal, F. (2025). Artificial intelligence and psychotherapy. Current Approaches in Psychiatry, 17(4), 643-660. doi: 10.18863/pgy.1538432.
  4. Barkham, M., De Jong, K., Delgadillo, J., & Lutz, W. (2023). Routine outcome monitoring (ROM) and feedback: Research review and recommendations. Psychotherapy Research, 33(7), 841-855. doi: 10.1080/10503307.2023.2181114.
  5. Barlow, D.H., et al. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders. JAMA Psychiatry, 74(9), 875-884. doi: 10.1001/jamapsychiatry.2017.2164.
  6. Blüml, V., & Doering, S. (2021). ICD-11 Personality disorders: A psychodynamic perspective on personality functioning. Frontiers in Psychiatry, 12, 654026. doi: 10.3389/fpsyt.2021.654026.
  7. European Association for Psychotherapy (EAP). (2017). The situation of psychotherapy in Austria. Retrieved from https://www.europsyche.org/portals/0/media/docs/Situation-Psychotherapy-in-Austria-2017-10-20.pdf.
  8. European Association for Psychotherapy (EAP). (n.d.). About the European certificate of psychotherapy (ECP). Retrieved from https://www.europsyche.org/ecp.
  9. European Parliament and Council. (2005). Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications. Official Journal of the European Union, L 255, 22-142.
  10. Federal Chancellery of Austria. (1991, January). Federal Act on the Practice of Psychotherapy (Psychotherapy Act – PsychThG). Retrieved from https://www.ris.bka.gv.at/Dokumente/Bundesnormen/NOR11010839/NOR11010839.html.
  11. Federal Chancellery of Austria. (2024, April). Psychotherapy Act (Federal Law Gazette I No. 49/2024). Retrieved from https://ris.bka.gv.at/Dokumente/BgblAuth/BGBLA_2024_I_49/BGBLA_2024_I_49.html.
  12. Federal Joint Committee (G-BA). (2019). Supporting reasons for the resolution on the amendment of the Psychotherapy Directive: Systemic therapy for adults. Retrieved from https://www.g-ba.de/.
  13. Federal Joint Committee (G-BA). (2025). Retrieved from https://www.g-ba.de/.
  14. Federal Ministry of Education, Science and Research (Austria). (2024). Psychotherapy training from 2026 at public universities. Retrieved from https://www.bmb.gv.at/Ministerium/Presse/2024_archiv/20240111.html.
  15. Federal Ministry of Social Affairs, Health, Care and Consumer Protection (Austria). (n.d.). Psychotherapy information platform. Retrieved from https://psychotherapie.ehealth.gv.at/.
  16. Flückiger, C., Del Re, A.C., Wampold, B.E., Horvath, A.O., & Crits-Christoph, P. (2018). The alliance in psychotherapy: Updated meta-analytic synthesis. Psychotherapy, 55(4), 316-340. doi: 10.1037/pst0000172.
  17. Frankova, I., Bahmad, M.L., Goloktionova, G., & Suvalo, O.B. (2024). Mental health and psychosocial support in Ukraine: Coping, help-seeking and health systems strengthening in times of war. Interdisciplinary desk review published by ARQ National Psychotrauma Centre and VU Amsterdam. ARQ & VU: Amsterdam. doi: 10.13140/RG.2.2.33092.85123.
  18. Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2012). Acceptance and commitment therapy: The process and practice of mindful change  (2nd ed.). New York: Guilford Press.
  19. Heymann, J., & Sprague, A. (2023). Meeting the UN Sustainable Development Goals for mental health: Why greater prioritization and adequately tracking progress are critical. World Psychiatry, 22(2), 325-326. doi: 10.1002/wps.21090.
  20. Hingley, S.M. (2025). Dialectically integrated psychotherapy: Unconscious internal models and unifying processes of change. Journal of Contemporary Psychotherapy, 55, 127-137. doi: 10.1007/s10879-024-09650-w.
  21. Holmes, C.M., Tariq, F., Heyward, K., & Hall, D. (2023). Training counselors using virtual reality. Journal of Technology in Counselor Education and Supervision, 3(2), article number 3.
  22. Hopwood, C.J., et al. (2017). The time has come for dimensional personality disorder diagnosis. Personality and Mental Health, 12(1), 82-86. doi: 10.1002/pmh.1408.
  23. Humer, E., et al. (2020). Provision of psychotherapy during the COVID-19 pandemic among Czech, German and Slovak Psychotherapists. International Journal of Environmental Research and Public Health, 17(13), article number 4811. doi: 10.3390/ijerph17134811.
  24. IQWiG. (2017). Systemic therapy for adults: Final report N14-02 (version 1.0). Cologne: IQWiG.
  25. Krishnan, M. (2025). AI-driven mental health monitoring and support system. Journal of Integrated Engineering Sciences, 1(2), article number 3049-3919. doi: 10.63686/Jies.v1i2006.
  26. Lahey, B.B., Moore, T.M., Kaczkurkin, A.N., & Zald, D.H. (2021). Hierarchical models of psychopathology: Empirical support, implications, and remaining issues. World Psychiatry, 20(1), 57-63. doi: 10.1002/wps.20824.
  27. Legal Framework of Psychotherapy Training in Austria. (n.d.). Retrieved from https://psy-akademie.at/ausbildung/psychotherapeutisches-propaedeutikum-a-pp/gesetzlicher-rahmen/.
  28. Levenson, H. (2017). Cyclical psychodynamics and the contextual self (2nd ed.). Washington, DC: American Psychological Association. doi: 10.1037/0000060-000.
  29. Maier, L., Engesser, D., Paul, R., Reuter, K., Petermann-Meyer, A., & Singer, S. (2024). The structural reform of the psychotherapy guidelines in Germany. Psychiatric Practice, 51(1), 31-38. doi: 10.1055/a-2112-3549.
  30. Martinsen, K.D., Fredriksen, A.L., Lunde-Hansen, C., Torbjørnsen, K., & Fedøy, B. (2023). A study of self-perceived change in CBT competence among Norwegian therapists undertaking a 2-year CBT training for working with young people. The Cognitive Behaviour Therapist, 16, article number e34. doi: 10.1017/S1754470X23000296.
  31. Meier, D., Tschacher, W., Frommer, A., Moggi, F., & Pfammatter, M. (2023). Growth curves of common factors in psychotherapy: Multilevel growth modelling and outcome analysis. Clinical Psychology & Psychotherapy, 30(5), 1063-3995. doi: 10.1002/cpp.2864.
  32. Melcop, N., von Werder, T., Sarubin, N., & Benecke, A. (2019). The role of psychotherapy in the German health care system: Training requirements for psychological psychotherapists and child and adolescent psychotherapists, legal aspects, and health care implementation. Clinical Psychology in Europe, 1(4), article number e2549. doi: 10.32872/cpe.v1i4.34304.
  33. Možina, M. (2024). Psychotherapy regulation in European countries: An overview of professional frameworks, training standards, and legal recognition. Psychotherapie-Wissenschaft, 14(2), 93-109. doi: 10.30820/1664-9583-2024-2-93.
  34. NHS Digital. (n.d.). Retrieved from https://digital.nhs.uk/.
  35. OECD. (2021). A new benchmark for mental health systems: Tackling the social and economic costs of mental ill-health. doi: 10.1787/4ed890f6-en.
  36. Palaniappan, K., Lin, E.Y.T., & Vogel, S. (2024). Global regulatory frameworks for the use of Artificial Intelligence (AI) in the healthcare services sector. Healthcare, 12(5), article number 562. doi: 10.3390/healthcare12050562.
  37. Pan, B., & Wang, W. (2024). Practical implications of ICD-11 personality disorder classifications. BMC Psychiatry, 24, article number 191. doi: 10.1186/s12888-024-05640-3.
  38. Parliament of Austria. (2024). Health Committee approves the academisation of psychotherapy training. Retrieved from https://www.parlament.gv.at/aktuelles/pk/jahr_2024/pk0354.
  39. Persons, J.B., Marker, C.D., & Bailey, E.N. (2023). Changes in affective and cognitive distortion symptoms of depression are reciprocally related during cognitive behavior therapy. Behaviour Research and Therapy, 166, article number 104338. doi: 10.1016/j.brat.2023.104338.
  40. Poss-Doering, R., Hegelow, M., Borchers, M.S., & Hartmann, M. (2021). Evaluating the structural reform of outpatient psychotherapy in Germany (ES-rip trial) – a qualitative study of provider perspectives. Durham, NC: Research Square. doi: 10.21203/rs.3.rs-685887/v1.
  41. Psychotherapists Act. (1999, January). Federal Law Gazette I (1311). Retrieved from https://www.bap-berlin.de/wp-content/uploads/2022/09/PsychThG-1998.pdf.
  42. Rief, W., Wilhelm, M., Bleichhardt, G., Strauss, B., Frostholm, L., & von Blanckenburg, P. (2024). Competence-based trainings for psychological treatments – a transtheoretical perspective. Clinical Psychology in Europe, 6, article number e13277. doi: 10.32872/cpe.13277.
  43. Rønnestad, M.H., Orlinsky, D., Schroder, T., & Skovholt, T.M. (2019). The professional development of counsellors and psychotherapists: Implications of empirical studies for supervision, training and practice. Counselling and Psychotherapy Research, 19(3), 214-230. doi: 10.1002/capr.12198.
  44. Ryan, R.M., & Deci, E.L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York: Guilford Press. doi: 10.1521/978.14625/28806.
  45. Schmid, G., Grünling, E., Haudum, B., Schildmair, U., Webersdorfer, T., & Steiner, V. (2025). The most common mental health problems in Austria. Retrieved from https://psychotherapeuten-linz.at/2025/03/03/die-haeufigsten-psychischen-probleme-in-oesterreich/.
  46. Schmidt, F., Hammerfald, K., Jahren, H.H., Vlassov, V. (2025). CFiCS: Graph-based classification of common factors and microcounseling skills. In A. Zirikly, A. Yates, B. Desmet, M. Ireland, S. Bedrick, S. MacAvaney, K. Bar, & Y. Ophir (Eds.), Proceedings of the 10th workshop on computational linguistics and clinical psychology (CLPsych 2025) (pp. 106-115). Albuquerque: Association for Computational Linguistics. doi: 10.18653/v1/2025.clpsych-1.9.
  47. Siddiqui, S., et al. (2022). Scaling up community-delivered mental health support and care: A landscape analysis. Frontiers in Public Health, 10, article number 992222. doi: 10.3389/fpubh.2022.992222.
  48. Simon, J., & Bach, B. (2022) Organization of clinician-rated personality disorder types according to ICD-11 severity of personality dysfunction. Psychodynamic Psychiatry, 50(4), 672-688. doi: 10.1521/pdps.2022.50.4.672.
  49. Tattersall, T.C., Rolli, N., & Butwell, M. (2024). Integrative child psychotherapy: Discussion of a common core and unified theory approach. AIMS Medical Science, 11(2), 181-209. doi: 10.3934/medsci.2024015.
  50. Trost, K., Ertl, V., König, J., Rosner, R., & Comtesse, H. (2024). Climate change-related concerns in psychotherapy: Therapists’ experiences and views on addressing this topic in therapy. BMC Psychology, 12, article number 192. doi: 10.1186/s40359-024-01677-x.
  51. Voloshyna, O. (2024). The problem of psychologist certification: A comparative analysis of international experience. Scientific Studios on Social and Political Psychology, 30(1), 6-15. doi: 10.61727/sssppj/1.2024.06.
  52. von Sydow, K., Beher, S., & Retzlaff, R. (2024). Systemic psychotherapy: An introduction to its theoretical foundations and clinical practice. German Medical Journal International, 121, 783-792. doi: 10.3238/arztebl.m2024.0194.
  53. Wang, P., Ai, X., Zhang, X., Ma, F., Zhuang, Y., & Wang, S. (2024). Evaluating virtual reality technology in psychotherapy: Current applications and future directions. Frontiers in Psychiatry, 15, article number 1480788. doi: 10.3389/fpsyt.2024.1480788.
  54. WHO. (2023). Updates & achievements: Ukraine. Retrieved from https://cdn.who.int/media/docs/default-source/mental-health/special-initiative/ukraine-achievements-2022_23.pdf?sfvrsn=142f5219.
  55. WHO. (2025a). Mental health atlas 2024. Retrieved from https://www.who.int/publications/i/item/9789240114487.
  56. WHO. (2025b). World mental health today: Latest data. Retrieved from https://www.who.int/publications/i/item/9789240113817.
  57. WHO. (2025c). WHO releases 2025 update to the International Classification of Diseases (ICD-11). Retrieved from https://www.who.int/news/item/14-02-2025-who-releases-2025-update-to-the-international-classification-of-diseases-(icd-11).

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