BRIEF ARTICLE

Family Therapy in Norway:

Development and Trends

Atle Roness

Norway has a state church, the Evangelical Lutheran Church, which in-
cludes in its membership 96% of the population. The church is supported
by government funds. For quite some time, the church has provided a
counseling service for single individuals, married couples, and families
with problems. Albert Assev was the initiator of this service, and was of
prime importance in its development. The first counseling center was
opened in 1958 and since then several similar centers have been opened
throughout the country. As this developed, the government also started its
own counseling centers. The staff of both the church and the government
centers consists of people from several disciplines including psychiatrists,
physicians, psychologists, social workers, lawyers, and ministers. At first,
the activity was mainly advisory but it gradually developed into a more
family-oriented treatment approach. The centers run by the church began
to arrange courses, seminars, and educational programs, and thus the
church's activities have had a special place in the development of family
therapy in Norway.
Working with the family unit also started quite early in child psychiatry
in Norway. Nic Waal, a pioneer in this field, was psychoanalytically
oriented, but was also concerned about society as a whole. She emphasiz-
ed the value of outpatient treatment. At outpatient clinics, the child
psychiatrist came in touch with the parents who brought their children to
the clinic for treatment of nervous disorders, and in this way conflicts
within the family were often revealed. Since individual treatment of the
child often causes conflicts between the parents clue to the disturbance of

Dr. Atle Roness is Director of Modum Bads Nervesanatorium, Vikersund, N-3370 Norway.
Reprint requests should be addressed to the author.

200 International ]ournaJ of Family Therapy, 2(3), Fall "1980

0148-8384/80/7500-0200500.95 @1980 Human Sciences Press
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ATLE RONESS

the homeostasis, guidance and therapy began to be employed for the

parents as well, and later therapy for the parents and child together was
used.
Quite some time had to pass before family therapy was used in adult
psychiatry. Psychoanalysis gained a foothold in Norway quite early,
through Ragner Vogt and Harald Schjeldrup. This developed into a strong-
ly psychodynamic therapy, mainly individual therapy, and as time passed
group and milieu therapy were included. It became evident, however, that
long and intensive individual psychotherapy could lead to adverse conse-
quences for the rest of the family, such as divorce, mental disorders or
suicide, caused by the disturbance of the homeostatsis within the family. It
then became clear that treatment of the whole family would be necessary.
Gordon Johnsen at Modum Bads Nervesanatorium, a psychiatric clinic
near Oslo, was an initiator in the use of family therapy in adult psychiatry
(Johnsen, 1968). He opened a special department at the clinic for the treat-
ment of parents and their children. Family therapy was also started quite
early at the Psychiatric Department VI at Ulleval Hospital in Oslo, where
Herluf Thomstad introduced the therapeutic community. It started with
mothers being admitted with postpartum psychoses, and itwas soon clear
that separating the mother from the newborn had bad results. Therefore
the newborn was admitted with the mother, and shewas given assistance in
learning how to care for the infant. The father was also included in the
treatment program (Albretsen, 1976). Patients were usually admitted to the
department as emergency cases of psychosis, and the patient's spouse was
gradually brought into the treatment program. Visits to the home were also
initiated, increasing the possiblity to work with the whole family.

FAMILY COUNSELING CENTERS

Outside of the psychiatric field, family therapy is mainly used by family

counseling centers. These centers are run by the church and by the govern-
ment, and are found throughout the country. They have no direct connec-
tion to the Medical Health Service. The church has 24 fully staffed centers,
as well as a number of smaller centers, and the government has about the
same number. The Church Family Organization has its own administration
to deal with its various centers. To illustrate the extent of this service, in
1978 there were 250 people from different disciplines employed and a total
of 10,500 people visited these centers. The government-run centers do not
have a special administrative office, and no statistics are available on the
extent of their activities.
In reality, the various family counseling centers function partly as psy-
chiatric outpatient clinics, because many of those who come to the centers
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do so primarily because of psychiatric disorders connected with problems

in their family situation. However, the centers also treat clients who are not
psychiatrically ill. These are people with general problems in their life
situation; for example, marital conflicts, problems in relation to their
children, sexual problems, infidelity, loneliness, etc. The centers mainly
use couple therapy in their treatment program, but are beginning to use
family therapy more and more, as well as family group therapy.

INPATIENT THERAPY

Family therapy in psychiatric treatment has been implemented in

hospitals and on an outpatient basis. As mentioned previously, there is only
one 24-hour family therapy department for adults in Norway, at Modum
Bads Nervesanatorium. Patients are admitted to this clinic from the whole
country. Because of the great distances in Norway, the patient's spouse as
well as children are admitted when this is suitable for the treatment pro-
gram. When the whole family is admitted, they live in small separate
houses which are in connection with the clinic. Schools and playgrounds
are available for the children. The family receives intensive
psychotherapy--as individuals, for the parent couple, and for the whole
family unit (Holm & Kvebaek, 1973).
In the field of child psychiatry, there are several 24-hour institutions for
family therapy. The State Center for Child and Youth Psychiatry in Oslo has
two departments, one in the children's unit (Fossum & Spurkeland, 1978),
and one in the adolescent unit. There is a separate family therapy unit con-
nected to the child psychiatry department in the towns of Molde and
Trondheim. In all of the above-mentioned child psychiatric hospitals,
parents and siblings are admitted together with the patient.
Since there is no separate family therapy department in most of the adult
psychiatric institutions in Norway, family therapy is integrated into the
general therapeutic situation. Whereas the Social Medicine Insurance
Scheme previously covered the admittance of family members in only a
few special psychiatric departments, it now covers the admittance of the
whole family in any of the psychiatric institutions throughout the country,
when this is deemed necessary for the treatment of the patient. It is often
realistic to admit the whole family to the hospital together with the patient,
since outpatient therapy of family members could not be carried out
because of the large distances in Norway.
A plan is at present being worked out whereby the various psychiatric in-
stitutions will become responsible for the population in a given area sur-
rounding the institution, and it is hoped the distance between the patient's
home and the hospital will be shorter in the future. This will help in carrying
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out family therapy on an outpatient basis. Family therapy has been used a
great deal at certain adult psychiatric institutions. This applies to the Psy-
chiatric Department VI at Ulleval Hospital where, as mentioned before,
family therapy has been practiced for some time, and where--in addition
to work with the mother/child relationship--they have considerable ex-
perience in treating married couples in psychotherapeutic groups. The
Lien Department at Dikemark Hospital in Oslo, which primarily treats
adolescents with borderline psychosis, has also worked with family
therapy. A special form of network therapy has been developed here by
Vaglum (1973), working with the patient's environment.

OUTPATIENT THERAPY

Psychiatric treatment in Norway had previously been carried out only in

hospitals. The development of outpatient treatment has been slow, but is
gradually being practiced more. Various forms of therapy are now in use
before patients are hospitalized, including psychoanalysis, behavioral
therapy, group therapy, and psychopharmacological treatment. The prin-
ciples of family therapy are also used in institutions, such as health centers,
social welfare offices, and by school psychologists, and counseling
centers.

EDUCATION

Norway has a strong psychotherapeutic tradition, and was the host for
the World Congress in Psychotherapy in Oslo in 1973. The formal educa-
tion in psychotherapy has been psychoanalytically oriented for many
years, but there has been a lack of comparable education in family
therapy. Up to the present time, educational programs in Norway for fami-
ly therapists have been poorly coordinated.
For the past several years, the church has had a 2-year educational pro-
gram for those to be employed in their counseling centers. The Directorate
of Health is now planning a special educational program for family
therapists which will be more extensive, and in addition to theory, practical
training under the supervision of an approved therapist will take place.
There are now plans for a more structured educational program for the
study of family therapy technique lasting 2 years and emphasizing both the
theoretical and the practical aspects of the technique. The Psychothera-
peutic Committee of the Norwegian Psychiatric Association is the initiator
of this project.
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RESEARCH

Very little research has been published as yet on family therapy in Nor-
way. Albretsen (1976) published his follow-up study of mothers and their
children admitted to the Psychiatric Department at Ulleval Hospital. The
observation period of 10 years has given this study special val ue. Fossum &
Spurkeland (1978) carried out a follow-up study of families who had been
admitted to the Child Psychiatry Department at the State Center for Child
and Youth Psychiatry, and this study illustrates the value of treating the
whole family.
A journal on family therapy was founded in 1973 entitled Fokus pa
Familien. This journal has about1,800 subscribers and appears four times a
year. It is sponsored by Modum Bads Nervesanatorium together with The
Church Family Organization, and is the only journal dealing with family
therapy in Scandinavia. The articles, which are published in Norwegian, are
primarily concerned with clinical problems.

REFERENCES

Albretsen, C.S. Modre med barn i psykiatriske avdelinger. Nordisk Psykiatrisk Tiddskrift,
1976, Suppl. 4.
Fossum, T.R., & Spurkeland, I. Familier reed nervose barn. Behandling ved innleggelse. Oslo-
Bergen-Tromso: Universitetsforlaget, 1978.
Holm H.J., & Kvebaek, D. Behandlin8 og pedagogikk. Fokus pa Familien, 1973, 1, 27-29.
Johnsen, G. Family treatment in psychiatric hospitals. Psychotherapy and Psychosomatics,
1968, 16, 333-338.
Vaglum P. Familiearbeid o8 nettverksforandring som ledd i behandlingen ved en psykiatrisk
sykehusavdelin8. Nordisk Psykiatrisk Tiddskrift, 1973, 27, 265-272.