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Finding your way in the Dutch Mental Health System

Recently, PsyGlobal interviewed Olga Kurek, a Ukrainian mental health professional, about her journey and insights into working in the Dutch mental health system. Her experiences offer valuable advice for other Ukrainian professionals looking to continue their mental health career while in the Netherlands. Olga Kurek

Olga Kurek is a 35-year-old Ukrainian mental health professional living in Amsterdam with her husband and dog, where she relocated three years ago, just before the war. Before Olga moved to the Netherlands, she lived in different countries across Europe and the U.S., studying and working in corporate finance and management consulting. After almost a decade working in the business, she consciously transitioned into coaching and psychology. She started a post-graduate training coaching program at the International Coaching Academy in Australia (“Online, as it was a bit too far and I don’t like big animals”), and parallel to that, she studied a Bachelor’s in psychology in Odesa, Ukraine, to gain a more in-depth understanding of the human psyche. She also completed a CBT study designed especially for coaches and counselors at Ukraine’s only accredited CBT training institute for mental health professionals to round her professional transition. 

 

Other paths towards working in mental healthcare 

When the war started, it did not immediately appeal to Olga to use her background in psychology to work with Ukrainian displaced people who arrived in the Netherlands. She felt insecure about her knowledge, and she did not feel prepared enough. She did, however, work as a project manager for PsyGlobal, putting her project skills into practice to help her compatriots indirectly. In this role, she learned about the other options for working in mental healthcare besides being a basic psychologist in a clinical (GGZ) setting. 

Olga is now working as a counselor / mental health coach (“I try not to stick to the titles anymore. I provide psychological support to Ukrainian displaced people”) for the Rotterdam-based foundation Mano (Stichting Mano). She also had an engagement at one of the largest Dutch GGZ organizations that, among others, provides preventive psychological support to employees of Dutch organizations. 


Looking back on the first days of a new project 

Before joining Mano, Olga worked at one of the largest Dutch Mental Health Organisations, providing preventive psychological support to employees of Dutch organizations. This was her first experience and presented certain challenges. She initially felt lost. She had to quickly figure out how the work needed to be structured and what was expected from her – she was just learning by doing. She got suggestions from her employer about how many sessions she would have with her client and how much direct and indirect time was available. However, onboarding an external mental health professional seemed not to be set in stone. All in all, it was challenging. It was unclear who was responsible for what and who you needed to contact with what kind of questions. Olga did not know who felt responsible for her or who was supporting her. 

It was Olga’s proactive personality that helped her in this specific example. She just asked a lot of questions. That led to a supervisor being assigned to her, someone she could discuss the case with, who helped her with coordination and reporting. 

 

Prepare and ask questions

That’s Olga’s first advice for other Ukrainian Mental Health Professionals: Prepare and ask A LOT of questions: 

In the Netherlands, employers assume that if you don’t ask questions, you know what you are doing. Autonomy is a big thing here. They give you a lot of freedom, but that also means they tend not to take much time to explain things. While coming from a different country, even with 20 years of experience, all is again new. 

So, ask questions. Prepare a list of questions to bring on your first day. What is the plan, how do I start, what do I need, what kind of tools would be helpful, how does this work on the technical or administrative side and who is my “go-to” person when I need support. 

Ask for proper onboarding. Even if they don’t have it, sit together and think it through. 

Make sure to clarify all of this in the beginning, not throughout the process. Then, it becomes overwhelming and unnecessarily frustrating.

“You can be very confident about how to counsel a person, but you don’t know the rest.”

You may be lucky to find an organization where your manager or supervisor feels very responsible and will proactively help you. Still, you may also find yourself in a situation where nobody steps up to help you. That’s never because they don’t want to help you; it’s just that they don’t know you need help. Your colleagues might have no clue that things are different in Ukraine and that you are not used to working in the ‘Dutch’ way. So, once again, ask questions. This might be challenging, not least for your ego, as it requires admitting that there are things you don’t know, but it will help you throughout the rest of your career. 

 

Adapt to Dutch Reporting Standards

A very important part of therapy in the Netherlands is reporting. This is due to insurance matters and keeping your supervisor updated, but it’s also important for you as the therapist to look back on the session and prepare for the following session. The reporting tools are usually Dutch, so that can be challenging. Since there are usually no formal reporting requirements in Ukraine, this was also something to learn from scratch. 

“I had to learn to make the decision which of my scribbles would go into the report and what would stay for me”

Olga can speak and write in Dutch, so for her, the challenge was more about the structure and the amount she had to report. She never received a clear instruction on reporting, she just learned by doing and looking at how colleagues wrote their reports. In the beginning, she spent too much time on the reports as she had to develop the structure and the method herself, and there was not much time for reporting (indirect time) in the Dutch mental health system. That was very challenging, and it still is sometimes. 

“You need to get the skill of quickly identifying from everything that you’ve heard within 50 minutes of the conversation what is most relevant for the report and for your supervisor to know.” 

 

An opportunity to grow personally and professionally

Working in the Netherlands did not only change Olga’s perspectives but also broadened her network. It also changed her view on psychology: “In Ukraine, I perceived psychology as a more humanistic science. It was more about self-development and personal transformation, changing who you are so you can live your life better.” In the Netherlands, psychology is more about treating a disease – more medicalized. It’s a precise science, and all treatments are research-based. This makes working in the Netherlands an opportunity to learn and grow professionally by learning new psychological approaches and expanding methodological knowledge. So embrace that opportunity. It will not only boost your competence but also your confidence.

 

PsyGlobal in gesprek met: Olga Kurek, over de unieke waarde van Oekraïense ggz-professionals

Onlangs interviewde PsyGlobal Olga Kurek, een Oekraïense ggz-professional, over haar ervaring en inzichten in het werken binnen de Nederlandse GGZ. Haar verhaal laat zien waarom Oekraïense ggz-professionals een waardevolle bijdrage kunnen leveren aan de Nederlandse geestelijke gezondheidszorg.

Olga Kurek is een 35-jarige Oekraïense ggz-professional uit Amsterdam. Drie jaar geleden verhuisde ze naar Nederland, samen met haar man en hond, vlak voor het uitbreken van de oorlog. 

Olga Kurek

Voordat Olga naar Nederland kwam, woonde ze in verschillende landen in Europa en de VS, waar ze studeerde en werkte in corporate finance en management consulting. Na jaren in een corporate omgeving maakte ze de bewuste keuze om over te stappen naar coaching en psychologie. Ze volgde een opleiding aan een coachingsacademie in Australië (“Online, want het was een beetje te ver weg en ik hou niet van grote dieren”) en deed daarnaast een bachelor psychologie aan een universiteit in Odessa, Oekraïne om een diepgaander begrip van de menselijke psyche te krijgen. Ook volgde ze een geaccrediteerde CBT opleiding voor coaches en counselors.

Andere wegen naar een carrière in de geestelijke gezondheidszorg

Toen de oorlog uitbrak, voelde Olga zich niet meteen geroepen om haar achtergrond in de psychologie in te zetten voor het werken met Oekraïense vluchtelingen in Nederland. Ze voelde zich onzeker over haar kennis en vond dat ze niet voldoende was voorbereid. Wel werkte ze een tijd als projectmanager voor PsyGlobal, waar ze haar vaardigheden gebruikte om indirect haar landgenoten te helpen. In deze rol ontdekte ze andere mogelijkheden om te werken in de geestelijke gezondheidszorg, naast het werken als basispsycholoog in een GGZ-instelling.

Tegenwoordig werkt Olga als counselor/mental health coach (“Ik probeer niet te veel aan titels vast te houden. Ik bied psychologische ondersteuning aan Oekraïense vluchtelingen.”) voor de Rotterdamse Stichting Mano. Ze werkte ook bij een van de grootste Nederlandse GGZ-instellingen, waar ze preventieve psychologische ondersteuning gaf aan werknemers van Nederlandse organisaties.

De toegevoegde waarde van Oekraïense psychologen

Olga heeft een duidelijk beeld van de toegevoegde waarde van Oekraïense professionals in Nederlandse organisaties: “Ik denk dat een Nederlandssprekende, Engelssprekende of andere professional meer dan gekwalificeerd is om Oekraïners te helpen. Maar ik denk dat Oekraïners liever door Oekraïners geholpen willen worden en dat ze Oekraïners meer vertrouwen als professionals.” Het hebben van een Oekraïenssprekende psycholoog laat zien dat uw organisatie openstaat voor mensen in nood, en deze mensen zullen hulp komen vragen, zegt Olga. “Ze zullen de barrières overwinnen om bij een Oekraïense psycholoog in jouw organisatie te komen.”

Deze barrières zijn volgens Olga minder makkelijk te overwinnen als het niet een Oekraïense psycholoog betreft: “Het is anders voor hen (Oekraïense cliënten) als ze door alle systemische uitdagingen heen moeten (een onbekend zorgsysteem, verzekeringskwesties, lange wachttijden) en uiteindelijk daar zitten met een tolk of een persoon die geen emotionele band heeft met het land en misschien niet begrijpt wat het nu betekent om hier te zijn, zo ver weg, of om iemand te verliezen.”

Promoot de aanwezigheid van Oekraïense zorgprofessionals 

Op het moment dat er een Oekraïense professional bij uw organisatie gaat werken, zorg er dan voor dat iedereen dat weet. Breng het nieuws breed naar buiten, mensen zullen komen. Olga is zeven maanden geleden begonnen met haar werk bij Stichting Mano. Er is geen dag voorbij gegaan dat ze geen cliënten heeft gezien, en dat alleen in Rotterdam. Het aantal cliënten groeide vanaf het begin af aan gestaag, en het groeit nog steeds. Als mensen begrijpen dat er een landgenoot werkt als psycholoog of counselor bij een organisatie in de buurt, dan zullen ze om hulp vragen en de instroom zal op gang komen. 

Wat kunt u verwachten? 

Hoewel Oekraïense professionals waardevolle expertise en culturele inzichten meebrengen, zijn er ook uitdagingen waar u als GGZ-instelling rekening mee moet houden. Volgens Olga is het belangrijk om de professionals vanaf het begin af aan goed te begeleiden: 

Zorg voor een duidelijke onboarding
Veel Oekraïense professionals zijn bekend met andere werkmethodes en hebben mogelijk niet direct inzicht in hoe administratieve en juridische processen in Nederland werken. Boek daarom in het begin voldoende tijd in om vragen te beantwoorden, ga er niet vanuit dat men alles wel zal weten. Bepaal samen hoe jullie de samenwerking tot een succes kunnen maken. Wat is hier voor nodig, wie benader je waarvoor, welke tools kunnen helpen, hoe begin je, hoe en voor wie rapporteer ik; dat soort vragen. Door hier echt de tijd voor te nemen zult u allemaal het maximale uit de samenwerking halen: uw organisatie, de psycholoog en de cliënten. 

Stel iemand aan als supervisor
We zijn in Nederland erg gehecht aan onze autonomie. Dit kan voor buitenlandse werknemers vaak overweldigend zijn. Als zij geen vragen stellen, gaat u er als organisatie vast vanuit dat ze alles weten. Dat is niet zo. Zorg ervoor dat de professional in ieder geval in de eerste weken goed begeleid wordt. 

Verlies niet de focus

In februari is het alweer drie jaar geleden dat de oorlog in Oekraïne begon. Hoewel er echt goede stappen zijn gemaakt in het bieden van psychosociale en psychologische hulp aan Oekraïeners in Nederland worden de problemen niet minder groot. Integendeel. Olga drukt ons daarom op het hart om de focus op de ondersteuning voor Oekraïeners in Nederland niet te verliezen. “Laat je niet afleiden.” Er zijn duizenden Oekraïeners in Nederland die al drie jaar in zeer moeilijke omstandigheden leven. Ze zijn ver van huis, ze zijn bezorgd, ze willen graag terug. Dat maakt hun psychische gezondheid kwetsbaar. 

“Ik hoop echt dat iedereen die betrokken is niet moe zal worden. Dat zeg ik, omdat ik denk dat veel mensen moe worden van de oorlog. Niet alleen Oekraïners, maar ook Nederlanders. Maar ik denk dat het nu nog niet de tijd is om te ontspannen.”

PsyGlobal in gesprek met: Albina Gizatova, Afdelingsmanager bij het Leger des Heils

Albina Gizatova, zelf een Oekraïense, meldde zich in 2022 direct aan bij de gemeente in Venlo toen ze hoorde dat er Oekraïense ontheemden naar Venlo zouden komen. Al snel werd ze gebeld door het Leger des Heils om de eerste 45 Oekraïeners die onderweg waren welkom te heten. Ze zegde haar baan op en voor ze het doorhad werkte ze als woonbegeleider op de opvanglocatie.

Albina GizatovaNu, bijna drie jaar later, is Albina afdelingsmanager bij een van de twee, en binnenkort drie opvanglocaties met in totaal 460 ‘deelnemers’ uit Oekraïne. Al vrij snel ging de gemeente Venlo een samenwerking aan met een Oekraïense ggz-professional. PsyGlobal sprak met Albina over deze samenwerking.

“Soms kijk je eventjes, sta je even stil en denk je, wow.”

Alles regelen

Toen Albina zich in 2022 meldde om de eerste groep Oekraïeners welkom te heten, was er nog niets geregeld. Er was een opvanglocatie, de Beerendonck, een voormalig bejaardenhuis, maar verder was er nog niets. “We moesten dat gewoon allemaal regelen, de catering, zorg, alles, maar het is ons binnen twee maanden gelukt om alles klaar te krijgen.” 

Het team van Albina bij het Leger des Heils bestaat uit 11 woonbegeleiders. Het is een echt dream team volgens haar, met mensen die Oekraïens, Russisch, Pools, Engels en Nederlands spreken. Samen met een andere manager bestieren ze, naast de Beerendonck, ook locatie Californië, een mobile home park waar de gemeente 100 chalets huurt. 

Op de Beerendonck is een aparte zorgvleugel gecreëerd met zeven aparte kamers voor mensen die een flinke rugzak hebben, vaak een verslaving of psychische aandoening, en die extra aandacht en begeleiding krijgen. 

 

Een Oekraïense psycholoog op locatie

Het team van woonbegeleiders ging direct na de aankomst van de Oekraïeners op zoek naar manieren om hen psychologisch te ondersteunen. Ze maakten voor een aantal deelnemers een afspraak bij de huisarts, maar deze wist op dat moment nog niet goed wat te doen met deze nieuwe groep patiënten. Daar kwam dus nog geen vervolg op. Dat was nogal een teleurstelling. Gelukkig bleek een van de deelnemers op de locatie een achtergrond te hebben in psychologie, en via PsyGlobal werd hij ingezet om psychosociale hulp te bieden aan de andere deelnemers op de locatie. De samenwerking met deze psycholoog liep ten einde toen hij naar een andere gemeente verhuisde, maar tot op heden werkt er een Oekraïense professional op beide locaties van het Leger des Heils in Venlo. 

 

Albina was direct heel enthousiast over de samenwerking. Ze wilde zo snel mogelijk mensen mentaal kunnen ondersteunen, en dat dat op locatie kon, was helemaal praktisch. Als de behoefte er is, kan er al binnen een paar dagen een consult worden gepland. Ze wil hierbij direct een groot compliment geven aan de gemeente: “We hebben de samenwerking met de gemeente zo fijn geregeld. We zitten elke week een keer met elkaar aan tafel, de gemeente luistert echt naar ons: Wat zijn de behoeften? Hoe kunnen we dit oplossen?”

Maar niet alleen de samenwerking met de gemeente is goed geregeld. Ook het contact met het netwerk van wijkteam, crisisdienst, raad van de kinderbescherming, veilig thuis is erg goed; iedereen werkt samen, en iedereen profiteert van de samenwerking met de Oekraïense psycholoog. 

 

Het taboe doorbreken

Albina is trots op de bijzondere band die haar team heeft met alle deelnemers op hun locaties. Mensen komen proactief naar de woonbegeleiders toe met hulpvragen, en haar team staat altijd klaar om met deelnemers een kop koffie te drinken. Soms komen er tijdens zo’n gesprek psychische klachten naar boven. Haar team kan indien nodig doorverwijzen naar het spreekuur van de Oekraïense psycholoog op locatie. Het feit dat mensen met hun problemen proactief naar de woonbegeleiders komen zegt echt iets over die bijzondere band die is opgebouwd. 

Het is voor Albina erg belangrijk dat het taboe op mentale problemen wordt doorbroken: “Als je hoofdpijn hebt, doe je daar ook iets aan. Dat moet je ook gewoon doen bij psychische klachten, beschouw het als een ziekte, waar je iets aan kunt doen.” Op deze manier kijken naar psychische klachten is niet gebruikelijk voor Oekraïeners. “Daar praten we erover met onze vriendinnen of een buurvrouw, dan is het uit de lucht en gaan we door.”

 

De aanwas van nieuwe cliënten voor de Oekraïense psycholoog gaat organisch. Deelnemers praten met elkaar, spreken iemand die een sessie met de psycholoog heeft gehad en komen de woonbegeleiders vragen of zij ook een afspraak kunnen krijgen. Het is een kettingreactie. 

 

De hulpvraag verandert

In het eerste jaar na het begin van de oorlog zag Albina vooral veel trauma om zich heen. Mensen waren echt in shock. Nu, bijna drie jaar later, ziet ze dat het vaak het topje van de ijsberg was. Enerzijds waren reeds aanwezige psychische klachten tijdelijk bedolven onder een laag adrenaline, en steken die nu weer de kop op, en anderzijds ontstaan er veel problemen door de situatie waar Oekraïeners zich in bevinden: de onzekerheid, gebrek aan privacy en structuur, gebrek aan vaderfiguren in families, kinderen in de pubertijd. Deze cocktail maakt een psycholoog of andersoortige psychische hulp op opvanglocaties echt noodzakelijk. Albina: “We praten steeds over bed, bad, brood. Ik zou daar echt een psycholoog aan toevoegen. Het is een basisbehoefte.” 

 

Veel ellende voorkomen

Onrust, agressie, verslavingen.. er zijn de laatste maanden veel negatieve verhalen in het nieuws over de situatie in opvanglocaties voor Oekraïeners en andere vluchtelingen. Albina is er erg trots op dat het in Venlo goed gaat. De aanwezigheid van een Oekraïense psycholoog heeft hier zeker aan bijgedragen. Bovendien is er die speciale zorgvleugel, waar ze mensen extra aandacht en begeleiding kunnen geven. Maar ook de bijzondere band die haar team heeft met de deelnemers heeft impact: “Als het een keer mis gaat, dan komt de deelnemer naar ons toe om excuses aan te bieden. ‘Ik heb het gevoel dat ik jullie heb teleurgesteld. Jullie doen zoveel voor ons.’ Soms kijk je je eventjes, sta je even stil en denk je, wow.”

 

 

Lees hier ook ons interview met Corma Poelen, GZ-psychologe, over de samenwerking met haar Oekraïense collega

 

Navigating Ethics and Legal Frameworks in Dutch Healthcare

No matter how many years of experience you have in the field of mental health, (re-) starting your career in a new country is always challenging. PsyGlobal wants to guide you in this challenging process, to make sure your landing is as soft as possible. One important part of this challenging process, is understanding ethics and legal frameworks that we use in the Netherlands. Here’s an overview of the most important principles.

Legal Frameworks

Ethical guidelines

1. Wet BIG 

The law on Healthcare Professions regulates healthcare professions to ensure client safety and quality care. It sets training and qualification standards and outlines disciplinary measures for misconduct (such as removal from the register in cases of severe violations). The law is only applicable for protected titles in healthcare: GZ-psycholoog (healthcare psychologist) and psychotherapist. Only professionals that meet the required education and training standards can call themselves GZ-psycholoog or psychotherapist. These professionals are listed in the BIG- register and are being held to very high standards. It is also only these profession that are eligible for insurance reimbursement.

2. AVG (General Data Protection Regulation)

This is a European law that protects patient information and ensures their privacy is respected.

3. Wkkgz

The Quality of Medical Care, Complaints, and Disputes Act requires healthcare professionals to have a complaints system available. Patients can turn to this complaints system if they are unhappy with the care they receive. Also, the law requires healthcare professionals to have an independent Disputes Committee in place.

4.WGBO 

The Medical Treatment Contract Act explains that the relationship between a client and therapist is a contract and protects the rights of the client.

Informed Consent: Clients must agree to their treatment plan. This is called shared decision-making.

Privacy: Everything discussed with a client must be kept confidential, with only a few exceptions. It also requires implementing specific administrative processes to ensure information security (secure systems for storing and sharing client information and adhering to privacy laws like GDPR).

Ending Treatment: Both the patient and the therapist can end the treatment. However, therapists need a significant reason to end the contract

 

Ethical Guidelines

Ethics go hand-in-hand with legal requirements. Healthcare professionals working in the Netherlands are encouraged to follow the ethical guidelines provided by the NIP (the Dutch institute for Psychologists). The complete ‘Code of Professional Ethics’ can be found here.

This Code of Professional Ethics describes the ethical principles and rules that psychologists observe when practising their profession.It serves as a guide or ethical compass for psychologists in their professional conduct and is structured around the concepts of: Responsibility, Integrity, Respect, Expertise

A few important outtakes:

Document Everything (Wie schrijft die blijft): Document everything you discuss with your client as well as your own considerations. For example, if a client threatens to kill someone, you have to assess what the chances are that he will actually do that. Write down your assessment of the situation, why you did or did not consider this a risk. If for some reason you have to defend yourself later, and you can show that you have carefully considered your decision, you can never be held responsible.

Confidentiality and Risk of Harm: If a patient threatens harm to themselves or others, the therapist may need to break confidentiality to prevent danger. However, they should carefully think about the situation and document their decision.

Taking Action to Prevent Harm: If there is a real risk to someone’s safety, the therapist must make a reasonable effort to warn the person or contact the authorities.

Stick to the Facts: When writing about a patient, therapists should only report facts. They should not make judgments about the patient, such as saying they are “too sick to work.

A final word of advice about ethics:

Don’t try to figure everything out yourself. It can help you to discuss the situation with a colleague or your supervisor. This might help you to come to a better decision.

 

About starting your Private Practice

In the Netherlands, only BIG-registered professionals can diagnose clients and treat clients independently. As a (basic) psychologist, you can only work under the supervision of a BIG-registered colleague. If not, the therapy you provide is not covered by insurance.

While your clients can choose to pay for therapy themselves, you are still obligated to have a complaints procedure and regulation in place, and to inform your clients about it. This includes providing access to a complaints officer and being affiliated with a disputes committee.

The NIP (Dutch Association of Psychologists) can provide you with these regulations, though it’s important to note that they are very costly.

Starting your own practice is ultimately your choice, as the title ‘psychologist’ is not legally protected. We would, however, advise against it and encourage you to find a position through official channels, working under the supervision of a regiebehandelaar. This way, both insurance reimbursements and all necessary regulations, are fully covered.

PsyGlobal has also written a series of articles on working in mental health care. These articles cover the subjects of Structure and Professional Relationship, the Intake Session and Diagnoses and Treatment Plans. Also, we have written extensive guidelines about working in the Netherlands; from peculiarities about the Dutch culture to roles and responsibilities within Mental Health Care. The guidelines can be found here. 

Please remember that PsyGlobal is here for you. There is no such thing as a stupid question, and we are available to answers yours anytime. You can also participate in intervision sessions to exchange experiences and ideas with us and fellow foreign mental health professionals, attend webinars or enroll for trainings. We will update you regularly through LinkedIn or our newsletter. Thank you for being part of PsyGlobal, and good luck!

 

Navigating Child and Youth psychology in the Netherlands

No matter how many years of experience you have in the field of mental health, (re-) starting your career in a new country is always challenging. PsyGlobal wants to guide you in this challenging process, to make sure your landing is as soft as possible. One important part of this challenging process, is understanding local systems. If you’re a child psychologist planning to work in the Netherlands, familiarizing yourself with the structure of child and youth care is crucial. Here’s a guide to help you navigate the Dutch system.

How is child and youth care organized?

In the Netherlands, child and youth care is managed locally by municipalities (gemeenten). Before 2015, these services fell under health insurance providers, but the shift to local governance aims to make care more accessible and locally coordinated.

Municipalities not only organize care but also handle its funding. As a child psychologist, securing a contract with the municipality is essential; without it, your services won’t be reimbursed.

Legal considerations

One very important aspect to keep in mind is consent. If you’re working with children under 16, consent from both parents is mandatory before starting therapy. For children over 16, parental consent is no longer required, but keeping parents informed and involved is still encouraged. Exceptions apply in cases of safety concerns or specific legal obligations.

Referrals: The starting point for therapy

In the Netherlands, therapy begins with a referral from one of these sources:

  1. General Practitioner (GP): The family doctor often acts as the first point of contact, providing early assessments and insights into the child’s and family’s situation.
  2. Wijkteam: These neighborhood teams specialize in youth care, offering tailored support to families.
  3. GGD: This preventive healthcare organization oversees health checks and vaccinations for children.
  4. Pediatricians: They address specialized medical concerns and can recommend further psychological support.

Key organizations in child and youth care

Several organizations are pivotal in supporting children and families in the Netherlands. Two of the most important in safeguarding child safety are Veilig Thuis and the Raad van de Kinderbescherming (Child Protection Board).

Veilig Thuis (Safe at Home)

Veilig Thuis serves as the national reporting center for domestic violence and child abuse. It is accessible to psychologists, social workers, neighbors, parents, and even children who suspect or experience unsafe situations. When contacted, Veilig Thuis assesses the situation to determine whether intervention is necessary.

In severe cases involving acute danger, repeated reports, or parental refusal to seek help, Veilig Thuis can escalate the case to the Raad van de Kinderbescherming. This ensures that no child is left in a harmful situation without action.

Raad van de Kinderbescherming (Child Protection Board)

The Raad van de Kinderbescherming steps in when a child’s safety is at serious risk. Their role is investigative, involving discussions with psychologists, teachers, social workers, and parents to understand the situation thoroughly. These roundtable discussions aim to find solutions that prioritize the child’s well-being.

In extreme cases, the Raad may recommend interventions such as:

  • Court involvement to enforce protective measures.
  • Out-of-home placement, which is only considered as a last resort when all other options have been exhausted. This ensures that removing a child from their family happens only when absolutely necessary and in the best interest of the child.

The focus remains on collaboration and providing support to families to avoid such drastic steps wherever possible.

A typical day as a child psychologist

Your work will involve a mix of responsibilities, such as:

  • Diagnosing and treating children through various therapies, including CBT and play therapy.
  • Consulting with parents and families.
  • Visiting schools to collaborate with teachers.
  • Offering advice to social workers and community centers.
  • Handling crisis interventions.

Practical tips for psychologists new to the Dutch system

  1. Focus on structure: Encourage children to maintain routines like attending school and engaging in hobbies.
  2. Trauma processing: Play, relaxation techniques, and open conversations about emotions are helpful tools.
  3. Short therapy sessions: Avoid long-term dependency by keeping treatments concise and monitoring progress post-therapy.
  4. Stay connected locally: Collaborate closely with social workers and provide guidance on creating better environments for children.

Continuous learning: Boosting your expertise

To excel in the Dutch context:

  • Gain experience with age-specific issues.
  • Seek guidance from supervisors (regiebehandelaars) on legal and cultural aspects.
  • Enroll in courses, webinars, or lectures tailored for child psychologists.
  • Learn basic Dutch and familiarize yourself with Dutch culture to build trust with clients and their families.

 

To conclude

Understanding the structure of child and youth care in the Netherlands can feel overwhelming at first, but with time and effort, you’ll find ways to adapt and thrive. The Dutch system’s emphasis on collaboration, prevention, and family support ensures that you’ll have the tools to make a real difference in young lives.

PsyGlobal has also written a series of articles on working in mental health care. These articles cover the subjects of Structure and Professional Relationship, the Intake Session and Diagnoses and Treatment Plans. Also, we have written extensive guidelines about working in the Netherlands; from peculiarities about the Dutch culture to roles and responsibilities within Mental Health Care. The guidelines can be found here. 

Please remember that PsyGlobal is here for you. There is no such thing as a stupid question, and we are available to answers yours anytime. You can also participate in intervision sessions to exchange experiences and ideas with us and fellow foreign mental health professionals, attend webinars or enroll for trainings. We will update you regularly through LinkedIn or our newsletter. Thank you for being part of PsyGlobal, and good luck!

 

Coming to work in mental health care in the Netherlands (3)? Diagnosis and treatment

No matter how many years of experience you have in the field of mental health, (re-) starting your career in a new country is always challenging. PsyGlobal wants to guide you in this challenging process, to make sure your landing will be as soft as possible.

diagnoses and treatment plan
Photo: Freepik.com

We interviewed Dutch professionals Wendy Weijts, clinical psychologist and psychotherapist, connected to WorldPsychologists, and teacher at RINO Amsterdam and Myra Haakman, psychologist, psychological lead at PsyGlobal, and co-founder of WorldPsychologist, about the Dutch vision on mental health care. In the first articles, we talked about structure and a professional relationship and the intake session. In this article, we talk about the diagnosis, treatment plans and closure.

 

The diagnosis and mutual understanding of goals

After the intake session, you’ll most likely be asked to set a diagnosis, together with your supervisor. You’ll set a diagnosis according to the DSM-5, together with a descriptive diagnosis. This descriptive diagnosis always includes the clients gender, age and the reason why they are getting treatment. For example: “Client is a 37-year old woman with a history of personality disorders. She is currently presenting increased depressive symptoms due to a life-event (divorce). Symptoms are worsened due to self-isolation and overall avoidance.”

This diagnosis leads to a certain treatment plan that has a clear start and finish. In the Netherlands, this diagnosis is always shared with the client due to insurance matters. This is done in the first meeting after the intake. You share the diagnosis and the treatment plan that you and your supervisor decided on. Clearly explain why this is the diagnosis according to you, how you are going to work together to treat it and what realistic goals can be set. This is a very important step in the process: the client must fully understand what the plan is from now on. Make sure there is mutual understanding about those goals and the path towards them.

Setting realistic goals is very helpful in keeping structure. Everything you do in the therapy sessions should be aimed towards reaching those goals.

 

The diagnosis is what you are going to treat

The diagnosis is set following a diagnostic decision tree. The DSM-5 serves as a guideline in this process. The order of the treatment is important here. In general, you will prioritize the most severe or acute problems and then proceed to evaluate other possible disorders. This may mean that substance use disorders or severe psychotic disorders are assessed first, followed by other disorders such as mood disorders, anxiety disorders, and personality disorders, and finally, behavioral issues or adjustment disorders.

It is possible that there is more than one diagnosis. For example, trauma and depression. However, it is important to only put a diagnosis on the issue that you are actually going to treat. If you set a diagnosis, you are going to have to treat it. That might mean that you are first (and sometimes only) going to work on a trauma, while your client also has a personality disorder. It is however important to take everything a client is dealing with into account, since it might have an effect on a treatment plan. For example, if a client is autistic and has a depression, the treatment for the depression has to be adjusted. Or, another example, if the personality disorder has affected the trauma, this has to be taken into account. 

The holistic theory on diagnoses

Looking at the interconnectedness of your client’s issues, as mentioned in the two examples above, is an example of a holistic approach. It’s used to gain a better understanding of the relationship between the client’s development, personality, and the symptoms they experience. It’s also very helpful to explain to your client how certain issues interconnect. And how, for example, certain behavior from their childhood, keeps them from healing. 

holistic framework example
The Holistic Framework

A possible model to use for the holistic theory consists of three parts: 

  1. The head: structural vulnerabilities or history. This consists of personal factors (genetics) and surrounding factors (the context of the family – cultural background, how someone was raised, childhood trauma)
  2. The middle: personality traits or instrumental vulnerabilities. These entail relatively fixed beliefs that someone holds about themselves, the world, or others.
  3. The tail: complaints and problems. What is the main complaint and what perpetuates what. 

If you click here, you can download a worksheet for the holistic theory, developed by the VGCT and translated into English.

 

Structured treatment plans

The diagnosis and the treatment plan set the structure for the treatment. There are protocols available for the process and guidelines for the number of sessions per diagnosis. Every process has a clear start and finish. Make sure to stick to this process as much as possible. It is well thought-through and very helpful for you as a therapist, as well as for the client: Everybody knows what is expected. Of course, there is some room to deviate. For example, when something intense happened in the client’s life, there is space to talk about that in the session. However, we really encourage you to return to the initial plan every time. For example, take ten minutes to talk about the current situation, and return to the plan for today after that.

Once again: a therapist in the Netherlands does not take over control. They set the structure, the framework, they will guide, but the client is in charge. You will be in this together.

 

Evaluation and closure

It can be very difficult to end a therapy process. There is always room to improve more, even though the initial goals are reached. If you use a certain protocol, closure is easier since you slowly reach the end of the process. But also if you are not following the protocol, there is still a guideline for the number of therapy sessions attached to a certain treatment plan. Or you make a plan with your client: how many sessions do you both think are necessary to reach a certain goal? You can also always emphasize on the insurance matter again; in basic GGZ, the insurance often only covers a certain number of sessions.

 

Make sure to announce in advance that the end of the treatment is approaching. Tell your client that you have reached the final step in the protocol, that there remain – for example – four sessions. Your client will feel more pressure to work towards their goals, there is a sense of urgency.

 

The closure comes with an evaluation. The intake form is used to evaluate the treatment, together with the questionnaire(s) that you used at the start of the treatment. Focus on the initial diagnosis and the goals that you agreed on at the start. There is probably always more to work on, but that was not part of this specific treatment plan. Celebrate the goals that you’ve reached together. The client can be very proud of what they achieved!

 

To conclude

We all agree that it’s very challenging for foreigners to come to work in a local environment. There’s the language, cultural differences, protocols, specific ways of working.. With these articles, we hope we have given you some tools to kickstart your work journey here. In addition to these articles, we have written extensive guidelines about working in the Netherlands; from peculiarities about the Dutch culture to roles and responsibilities within Mental Health Care. The guidelines can be found here.

 

Please remember that PsyGlobal is here for you. There is no such thing as a stupid question, and we are available to answers yours anytime. You can also participate in intervision sessions to exchange experiences and ideas with us and fellow foreign mental health professionals, attend webinars or enroll for trainings. We will update you regularly through LinkedIn or our newsletter. Thank you for being part of PsyGlobal, and good luck!

 

Coming to work in mental health care in the Netherlands (2)? The Intake Session

No matter how many years of experience you have in the field of mental health, (re-) starting your career in a new country is always challenging. PsyGlobal wants to guide you in this challenging process, to make sure your landing will be as soft as possible.

Photo: Freepik.com

We interviewed Dutch professionals Wendy Weijts, clinical psychologist and psychotherapist, connected to WorldPsychologists, and teacher at RINO Amsterdam and Myra Haakman, psychologist, psychological lead at PsyGlobal, and co-founder of WorldPsychologist, about the Dutch vision on mental health care. In the first article, we talked about structure and a professional relationship. In this article, we talk about the intake session. An article about the diagnosis, treatment plans and evaluation will follow.

 

Everything starts with a good intake

In Mental Health Organisations (curative clinical care – GGZ)*, the first session with a new client lasts 60 minutes. This intake is often done by you as the basic psychologist, and your supervisor might join in the last 15 minutes to get a feeling with the client as well. In these 45 or 60 minutes, the most important role of a therapist is to ask questions. Some psychologists have their own ‘intake format’ that lists important questions. This is up to you. It can however be helpful to work with standardized questionnaires, to make sure you don’t miss anything.

 

Steal with pride

We asked Myra and Wendy to share some of the questions from their intake format. Feel free to pick the ones that resonate. They might come in helpful.

First, it’s important to clarify the client’s issues. Always keep the DSM-5 in the back of your mind when clarifying these: 

  • How come you are here today? What makes you come to seek help specifically today, instead of two months from now, or two years ago? 
  • Can you describe your challenges / issues?
  • How did these issues become problems now?
  • How do you deal with your challenges / issues? What do you do to cope with them?
  • If you were your own therapist, what would you advise yourself to do?
  • How would somebody else explain your issues? (Your mum, partner, friends)

It’s also important to get to know the client:

  • Can you tell me something about yourself? What do you do in your day-to-day life? How is your family situation? Do you have friends with whom you can talk about your problems?
  • Who knows you are here today?
  • Who supports you?
  • When you are not feeling well, how can I see that?
  • Is it difficult for you to ask for help?
  • Do you drink alcohol, use drugs, or take medication?
  • Do you notice physical problems that are or might be related to your mental problems (somatic)?

Learn about their past:

  • Have you been diagnosed before? Are there any mental problems in your family?
  • Have you had treatment before? What worked and what did not?
  • Did you ever take medication before? Did that help?
  • What have you done yourself to cope? What worked?
  • Have you ever attempted suicide (before)?

And finally, it’s important to understand your client’s goals:

  • If this treatment is done, what has changed?
  • If you wake up tomorrow and a miracle has happened, what has changed? What do you do that’s different from what you do today? How would you notice that something has changed? 
  • Is there a parallel goal you want to accomplish besides solving your mental issues? For example: find a job, a new house, get married, change the relationship with friends / family.
  • What is your goal for this treatment? (There might be more than one issue, but it is not said that the client wants to work on every issue.)

Setting goals is probably the most important, but also most difficult. If you set goals with your client, make sure to make them SMART. They must be realistic. If you don’t think they are, be honest about it. That also helps in growing trust.

 Some Mental Health Organisations use their own standard questionnaires for intake sessions, also to measure effectiveness of the treatment. You will use the same questionnaire at the start and at the end of the treatment. An example of such a questionnaire is the ROM, the Routine Outcome Monitoring. The ROM used to be mandatory for insurance. This is no longer the case, but it can still be useful.

 

Insurance Matters

Working in curative clinical care (GGZ)* in the Netherlands means you have to deal with your client’s insurance and other stakeholders. That means that certain steps in the process are mandatory to take. Let’s put those chronologically:

  1. A client comes to you with a referral from their family doctor. After the intake session, you have to send a letter back to the family doctor to report about the client. The content of the letter should always be discussed with the client, before you send it. 
  2. After you set a diagnosis, you have to share this with the insurance company. This is done through the HoNOS+. This is a questionnaire from the ZPM (Zorgprestatiemodel – Care Performance Model) and it stands for ‘Health of the nation outcome scale’. The only thing that you share with the insurance is the so-called ‘Zorgzwaarte’, the intensity of the care. Everything else is private information. 
  3. Together with your client and your supervisor, you finalize the treatment plan.
  4. It’s also important to keep in mind that your client has to be seen by your supervisor (the ‘regiebehandelaar’), at least once within the first four sessions, and after that at least once a year. This is also due to insurance matters.

After the intake session, you’ll most likely be asked to set a diagnosis, together with your supervisor. We’ll dive into this process in the next article. 

* if you work in a municipality or preventive care, the ‘rules’ in this article often don’t apply. However, it could be very useful to keep them in mind in your work, as they might help you to structure your sessions.

Do you want to read more about working in a merely Dutch culture? We have written another article about stereotypes in the workplace. You can find it here.