THE APPROACH TO A PSYCHOLOGIST is still experienced by many as a serious overcoming, practically a revolution. In American films, heroes go to psychotherapists as if they were going to work; in Russia, making an appointment is a turning point that not everyone dares to. And in vain, because states like the same depression are not a whim that must be dealt with on their own, but a disease that can be treated. Choosing a good doctor is not easy at all, and finding the right psychotherapist is doubly difficult. The market has not yet formed – there is a big risk of stumbling upon charlatans or simply incompetent people. The costs of the wrong choice are very high: the patient will receive psychological trauma, it will be difficult to accept even qualified help in the future. We asked Ekaterina Sigitova, psychiatrist and psychotherapist, to tell how to avoid mistakes.
What kind of education should a psychotherapist have?
A good psychotherapist must meet a set of mandatory criteria – have a kind of “minimum package”, a package of guarantees necessary for the healing process to begin at all. In countries with strict legislation, physicians who have not been able to complete these procedures are screened out or additionally trained so that they eventually “grow” to the standard.
The psychotherapist should have an education in psychotherapy proper or psychological counseling. The international level implies at least three to four years of study. This education can be obtained from scratch or in addition to higher education: psychological, medical, or any other. It is important that a higher education and even a specialization in psychiatry in itself do not provide an opportunity to work as a psychotherapist.
There are certain features of the training and work of psychotherapists in Russia. On the one hand, there is a clear definition: a psychotherapist , according to the legislation of the Russian Federation, is a professional with a higher medical education and two specializations (psychiatry and psychotherapy) for at least nine months. On the other hand, in everyday life the word “psychotherapist” is used to refer to everyone who has something to do with working with the psyche, including psychiatrists, psychologists and consultants.
The more clients a psychotherapist has, the higher the likelihood of effective help
It is very good if a specialist has already led and is leading clients – then the likelihood that he will be able to help you increases. The more clients, the higher the likelihood of effective assistance, because with experience not only knowledge accumulates, but also the number of hours of supervision and personal therapy grows. If the specialist has focused counseling experience (for example, working with pregnant women or victims of abuse), then this is an additional plus for those whose situation is similar.
Unfortunately, the legislation governing psychotherapeutic services in Russia is in its infancy. There are no requirements for the professional level, there is no clear code of ethics, there is no single certification procedure, there is no state register of specialists. There is no protection at the level of the law, both for clients and for the consultants themselves. As a result, the number of strong professionals who meet international standards is small in Russia.
Why do psychotherapists receive therapy?
Experience of your own personal therapy is a must. To obtain a certificate of psychotherapist, in most cases, 50-100 hours of personal therapy is sufficient, for membership in associations of psychotherapists – from 200 hours. This is a necessary minimum so that the therapist’s own problems are not unconsciously brought into the work with the client. Personal therapy is also important in the context of the resilience of the professional, his safety for clients and for himself, compliance with ethics and laws. The more hours of therapy, the less likely it is for unethical behavior and abuse of power. Many psychotherapists continue personal therapy for many years.
Another important criterion is supervision, during which a professional, together with a more experienced psychotherapist, examines work with clients, comprehends the methods used, exchanges experience, and understands how to correct mistakes. Supervision is compulsory for all practicing psychotherapists, both beginners and experienced. For certification, 40-50 hours is enough, but it is good if there are 100 hours or more, and membership in associations of therapists requires 200 hours of supervision.
Personal therapy is needed so that your own problems are not unconsciously brought into the work with the client.
A supervisor is an outside observer, and that’s what he is for. Any phrase or question uttered by the psychotherapist during the session may come from his personal experience and personal “picture”; of course, they may be appropriate and appropriate to the client’s experience and goals. But this is not always the case, the probability of coincidence is not 100%. This is not scary and does not always lead to some kind of damage, but it is difficult for a psychotherapist to see it, to realize it, being inside the situation. Therefore, the supervisor catches such “controversial” points in the sessions and discusses them with the therapist. He also assesses how the work complies with the principles – including ethical – of psychotherapy. In some countries, the supervisor is responsible by his license for the safety of the clients of the therapist he leads.
What ethical principles should he adhere to?
Compliance with the ethical principles of psychotherapy means that the specialist does not go beyond his competence, openly and honestly talks about himself and the methods of work, ensures the confidentiality and safety of patients, and observes the laws. The ethics of the psychotherapist is the main thing that confirms the safety of interaction with him. If everything is in order with ethics, then you will receive all the information you need to make a decision about whether to become a client.
What else does not hurt?
The rest is bonuses, and their absence does not affect the quality, efficiency and safety of work. However, if present, it can add points to the selected specialist. For example, an academic degree of candidate or doctor of science; however, it does not always mean practical benefits in working with clients when it comes to science in its purest form. To find out exactly, take an interest in the topic of the work – professionals whose dissertations are oriented towards practice will be happy to mention them. For example, I openly tell patients that my PhD is about bipolar disorder.
Certificates of seminars and conferences show that the specialist is constantly studying new methods and approaches – which means that he is aware of the latest research, constantly improves and communicates with colleagues. Please note that not everyone has the actual opportunity to travel somewhere regularly – so if your specialist does not do this, this does not mean badly about his competence. Perhaps he writes articles at the same time – it makes sense to read them in order to get an impression of the approach and style of work, since the personality of the therapist plays an important role in the treatment.
The personality of the therapist plays an important role in the treatment.
Additional education in other areas of psychotherapy is a definite plus, allowing you to combine methods and techniques. But education also requires a significant investment of time and money, and not all psychotherapists have such opportunities. Membership in associations or work in psychotherapy centers is an important point that means recognition of a specialist by the professional community. Psychotherapists who are members of associations and work in renowned centers and consulting studios have passed the filter of their colleagues. If the therapist is shunned by colleagues, or shuns them himself, this can be a worrying sign.
And if the psychotherapist is a beginner?
Every seasoned professional was once a student and each had their very first clients. Many people do not want to go to beginners and, of course, have the right to do so, because this kind of work has its drawbacks. The main one is little or no experience. Such a psychotherapist, of course, is able to work and help, because he has learned this, but he will still have certain limitations and difficulties. Another disadvantage is that you can hardly find information about him. He does not yet have a reputation, recommendations and customer reviews, recognition from colleagues. It is not known how he observes ethics and how he relates to something that is important to you personally.
But the advantages of psychotherapy for a novice specialist or student are also significant. First of all, it is low cost or even free work, which is important for those who cannot allocate a large budget for an experienced consultant. The second plus is, oddly enough, safety: beginners often work very carefully and delicately, carefully undergo supervision and personal therapy, and do not use provocative methods. The third plus is great personal involvement: beginners sincerely invest themselves in the work process, try to give their all.
Sometimes, in order to get all these benefits, you can take some risks. Moreover, many professionals with many years of successful practice do not meet absolutely all of the above criteria or international standards. Perhaps it makes sense to soften the selection, because it is better to get help than not to receive it at all due to the fact that we had to weed out all the “objectionable” specialists.
When should you contact only experienced psychotherapists?
There are cases when you need to treat the choice of a specialist very carefully and even strictly: these are severe psychological trauma, experience of relationships with violence and abuse (including in the family), mental illness, addictions, eating disorders, suicidal and auto-aggressive behavior. In all these cases, it is better to choose experienced high-level specialists, with all the mandatory criteria, and, ideally, to undergo therapy in person, and not via Skype.
Remember that you deserve to be cared for and treated with care. You have the right to ask what is important to you and choose a therapist based on the answers you receive. It is not a shame to be picky and picky; a meticulous client does not cause aggression or anger in a professional. It is pleasant to answer thoughtful questions, because a serious approach to choosing a consultant who can be trusted means seriousness in the very process of work. The main thing is that doctors and patients are on an equal footing – and both parties can freely choose.