What role does psychological help play in our lives? Why do so many people fear therapy? What rules, prohibitions, recommendations govern the work of a psychotherapist?
Let’s start from the very beginning. How do I know if I need the help of a psychotherapist?
Anna Varga, Systemic Family Therapist: The first sign that the help of a psychotherapist is needed is mental suffering, sadness, a feeling of impasse when a person realizes that his relatives and acquaintances do not give him the right advice.
Or he believes that he cannot discuss his feelings with them — then he should try to find his psychotherapist and talk with him about his experiences.
Many people think that the specialist with whom they will work will invade their personal space. How would you explain that this is help, and not just a painful discussion of problems?
Or the psychotherapist’s morbid curiosity… You see, on the one hand, these views do credit to the psychotherapist: they suggest that the psychotherapist is some kind of powerful being who can get into someone’s head. It’s nice, of course, but it’s not.
On the other hand, there is no special content of your consciousness — one that is «on the shelves» in your head, behind a closed door, and which the therapist could see. This content cannot be seen either from the outside or, by the way, from the inside.
That is why people who are faced with psychological problems need an interlocutor.
Psychological contents are formed, structured and become clear to us (both on the intellectual and emotional levels) only during the conversation. This is how we are.
That is, we do not know ourselves, and therefore no psychotherapist can penetrate …
…Yes, to penetrate into what we ourselves do not know. Our sorrows become clear to us (and thus we can somehow work with them and move somewhere) in the process of conversation, when we formulate, receive a response, and consider the situation together from different angles.
Sadness is often present not in words, not in sensations, but in a kind of twilight form of pre-feelings, pre-thoughts. That is, to some extent, continues to remain a mystery.
There is another fear: what if the psychotherapist condemns me — says that I do not know how to handle myself or make decisions?
The therapist is always on the side of the client. He works for the client, in order to help him. A well-educated psychotherapist (and not a person who picked up somewhere, called himself a psychotherapist and went to work) is well aware that condemnation never helps anyone, there is no therapeutic sense in it.
If you did something that you really regret, it means that you survived that moment so much, and no one has the right to judge you.
«Well educated therapist»: what do you put into it? Education is academic and practical. What do you think is more important for a therapist?
My opinion here does not matter at all: a properly educated psychotherapist is a professional who meets certain criteria.
We do not ask what a properly educated mathematician is! We understand that he should have a higher education in mathematics, and everyone asks psychologists and psychotherapists this question.
We also often ask this question about doctors: he may have a doctor’s degree, but we will not go to him for treatment.
Yes it’s true. What does the generally accepted education of a helping psychologist, psychotherapist look like? This is a basic psychological, medical education or a diploma of a social worker.
Basic education assumes that the student has received basic knowledge about human psychology in general: about higher mental functions, memory, attention, thinking, social groups.
Then special education begins, within the framework of which they teach actually helping activity: how human dysfunctions are arranged and what are the methods and means by which these dysfunctions can be transferred to a functional state.
There are moments in the life of a person or family when they are in a pathological state, and there are moments when they function perfectly. Therefore, the concept of pathology and the norm does not work.
And there is another important point when the helping specialist prepares himself for professional activity.
This is a personal therapy that he must undergo. Without it, he cannot work effectively. Why does a professional need personal therapy? In order for him, firstly, to understand what the client is like, and secondly, to receive help, accept it, which is very important.
Many students of psychological faculties believe that, having started the practice, they will powerfully help and save everyone. But if a person does not know how to take, receive, ask for help, he will not be able to help anyone. Giving and taking are two sides of the same coin.
In addition, he must be treated himself in the process of psychotherapy: «to the doctor, heal yourself.» Get rid of your own problems that everyone has, those problems that may interfere with helping another person.
For example, a client comes to you, and he has the same problems as you. Realizing this, you become useless for this client, because you are immersed in the world of your own suffering.
In the process of work, the psychotherapist experiences new suffering, but he already knows how to deal with them and where to go, he has a supervisor, a person who can help.
How to choose your psychotherapist? What are the criteria? Personal affection? Gender sign? Or does it make sense to approach from the side of the method: existential, systemic family or gestalt therapy? Does the client even have the opportunity to evaluate different types of therapy if he is not a specialist?
I think it all works. If you know something about the psychological approach and it seems reasonable to you, look for a specialist who practices it. If you met with a psychologist and there was no trust, the feeling that he understands you, look for someone with whom such a feeling will arise.
And a male therapist or a female… Yes, there are such requests, especially in family therapy, when it comes to sexual dysfunctions. A man can say: «I will not go to a woman, she will not understand me.»
Suppose I have already entered therapy, it has been going on for some time. How can I understand if I am progressing or, on the contrary, I have reached a dead end? Or that it’s time to end therapy? Are there any internal guidelines?
This is a very complex process. Criteria for ending psychotherapy should, in theory, be discussed in the process. A psychotherapeutic contract is concluded: the psychologist and the client agree on what will be a good result of joint work for them. This does not mean that the idea of the result cannot change.
Sometimes the psychologist says something that clients don’t like to hear.
For example, a family comes with a teenager, and this teenager understands that the therapist has created an easy and safe communication situation for him. And he begins to say very unpleasant things to his parents, offensive and difficult for them. They begin to get angry, they believe that the therapist provoked the child. This is normal, the most important thing is to tell the therapist about it.
For example, I had a married couple. The woman is quiet, submissive. During therapy, she began to «get up off her knees.» The man was very angry with me: “What is this? It is because of you that she began to set conditions for me! But in the end, the love that they felt for each other began to expand, deepen, discontent was quickly overcome.
Psychotherapy is often an unpleasant process. It is highly desirable that after the session the person leaves in a better mood than he came in, but this is not always the case. If there is trust in the psychotherapist, then the client’s task is not to hide his dissatisfaction with him, disappointments, anger.
The psychotherapist, for his part, must see signs of hidden discontent. For example, he always came to the appointment on time, and now he began to be late.
The therapist should ask the client the question: “What am I doing wrong? I believe that since you are late, then, in addition to the desire to come here, you also have a reluctance. It’s obvious that there’s something going on between us that doesn’t suit you very well. Let’s find out.»
A responsible client does not hide if something does not suit him in the process of psychotherapy, and directly tells the therapist about it.
Another important topic is ethics in the relationship between the therapist and the client. For those who are going to an appointment, it is important to imagine within what boundaries they will interact. What are the rights of the client and the responsibilities of the psychotherapist?
Ethics is really very serious. The psychotherapist has information about the client, he is an authoritative, significant figure for the client, and he cannot abuse this. It is important to protect the client from voluntary or involuntary abuse by the psychotherapist.
The first is privacy. The therapist respects your privacy, except when it comes to life and death. Second — and this is very important — no interactions outside the walls of the office.
This is an essential point and very little realized. We love to be friends with everyone, communicate informally …
Clients love to involve us in relationships: in addition to being my therapist, you are also my friend. And this is done to improve security. But as soon as communication outside the office begins, psychotherapy ends.
It stops working because the client’s contact with the therapist is a subtle interaction.
And more powerful waves of love, friendship, sex wash it away instantly. Therefore, you can’t look at each other’s houses, go to concerts and performances together.
Another issue that is extremely relevant in our society. Suppose I understand that my friend, brother, daughter, father, mother need help. I see that they feel bad, I want to help, I persuade them to go to a psychotherapist, but they do not go. What should I do if I sincerely believe in therapy, but my loved one does not believe in it?
Reconcile and wait. If he does not believe, then he is not ready to accept this help. There is such a rule: who is looking for a psychotherapist, he needs help. Let’s say a mom who thinks her kids need therapy is most likely a client herself.
Do you think that psychotherapy is still not well known in our society? Should it be promoted? Or is it enough that there are psychotherapists, and anyone who needs them will find his own way to them?
The difficulty is that there is no need to talk about a homogeneous society. Some circles know about psychotherapists and use their services. But there are also a huge number of people who experience mental suffering and whom a psychotherapist could help, but they do not know anything about therapy. My answer is, of course, it is necessary to educate, propagandize and tell.
The interview was recorded for the joint project of Psychologies magazine and radio «Culture» «Status: in a relationship» in January 2017.