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I am against psychotherapy — and this is not a joke. This is just some exaggeration to interest you in this text.
In fact, of course, I am not against psychotherapy. I am against psychologists doing psychotherapy.
It can be said otherwise. What psychologists do cannot be called psychotherapy. It can’t even be called psychological help.
These names arise from the use of the medical model in psychological practice. And she, in my opinion, is completely inappropriate here.
This is what I propose to look into. Get ready, the article will be large and detailed.
medical model
The medical model of interaction is a term for a specific type of communication between two people. One of them is a patient who is ill, who is suffering and who needs help. The second is the doctor who knows what is wrong with the patient and can remove his suffering with the right medicine.
Of course, this model is much simpler than reality, but so with any model. It highlights the main features to make it easier to navigate and make the right decisions.
Today, psychologists have a medical model ubiquitous. Only renegades like me are trying to challenge it (and hopefully, in time, this will work out).
This model assumes that a psychologist can somehow cure a person. Hence the term “psychotherapy” itself, which in Greek means the treatment of the soul (the soul is understood as the psyche).
This term is similar to phototherapy (light treatment), apitherapy (treatment with bee products), phytotherapy (herbal treatment).
Sometimes the term «psychotherapy» is translated as treatment of the soul. This is a mistranslation, but even in it the idea of treatment remains the key.
As you can see, even at the level of terms in psychological practice, it is assumed that the psychologist treats, and the person who comes to him is a suffering patient.
In other words, it is a medical model. Let’s remember this.
The origins of the medical model in psychology
Why did psychologists develop the medical model? The answer is on the surface — from a good life to a psychologist do not come. People come to us with difficult experiences, inner pain (sometimes literally), with suffering.
People who turn to a psychologist are really bad. No fools — they really suffer, they really feel bad. By the way, the fact that these people have found the strength to do something about this suffering, already arouses my respect.
And then, as you work with a psychologist, it becomes easier for a person — it hurts less, there is less suffering. And it seems obvious that the psychologist somehow cured the person. Either in words or in spirit.
Therefore, a psychologist is a doctor. Peculiar, but still a doctor and provides psychological assistance.
Another medical model.
Why am I against the medical model?
A reasonable question is why is the medical model so bad?
I answer — nothing. It is simply out of place in psychological work.
The medical model assumes that the doctor has a drug that passively, by itself, can cure. Yes, the same magic pill from jokes. You just need to take three times a day after meals.
Therefore, using the medical model, we kind of offer a person to simply wait for a miracle. Here the psychologist will listen to you (analogous to tests), make a diagnosis and prescribe the right medicine. And then you just need to take it as directed.
But that doesn’t work! In psychological work, the active participation of the person himself is fundamentally important (more on this a little later).
The medical model, as it were, imposes passivity on a person — all that remains is to wait for a miracle from the doctor. And in medicine, a doctor can really create this miracle — prescribe the right treatment that will put a person on his feet.
If you want to tell me that in modern medicine there is a departure from such a rigid directiveness and authoritarianism of a doctor, then don’t. I know about it. Now, indeed, doctors are oriented not to orders, but to cooperation. As it turned out, if the patient understands what the doctor is doing to him, then he recovers faster (for example, because he fully follows the doctor’s prescriptions, that is, he cooperates).
And yes, I know that in many cases the doctor teaches the patient. For example, helping to recover from a stroke.
The problem of the medical model is not so much directiveness and expectation of a miracle. The problem is that the medical model expects from the psychologist what we don’t have: a cure.
Psychologists don’t have medicines and can’t have them.
Psychological support
In popular culture, a psychologist is first of all a person who listens attentively and supports you. And it is right.
To listen, to sympathize, to say, they say, I know such feelings, it happens to people — this is all very important. This is psychological support.
Thanks to her, a person feels that he is not alone in his experiences, that there is a caring person nearby. We, as representatives of an ultrasocial species, need psychological support in difficult situations like air.
Without psychological support, a psychologist cannot work — everything begins with it. After all, even at the very beginning of the very first meeting, the psychologist already provides the visitor with psychological support. He is interested in how he got to the office, is it comfortable for him to sit, etc.
Support is very important — if a person with a psychologist is uncomfortable, everything is useless.
Sometimes a psychologist is the only person who can give support. There may simply not be others in the life of a visitor.
However, the opposite is also true — not only a psychologist can provide psychological support. I will say more, with all categoricalness — it is even better that it is not done by a psychologist.
Why? Because the psychologist works for money. He gives his encouragement sixty minutes once a week. And this is simply not enough.
Friends and loved ones can give support more often and longer. Here the man got divorced and now sits in the kitchen with a friend, tells him about his experiences. A friend nods, sympathizes, says, they say, I understand you, it was not sweet for me either and listens. And this has been going on for the fourth hour — as long as it takes. And if necessary, tomorrow a friend will listen to everything again. You don’t need a psychologist.
Yes, I know that our loved ones are not always able to support. In the same example with a divorce and a friend, it may be different. Let’s say a friend starts nailing, they say, you’re a fool, if you got divorced, then you’re worthless and other tin. It’s not necessary, I agree.
However, on average, friends and loved ones support us quite well. And where only psychological support is enough, talking in the kitchens is a great solution.
Psychological support is not enough
The main apologist for psychological support was Carl Rogers. Judging by his work, he sincerely believed that it was enough.
He believed that acceptance by a psychologist allows a person to start the internal mechanisms of healing. Allegedly, we have some kind of system that in itself can cure a person of psychological problems. Just as the immune system itself can cure a person of physiological problems.
Alas, this is not entirely true. Yes, a person has built-in mechanisms for change (more on that later). Yes, they are often enough.
However, there are times when they do not turn on. And no matter how much you support a person, there will be no changes for the better.
In addition, acceptance by the psychologist is still incomplete. After all, it’s for money. Of course, a psychologist can be a paid friend — and, as I wrote above, sometimes this is the only friend available to a person.
And yet, it’s still clear to any visitor that this acceptance is about money. The psychologist is not really friendly. This is neither good nor bad, it’s just a fact.
The psychologist treats the person extremely well and accepts him completely. And he gets paid for it. And without money — does not work, does not accept this person in his office.
Yes, it happens that a psychologist works without money — I myself do this as part of charity in certain cases. But my friend can call me at night, but my visitors cannot.
In a word, psychological support is not always enough. Something else is needed.
Psychological training
In cases where support is not enough (that is, almost always), the psychologist begins to use psychological training.
Psychological training is a conditional term. It means that the psychologist teaches the visitor to use those very built-in mechanisms of change. Yes, the ones mentioned above.
There are only two of them — rethinking and addiction. Scientifically, cognitive reappraisal and desensitization, respectively.
We have these mechanisms from birth, most often they work well without our participation. And in those rare cases when they cannot cope on their own, a psychologist is just what is needed.
We explain these mechanisms to the visitor, and give specific tools for their use. No treatment, no medicine.
Only training.
I wrote more about this in the article. «Neurocognitive Relearning: Here’s What I Really Do».
As a seasoning for this dish, you can add more training in specific skills. Usually these are social skills (how to communicate, how to get acquainted, how to refuse), but not necessarily. For example, the skill of planning your day is not exactly social, but sometimes you need it. Such skills are taken from the scientific research of psychologists.
Support and training — brothers forever
Let me emphasize in yard letters: psychological support is not enough without psychological training. And psychological training is impossible without psychological support.
These two processes are connected and important at the same time. It is important to both support a person and educate. If you do not support, but only train, a person will not learn due to lack of resources. If you do not train, but only support, there will be no significant improvements.
Psychological support comes in the background. It provides some resource for learning. It is important to provide it and it is important not to be limited only to it.
As you can see, there are no drugs here, so talking about a medical model is simply meaningless. Psychologists do not provide any help, this is an incorrect term, it categorically cannot be applied to what we are doing.
New model instead of medical
Imagine a person who suffers from not knowing English. For example, he is worried that he cannot watch new episodes of his favorite series as quickly as he wants. After all, you have to wait until it is transferred, and this, sometimes, is delayed …
This person goes to the English teacher. The teacher in our example is good, because he will definitely support the student, encourage him and notice his successes. But will he stop there? No, of course not.
The teacher will teach English. Give tasks, explain the theory, train pronunciation.
Does it provide educational assistance to the visitor (similar to medical assistance)? Of course not.
The medical model is simply out of place here. There is no cure, no pill. There will be no miracle, but there will be a long and hard work.
Therefore, we need not a medical model, but another one. Let’s call it teaching.
The teaching model assumes that one person can do something better than another. And the other wants to learn this “something”.
The result of teaching depends on both. After all, the activity of the student is the most important predictor of his success. See my video for more details «The main factor in successful learning (scientific evidence)».