Speech at the 1st congress of psychotherapists and consultants of the North-West region of Russia «Strategies for the development of domestic psychotherapy and psychological counseling»
Dear colleagues and friends,
I want to thank you for the honor of speaking at our 1st Congress with a plenary report, and I will try to be as specific as possible.
About 10 years ago I already had to give a report on this topic and even with the same title at the PPL conference in Moscow. I must immediately admit that at that time much seemed simpler and more easily achievable, including the key issue, namely: reaching the agreement of the majority of psychotherapists in understanding our problems and the possibility of their solution by common efforts. I must admit that it turned out to be an illusion.
Turning again to the same topic, I will try not so much to convince the audience of why we need to unite, but to analyze the reasons why we cannot unite in any way. I will make a reservation right away that this will rather not be an analysis of the problem, but only its statement, indicated in several theses, which seem to me to be key.
The older generation of specialists, of course, remembers well how 10-12 years ago, one after another, psychotherapeutic communities began to appear in our country. City, regional, regional, interregional, all-Russian. Why is there such a need at all?
An attempt has already been made to give one of the possible explanations for this situation. In particular, based on the fact that any associations (on a professional, sexual or social basis) arise when individual personalities possessing this sign begin to realize a certain commonality of their personal interests and at the same time understand that they cannot realize these personal interests one by one. I will add that from the realization of common interests to real steps towards unification for their implementation — the path, as a rule, is not very easy and not close, and there are more than enough obstacles on it.
It is no coincidence that I singled out the word “personal” interests. As long as this or that association does not proceed from the satisfaction of precisely these — personal — interests of its members, it cannot be in any way viable.
Let’s try to formulate, at least as a first approximation, what are these common and personal interests in such an extremely complex community as psychotherapy, and is it possible to combine these common and personal interests productively?
1) Of course, first of all, it is a professional identification. Someone, speaking in a high style, is identified with Freud and psychoanalysis; someone with Watson and behavioral therapy, someone with Perls and Gestalt, someone with Rogers, etc. But let’s go down to a level closer to us. Most of the first professional associations in Russia were created on the basis of identification with their extraordinary leaders — bright personalities, such as prof. B.D. Karvasarsky, prof. V.V. Makarov, prof. A.I.Belkin, prof. V.A. Ananiev and others. Sad as it is to realize this, but this generation will gradually leave, more precisely, it has already begun to leave the sphere of active social work (someone tragically, like Viktor Ananiev, someone just out of fatigue). This is a very painful process — a change of leadership rarely contributes to unification, since new leaders still need to establish themselves in this position, really compare their capabilities and their ambitions, and this is not a year or two.
2) The next aspect. Professional recognition, behind which there is always a question of external evaluation of personal professional success. In such a field as psychotherapy (where the factors of personal talent, science and art are always combined), this is especially important and especially painful, because the result of this process is a professional hierarchy, or rather, an understanding of who is who in our common professional field and each individual association. This professional hierarchy is no longer connected with positioning in this or that society as the President, member of the Board or chairman of this or that committee. She may be far above this narrow career hierarchy. There are also a lot of problems in this regard, since even the most respected specialists of some communities in some cases will not be able to claim even simple membership in others, because they operate within the framework of different methodological and worldview concepts.
3) Third. Vocational training and training. Some communities are focused on international criteria for theoretical training and practical training, as well as on recognized schools and methods of psychotherapy, of which there are only six (let me remind you once again of their list: methods of suggestion, directive and non-directive; psychoanalysis; rational therapy; behaviorism; gestalt; and — traditional for Russia — integrative or multimodal psychotherapy [everything else is techniques, not methods, or options for applying the main methods: children, family, group, etc.]); but there are associations operating within the framework of some homegrown techniques that do not correlate with any of the world’s schools, or proceed from dubious adaptations of classical methods. It is hardly possible to unite such specialists in one group. This is a matter not only of the education received, but of the psychotherapeutic culture as a whole. Unfortunately, we still have not decided which methods and techniques of psychotherapy are recognized in Russia. Previously, this task could be solved by a methodological center for psychotherapy, but now there is no such center.
4) Fourth. Experience exchange. It would seem that everyone is definitely interested in this area. Unfortunately no. What would be the benefit of an exchange of experience between, for example, a cognitive behavioral therapist and a psychoanalyst if they speak different languages; and even more so — what kind of exchange of experience can there be with representatives of non-classical trends, who, in fact, do not know any of the psychotherapeutic languages? That is, this factor is also of little use for association.
5) Perhaps an interest in professional information can serve as a reason for association? Also no. Many regularly receive notifications from their unconditionally respected colleagues Viktor Makarov or Konstantin Pavlov about their seminars and trainings, but this information, for example, for me is only evidence of the activity of these respected colleagues, since neither Gestalt nor polymodal psychotherapy is within my scope of interests. . Just as psychoanalysis is not included in the circle of interests of V. Makarov or K. Pavlov and their colleagues.
6) Not many common problems remain. One of them, or rather, a whole complex, is licensing, certification and accreditation, state and / or public. It is impossible not to admit that there are psychotherapists who are focused exclusively on the state, and knowingly give it all aspects of licensing, certification and accreditation, when a state official decides who is a psychotherapist and who is not. If this or that specialist has attended state advanced training courses for several months, then in this case, unequivocally, the state issues a certificate to this “supposedly specialist” that he is a specialist in all existing methods of psychotherapy. There are now only about 2 such state-recognised psychotherapists. Another, much larger group of psychotherapists is focused exclusively on public accreditation, when it is the community of professionals acting only within the framework of one method (or one of the directions) of psychotherapy that decides whether this or that candidate can be ranked among their circle. There is also a 3rd group, which, taking advantage of the legislative vacuum, declares: “But we don’t need any accreditation, we are already making good money.” Thus, these issues also cannot serve as a basis for unification.
7) The question of psychotherapy as a profession, which has its own specialties — hypnologist, analyst, behavioral psychotherapist, etc., does not even make sense to raise — this is a distant future. Unlike most European countries, where psychotherapy is an independent profession, we remain a sub-specialty in psychiatry, and the existence of specializations in a sub-specialty even sounds quite curious. Considering that psychotherapy is managed by psychiatrists, it would be naive to wait for a positive decision on their part — no one will strengthen the position of his own potential competitor on his own.
8) Eighth. Market fight. We further analyze the factors that could contribute to the unification and, at the same time, do not allow us to unite. Belonging to a very respected society and mentioning it on an office sign or business card, especially with the prefix «All-Russian …» or «National …» creates a certain authority of a specialist, and increases his income … But only at the first stage. Then there is already «word of mouth» — from patient to patient. And a very successful specialist just says: “Why do I need your professional society, I am already successful.” Given the shortage of specialists in our sector, even someone who can just talk like a human can already be successful. First of all, financially successful, which does not always determine his therapeutic success. Of course, this won’t be for long. But so far the situation is this, and it also does not contribute to unification.
9) Another aspect of the struggle for the market. The trend towards the commercialization of medicine has not bypassed psychotherapy. When contacting a specialist of any modality, the patient in 99% of cases will be immediately guaranteed that he “hit” exactly where he needs to, even if this specialist does not know anything about this form of pathology or personality disorder.
10) Commercialization has had an even greater impact on the methodological orientation of societies, training and certification of specialists. Along with the tendency of most societies to act in the field of a particular modality, there are societies where specialists of not only different modalities coexist under one “roof”, but also those to whom the definition of “specialist” is, in general, of little use, including sorcerers, magicians, fortune-tellers on cards, etc. I have no serious claims or prejudices against these people. And this has been explained by me (metaphorically) more than once: admiration for the painting of the great Dutch does not at all imply that the Aboriginal rock paintings should be destroyed. They have their value. But it is hardly appropriate to nominate the authors of such drawings to the Academy of Arts. In the latter case, I mean Russian and international psychotherapeutic communities, and situations where this category of «natives» is among the certified specialists. Thus, we ourselves only discredit our profession and do not contribute to the unification of specialists.
11) Let’s go further. Many associations arise on the basis of professional competition. The more “status” an association is, as it was with the RPO when it was headed by the Chief Psychotherapist of Russia, or the larger the association, such as, for example, the largest in Russia, the PPL, the more competitive it would seem. But it’s not. This rule of the status and «coverage» of the sector clearly operates only in an economy where the main issue is profit. And in the humanitarian spheres, competition is never removed by absorption or merger, since this requires a change in all worldviews of those who would like to merge with someone. And for this, someone must offer not only a different worldview, but also a different level of intellectual leadership. And this is no longer determined only by the official status or the number of members in a given society. Such people, I have no doubt, exist or — inevitably — will appear, but for this we must, in the language of advertising, «meet more often.» And I want to thank Prof. Victor Makarov for the initiative to hold our 1st congress and the initiation of similar congresses throughout Russia, as well as for the support of this initiative — the Chief Psychotherapist of St. Petersburg Oksana Evgenievna Kashkarova and Boris Dmitrievich Karvasarsky.
12) And now let’s move on to the area about which we think very little so far. to the field of professional ethics. Perhaps this is the only area in which most experts can find clear points of contact. And perhaps this is where we could start. It is professional ethics that should initially determine: who, after what training and what kind of training, has the right to apply for psychotherapy, and what kind of psychotherapy — taking into account the methodological and practical training of a particular specialist. For now, we are most interested in the techniques of psychotherapy, where neither ethics nor methodology are practically present at all.
13) Probably, many will be surprised that I only indirectly touched on the issues of psychotherapy that have long been of concern to everyone, as a sub-specialty in psychiatry. There are also different points of view here. Some psychotherapists believe that the current orders of the MLO are absolutely correct, and the psychotherapist is first a psychiatrist, and only then he must, contrary to logic and common sense, receive additional training, and only then move from the category of specialists to the category of sub-specialists. I don’t really like this point of view. Psychiatry and psychotherapy are not only different specialties, they are, in general, different worldviews of people and different fields of knowledge: one of which belongs to the humanities, along with literature, philosophy and psychology, and the other to the biological sciences, along with anatomy and physiology. Therefore, the thesis about psychotherapy as a sub-specialty in psychiatry sounds to me also like a thesis about philosophy, as a sub-specialty in anatomy or physiology. And this is one of the few issues that can also bring together a new wave of psychotherapists and clinical psychologists, namely, in the struggle for the recognition of psychotherapy as an independent specialty.
14) I have already mentioned psychologists, and I will not repeat what has already been said many times about their professional discrimination. I will only emphasize once again: all psychotherapy is built on psychological concepts — there is not a single biological concept in psychotherapy. Therefore, one should agree that psychotherapy is a profession that can be trained and allowed to work as professionals — both psychologists and doctors. Considering that now more than 70% of psychotherapeutic assistance in Russia is provided by psychologists, this trend can be resisted, it can be categorically rejected or criticized, but no one will be able to change it.
15) Therefore, we — and doctors and psychologists operating in the field of psychotherapy — can only unite on the basis of recognizing the commonality of our ethical principles, worldview and conceptual unity, as representatives of the humanitarian field of activity, as well as the independence and uniqueness of our specialty.
16) The next step could be the solution of the issue (more precisely, the most common issues) of professional training and training, as is done in Europe: common time parameters for the training of psychotherapists in any methods of psychotherapy, both in theoretical terms and in practical training, should be determined (and it should be years of preparation, not months), and also define a list of these methods. I think that state-oriented psychotherapists, psychoanalysts and gestalt therapists can agree with this. Simply put, those who have received sufficient education and are interested in training professionals of a different quality are much more ready to unite.
17) Speaking about Western standards, I will immediately add that I still think that Russian standards of training and training should be somewhat lower than Western ones, since the high standard of training of Western specialists, in addition to high quality, has one more goal: in connection with the overproduction of specialists reduce their influx into the profession (a typical struggle for the market). We are not yet threatened with an overproduction of psychotherapists. And unfair competition is already present.
18) The most important question. We are still developing in a significant separation from the international therapeutic community. And the main problem here is not the qualifications of specialists, but the language of international communication. All world psychotherapy speaks English. And if we do not intend to remain the backyard of world psychotherapy, if we want to be heard and recognized, we must also speak in English, which is still not close to us.
19) Nevertheless, the main and most difficult thing is to work out the most honest and common “rules of the game” for all Russian specialists, general principles of professional training and recognition of specialists as such. I will not attempt to offer any solutions to these issues. I will only say that, although I would be happy with such a decision, I do not yet share the optimism of prof. Viktor Makarov about the possibility of creating the Confederation of Psychotherapeutic Societies of Russia. This should be the result of a collective discussion, therefore, at the first stage, I propose to create a public Council of Presidents of Psychotherapeutic Societies, in the form of a legal entity, open to the entry of any societies and with variable chairmanship, that is, without personifying its leader. Because if we try to carry out the unification under the auspices of the PPL, NFP or RPO, it will be obviously doomed to failure. And I repeat: according to my ideas, it is necessary to start with the problems of ethics and the general principles of training and professional training of specialists.
20) The last (in my list) and very important aspect. Despite the difficult relationship with psychiatry, we must demonstrate the highest level of corporate ethics and discussions with our colleagues from the related field of knowledge and practice — they have their own worldview, and this must also be respected. They, like us, work with the most difficult patients, and in the same way they would like to help them most effectively. The same applies to the relationship between different strands in psychotherapy: tolerance is far from the worst human quality, and we know this better than anyone else.
Of course, this is not the whole list of problems and is far from the ultimate truth. I am sure that this list will be supplemented, and a number of provisions can be classified as debatable. There is no doubt only one thing — our strength lies in unity, and none of the present and future problems of modern Russian psychotherapy can be solved by the isolated efforts of any one specialist or one society.