I have deep compassion for these people! Finding qualified help in the field of emotional health in Russia is very difficult. And into this sphere — with colossal demand and an equally colossal shortage of supply — investors are now ready to pour money generously. After all, the barrier to entry in this business (or, if you will, “business”) is very low. Any person with a diploma of unknown provenance calling themselves a “psychologist” can start a practice and, influencing the public through aggressive promotion, charge tens of thousands for a single, non-binding consultation — or even more.
And now an influential and popular “psychology” magazine — a “glossy publication with a human face” claiming “intellectual depth” — refuses to publish material expressing doubts about the ethics and professionalism of certain so-called “non-medical psychologists,” so as not to offend potential advertisers under any circumstances...
When we have health problems, whether physical or emotional in nature, we become vulnerable. Like children, we await a diagnosis and prognosis from doctors with bated breath; unconsciously we expect protection and help from them. Doctors are taught this. Self-appointed practitioners are free from these ethical obligations and standards of knowledge.
Perhaps no other medical specialty in our country has suffered such devaluation as psychotherapy. Across the Russian internet, we can see dozens and hundreds of advertisements from people whose professional competence in this field is backed by nothing but their pathological ambitions. This does not stop them from offering themselves as specialists capable of resolving your emotional problems of any depth and complexity. Although, by law, only a DOCTOR with specialized postgraduate education in this field may call themselves a psychotherapist.
The Path to Becoming a Psychotherapist
Why has such an important and complex medical specialty — one concerned with people's mental health — met such an unenviable fate in our country? To become a top-class psychotherapist requires as many years of study as, say, becoming a cardiac surgeon, an intensive care specialist, or a neurosurgeon. That means six years of medical school, two years of residency, and three years of doctoral study in one's chosen specialty, combined with simultaneous clinical work under the guidance of an experienced practitioner and academic supervisor.
No one would entrust a student with performing a complex surgery — at best they might be allowed to stand beside the operating table and catch a glimpse of the master at work. After that, three to five more years of practice are needed, during which you learn from your mistakes while lying awake at night worrying about your patients. This is how an outstanding independent specialist is born. Thus, the maturation cycle of a doctor takes 15 to 16 years.
In the profession of a psychotherapist, everything is even more complex. Three stages must be completed:
- General medical training, which provides an understanding of the interrelationship of all processes in a system as complex as the human body;
- Internship or residency in psychiatry, which provides a deep understanding of psychopathology and the connection between mental and somatic processes;
- A three-to-five-year immersion in one of the schools of psychotherapy, where masters pass on their knowledge and skills of working with the human soul from hand to hand.
Simultaneously, the doctor must undergo many hours of their own psychotherapy. During the first three to five years of practice, they must have regular supervisions — that is, consult with a more experienced master regarding therapeutic strategies and their own emotional processes. Only after all this is one intellectually, emotionally, and spiritually ready for serious independent practice.
The golden rule applies here, as it does for experts in any field: natural talent, quality education, plus 10,000 hours of practice.
What Happened to the Profession in Russia?
Unfortunately, in the 1920s, psychoanalysis in Russia was severed from psychiatry and neurology and declared illegal. In all civilized countries of Europe and America, these disciplines evolved together, creating fertile ground for the development of top-class specialists who simultaneously possessed knowledge in psychopathology and psychotherapy — since not all patients need psychotropic medication. But in Russia, psychiatry was forced to develop as a separate discipline, and of all the possibilities of psychotherapy, we had access to, perhaps, only rational conversations with the patient and autogenic training.
In the late 1980s, political warming began, and progressive professors started reuniting psychiatry and psychotherapy. The best psychiatrists, psychoanalysts, and psychotherapists from around the world came to our country to share their experience. We eagerly absorbed their knowledge and experience — after all, we had fallen some sixty years behind the world in this area. This process proved to be quite painful and complex.
I was one of the first psychiatrist-psychotherapists in Russia, and I remember well how frightening it was for people to come for an appointment: what if those around you think you are “crazy,” or the information leaks to “the authorities” and they take away your driver's license, or block your career advancement... Such was the bitter legacy left by psychiatry, cut off from humanistic psychotherapy, in the hearts of the Soviet people.
Gradually, people in Russia began to make more active use of psychotherapy. Naturally, the most courageous and pioneering consumers were at the forefront — entrepreneurs and business people. A rapid development of psychotherapy began, but emotionally unhealthy individuals, lacking ethics and restraint, took advantage of the absence of regulation and the lawlessness of the market, seeing an excellent opportunity to profit. And so it began... Fortune tellers, psychics, and folk healers started calling themselves psychotherapists. The law did not respond.
Then freshly minted psychologists began appearing — graduates of commercial universities with no clinical base and no qualified professors with clinical experience. Many started calling themselves psychotherapists — that is, doctors — having neither the right nor the necessary competence for this profession. Then came television shows where unhappy, neurotic, suffering, and immature individuals were emotionally “stripped bare.” Why not broadcast a gynecological or proctological examination on national television? Is the pain of the soul less sacred than pain in other areas?
Is the pain of the soul less sacred than pain in other areas of the body?
Three Cases from My Practice
Time after time, people come to my office as a last hope. “Psychotherapist” imposters at best have been unable to help the client over many months of treatment, and at worst have re-traumatized them. And how many people, after such “psychotherapy,” will never seek help again, having completely lost trust in psychotherapy as such? The lack of professionalism and vandalism of such characters sometimes simply defies the imagination.
Case 1
Some time ago, I had to pull a young woman out of a state of deep depression — after a suicide attempt that permanently damaged her physical health. As a child, she had been subjected to sexual violence by her brother. Her parents ignored the problem. The psychological trauma was, understandably, so great that for a long time she could not build stable relationships with any man, experiencing fear and total distrust.
She sought help from an aggressively self-promoting “psychotherapist” who turned out to be merely a graduate of a third-rate pedagogical university's psychology department. He apparently decided that “like cures like” and convinced his client to have sex with him after every session. He interpreted the woman's confusion and complete lack of sexual desire for him as “resistance to change” and assured her that what he proposed was the only way to overcome her fear of physical intimacy.
This story nearly ended tragically for the young woman. She could not find the strength to leave this “doctor,” consumed by shame and guilt. She saw suicide as the only way out. It was years before she could bring herself to try psychotherapy again.
An ethical and professional crime. The person who shamelessly called himself a psychotherapist was bound by no ethical or professional standards.
Case 2
A young woman sought psychotherapy for help. She could not bring herself to divorce. Her husband was a harsh and authoritarian man, yet quite influential and wealthy. For years she endured his disrespect, which easily escalated into emotional abuse — afraid to break up the family, to leave her three children without a father, and she herself was afraid of being left without a strong shoulder, without status and money. A difficult situation.
When her husband severely beat their teenage son several times, she felt the resolve to leave. She needed an outsider who would understand and support her. She found a specialist on Instagram who called herself a psychotherapist and specialized in family relationships. Beautiful texts and photos left a pleasant impression; an enormous number of followers inspired trust.
The specialist listened attentively to her client's story and then firmly advised her under no circumstances to divorce: “Only fools leave men like that! Women line up by the hundreds for them!” The client left the session in complete confusion.
A textbook example of completely unprofessional behavior. The “psychotherapist” merely projected her own fantasies onto the client. Later, the client discovered the “specialist” had only a diploma from a department of social psychology.
Case 3
A 39-year-old man, owner of a small business, began feeling weak and fatigued a year earlier. Having endured many hardships since childhood, he had learned not to feel sorry for himself and to be strong. His condition did not improve, and three months later, at his wife's insistence, he turned to a psychotherapist.
For six months, the client diligently came to sessions every week. The specialist tried various methods to lift his client's mood: from positive affirmations to be stuck on the refrigerator door for viewing at breakfast and dinner, to art therapy. The client drew his sadness and growing depression on paper and then burned the drawings. Nothing helped.
At our very first meeting, I was deeply alarmed by the man's ashen, lifeless complexion. After thirty minutes of conversation, it emerged that over the past six months he had lost significant weight and his morning cough had worsened. I made it a condition: psychotherapy continues only after a comprehensive medical examination.
Two weeks later, the client did not show up for the appointment and did not even call. I called myself. On the line I heard a weeping woman, who told me her husband had died that morning. He had coughed violently as usual; the wall of a major artery ruptured. He simply bled out in her arms before reaching the hospital. Two days before the tragedy, his wife had been told that her husband had terminal lung cancer.
A sketch of impoverished professional knowledge and pathological overconfidence. The “specialist” never considered that some emotional disorders are consequences of developing dangerous somatic diseases. This is taught only in medical school — which our “specialist” had not attended. The lost time cost this man his life.
The Responsibility We Bear
When patients come to doctors, they do not know — and should not have to know — the causes of their suffering. Accomplished adults worry and often feel like small children, awaiting our diagnosis. They entrust us with their health, their lives. It is WE who must figure out the diagnosis, drawing on our knowledge and experience, and propose a course of action — and WE must bear responsibility for its competence. After that, it is the patient's responsibility to follow our recommendations or not. BUT WE MUST PROVIDE THEM.
In all the cases I described, the practitioners called themselves psychotherapists but were not. Each of them held a psychology diploma. In Russia, unfortunately, nearly anyone who takes it into their head can call themselves a psychotherapist without consequence. It is enough to obtain a “psychology” diploma from a pedagogical, technical — any kind of — university that has opened a corresponding “paid” department, or simply to buy the diploma and open a private practice.
What a contrast with Europe and the United States, where psychoanalysts and psychotherapists — doctors — undergo many years of expensive training, then complete their own lengthy therapy and supervision to rid themselves of their own psychological traumas and internal conflicts, which would inevitably affect their work with patients if left unaddressed... Where the strictest ethical code operates, where a specialist is accountable for every action and word, where professional associations examine even the most seemingly minor cases — because in this profession there are no small details, and the slightest error can have catastrophic consequences for a person...
In this profession there are no small details, and the slightest error can have catastrophic consequences for a person.
A Word About True Professionals
I in no way wish to be disrespectful to people who professionally engage in work adjacent to psychotherapy — clinical psychologists and psychological counselors, or “counselors” as they are called in the English-speaking world. If these specialists are professionals, they never call themselves doctor-psychotherapists and know the boundaries of their competence very clearly. When encountering a deeper problem in a client, they carefully refer them to a psychotherapist. Here too, the commandment “Do no harm” is observed.
These professionals do very important work, providing people with support and help in solving emotional problems. They too have invested much effort, money, and time in obtaining their profession. After a university psychology department, they usually train in one of the therapeutic approaches for no fewer than three years, naturally receiving consultations to enhance their own emotional intelligence and level of self-awareness.
How to Choose a Psychotherapist You Can Trust
- By no means should you rely SOLELY on a specialist's social media activity: an impressive number of followers, beautiful photos, frequent publications. Here lies the very first trap for clients of psychotherapy-as-business. This content may not be the fruit of your future psychotherapist's knowledge and experience at all, but of an entire team of social media managers; articles may be written by copywriters or simply stolen. A pleasant, inviting face may be nothing more than a sign.
- Never agree to a written consultation. Every person and every situation is unique. At best you will receive a useless response, at worst a disorienting one, written by who knows whom.
- Carefully check for a medical diploma in “general medicine.” Which specific medical school did the doctor graduate from?
- Look at the seriousness of the postgraduate training program in one of the areas of psychotherapy and the number of years of study — it cannot be fewer than three, and preferably five. Ask whether the doctor underwent their own personal psychotherapy during their training. This is an entirely appropriate question.
- Ask for recommendations from people who have received genuine help from this doctor.
- Even if all recommendations and credentials are in order — during your very first visit, look at the specialist as a person. True professionalism means not only knowledge and experience, but also humanity. From a true doctor, you should feel a deep interest in you as a person. You should sense their desire to understand your problem in order to help you.
- Listen to your intuition and your feelings. This is “chemistry”: next to “your” doctor, you should begin to feel a sense of hope and safety.