How to choose a psychotherapist when you are ready to ask for help
HIKE TO PSYCHOTHERATE Many still experience it as a serious overcoming, practically a revolution. In American films, heroes go to psychotherapists as if they were at work; in Russia, making an appointment is a crucial event that far from everyone dares. And in vain, because states like the same depression - this is not a whim to cope with, but a disease that can be treated. It’s not easy to choose a good doctor, and doubly difficult to find a suitable psychotherapist. The market has not yet formed - a big risk to stumble on charlatans or simply incompetent people. The costs of the wrong choice are very high: the patient will receive a psychological trauma, will hardly accept even qualified help in the future. We asked Ekaterina Sigitova, a psychiatrist and psychotherapist, to tell how to avoid mistakes.
What education should a psychotherapist have?
A good psychotherapist must meet a set of mandatory criteria - possess a kind of "minimum equipment", a package of guarantees necessary for the healing process to begin at all. In countries with strict legislation, therapists who have not been able to undergo these procedures are screened out or additionally trained so that they will “grow” to the standard over time.
The psychotherapist should have an education on the actual psychotherapy or psychological counseling. The international level involves at least three or four years of study. This education can be obtained from scratch or in addition to the highest: psychological, medical, any other. It is important that higher education in itself and even specialization in psychiatry make it impossible to work as a psychotherapist.
There are certain features of training and the work of psychotherapists in Russia. On the one hand, there is a clear definition: a psychotherapist, according to the legislation of the Russian Federation, it is a professional who has a higher medical education and two specializations (in psychiatry and psychotherapy) for at least nine months. On the other hand, in everyday life, the word "psychotherapist" is used to refer to anyone who has something to do with the work of the psyche, including psychiatrists, psychologists and counselors.
Very well, if a specialist has already led and leads clients - then the likelihood that he will be able to help you will increase. 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 with abuse victims), then this is an additional plus for those whose situation is similar.
Unfortunately, the legislation regulating psychotherapeutic services in Russia is in its infancy. There are no requirements for the professional level, there is no intelligible ethical code, there is no single certification procedure, there is no state register of specialists. There is no security at the level of the law, both for clients and for consultants themselves. As a result, the number of strong professionals that meet international standards in Russia is small.
Why do psychotherapists undergo therapy?
Experience own personal therapy is required. In most cases, 50-100 hours of personal therapy is enough to obtain a psychotherapist certificate, and 200 hours for membership in associations of psychotherapists. This is a necessary minimum so that the therapist’s own problems are not unconsciously brought into work with the client. Personal therapy is also important in the context of professional resilience, safety for clients and for themselves, compliance with ethics and laws. The more hours of therapy, the less likelihood of unethical behavior and abuse of one’s power. Many psychotherapists have continued personal therapy for many years.
Another important criterion is supervision, during which a professional together with a more experienced psychotherapist examines work with clients, interprets the methods used, exchanges experience, and understands how to correct mistakes. Supervision is required for all, without exception, practicing psychotherapists, both beginners and experienced. 40-50 hours is enough for certification, but it is good if there are 100 hours or more, and membership of the therapist associations requires 200 hours of supervision.
The supervisor is an external observer, and that's what it is for. Any phrase or question uttered by a psychotherapist at a session can proceed from his personal experience and personal “picture”; Of course, they may be relevant and adequate 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 damage, but it is difficult for a psychotherapist to see it, to realize it, being inside a situation. Therefore, the supervisor catches such "controversial" moments in the sessions and discusses them with the therapist. He also assesses how the work complies with the principles - including ethical - psychotherapy. In some countries, the supervisor is responsible with his license for the safety of the therapist’s clients that he leads.
What ethical principles should he follow?
Compliance with the ethical principles of psychotherapy means that the specialist does not go beyond his competence, openly and honestly talks about himself and his 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 ethics is okay, then you get all the information you need to decide 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 they are, it can add points to the selected specialist. For example, the degree of candidate or doctor of science; however, it does not always mean practical benefits in working with clients, if we are talking about science in its purest form. To find out exactly, ask about the topic of work - professionals whose dissertations are practice-oriented are pleased 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 exploring new methods and approaches - which means that he is up to date with fresh research, constantly improving and communicating with his colleagues. Consider that not everyone has an actual opportunity to go somewhere regularly - so, if your specialist does not do this, it still does not speak ill of his competence. Perhaps, while he writes articles - it makes sense to read them in order to create an impression about the approach and style of work, since the personality of the therapist plays an important role in treatment.
Additional education in other areas of psychotherapy is a definite plus, allowing you to combine methods and techniques. But education also requires a serious investment of time and finances, and not all psychotherapists have such opportunities. Membership in associations or work in psychotherapeutic centers is an important point, meaning the recognition of a specialist by the professional community. Psychotherapists who are in associations and work in well-known centers and counseling studios, as if passed the "filter" of their colleagues. If the psychotherapist is avoided by a colleague or he himself avoids them, this can be a disturbing sign.
And if the psychotherapist is a beginner?
Each experienced professional was once a student, and each had the very first clients. Many people do not want to turn to beginners and, of course, are entitled to it, because such work has its drawbacks. The main thing is a little experience or lack of experience. Such a psychotherapist is certainly 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 still has no reputation, recommendations and customer reviews, recognition of colleagues. It is not known how he abides by ethics and how he relates to something that is important to you personally.
But the advantages of psychotherapy in 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, do not use provocative methods. The third plus is a great personal involvement: beginners sincerely invest themselves in the work process, try to give everything.
Sometimes in order to get all these advantages, you can take some risks. Moreover, many professionals with many years of successful practice do not meet absolutely all the above criteria or international standards. Perhaps it makes sense to soften the selection, because it is better to get help than not to get 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 it is necessary to take the choice of a specialist very carefully and even strictly: severe psychological traumas, experiences of dealing with violence and abuses (including in the family), mental illness, addiction, eating disorders, suicidal and auto-aggressive behavior. In all these cases, it is better to choose experienced high-level specialists, with all the required criteria, and, ideally, to undergo therapy in person, and not via Skype.
Remember that you deserve care and respect. You have the right to ask what is important to you and choose a psychotherapist based on the answers received. It is not a shame to be picky and legible, 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 process itself. The main thing is that doctors and patients are on an equal position - and both parties are free to choose.
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