Why Russians do not go to psychologists
And how to bring Russian psychology out of the “wild field”
In the United States, almost every able-bodied citizen of the middle class has a personal psychologist — just like their own hairdresser, dentist or car mechanic. In Russia, the most common response to the phrase “I'll try to see a psychologist” is an offer to have a drink together in the kitchen — and all the problems will resolve themselves. In our country, the sphere of psychological services is practically unregulated, and, as a result, a wild field of speculation and quackery is formed around this serious science. Doctor, Deputy of the State Duma of Russia from Tatarstan Boris Mendelevich in his author's column for Realnoe Vremya discusses how to solve the problem of Russian psychology.
Psychologists vs psychiatrists
The problem of psychology as a science has been standing for a very long time. First, until recently, many people confused psychologists and psychiatrists.
Just in case, I'll remind you: psychiatrists are qualified certified doctors who have studied in medical schools with a specialty in Psychiatry and treat mentally ill people.
Psychologists provide psychological services and communicate with healthy people, trying to solve their psychological problems, and not health problems per se.
It is clear that psychologists in their work can be at the intersection of these two disciplines. For example, a person's psychological problems can lead him or her to the verge of clinical depression, and this is a condition that can only be cured by a psychiatrist.
Another very clear difference between a psychologist and a psychiatrist: the first (if he does not have a medical education and a corresponding license) does not have the right to prescribe medications, he is not a doctor. For a prescription for, for example, antidepressants, you can only contact a psychiatrist (not to frighten patients with the word “psychiatrist”, many of them often call themselves psychotherapists, but in any case, they always have a medical license and a doctor's degree).
If you want to be a psychologist, be one?
When the terms “psychologist” and “psychiatrist” finally began to be separated in the minds of society, we somehow forgot that any service must be regulated in some way. And the work of a psychologist is a clean, transparent service sector.
For example, if we move away from our topic and take hairdressing services: a hairdresser must pass exams for the right to work, have disinfection skills, must have a certain set of tools, and be able to provide first aid. And so it is in the vast majority of professions: everywhere there are professional standards and a system for evaluating specialists, according to which they are issued certificates.
But the provision of psychological services in our country today is not regulated in any way. In fact, any person who received a psychological education (even if it was a three-month course), and moreover, even if they did not receive it at all, can declare that they are a psychologist, advertise in the media and in social networks, post an ad about their services and start provide them. And no one can forbid it.
While advertising medical services is prohibited if the organisation does not have a license. And psychologists and people who pretend to be them are not obliged to get any certificates or licenses for their activities. What will it lead to?
There are a lot of people who think they can be psychologists, and they don't even need to study. For example, a person is often approached by relatives for everyday advice, and he “self-declares” himself a psychologist. But to get at least a semblance of some official document that could confirm his vast talents, he goes to short-term courses.
On this wave, in the 1990s and 2000s, second psychological education was very common — almost every university, even technical, had courses. Those who passed these courses received a certificate of a psychologist and had the full right to go to work in this specialty. At that time, a huge number of “specialists” were graduated with formal qualifications of a psychologist, but they did not have a basic, fundamental psychological education — those basics of the profession that are taught at psychology departments for 5 years. In those years, there were tons of such psychologists. Despite that it was not necessary to have certificates and licenses, many of them went to the masses. Unfortunately, this whole situation has largely discredited, in my opinion, the entire science of psychology as such and psychological services in particular. But people so need such services!
Problem No. 1: how do I choose a psychologist who doesn't do any harm?
In our country, going to psychologists is still uncommon practice. They say that compared to Europe and the United States, we have a different mentality. But in my opinion, the mentality has nothing to do with it. We have been living in the new Russia for so many years and creating a new life that this useful tradition could also take root in our country. But all the current confusion and lack of regulation leads to that people do not go to specialists. They believe that psychology is either quackery and unprofessionalism, or it will not be of any use anyway. But if the question was only in the absence of usefulness, then personally I would not even raise these questions now.
Unfortunately, a psychologist, especially not a professional one, can not only not help a person but also cause harm by their actions. And this is very dangerous. As a result, today the average Russian does not have any guidelines and criteria by which he could choose which psychologist to turn to.
How do I do this? Based on reviews on the Internet? But you and I know very well how reviews are written. Ask your friends? We have already said that there may not be such acquaintances in the environment, because, in principle, it is not customary for us to go to psychologists. Where do I get relevant information? There are a lot of offers, but how to choose a psychologist who would help at best, and at worst — at least not harm, is still unclear.
Problem No. 2: who will approve the methodology?
In medicine, any methodology must:
- a) tested,
- b) scientifically proven,
- C) registered.
Let's say you come to a gastroenterologist, and he or she offers you his author's method of treating stomach ulcers. Certainly, you will ask if it is registered somewhere and if it is safe. Meanwhile, none of the author's psychological methods are subject to any registration: you come up with it — go and work. Almost every popular psychologist believes that he came up with his own author's method of helping people.
Back to medicine. How do clinical recommendations appear? They are developed in the profile association of doctors of a particular profile (for example, it may be the Russian association of cardiologists, or gastroenterologists, or dentists). A special commission reviews the information collected, then they approve these clinical recommendations as a whole and direct them to the ministry of healthcare, which approves them (or does not approve them, which happens much less often). After approval, these clinical recommendations acquire some semblance of a regulatory act.
I suggest creating something similar in psychology. To ensure that the methods of psychological assistance used are tested for adequacy, effectiveness and safety in a specialised professional association (which, by the way, exists in Russia and is very strong).
By the way, the Russian psychological society, which unites numerous professionals, also supported the regulation of this sphere and even tried to draft a corresponding bill five years ago.
In the meantime, we can't guarantee people that even if they go to a certified psychologist, the method they use is safe for their mental and psychological health.
Problem No. 3: how to protect yourself from charlatans?
Against the background of the development of social networks, a huge number of people have divorced, masking their activities as psychological, calling themselves coaches, coaches, gurus. There're plenty of them. I don't want to and won't talk about them making money — it's not relevant at all. In general, prices for psychological services should not be regulated in any case — this is the market, and it will regulate itself. For example, Labkovsky cost more than 90,000 rubles for a visit, it seems to me, for one simple reason. Among all the huge mass of people who call themselves psychologists, it is difficult for a person to choose, and he goes to the most advertised name in the hope that this one will definitely help. For such money he must help!
But let's go back to coaches. I believe that the activities of many of them are quackery, which should be dealt with by law enforcement agencies. Because in my opinion, it is a fraud to pretend to be a psychologist, without having any reason to do so, and to provide certain services (perhaps, not even calling them psychological, but in fact they are).
There are surely successful methods for personal growth developed by professional psychologists who have the appropriate qualifications. I'm not talking about them but about hundreds of valiant bloggers who pretend to be gurus, healers, sensei, trainers, and are engaged in cheating on a large scale.
But law enforcement agencies can only deal with what is regulated. But again, we have no clear concept in the law about what psychology is, who a psychologist is, what methods he can use and what methods he can't, how these methods are registered, how a psychologist can see clients.
While it is not regulated, it means that there is nothing to punish for. It turns out that there are no guidelines for both potential clients of psychologists and law enforcement officers.
What should we do?
The conclusion from this is very simple. We need a framework law on psychological services. It should not contain details about each individual method: it should be regulated by separate bylaws. But this law should at least:
- give all the necessary definitions: what psychology is, who a psychologist is, what a psychological service is, what the scope of the psychologist's activity is, what are the rights and obligations of him and the patient, etc.;
- determine the responsible body, self-regulatory organisation, which would be responsible for reviewing and evaluating the proposed methods;
- determine not only the mandatory certification of methods, but also the requirements for licensing psychologists. A specialist in the human soul should not work without a license. Moreover, he, like a teacher and a doctor, must regularly confirm his qualifications, proving his professional aptitude.
I know for sure that in the West, all the psychological methods used are certified, and all the existing psychologists have a license. We don't have anything like that. The only document that a working psychologist in Russia can present is a diploma of education (and very often these will be courses lasting several months). For some reason, we are always looking for some way of our own. But there is no need to invent anything. In the countries where people go to psychologists for many decades, everything is already regulated. We need to take their legislation, apply some of their nuances and put it into effect. Everything has already been invented before us. But, despite this, nothing has changed so far.
After all, the state at least began to regulate even alternative medicine. There is an order that a person who wants to engage in alternative medicine can describe what they are doing and send information about themselves to the regional ministry of healthcare in a notification order. There he will be registered as a specialist in alternative medicine. At the same time, Roszdravnadzor can go to him on any complaint and see if he is causing harm to someone there. So the state is trying to regulate this sphere at least in some way. So if even the activities of shamans and healers are already regulated, why haven't we reached psychology yet?
We definitely need a law and regulations in this area.
In addition to certification of methods and licensing of psychologists themselves (I am convinced that psychologists must have a license), it is necessary to create a certain register of specialists, which will exist in the form of an independent formalised rating of psychologists.
We should proceed from the common man
It is necessary to proceed from the needs of an ordinary person. And we need to make sure that if he has a difficult situation in his life, he can easily find a suitable psychologist who will be qualified, help him and not cause harm.
The main request of a person is formed for the opportunity to get qualified help, and that this help is safe. And we — the state — as the regulator of all contractual relations must guarantee this to the individual. As of today, we can't do that.
The state cannot yet guarantee a person that, having found a psychologist on the Internet or on a tip from friends, he really see:
- a) to a qualified specialist,
- b) a specialist who works according to a registered method,
- C) to a specialist who does everything safely.
And this is the essence of what I want to say.
The problem needs to be solved — and we need to start with the development of a framework law. We are considering budgets for three years, changing the constitution, fighting coronavirus — we can't deal with the issues of psychology now. But this lacunae must be filled. And as soon as there is a legal framework, as soon as it becomes clear who is a psychologist and who is not a psychologist , who has or does not have the right to provide these services, then much will change in the situation. Law enforcement agencies will have clear levers to respond to numerous scammers who earn money from human misfortune. And a person who needs psychological help will have clear guidelines that will help them get this help.