On Psychotherapy, Legality And Linguistics

2024 Author: Harry Day | [email protected]. Last modified: 2024-01-12 20:57

Informed and interested colleagues are discussing a case when a psychologist (according to other sources - a gestalt therapist) received a criminal record and a suspended sentence on charges of illegal provision of psychotherapeutic services. I know about this case only by hearsay, but I can give a couple of examples from personal experience.

In the first example, a psychologist colleague from one Central Russian city approached me, having learned that I was conducting complex forensic psychological and linguistic examinations - I was participating as a psychologist. According to her, she was working with a client who had some kind of emotional distress. He decided that her services did not help him, that she was “pulling money out of him,” and so on. A conflict arose in which he eventually sued her, accusing her of providing illegal medical services. She built her defense on evidence that she did not provide medical services, that a psychologist was not a doctor, and showed her diploma in psychology. But at the disposal of the court was her business card with the word "psychotherapist".

Such is the linguistic problem: if she is a psychologist, then why does she call her services “psychotherapy” and not “psychological help,” as it is called in the professional standard of a psychologist? For the court, this was unequivocal evidence of the implementation of medical activities without a license and violation of the licensing procedure. I don’t know how the matter ended, but, in my opinion, she “got stuck” fundamentally just because of the incorrect name of the advertised service.

In the second case, the psychologist worked with a depressed client, and he committed suicide during the meetings. The relatives made a complaint about the insufficiently complete diagnosis and the prescription of the wrong method of treatment. According to their lawyer, if antidepressants were prescribed, and not psychotherapeutic methods, then there would be no suicide. And in this case, the same linguistic problem arises: what are the labor operations performed by the psychologist called? If the psychologist did not engage in “psychotherapy for depression”, but “performed psychological counseling,” then there simply would be no corpus delicti, since unlike "psychotherapy," "counseling" is not defined as "treatment."

"Carrying out entrepreneurial activities without a license in cases where a license is required or in violation of licensing requirements and conditions, if this act caused major damage to citizens …" is a completely criminal article, providing for a very real criminal record in the biography. They are not persecuted for "gestalt therapy" or "art therapy", but for illegal medical practice.

The point is that words have certain fixed meanings. For half a century now, psychotherapy in our country is “a theoretically grounded system of methods of medical influence on the patient's psyche, and through the psyche - also on his body and behavior, based on knowledge of the pathogenesis of painful conditions and methods of medical influence on the psyche, allowing to achieve the desired therapeutic effect on VN Myasishchev. Or in a simplified formulation: "treatment by talking, not medication."

Adding the definition of “non-drug” or “non-medical” to the word “psychotherapy” does not change the fact that in the legal field of the Russian Federation it still remains “treatment” and is regulated by N 323-FZ. If a person does something for a monetary reward, he "conducts economic activity." Economic activities are listed in the All-Russian Classifier of Economic Activities (OKVED). Psychological assistance can be provided in 4 sections of OKVED: education, medicine, social services and "miscellaneous". In the zero years, "psychotherapy" in accordance with the "National Standard of the Russian Federation for Social Services to the Population" was included in the list of social services. It was recognized as a social service - a kind of "psychological assistance", but now it has disappeared from this standard and has remained only in the list of medical services. It follows from this that if a person offers "psychotherapy" - this, naturally, will be interpreted as "providing medical services" with all the ensuing consequences.

I see several ways out of the current situation with "psychotherapy". First of all, this problem should be viewed as linguistic, not organizational: the question is not whether psychologists should be allowed to "engage in psychotherapy", but what to call the word "psychotherapy"

Then, at least three options arise:

Option 1 - the adoption of the law "On Psychological Assistance", which unambiguously places psychological assistance in the OKVED section "social services to the population" and defines psychotherapy as a kind of psychological assistance along with counseling, training, psychocorrection, etc. In this case, psychotherapy ceases to be a treatment, i.e. medical service. This does not exclude its use in psychiatric hospitals and outpatient treatment of mental disorders: the hospital staff includes social educators, music workers performing "dance therapy", grooms engaged in "hippotherapy", and psychologists conducting "psychological therapy" in individual and group format.

Option 2 - permission for qualified clinical psychologists, under certain conditions, to engage in psychotherapy in the usual sense of the word - "treatment by talking", ie. provide medical service "treatment". In this case, it will be necessary to resolve a number of issues related to the responsibility for the process and consequences of such treatment in accordance with medical standards. In addition, the question of the correspondence of the education of such a specialist to the criteria established in foreign practice cannot but arise. Of course, if a person received a diploma of "clinical psychologist" in two-month distance courses, then there can be no talk of any admission to independent treatment of mental disorders. Here, the position of the Ministry of Health is clear to me, and I am quite in solidarity with it.

The above options for the course of events, in my opinion, are unlikely - the draft law "On psychological assistance" disappeared without a trace, as well as the "Law on psychotherapy." Maybe for the better, since in the edition I know of, its text does not solve a single real problem in creating a practice of private professional psychological assistance. Psychological assistance in it is completely groundless and mistakenly viewed not as a social service, but as a medical service - the authors of the bill propose to control the activities of psychologists to the Ministry of Health. For school, family, or organizational psychologists, this decision is perplexing.

There is a third option - the simplest and most rational.

Option 3 - We stop discussions on the topic "Can a psychologist engage in psychotherapy?" and focus on the terms used, give definitions to the labor functions of psychologists and then fearlessly use these terms. Yes, this is an equally difficult problem: for example, it suddenly turns out that in the professional standard "teacher-psychologist" there is no function of "providing psychological assistance" … It turns out that a school psychologist should not help anyone at all and even be able to do it …

In the "nineties" and "zero" years, I still hoped that a law would be passed allowing psychologists to "engage in psychotherapy" by analogy with the EU and the United States. That the requirements for the education of such specialists will be formulated and, on the basis of their compliance with the educational criteria, their certification will be organized: he studied for eight years (including personal therapy and a year of work under supervision), passed the qualification exam of the state commission, received a certificate of conformity and go ahead: open an office, conduct an appointment, pay taxes … By the "tenth" years it became obvious: this will not happen.

Personally, I have been conducting “social and psychological trainings” and “providing psychological assistance” in my private organization for more than 30 years. For 25 years I have been doing “psychological counseling” in a health care institution … My colleagues-psychiatrists refer their patients to me, if they need “psychological help”, in parallel with or instead of treatment, and at the same time it does not upset me in the least that I do not have the right to be called a “psychotherapist”.

For the last decade, I have persistently conveyed to my students-psychologists a simple professional position: it should be remembered that a word is just a sign and it has a dictionary meaning. For the law it does not matter at all what meaning you attribute to the word "psychotherapy", in what sense you use it and in what sense it was used by your teachers at the university or in retraining courses. It is important in what meaning this term is interpreted by a law enforcement officer at the moment. Today, the word "psychotherapy" is assigned the meaning of "treatment" - a licensed type of activity. Do not engage in "psychotherapy", "providing psychological help" is no less worthy and sounds no worse.