First Intercontinental Extraterritorial Congress
First Intercontinental Extraterritorial Congress
«Planet of Psychotherapy»
Children. Family. Society. Future.
2022 21-26
June

V.V. Makarov Psychotherapy in Russia

Psychotherapy in Russia: the past, the present, the future

Victor V. Makarov — President of the All-Russian Professional Psychotherapeutic League and the NationalSelf-Regulating Organization «Union of Psychotherapists and Psychologists», Vice-President of the World Council for Psychotherapy and the Asian Federation of Psychotherapy, Head of the Department of Psychotherapy and Sexology of the Russian Medical Academy of Continuous Professional Education, MD., Professor.Moscow, Russia.

Summary: V.M. Bekhterev’s school of psychotherapy emerged in tsarist Russia. During the Soviet time three psychotherapeutic schools loyal to the totalitarian regime were formed in Moscow, Leningrad and Kharkov. In 1970s the Eastern trend of psychotherapy started developing within the confines of dissident movement. Unlike the three above-mentioned schools of psychotherapy, the Eastern trend aimed not for the Soviet state, but for its people. Nowadays 47 modalities and methods of psychotherapy are recognized in Russia. According to experts, about 45 000 professionals are engaged in psychotherapeutic practice in our country. We work on the draft of a bill «On psychotherapeutic practice». Professional activities of psychotherapists working outside of the institutions affiliated to the Ministry of Health are regulated by the Self-Regulating Organization National Association for the Development of Psychotherapeutic and Psychological Science and Practice «The Union of Psychotherapists and Psychologists».

Our country is the one of the world flashpoints of psychotherapy development. We realize this fact during preparations to host the IX World Congress for Psychotherapy in the summer of 2020.

The history of psychotherapy in Russia goes back to tsarist times. The birth of Russian psychotherapy is associated with the foundation of V.M. Bekhterev’s school, which later became the school of the Bekhterev’s Institute located in St-Petersburg. From our point of view, it’s not quite accurate to call this school a Leningrad school,as it was formed under the influence of European psychotherapy and contributed to its development.

Later, during the Soviet era two other Russian psychotherapeutic schools — of Moscow and Kharkov — emerged. Both of them were initially loyal to the Soviet government, whereas the students and followers of V.M. Bekhterev needed to make constant efforts to maintain their loyalty. All three schools were focused on the demands of the Soviet state and fulfilled all requirements of censorship.

In the 1970s and 1980s the Eastern trend of psychotherapy started developing. The roots of it can be found in the Soviet dissident movement, which was represented especially broadly in the Novosibirsk Academic City. Later these ideas penetrated the minds of young psychiatrists and psychologists in Novosibirsk and little by little spread on the eastern part of the Soviet Union. In contrast to the three Soviet schools of psychotherapy, the Eastern trend was not Soviet state oriented; it aimed at common people who nowadays reflect the seedlings of civil society.

Thus, in our country there were: a school founded before the revolution, two schools formed during Soviet era and one school which began to grow at the end of the Soviet epoch and has been developing till present. We call the latter “the New School”.

According to expert estimates, on the edge of the 1990s there were about 600 psychotherapists in Russia, mostly psycho-neurologists, neurologists and psychiatrists. We were enthusiastically enriching our education and practice with new theories and technologies from Western methods and modalities of psychotherapy which filled our country during post-soviet years.

In the beginning of the 1990s for the first time in the history of our profession psychologists began to massively engage in psychotherapy.Asforeign methods of psychotherapybecame widely introduced within Russia, young psychologists began to master these new methods with great enthusiasm and promote them broadly throughout the country.The foreign methods, developing independently and in competition with each other, brought previously uncommon rivalry and mutual criticism between Russian psychotherapists.At that time, the interest towards psychotherapy was rapidly growing.From 1991 to 1996, the city of Krasnoyarsk alone was visited by at least 2500 professionals per year who came to receive training in psychotherapy and to exchange professional experiences. These people attended numerous conferences and decadnicks (ten-day workshop marathons) organized in the picturesquesuburbs of Krasnoyarskand on the motor ship “A.Matrosov” during Krasnoyarsk-Dudinka-Krasnoyarsk cruises; they participated programs of advanced trainingin the Krasnoyarsk State Medical Academy.

The need for psychotherapywasso great, the scope of psychotherapy was so obvious and the psychotherapeutic training was so accessible that a large number of psychologists joined our profession. Due to the ban on the profession of psychotherapist for psychologists issued by state medical authorities, psychologistswere engaging in psychotherapy but calling it a vast majority of names: psychological correction, practical/applied psychology, psychological counseling, psychological practice, etc. The newly invented title “non-medical psychotherapy” arose only after medical practitioners introduced the concept of medical psychotherapy. Of course, the above-mentioned non-medical areas of practice are not regulated legally. It is not even clear to which ministry should these areas be liable to.

Since the mid-1990s the number of medical practitioners-psychotherapists also grew. The maximum number of psychotherapists working in the institutions of the Ministry of Health in our country,according to experts,reached 5000 employees, 3000 of which were psychiatrists.Inrecent years the numberofpsychotherapists employed by the Ministry of Health institutionsdramatically decreases every year.At present, we are not able to provide statistical data, as considerable part of psychotherapeutic jobs has been being taken by psychiatrists who, as it’s widely known, arenot yet psychotherapists.According to expert data, thenumber of medical practitioners of psychotherapy in the institutions of the Ministry of Health steadily approaches the figures from the mid-1990s.

So, the first line of development of Russian psychotherapy lies with the state, within the institutions of the Ministry of Health of the Russian Federation. State (mainly psychiatric) psychotherapy was considered a singular specialty, later (and now) — asub-specialtyof psychiatry.During the last decade, this area is experiencing significant organizational difficultiesdue to the widespread reduction of psychotherapeutic positions and low wages in public institutions.

In recent years, neurologists take up psychotherapy with increasing intensity and interest, and it is very helpful for psychotherapy itself. After all, a psychiatrist’s work is grounded on psyche, which we consider being a brain function, whereas a neurologist’s work relies on the very structure of brain, linkingit with brain functions.

Furthermore, for more than 25 years non-state psychotherapy has been developing in Russia. The rapid evolution of private psychotherapy is being done in particular methods and modalities of psychotherapy.According to various sources,there are hundreds or even thousands of psychotherapeutic methods.The progress of non-state psychotherapy in our country is very spontaneous; it has swept the majority of the regions of our country like an explosion.Each modality of psychotherapy develops in its own setting and conditions.The European Association for Psychotherapy has vast experience in bringing such individual, scattered modalities of psychotherapy together. In Russian Federation the unification and cooperation of various modalities and methods of psychotherapy is being done by the All-Russian Professional Psychotherapeutic League (PPL, or the League) for twenty years. The list of methods of psychotherapy and counseling as of June of the current year is given in the table below:

Table.

Methods of psychotherapy and counseling

Approaches, modalities (methods) of psychotherapy and psychological counseling which have received professional recognition in the Russian Federation:

1 Hypnotherapy RashitTukayev Moscow
2 Multimodal psychotherapy Victor Makarov Moscow
3 Systemic family psychotherapy Anna Varga
(representative -Tatyana Rytsareva)
Moscow
4 Existential psychotherapy Alexander Barannikov Moscow
5 Body-oriented psychotherapy Lev Belogorodsky Moscow
6 Resource-oriented systemic psychotherapy Mark Sandomirsky
Lev Belogorodsky
Moscow
7 Positive psychotherapy Ivan Kirillov Moscow
8 Symboldrama Jakov Obukhov-Kozarovitsky Moscow-Zaporozhye, Ukraine
9 Transpersonalpsychotherapy VladimirMaykov Moscow
10 Neuro-linguistic psychotherapy Sergey Kovalev Moscow
11 Therapy by creative means of self-expression by M.E.Burno Mark Burno Inga Kalmykova Moscow
12 Psychocatalysis Andrey Yermoshin Moscow region
13 Clinical classical psychotherapy Mark Burno Luidmila Makhnovskaya Moscow
14 Dianalysis Vladimir Zavialov Novosibirsk
15 Psychodrama Ilona Romanova Ekaterinburg
16 Emotional-image psychotherapy Nikolai Linde Moscow
17 Psycho-organic analysis Oksana Mironik-Aksenova Moscow
18 Transactional analysis NadezhdaZuikova Moscow
19 Psychotherapeutickinesiology Irina Chobanu Moscow
20 Erickson's psychotherapy and Erickson hypnosis Vladimir Domoratsky Minsk, Belarus
21 Perinatal and reproductive psychotherapy Elena Pechnikova
Galina Filippova
Moscow
22 Religion-oriented psychotherapy Sergey Belorusov
Lyubov Bitekhtina
Moscow
23 Musical-integral psychotherapy Valentin Petrushin
Alexander Tabidze
Moscow
24 Differential cognitive therapy Anton Burno Moscow
25 Clinical psychosomatic psychotherapy NadezhdaZuikova Moscow
26 Healing creative psycholinguistics Alla Semenova
Elena Abrashkina
Canberra, Australia-Moscow
27 Cognitive-behavioral psychotherapy Elena Korabelnikova Moscow
28 Client-centered psychotherapy Alexander Kocharyan
Victor Kuzovkin
Kharkov, Ukraine
Moscow
29 Integrate-dialogue,cognitive-orientedhypnotherapy (psychotherapy) Rashit Tukayev Moscow
30 Art therapy Alexander Kopytin St. Petersburg
31 Jungian analysis Liya Kinevskaya
Lydia Surina
Moscow
32 United psychoanalytic approach Alexander Kharitonov Moscow
33 Balintgroups Nikolai Klepikov Moscow
34 Integrative child psychotherapy Albina Loktionova Moscow
35 Systemic family psychotherapy: Eastern version Nina Lavrova St. Petersburg
36 Eastern version of transactional analysis Galina Makarova Moscow
37 Integral Neuroprogramming Sergey Kovalev Moscow region
38 System-phenomenological psychotherapy (counseling) andclient-centeredconstellations® Mikhail Burnashev Moscow
39 Ethical personalism Alexander Bondarenko Kyiv, Ukraine
40 Process-oriented psychology and psychotherapy Liudmila Serbina Moscow
41 Generative psychotherapy Petr Silenok Krasnodar
42 Eastern version ofpsychosynthesis Sergey Klyuchnikov Moscow
43 DMO approach Yuliya Ogarkova (Dubinskaya) Moscow
44 Sand therapy Oleg Starostin St. Petersburg
45 Gestalt Therapy Elena Petrova St. Petersburg
46 Personality-oriented (reconstructive) psychotherapy Vera Arseneva St. Petersburg
47 Rodologic method of counseling Larisa Dokuchaeva Yekaterinburg

Of course, we are fully aware of the fact that this list does not include all methods of psychotherapy and counseling widely spread in our country. In 2013, we conducted an expert survey among the leaders of psychotherapeutic modalities regarding the number of practitioners within their methods. We interviewed the leaders of 30 modalities of psychotherapy, and according to their expert opinion,by 2013 the minimal estimated number of practitioners in their modalities was 28 045, whereas the maximal estimation was 30 485. The interviewed persons were also asked to make a forecast for 5 years, i.е. for the year of 2018 — and their estimation is that the minimal number of practitioners would be 43 740 people and the maximal — 45 450 people. Certainly, much has changed in Russia ever since, thus we are determined to repeat the survey, especially because the number of psychotherapeutic modalities within our organization grew up to 47 in total.

However, not nearly all of the new initiatives proposed by our colleagues quickly get professional acknowledgement and become introduced as new methods of psychotherapy.According to our point of view, each valid method of psychotherapy must have its proper theory; practice which includes a set of technologies and techniques for psychotherapeutic work; proper training program based on afour-part education system: personal psychotherapy within training, theoretical training, practice during the training, and trainingsupervision.The total amount of training often goes up to 3200. And the final important issue for a psychotherapeutic modality is to have followers.If not all four components are yet present within a modality, we do not consider it a modality or method of psychotherapy but we call it an “author's method”.It is copyrighted to a certain author and does not belong to psychotherapy in general.

Now let's pass to legislative initiatives in our field.

The legislative initiatives in psychotherapy also emanate from the Professional Psychotherapeutic League. Up till now we have proposed three such initiatives in total. In 1998, the League drafted a bill on psychotherapy. Six months later a project on similarlaw was introduced by the Russian Federal Scientific and Methodological Center of psychotherapy and medical psychology, and in a few months the third project was presented by the Psychotherapeutic service of Moscow. At that point, three different drafts of the bill on psychotherapy were presented to the public and it became clear that we were not yet able to come to an agreement within our own professional community and, therefore, we were not ready to pass the draft of the bill to the State Duma of the Russian Federation.In 2014, the League createdthe second draft of the law:“On psychotherapeutic help in the Russian Federation” which was widelydiscussed in the professional communities and was submitted to the State Duma of the Russian Federation for preliminary consideration.The Health Committee of the State Duma sent the draft to the Ministry of Health for an expertise, and abriefconclusionwas receivedon the inexpediency of such law.Soon,in 2016, theLeague came up with the third draft of the psychotherapeutic law “On professional psychotherapeutic activities in the Russian Federation”.Now we wait for a favorable moment to present the draft to theState Duma.All three drafts of the law introduced by PPL represent succession and orientation towards practice, astheir initialversions were developed by same author, Professor Alexander Katkov.

Legislative initiatives towards psychologyin our country are also ofunique history.In 2012, the work on a bill on psychological help in the Russian Federation started.The League participated in the discussion on thedraft law just once.Our proposalswere not taken into considerationeither,and wewerenot invitedto further discuss the project.This bill was not adopted.In 2017, we were again invited, now to theSupreme Council of the Russian Federation, to join the working group on a new version of thebill “Psychological help in the Russian Federation”.In future, as far as we are awareof, some of the participants of the meeting, personnel of the Moscow State University, organized a working group to continue their efforts on the draft law.

Further attempts to outline the legislative regulation of psychotherapy brought our attention to self-regulation in our country.Self-regulation in Russia was introduced by theFederal Law"On Self-Regulating Organizations" N 315-FZdated 01.12.2007.The entire branches of the national economy are now regulated by this law.However, there hasn’t been a single self-regulating organization founded neither in medicine nor in psychology.All-Russianprofessionalpsychotherapeuticleague is included intothe National Medical Chamber(NRM) since the establishment of the latter.It was NRM who took the initiative to pursue the amendment of the law onself-regulationof medicine.Unfortunately, this goal has not yet been accomplished. In October 2014, we adopted the first Charter of the Self-Regulating Organization (SRO) — Association for the Development of Psychotherapeutic and Psychological Science and Practice «The Union of Psychotherapists and Psychologists» and put this organization to action. In October 2015, certain amendments and additions to the Charter of our National Self-Regulating Organization «The Union of Psychotherapists and Psychologists» were made. As it is mentioned in the full name of the organization, it has acquired a national status. According to the current legislation, only one national self-regulating organization is authorized to function per industry. A national self-regulating organization unites all self-regulating organizations in our work field, interacts with the state regulatory bodies and is endowed with legislative rights. The further development of our national self-regulating organization led to significant adjustments in Charter of the organization. Since the beginning of 2018, after the Ministry of Justice affirmed the amended Charter and included it in the official state register, we have been working in accordance with the updated Charter. During the extraordinary board meeting in March 2018 the Board of our organization has come to several important decisions to stimulate the further development of our national SRO.

Our self-regulating organization includes: psychotherapists, psychoanalysts, counselors, applied psychologists, mediators, supervisors, coaches and other specialists engaged in the field of psychotherapeutic science andpractice and those who are private entrepreneurs;legal entities that provide psychotherapeutic assistance, vocational education and research in the field of psychotherapeutic science and practice.We are authorized to establish branches and representative offices in the regions of the Russian Federation.

The subject of self-regulation is professional entrepreneurship ofpsychotherapists, psychoanalysts, counselors, applied psychologists, mediators, supervisors, coaches and other professionals engaged in psychotherapeutic science and practice, and legal entities that provide psychotherapeutic and psychological assistance, vocational education and research in the field of psychotherapeutic science and practice.

Our missionis to develop andunify standards and guidelines of entrepreneurship among specialists of psychotherapy and psychology.

It is certain that our standards andguidelines strictlycorrespond to federal laws and otherstate legislative instruments.Standards and guidelines of the Association may set additional imperatives for the professional activities of its members. Firstly, we define additional requirements for education. We introduce a four-part paradigm of vocational education, which includes theoretical study, practice under supervision, personal therapy and supervision during training. The required training standard for psychotherapeutic education proposed by us is more than six times bigger than the standard adopted by the Ministry of Health, and meets the standards of the European Association for Psychotherapy. It is important to list the most important functions of our organization: vocational training, licensing of employees, certification of services provided by the members of the SRO. Both licensing and certification will be conducted within approved modalities of psychotherapy. Our other great concerns are research in the field of psychotherapeutic science and practice; establishment of rules for psychotherapeutic practice, mediation, counseling and psychological assistance; development of training standards in psychotherapy and common examination of scientific and practical techniques, programs and projects in psychotherapy and psychology. We will be engaged in counsel on the drafts of federal laws and other legal acts of the Russian Federation.

Our rules enforce a ban on the activities of SRO members which may cause damage to other entrepreneurs in the field of psychotherapy and psychology, we also set rules against unfair competition, commission of acts which may cause any kind of moral harm or non-pecuniary damage to consumers of psychotherapeutic and psychological services and/or third persons, actions which may degrade business reputation of a SRO member or business reputation of the SRO itself.

According to the new version of the Charter, between yearly board meetings the SRO is being governed by the Presidential Council which consists of its department leaders.

Professional bodies compulsorily established by the Presidential Council of the SRO are the following:

1) The Expert Commission monitors adherence of the SRO members to the standards and rules of the Association;

2) The Disciplinary Commission scrutinizes cases on disciplinary actions against members of the Association;

3) The Ethics Commission monitors abidance of the SRO members by Rules of Professional Conduct approved by the General Meeting of the Association;

4) The Academic council engages in development of psychotherapeutic and psychological science, practice and education, and profile research in mentioned fields;

5) The Supervisory Board exerts control over entrepreneurial activities of the SRO members concerning psychotherapeutic and psychological assistance

and vocational education in terms of compliance with the requirements of the Association's Charter and the regulatory legal acts of the Russian Federation.

The Presidential Council is authorized to establish other governing bodies important for the successful functioning of our self-regulating organization.

We have signed cooperation agreements with the largest associations of psychotherapists: the European Confederation of Psychoanalytic Psychotherapies — Russia and the Association of Cognitive-Behavioral psychotherapy.

It is especially important to realize that the lack of legislative regulation of psychotherapy and psychology leads to obvious losses, primarily for the consumers of our services and for our profession. Thus, business workshop activities, which mainly originated from psychology, have been practically separated from it; same happened to coaching, and now is happening to personal growth training. Professionals in these areas are being replaced by charismatic amateurs whose biggest concern is money. Now such profit-oriented dilettantes are aiming at psychotherapy.

As it has already been mentioned in this article, originally there were three schools of psychotherapy in Russia, and later the fourth, New School began its active development. In which conditions are these schools nowadays? Which prospects so they have? — We’ll find the answers to these questions during the special conference dedicated to the Russian domestic schools of psychotherapy. The conference is scheduled within the framework of the Yearly Congress of the Professional Psychotherapeutic League of Russia “Psychology and psychotherapy of each passing day and of whole of our lives” on 15-18th November 2018 in Moscow. Before 2010s a new kind of psychotherapy and — for the first time in Russian history — applied psychology has emerged. Both of these areas largely coincide with each other in terms of contents of activities, but only a minor part of psychotherapy is being legally regulated by the decree of the Ministry of Health, whereas most of the psychotherapy and applied psychology are to some extent regulated within the methods and modalities of psychotherapy. The methods and modalities of psychotherapy in our country are united by the All-Russian Professional Psychotherapeutic League.

Today, psychotherapy within state institutions in Russia coexists with independently practiced psychotherapy. Moreover, there is a sufficient number of psychotherapists who work both in public state medical institutions and are engaged in private practice at the same time. Private practice in psychotherapy, while having a nature helping profession, strictly depends on the rules of business. Therefore, efficient self-regulation is particularly important in this area. The time has come for independent psychotherapy to give a helping hand to psychotherapy within state medical organizations, which is now experiencing great hardships, almost at the level of a systemic crisis. Nowadays it becomes difficult for psychotherapists to be on their own, and professionals in the field of psychotherapy and psychology determine which organizations should they choose to side with.

New modalities and methods of psychotherapy are born in our country. We welcome and support the creativity and dedication of Russian professionals and invite the leaders of new modalities o join the Committee of methods and modalities of the PPL.

Our country proves to be the one of the global flashpoints where psychotherapy develops. We fully realize this fact, especially while being actively engaged in preparations to host the IX World Congress for Psychotherapy in Russia in the summer of 2020. At present we created the most favorable conditions to demonstrate the achievements of Russian psychotherapy to the entire professional world. The congress will be held in June-July 2020 in St. Petersburg, Moscow, Altai and at Lake Baikal. The theme of the congress is “The Planet of Psychotherapy”.

Dear colleagues! We all have lots of work ahead — in each and every day and through the whole of our lives, and we have very optimistic prospects towards our future! Today, in many aspects, we ourselves create our future!

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