I just canʼt take it anymore and (probably) itʼs time to go to a psychotherapist. How to choose it, not to become dependent on therapy and not to spend all the money? Here are detailed instructions

Every fourth Ukrainian can get serious mental problems because of the war — from anxiety and stress to depression and post-traumatic stress disorder. Often itʼs not enough inner resources to cope with this on your own. Then it is better to seek specialized help from a psychotherapist or psychologist. They are becoming more and more popular, but there are still many questions — which specialization to choose, where to look for a therapist, how to understand that he/she is helping you? “Babel” correspondent Ghanna Mamonova didnʼt know the answer to these questions herself. She asked psychotherapists Natalya Pidlisna, Yuliya Melashchuk, Volodymyr Kazantsev, and Natalia Stoyetska to tell how a psychotherapist differs from a psychologist and a psychiatrist, how to choose one, what problems he/she works with, how to finish psychotherapy on time, and how much consultations cost.

What is the difference between a psychologist, a psychotherapist and a psychiatrist?

Letʼs start with the psychiatrist, because this difference is the most revealing. A psychiatrist is a doctor who works with mental illnesses or physical brain injuries. He/she treats medically.

A psychotherapist or psychologist works specifically with mental issues. The difference between them lies in the approaches. A psychologist helps in the short term, with a specific problem. For example, you have been fired from your job and are very worried about it. Or you notice that your concentration or memory has deteriorated. In such cases, a psychologist will help you make a plan to solve the problem, and this will take 5-10 consultations.

Psychotherapists work with deeper problems. These can be various mental disorders, such as anxiety-depressive disorder, paranoia, depression, schizophrenia, obsessive-compulsive disorder, panic attacks. A psychotherapist must have additional psychotherapeutic education. It has many directions, it is quite expensive and long-lasting. And therapy is usually a slow process. Depending on the course and complexity of the problem, it can last for years.

How do I understand that I need a psychotherapist, not a psychologist or a psychiatrist?

If you are seeking psychological help for the first time, it doesnʼt matter who you go to. If the psychologist sees that your problem is complex and deep or there is a suspicion of mental disorders, he/she will refer you to a psychotherapist. A psychotherapist can refer you to a psychiatrist if they see that you need medication. If you feel really bad — your appetite and sleep have disappeared, suicidal thoughts have appeared, you can go to a psychiatrist in the nearest hospital yourself. The main thing is to start doing something, and then you will be helped and guided according to your needs.

There are more than 400 psychotherapeutic approaches in the world. Why are there so many of them and which one to choose?

There are many therapeutic approaches because we are all different. Different ways of solving psychological problems are founded by people who have extensive experience in practical work, so they add their observations and research to the known methodology. Cognitive behavioral therapy is very popular now. CBT is an effective method of treating anxiety and depressive disorders, it helps to overcome stress and fear.

Ten years ago, Gestalt therapy was at the peak of its popularity, now the hype surrounding it has somewhat decreased. Gestalt therapy helps to find out what is really important to you, your needs, emotions, and feelings. You will understand whether your emotions or desires are really what you feel and want, or whether they were imposed on you by friends, parents, or society.

Another popular trend is transactional analysis. During therapy, you will be helped to change life scenarios. For example, a person works and has a toxic boss, he changes companies and ends up with the same boss again — that is, this scenario is constantly repeated. The therapist will help such person understand why this is happening and change it.

One of the most widespread psychotherapeutic practices of all time is psychoanalysis. It helps to build relationships with other people — parents, husband or wife, children, friends, colleagues. A psychoanalyst works with the unconscious, a person untangles the tangle of his/her beliefs, which were formed in childhood in the relationship with his parents. During therapy, fears and anxieties are worked through, the psychoanalyst helps to survive loss, separation, and grief.

How do I understand which psychotherapeutic practice I need?

If you are aware of this and understand what you specifically want, then choose a specialist in the approach which you find suitable. If you are a beginner, it is better to focus not on therapeutic methods, but to find a good specialist. In therapy, it is not the method that is important, but the psychotherapist. If you are in the right hands, a psychotherapist will use different methods during therapy. There are no specialists who work in only one direction. Psychotherapists constantly study different practices, apply them and have supervision groups — communicate with colleagues where they discuss situations that arise with clients. Names are never mentioned in such groups, everything happens anonymously. Supervision groups help the therapist to see the moments that he/she overlooks during therapy.

Where to find a good specialist? There are many psychotherapists, what should I pay attention to?

There are two ways. The first is to ask friends and acquaintances. It isnʼt a fact that a specialist who helped a friend will also suit you, but when you go to a specialist for a recommendation, you trust him or her more. The second way is to search on specialized sites. There are photos of therapists, the description indicates what problems they work with, their experience and education. After the first consultation, you will understand whether the chosen therapist is right for you.

As recently as 15-10 years ago, there was a rule according to which a psychotherapist was publicly “neutral” — he didnʼt talk about politics, values, or shared his private life. Now that has changed. If you like the way a specialist lives, his interests and beliefs are good, it will be easier for you to communicate. The main thing to know: a psychotherapist cannot be your friend, acquaintance, or colleague.

What to ask a psychotherapist at the first meeting?

There are no limits — ask about everything you think is necessary. It is considered unethical to ask about personal life. But many violate this restriction because, for example, it is important to them that the psychotherapist has children or is married.

During the meeting, it is important to discuss organizational points. If the consultations are held online, then establish the rules of who calls whom, if offline, then where to come. Discuss how long the consultations will last, at what time and day. In what condition can you not come to consultations, if it is about the treatment of alcohol or drug addictions. How to announce that you cannot come, what topics will not be discussed at the beginning of psychotherapy.

What is a better way to work with a psychotherapist — do this online, come to the office, or sign up for group classes?

The best option is to meet in the therapistʼs office. Then the therapeutic effect begins already on the way to it and continues until you return home. But in todayʼs realities, this is not always possible. Many specialists conduct consultations online — so you can “go” for therapy even in another country or city. But a significant disadvantage of such a consultation is that the psychotherapist doesnʼt see you completely during the conversation. For example, you are discussing something and unconsciously started shaking your leg. The therapist will not see this. Also, it is difficult for a psychotherapist to understand what your complexion is, how you are dressed, or how you take care of yourself — the conditions are different, and any details are important during therapy. Therefore, they should be discussed during the sessions.

Group therapy is important as an adjunct to individual counseling. It is better when you practice both individually with a therapist and in a group. But if there is no such possibility, choose only individual therapy.

How to understand that psychotherapy works?

Only you can feel it. But you need to agree on indicators with a psychotherapist — for example, you will feel better when you start sleeping eight hours instead of three. Or stop being as annoyed as you are most of the time now. Indicators will help both you and the psychotherapist understand whether there is a dynamic.

How to understand that a psychotherapist is not suitable for me? Maybe he or she is good, but his methods donʼt work?

If you feel uncomfortable during consultations, you donʼt need to force yourself and think that there is something wrong with you. First of all, tell the psychotherapist about your emotions. Perhaps these feelings appeared because the treatment is working — something was dug up during the therapy, it hurts you, but later this pain will pass. If you understand that negative emotions are not related to treatment and feel three times that your legs are not carrying you to the meeting, stop. Take a break, find another therapist. Presumably, the problem is not in the psychotherapy practice — the particular person isnʼt right for you.

It is necessary to say goodbye to a specialist if you are devalued. For example, you are a religious person, and a psychotherapist begins to prove that there is no god. Or if a therapist talks a lot about himself/herself during consultations, a professional person will not do that.

My relationship with a psychotherapist is excellent, at first it really got easier, but now itʼs like Iʼve fallen into an abyss. Is this normal?

During psychotherapy, there are different stages — relief and aggravation. Psychotherapists donʼt sell happiness pills. On the contrary, treatment is sometimes difficult. If you have come across something painful, then psychological protection — resistance — can be activated. You will unconsciously look for reasons why you donʼt want to go to the session. Headaches, colds, and being late may appear before the consultation — these are signs that the therapy is working, but now is a specific moment. You need to talk it over with a psychotherapist, figure it out, and the negative emotions will disappear.

Friends have been going to psychotherapists for years, but I donʼt want to do it like that. How to understand that it is time to stop or at least take a break from a therapy?

Whether you brush your teeth or have lunch every day, the same goes for work in therapy — it is needed all the time. But there are situations when the treatment can be ended. The very first signal for this is that you have dealt with your inner feelings and understand that you can move forward on your own. If you feel that you will not learn anything new during consultations, this is also a signal to stop. Maybe itʼs temporary, or maybe a different therapist is needed.

There are cases when psychotherapists “addict” to themselves. The most vulnerable to this are people who are prone to addictions — in relationships, from alcohol, video games, drugs. They simply change one dependency to another. Such moments must be monitored and realized. For example, during therapy you feel like a small and weak child — this may indicate that you are becoming dependent on the therapist, so you must tell him/her about it. And remember that you can end the therapy at any moment of your own free will, the therapist does not have to stop you. He or she can only explain why the therapy possibly should be continued — but under no circumstances will he/she force you to stay in it. The main thing is not to disappear from therapy without warning and explanation. For you, this will be a traumatic experience and a signal that you havenʼt learned how to build relationships with people.

How much do psychotherapist consultations cost? And should you contact free specialists?

The cost of consultations consists of many factors. It is cheapest to go to a psychotherapist who is still studying. Prices for his consultations range from 300 to 500 UAH. A young specialist takes a low fee in order to gain as much experience as possible. This does not mean that his therapy is of poor quality. Young specialists are professionals, they have a supervisor who focuses their attention and helps with advice.

Specialists who have completed their studies, have undergone their own psychotherapy and have some work experience charge from 500 to 1,000 UAH for a consultation. Psychotherapists with a name and extensive psychotherapeutic practice, who act as mentors, train students and colleagues, are the most expensive. Their consultations cost from one to four to five thousand UAH per session.

Many psychological organizations provide free psychotherapy. This does not mean that the therapist works for an idea — the organization pays him/her some small money. Also, free therapy is not necessarily low-quality. But you yourself can treat such therapy not seriously.

Translated from Ukrainian by Anton Semyzhenko.

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