Psychotherapy in Russia: Historical Backgrounds and Current Practice

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Johan M. Havenaar, M.D, Ph.D.* Ludmila Meijler-ljina M.D. Ph.D** Jan van den Bout Ph.D*** Alexander V. Melnikov M.D.****

During recent years, the former Soviet states have witnessed enormous social and cultural changes, which have also greatly influenced the field of mental health, including psychotherapy. In this article, the historical backgrounds of Russian psychotherapy and its current practice are described. Psychotherapy in Russia and in Western countries share common roots, but have developed into different directions during the 70 years of Soviet regime. In more recent years, they have begun to slowly converge again. In the West, a trend away from insight-oriented, nondirective psychotherapy is taking place in favor of more directive approaches, aimed at changing overt behavior In contrast, there is a tendency for therapies in Russian-speaking countries to become gradually less directive and authoritarian. In these countries there is an increasing interest in psychodynamic, insight-oriented therapies.

INTRODUCTION During recent years, the rate of exchanges between psychotherapists in the former Soviet Union and the West has increased dramatically. Through these contacts, the influence of Western psychotherapeutic concepts on Russian psychotherapy has grown, and the knowledge about Russian psychotherapeutic concepts and methods has become more accessible to the West. Until recently, information about psychotherapeutic theory and practice in the former Soviet Union was scarce. Granted, a number of leading exponents of Russian psychophysiology and psychology, like Pavlov, Vigotsky, and Luria, have gained worldwide recognition because of their contributions in the fields of neuroscience, but it is still generally assumed that psychotherapy in Russia is practically nonexistent. This assumption is, however, to a large extent based on prejudice and incorrect. The use of psychotherapy and related techniques is much more common in the countries of the former Soviet Union than is generally acknowledged. Although the number of psychotherapists is very low in comparison to most countries in North America and Western Europe, psychotherapy is practiced in a number of settings in mental health care and in psychosomatic medicine in Russia. The concept of psychotherapy is used in a wider definition in Russia than is usually the case in Western countries. It includes all healing methods that make use of information and emotion. As such, it is an integral part of medical practice in general. Psychotherapy plays an especially important role in preventive medicine and is practiced for this reason in "sanatoria" and "prophylactoria," which exist in all parts of the country, often in resortlike settings. Another important field in which psychotherapy is practiced is in the treatment of (psycho-) somatic disorders.

In Russia the profession of "psychotherapist" has only been officially recognized since the late seventies. Specialization courses for psychotherapy, lasting three to six months, require a previous experience of two years in psychiatry. During this period the trainee usually works in a clinical ward with neurotic patients. In addition to these psychiatrist-psychotherapists, there is a small but increasing number of psychologists who practice psychotherapy, often however without having followed specialized courses after their basic university training in psychology.

Most psychiatrists and psychotherapists in Russia are more or less familiar with the main Western psychotherapeutic schools, even though usually the practical experience in the application of these therapies is lacking. The developments in this field in Russia, to a large extent, took their own course. Partly, this was because of the long-standing ideological isolation, which was unfavorable toward Western-style psychotherapy. Also, the closely knit structure of Soviet society put different demands upon the mental health care system. …