Going to psychotherapy is no longer a shame. The problem now is accessing it: while waiting times are impossible for public assistance, private assistance is not available to everyone.
We spoke with Guillermo Mattioli, dean of the Col·legi Oficial de Psicologia de Catalunya (COPC), about the present and future of mental health, and about the role that the pandemic has had in the social acceptance of psychotherapy.
“The covid has been a great alibi, because we had a non-shameful cause to feel bad about,” explains the dean. “That is to say, if an understandable misfortune happens to a person, such as the death of a relative, he dares to explain it. But if he fails to connect his suffering with any cause that he considers sufficient for as much discomfort as he feels, he is ashamed. Fortunately, with the disappearance of the stigma, this shame also disappears.
As a result of the pandemic, there is also the perception that we have worse mental health than a few years ago. In this sense, Mattioli points out that “the demand for psychological assistance has risen, but I don’t know if because we are worse off or because it is less difficult for us to ask for help. Serious disorders remain the same. For example, there is the same percentage of psychosis as a few years ago”.
What is clear, he points out, is that since the pandemic “there is more assumed and recognized discomfort.” Another widespread feeling is that there is a lack of psychologists available to meet the growing social demand. “Yes there are, in private. But a lot of people can’t afford it. And for the National Health System (SNS) psychological care has never been a priority: the first visit is given weeks away, the second we’ll see… You have to be on the verge of suicide to be seen in days. Citizens should be able to decide if they go public or private, and now they can’t”. From the COPC, he details, several initiatives are carried out to help alleviate this situation.
“We have a service called Psicoxarxa Solidària that offers psychological care to people with low incomes. During the pandemic, in collaboration with the Barcelona City Council, we set up an emergency telephone number that served thousands of people. We also did it for the Barcelona Provincial Council and other cities. We have recently signed an agreement with the Terrassa City Council, and now the Psicoxarxa is also there, and people with average incomes will have access to psychological care at a shared cost with the City Council”.
Another very important initiative that Mattioli highlights is that “thanks to the Plan for Emotional and Community Referents (REBEC) of the Department of Health of the Generalitat and the enthusiastic participation of our school, 350 general health psychologists (PGS) have been hired. to work in the CAPs, in order to avoid default and premature medicalization, through early detection and community psychology activities”.
And he warns about the danger that this medicalization posed: “When it occurs by default and in the absence of psychological care, it ends up being a way of avoiding the reasons for our mental suffering, and avoiding it instead of confronting it when it is still tolerable only increases it” . According to the dean, this leads us to make erroneous decisions just to flee from the condition, and we end up creating pathological symptoms, which has another undesirable consequence: the appearance of gurus.
For the doctor in Psychology, although it is true that we are all natural psychologists and we can connect with other minds, a psychology professional does much more than that, because they have been educated and trained to refine the natural abilities of any human being. “We spend our lives studying, supervising, going to therapy… Psychology is a young science, but it is a science. Do not settle for less ”, he advises. For this reason, he recommends entering the professional directory of the COPC, the easiest way, he explains, to find a psychologist with minimal guarantees. And that, once we have chosen, we ask him everything we need: what he thinks is wrong with us, how he is going to help us, with what method, for how long and at what cost.
Thanks to his extensive career, Mattioli has learned to gauge what evolution a patient may have. “I know that when he comes willing to have them do whatever, with an attitude of submission, he usually does not have a good prognosis. However, the critical, demanding, informed patient, who wants to know what we are going to do together –because therapy is collaborative work, it is not that the therapist does something to the patient and then he is cured, it is a hand in hand job between two–, then you have a good prognosis. And the more judgment the patient has, the better. The psychotherapist is a useful tool for the patient, and not accepting oneself as such can lead us very close to believing ourselves to be saviors”, he warns.
Looking to the future, the improvement of the psychological care system depends, in his opinion, on overcoming, among other things, a legal anachronism that prevents the PGS from entering the SNS. “It is a paradox: the law says that they have diagnostic and psychotherapeutic powers, but that they can only exercise in private practice, not in public.” He also claims that there should be more health specialties: “Currently there is only one, and everyone knows that there is child and adolescent psychology, neuropsychology or forensic, educational and social intervention psychology, but they are not recognized as full-fledged specialties”.
And as other essential demands, he highlights “reaching, as a minimum, the European average of 18 psychologists per 100,000 inhabitants (now we are at 6), and seeing more public-private articulation systems. We would all benefit.”
