Suicidal diagnosis: when the help of a psychologist can be harmful
In Moscow, a 24-year-old man committed suicide after going to a psychologist who suggested he had a mental disorder. Izvestia, together with a clinical psychologist and a psychiatrist, figured out why a person can get worse after consulting a specialist, how to properly provide assistance in dangerous conditions and who to contact in such situations.
Severe consequences
In Moscow, a man committed suicide after consulting a psychologist who suspected he had a mental disorder. The man's body was found in Izmailovsky Park, the Telegram channel Mash writes.
A 24-year-old young man recently moved to Moscow to live with a girl. He told her about feeling lonely and having problems at work, as if his colleagues were watching him. In the capital, he made an appointment with a psychologist and shared his experiences. The specialist suspected the client had a mental disorder and informed him about it.
After the conversation, the man withdrew into himself, and soon he was found dead. The victim's girlfriend told the police that in recent days he had been "on edge" due to mental problems and financial troubles. The Investigative Committee is currently investigating the circumstances of the young man's death.
Experts interviewed by Izvestia note that psychiatrists or psychotherapists should work with patients with severe mental disorders, suicidal thoughts and behavior. They should assess the person's condition and, if necessary, offer him hospitalization or even call an ambulance.
In this case, it is critically important to get to a competent specialist: a consultant who does not have the necessary qualifications can worsen a person's condition. Ekaterina A., a Muscovite, shared one such example with Izvestia.
— I had anxiety after the car accident. I found a medical psychologist on the Internet who claimed to deal with exactly such cases. At the very first session, she suggested that I perform the eye movement desensitization and processing technique (DPDG), in which she immersed me in my situation 10 times in a row, "cultivating" anxiety. And then she said it could get worse," says the girl.
As a result, after the consultation, the girl began to have panic attacks, her mood decreased, apathy and suicidal thoughts appeared. I had to see a doctor — he called the patient's condition serious and suggested hospitalization.
— The second doctor said that in my case this technique could not be performed, it is permissible only in a more stable condition or in a hospital setting. Now I have to undergo treatment," says Ekaterina.
Why can the condition worsen after a psychologist
After a visit to a specialist, a person may actually temporarily feel worse, clinical psychologist Margarita Rudenko tells Izvestia. This doesn't always mean that therapy doesn't work—it's often a natural part of the process. The exception is borderline states, which a psychologist may notice during the first sessions and tactfully redirect to another specialist — a psychotherapist or a psychiatrist.
— At first, there may be an exacerbation of suppressed emotions, because the therapeutic process often brings up painful memories and feelings that have been ignored for a long time. This can cause discomfort, "emotional swings", which the psychologist should warn about, the specialist explains. — A person who starts discussing childhood trauma may encounter a wave of anger or shame that was previously repressed. Healing is impossible without experiencing these emotions.
It can get worse because of the overestimation of important things — work, relationships, values — if a person suddenly realizes that he lived "not his life." In addition, attempts to change their behavior may begin: for example, a hyper-responsible leader with perfectionism may initially experience anxiety, allowing himself to make mistakes.
Sometimes, the psychologist continues, the client has resistance to change and he sabotages the process. In this case, a competent specialist will reduce the intensity of the impact on the psyche. This means that therapy affects the "sore" points, and this is more of a signal to work rather than stop — it's just worth changing the strategy. If the psychologist has chosen the wrong tactics or there is no trusting relationship between him and the client, this can increase the feeling of insecurity.
— For example, a client with PTSD may have a worse condition if the therapist started exposure therapy or the same DPDG technique for dealing with trauma too early. Therefore, a good specialist will first assess a person's condition — and for this you need to be sensitive to indirect, external non—verbal signals that the client unknowingly gives, says Margarita Rudenko.
If a person continues to feel unwell during therapy, this is a reason to change a specialist or method — for example, to switch from cognitive behavioral therapy (CBT) to gestalt therapy. If the condition worsens within two to three weeks, suicidal thoughts, panic attacks or insomnia appear, you need to seek help.
How to choose a competent psychologist
According to Anna Korendyukhina, psychiatrist and chief physician of the Mental Health Center, the main risk when working with a psychologist is associated with unqualified specialists who are easy to meet on social networks. An experienced and trained psychologist will respect boundaries, ethical principles and work within their competence. But specialists without education or with questionable training may not have the necessary knowledge, skills, or understanding of how to act when the client's condition worsens.
— "Red flags" are, for example, inappropriate jokes, unprofessional publications on social networks, violation of personal boundaries, devaluation, pressure, imposition of their own attitudes. But the danger is that outwardly such specialists may seem friendly and even charismatic, so it is important to remain attentive to your feelings after each session. It is important to understand that in cases of serious mental disorders, safety should always be given priority," says the psychiatrist.
When choosing a psychologist, Margarita Rudenko advises paying attention to his education (the priority will be basic higher education), certification, advanced training in therapy methods, accreditation (for clinical psychologists it takes place in three stages), supervision and compliance with the code of ethics (confidentiality, non-harm).
When can a psychologist refuse to see a client?
There are situations when a psychologist may refuse to see a patient and refer him to another specialist — this is part of professional and ethical responsibility, says Anna Korendyukhina. The psychiatrist refers to them:
• ambivalent relationships — for example, if the client is a friend, relative, or partner;
• multiple intersections — when intersecting with the client's inner circle;
• insufficient qualifications — if the request goes beyond the competence of the specialist;
• the need for an in-person appointment if the specialist only works online;
• Suspected mental disorder requiring psychiatric intervention.
— In these cases, an ethical psychologist will redirect the client to a more suitable specialist, rather than trying to work "at all costs," the Izvestia interlocutor notes.
If the specialist sees that the client may pose a danger to himself or others, according to the psychiatrist, he is obliged to take the following steps::
• assess risks based on the behavior and words of the client;
• document observations — even in private practice;
• Contact emergency services: ambulance, police — if there is a threat to life;
• notify the client's loved ones if possible;
• contact your attending psychiatrist, if available;
• Create a crisis plan with the client, if possible.
In such cases, it is permissible to violate the principle of confidentiality: security is always more important, concludes the interlocutor of Izvestia.
When a patient does not need a psychologist, but a psychiatrist
Patients in severe conditions deserve special attention. When it comes to mental disorders (depression, bipolar disorder, anxiety disorders, schizophrenia), acute conditions (suicidal thoughts, psychoses, hallucinations), disorders requiring medication, or, if necessary, in-depth diagnosis (for example, if organic brain damage is suspected), a psychiatrist or clinical psychologist is already required.
— An ordinary psychologist (for example, a consultant) helps in solving household stresses, communication problems or personal crises, but does not have the right to work with clinical diagnoses. If the condition is life—threatening (aggression, attempts at self—harm) or is accompanied by marked disorganization of behavior, you need to consult a psychiatrist, says Margarita Rudenko.
A psychiatrist is a specialist with a medical degree. He is able to diagnose mental disorders, prescribe medication and, if he has additional training, conduct psychotherapy. It is the psychiatrist who can make the diagnosis, if there is one, and determine which intervention is necessary — medications, psychotherapy or hospitalization, says Anna Korendyukhina.
According to the expert, private psychology and coaching are currently not licensed in Russia. This means that anyone can call themselves a psychologist or coach without incurring any legal or professional responsibility. Therefore, it can be very risky to contact any such specialists from social networks without checking their education and experience.
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