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The World Health Organization (WHO) predicts that by 2030 mental health will be the leading cause of disease in the world. The outlook is not rosy, but it is encouraging that, at least, going to a psychologist is becoming less and less

taboo

. The practice has become normalized and, with it, part of the stigma attributed to mental health problems has begun to break down.

Ricky Rubio, Violeta Mangriñán, Iván Ferreiro,

Marta Pombo or Jaime Lorente

are just some of the names who, on the social scene, have made public their psychological problems and the need to go to a professional. Going to the psychologist has stopped being a 'crazy thing' and has become something cool, a decision that today has strong social reinforcement.

The pandemic has also contributed to more talk about mental health. Having anxiety, depression or going through grief has become normalized. We are more aware that the mind

can get sick

. It even seems that, when we meet someone and they admit that they are going to a psychologist, a climate of greater trust is created.

However, going to therapy is not a magic trick. Simply going to a mental health professional does not ensure that your problems will go away or that you will become the best version of yourself. There are many factors that can contribute to the success of a therapeutic treatment, some associated with the therapist and the resources of the health system, others with the psychological approach and, of course, many others with the patient themselves and their context.

Waiting lists and the effectiveness of treatment

Waiting weeks or even months for a consultation can be a barrier to the effectiveness of treatment. Although some Autonomous Communities have more resources than others, there seems to be a consensus among psychologists who work in the public system:

there is a lack of

more professionals. According to a recent 'Mental Headway' report (2023), Spain and Bulgaria are the two countries in the European Union with the fewest

mental health

professionals

. Investment in this resource is also low: a little more than 5% of total health investment. The data is frankly surprising when, in addition, our country has a high incidence of mental disorders, especially depression and anxiety.

All pathologies require time. However, attention to mental health problems in the public system is very deficient. The delay in

waiting lists

, the frequency between sessions or staff rotation not only affect the precariousness of the service, they also impact the effectiveness of the treatments. If early and ongoing care is not received, symptoms may worsen or the problem may become chronic.

Faced with insufficient psychological coverage and bad experiences with the health system, many people are forced to ask for help in the

private

sector . However, there are also many professionals who, even working outside the public eye, have their agenda covered. Furthermore, there are various factors that can condition the demand for help outside the public system, such as purchasing power, awareness of the problem, differences in the expression of symptoms or the individualization and invalidation of suffering by the person themselves or the patient. around.

The patient's attitude and motivation

The patient has a leading role in psychotherapy. This means that it is not just a person who suffers from a psychological problem or difficulty, but it is also the person who must develop a treatment plan that, by consensus, is established with the therapist. Therefore, the patient's attitude and motivation will largely determine the outcome of the treatment.

There are patients who believe that therapy is reduced to 'talking' or 'listening', that it only focuses on the 50 minutes that a session can last, that it is reduced to completing one more task on the agenda. Often, they can neglect or forget the guidelines or

activities they propose

for home. Part of the therapy may be teaching skills or techniques that help the patient reduce their symptoms or confront and manage their conflicts. If this is not practiced or perfected outside of the consultation, it will be very difficult to achieve the goals that have been set for recovery.

At other times, patients may be quite

intermittent

about appointments or their involvement in them. In these cases, the consequences can range from increasing the severity of the problem, making the evaluation process more difficult, or lengthening the duration of therapy. It must be clear that therapy is not only what happens in the psychologist's office, it is also what happens between sessions.

The training and professionalism of the therapist

Psychology is a scientific profession and, therefore, professionals have the duty to base their practice on scientific evidence and act from certain ethical precepts such as: beneficence, non-maleficence, autonomy and justice.

Unfortunately, some 'therapists' take advantage of people's vulnerability and lack of specialized knowledge about psychological practice, as well as beliefs and superstitions to use pseudotherapies. On the other hand, clinical practice presents certain limitations to apply the scientific method and ensure the conditions of experimental research, such as the control of variables, the diversity of people's contexts or the possible incompatibility between standardized manuals and the therapeutic alliance. , which can be reduced due to the rigidity of the former.

These aspects allow us to maintain a certainly permissive attitude towards the application of any treatment and, therefore, have contributed to the proliferation of pseudoscientific activities. It is unrealistic to think that even though some therapies may have difficulties in being empirically validated, all the interventions offered by psychologists and without exception

are effective

.

Pseudotherapies lack knowledge and foundation in scientific evidence, thus being unable to guarantee either efficacy or safety. Its popularity sometimes lies in scientism or in the charisma and/or manipulation of the therapist or false specialist. Some pseudotherapies have been publicly identified as dubious and/or fraudulent. Campaigns such as

#Conprove

, promoted by the Government of Spain, alert citizens to pseudotherapies. However, the institutional effort continues to be insufficient to protect health against these doctrines.

It is considered that some pseudotherapies, beyond the economic investment, may not have a serious impact on health. Although, depending on the approach and the psychological problem, they can also aggravate the symptoms and prevent the person's evolution. There may not be a change or an increase in well-being, but the mere fact of going and paying attention to the pseudotherapeutic

generates a placebo effect

. Likewise, visits may be maintained due to superstitious behavior or because people are simply motivated to pay for someone who will listen to them and make them feel less alone, even at the risk of their problems not being solved.

  • Psychology