Georgia: Psychotherapy Sheds Past Stigma

A man visits St. George's church in Adishi, in Georgia's Svaneti region. The conservative Georgian Orthodox Church has recently taken a stance endorsing counseling and psychotherapy, some of which is conducted by priests trained in psychology programs. (Photo: Temo Bardzimashvili.)

At first glance, you might think that psychotherapy would be a natural fit for the South Caucasus country of Georgia, a society famed for its love of conversation and sharing emotions. But only now are Georgians turning to counseling to solve problems that would ordinarily have been left to families to resolve privately.

For decades, psychotherapy in Georgia has been bedeviled by its stigma from Soviet times, when going to a therapist meant that “you are insane . . . [or] seriously ill,” and resulted in “social marginalization,” according to one therapy patient. (It did not help that mental hospitals had often doubled as prisons for undesirables during the communist years.)

As many old social restraints crumble away, however, local psychologists and counselors say popular views of psychotherapy are also undergoing change.

“[N]ow, people are more free to talk about their problems . . .” noted Dr. Rezo Korinteli, a psychologist and a founder of the Georgian Association of Analytical Psychology.

“People were afraid before that you have to talk about some family problems,” he continued. “But, step by step, it became popular that you can go to a psychotherapist and talk about anything . . .”

There are no concrete figures for the number of psychotherapists in Georgia or how many Georgians seek out their services. Individual sessions in Tbilisi, the Georgian capital, top out at 30 lari ($18.21) per hour -- inexpensive by American standards, but pricey in Georgia, where the average salary is around 500 lari a month ($303.60).

While Georgians have tended to eschew outside help for coping with a troublesome child or a runaway spouse, therapists increasingly are seen as worth the cost. “You are not a stranger,” said Dr. Korinteli. “You are an expert. They are coming here to find help.”

An uptick in complex social problems such as divorce (nearly threefold since 2001) and drug abuse, aggravated by widespread unemployment (more than 50 percent of the population, according to some unofficial estimates), helps explain the change, therapists say.

So does the support for therapy from an unexpected corner -- the conservative Georgian Orthodox Church, ranked as the country’s most trusted institution, according to a 2011 poll by the Caucasus Research Resources Center.

In a January 10 sermon, the head of the Church, Patriarch Ilia II, urged the country’s “education ministry, families, parents, clergy, patriarch and president” to “pay attention to . . . psychology and philosophy” because “we need a youth that thinks . . . that will not allow mistakes . . . “

St. Andrew’s Georgian University in Tbilisi, a higher-education institution supported by the Church, has seen psychology become its most popular major, according to Dimitri Nadirashvili, the dean of the school of social sciences and law and the head of the psychology faculty. This year, the university had 80 applicants for just 25 places, he said.

Nadirashvili, who credits the patriarch in part for the subject’s popularity, trains a group of 20 priests in psychotherapy; priests often send parishioners to therapy sessions, counselors say.

“There was a time [when Georgians felt shame at going to a psychotherapist], but we have gotten past that,” Nadirashvili commented.

Zaza Kvertskheshvili, an active church member and one of Dr. Korinteli’s clients, sees psychotherapy as a natural part of his faith.

Kvertskheshvili said that listening and developing empathy for others -- a core part of the free, weekly 90-minute group therapy sessions he attends -- dovetails with his efforts to live a religious life. Talking about his problems actually helped him more than the anti-depressants he finally agreed to use a decade ago, he added.

At the session in a Tbilisi suburb, Dr. Korinteli leads ten Georgians, including Kvertskheshvili, in discussion, teasing out insights into their problems as they speak about issues ranging from dominating relatives to runaway husbands. The conversation is frank and straightforward.

Yet compared with the numbers of psychotherapists found in any major Western metropolitan area, the number in Tbilisi, a city of just over 1.1 million, appears relatively modest – just 28, according to the city’s 2012 yellow pages.

Even that number, however, exists beyond government regulation. No official bodies exist to license practicing psychologists or to ensure that treatment adheres to established standards or ethics.

Nonetheless, the government has started hiring psychologists for everything from training police officers to using counseling as part of its juvenile probation program.

The Ministry of Labor, Health, and Social Services did not respond in time for publication to questions about the lack of regulatory bodies.

In the vacuum of government regulation psychologists like Drs. Korinteli and Nadirashvili are partnering with European and American professional associations to create accredited training programs.

Tbilisi State University psychologist Dr. Marine Chitashvili, a practicing clinical psychologist for 20 years, said the lack of oversight is a real problem, however.

“The real practice [today in Georgia] shows that everyone can claim that they are psychologists or psychotherapists or whatever, and what they are doing no one knows,” Chitashvili said. “And because you cannot go . . . anywhere and complain that some of your dear colleagues made an unethical decision . . . no one will listen.”

Patients, according to Dr. Chitashvili, suffer in the end, but little sign exists that that has discouraged the interest.

Ultimately, though, stressed Marina Tarasashvili, director of The Green House, a non-governmental organization that uses psychoanalysis to help troubled children, psychotherapy is “close to [the] Georgian mentality.”