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V. Kuzmienės pranešimas III Europos vaikų ir paauglių psichoanalitinės psichoterapijos konferencijoje

THIRD EUROPEAN CONFERENCE ON CHILD AND ADOLESCENT

PSYCHOANALYTIC  PSYCHOTHERAPY

ROME, ITALY , OCTOBER 1999

what is new about child psychotherapy in the Eastern European Countries?

 

VILMA KUZMIENĖ

PSYCHOTHERAPY IN LITHUANIA: PROBLEMS AND GOALS

 

Lithuania and psychoanalysis:

 

Freud wrote in his short autobiography in 1925 that his father's family after a many years of persecution migrated from Lithuania through Galicia into German Austria. (S.E.20, pp.7-8) .One more tie that binds Freud with Lithuania was his participation in the establishment and support of the World Jewish institute of Science in Vilnius (opened in 1925 and closed down in1940).

Before the war the intellectuals in Lithuania were greatly interested in the ideas of Psychoanalysis. In 1921, J.Blazys the father of Lithuanian psychiatry wrote in the journal Medicina that psychoanalysis was the main tool for understanding and treating neurosis. Several doctors published articles in journals Medicina and Kultura.

The Psychologist V.Lazersonas, the head of a private hospital for mental diseases, interested in psychoanalysis, used it in his medical practice. He also invested a great deal of effort in the psychoanalytically based education of parents and teachers (the course "sexual pedagogic" in 1933). Lithuanian priests analysed the relationship between psychoanalysis and religion.

After the war there was no place for psychoanalysis in soviet psychiatry, it was prohibited. But…. Prof A.Gucas( who studied in Vienna in the forties) supported psychoanalysis in Vilnius University and there were students who wrote their diploma thesis on psychoanalysis under his supervision.

 

While studying at Vilnius University, I got acquainted with 5 colleagues interested in psychoanalysis and joined the Group of Dynamic Psychology. Soon more people became interested and in 1988 we founded the Lithuanian Society For Application of Psychoanalysis (LSAP).

In 1990, 5 people were invited by the European Psychoanalytic Federation to go to Finland to study psychoanalysis and have already completed their studies. The IPA training standards applied without concessions. Their studies in Finnish lasted for 6-7 years; personal analysis took place 4-5 hours per week.3 cases were supervised once per week throughout. One of them is going on with his studies of child psychoanalysis in the USA. 3 Lithuanians are now also studying psychoanalysis in Germany and Holland.

 

In 1993, we established the child and adolescent section. There are 8 members.

And 34 members are in all.

 

The Activity of Lithuanian Society For Application of Psychoanalysis:

 

As I have already mentioned, the first contacts that we had were with EPF. Some analysts used to come to LT to hold seminars. 5 years ago, our activity gained a more clear structure - with the help of the Dutch psychoanalysts, a program of psychoanalytical psychotherapy was started in Lithuania. I am its student as well. The group contains 18 students who are psychiatrists and psychologists from all over Lithuania. The Government of the Netherlands finances the program and the teachers are analysts from the Netherlands, Finland, and the Czech Republic. The seminars are held every month and a seminar consists of 10 hours of theory, 6 hours of group supervision and 1 hour of individual supervisions. Besides, we undergo personal therapy, which takes at least 50 hours. The program will end in June of the next year and we will be awarded certificates of psychoanalytical psychotherapist and we will gain the right to teach others.

 

That is a program for psychotherapy with adult patients. Of the 18, 7 people are working with children and adolescents. In the theoretical course we have a lot of subjects related to the psychology of the child. However, we are not able to have supervisions for our child and adolescent cases. To some extent, we are "rescued" by an old relationship with some German child analysts - two analysts are coming to Vilnius and hold supervision seminars for us. But those are not constant or continuous supervisions.

We try to study theoretical subjects by ourselves in discussion groups. We also had peer group supervision of our child and adolescent cases, where we work on the contra transference.

There occurred more possibilities in the child section after contact with the EFPP was established.

In 1995, 4 people for the first time participated in the child section conference in Stockholm. In 1997 we were granted guest status of the EFPP .We are glad of this new relationship as we receive more information and we do not feel ourselves so isolated. I mean that this is the only strong relationship with professional child psychoanalytic psychotherapists. We are looking for a possibility for serious study of child psychoanalytic psychotherapy and we hope that in future we will also be able to have a program like that in the Czech Republic.

 

Problem analysis: 1. New Society and Psychic Problems

 

After Lithuania gained independence, it became open to various cultures, which at the same time brought in progress and new problems.

Often, parents addressing us about their children are at a loss - at present young people are offered so much: concerts, nigh clubs, fashions, drugs, etc. Adolescents want to try everything and parents forbid and set limits as they are afraid that something may happen to their children in this new world. Parents afraid that somebody can rape, kill their daughters, they afraid of drugs addictions or early sexual relations and calling all this "bad friends company". Thus, the adolescent is both - offered and forbidden. This type of conflict is very common and intense. During the period of socialism, families did not have such conflicts.

There also appeared new tendencies, such as more gays and lesbians. Such relationships are especially popular among girls. There exist commercial telephone dating numbers, and sex change operations are taking place.

Besides, the boom of models has not stopped yet. Beauty competitions, fashion festivals are very popular in Lithuania. Young girls want to become models and we are more often faced with the problem of bulimia and anorexia. These problems come from psychiatry and endocrinology to psychotherapy now. A slide.

The problem of suicides is very grave 1700 people commit suicide in: approximately Lithuania every year, ten times more attempt suicide. Every day 4-5 people commit suicide. Every suicide has an emotional effect on at least on 6 people. Twice as many people commit suicide in the countryside that has suffered most from the reforms.

These slides show you the groups of mental disorders. The number of adaptation and anxiety disorders has increased. People are greatly affected by unstable external factors: constant changes in politics and economy (for example, 9 governments have already changed during the years of independence of Lithuania), and an uncertain future.

Talking with the parents of the patients you feel that they are under strain suffering anxiety concerning their financial situation, and loss of work. Stress prevailing in the family is affecting the children as well. Besides, many changes in the educational system have occurred - there are many problems in schools as most of them have too high demands and usually adolescents graduate from school totally exhausted.

 

Of-course, changes in society affect the internal life of all the sections of society.

As you know, Lithuania was a part of the Soviet Union from 1940 -50 years; a lot of people were deported to Siberia either themselves, or their parents. Very specific changes in the personalities were created by that repressive regime - the so called the phenomena of "Homo sovieticus.

And now- after that repression and dependence people move to freedom and independence. I would like to describe some "past stamps" and inner conflicts, occurring today:

 

1.Basic fear and anxiety to take responsibility and/or risk making his or her own decisions ("chief knows better")

2.Lack of interest in the end product of his/her activity, rather deep concern not to be accused of some independent move;

3. Very deep split between openly proclaimed values of society and the private values of the individual ("one way you talk, another way - you think, and third way you -behave").

4.The high level of control of all areas of life by repressive structures: the police, the KGB, party members, neighbours, created a specific way of life, where the kitchen was the only place for free exchange of unacceptable ideas - so called "kitchen culture". As a result of this system members of society were under enormously anxious for their existence and the main way of coping with it was drinking. The result of 50 years "training" was the ruin of our traditional way of life.

Despite the common neurotic defence mechanisms, which are universal throughout the world, our patients very often use the "post-soviet common sense", defence or explain their rigid and unproductive behaviour patterns by their previous life experience. Very often are used such claims as "basically nothing has changed, if anything they have changed to worse".

So, we have a conflict between homo sovieticus personalities and their children, two quite different generations. Adolescents more often then their parents see the problem as not only external but as internal too. And there are cases when adolescents come in therapy with the questions: "I want to know my boundaries, who am I, why I'm so?"

It should be noted that people became more frank and their views towards psychological, psychiatric help has changed. There occurred more popular literature, informative articles in the press. Now, people start seeking psychological help much earlier, when the problem has not yet become (inveterate) intractable. They are less shy and less afraid that the visit to a psychiatrist will have negative influence upon their life and occupation.

 

2. Concerning Psychological Help

 

In 1998, the reform in the sphere of medical services was started -medical insurance was introduced. Before June 1999, there were no tariffs of clinical psychologist and their salaries were irregular .The tariffs of the psychiatrists were so low that after deduction of taxes there remained an unrealistically small amount (LTL217). The poor salaries had an impact on the workers: As it is impossible to survive on such salaries people started work in several jobs. And this leads to burning-out.

Intro-institutional tensions have arisen between institutions and independent practitioners who have a different caseload but equal salary.

As a result of financial problems, two departments of our psychotherapy centre were closed, namely the 24-hour in-patient and children day -care department.

 

After long struggles, the experts of the patients' funds took notice of our specialists' proposals, and slightly increased the old tariffs. At present, irrespective of the psychic disorder, the patients' fund pays for 24 (previously only 12) psychotherapy sessions per year for one person. Some doctors and psychologists have their private practice, however, the number of patients who can pay is low in Lithuania.

On the other hand, although the system of health care was in such disorder in 1998 the profession of psychologist - psychotherapist obtained legal status for the first time in the history of Lithuania. Only medical doctors were called "psychotherapists" until then. That was a very important moment for all of us.

Psychologists at Vilnius University qualified since 1969. The strongest subject was clinical psychology. Psychologists from all over the Soviet Union came to Vilnius to train in group psychotherapy during the period of socialism.

Many psychologists during that period worked in hospitals. But services for children and adolescents did not exist until 1988. Children could get psychological help only at psychiatric hospitals. Later the situation became better: A Child development research centre was opened in 1988.

The big event was the establishment of the Vilnius clinical psychotherapy centre in 1990.The idea to set up this centre belongs to my colleagues who are analysts now. Child specialists work at our centre, we opened a day care department for children and a "Hot-line" for adolescents. From 1993 psychologists have worked at policlinics, and there are psychological services in schools. A network of psychological services is developing all the time since the reform in medicine in 1998.

At the same time, never ending problems induced us to look for other possibilities. My colleague and I established a new consultation centre, which is a non-profit organisation. We have prepared a project "Crisis Situations in Adolescence and Youth - Seeking For Alternative Way" and we hope to get the support from Soros foundation (functioning in Lithuania) .We think that training of specialists could also be held in this centre

 

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In Lithuania, there is a considerable interest in psychoanalysis. In Vilnius there is a psychoanalytic psychotherapy program for psychiatrists, also a program of group analysis, and a course of dynamic psychotherapy for doctors at the University.

In 1998, the first issue of the Lithuanian Journal of Psychotherapy was published.

In Lithuania, it is more real to apply psychoanalytical psychotherapy, as psychoanalysis is a long and expensive process. And we have a really good training for specialists working with adult patients.

 

On behalf of my colleagues and myself, I would like to thank the organisational committee of EFPP and the Italian colleagues for giving me a possibility to tell you about the situation in Lithuania. I am especially grateful to Mrs. Lydia Tischler and Mrs. Birgit Hallerfors who were very attentive towards us.

Thank you for understanding, support and backing up.

 

GROUPS OF MENTAL AND BEHAVIOURAL DISORDERS (ICD - 10)

 

 

40,8% reaction to severe stress and adjustment disorders (F43)

26,8% other neurotic and somatoform disorders (F40 - F48)

14,4% behavioural and emotional disordrs with oset usualy occuring in childhood and adolescense (F90 -F98)

11,6% specific personality disorder (F60)

5,1%  mood (affective) disorder (F30 - F34)

1,3%  intentional self - harm (suicide) (X-60 - X-84)

 

 

BEHAVIOURAL AND EMOCIONAL DISORDERS

WITH ONSET USUALLY OCCURING IN

CHILDHOOD AND ADOLESCENCE F90 - F98

 

22.7%   Separation anxiety disorder (F-93,0)

22,7%   Depressive conduct disorder (F92)

20,5%   Tic disorders (F95)

18,3%   Stuffering (stammering) (F98,5)

8%        Nonorganic enuresis (F98,0)

6,8%     Opposition defiant disorder (F91,3)

 

 

 

 

Data on suicide rates compiled from world Health Statistics Annual.Geneva:World Health Organization,1996

 

REFERENCES

Gailienė Danutė. Jie neturejo mirti. Tyto Alba,1998

Laurinaitis Eugenijus, M.D, Ph.D. "From totalitarism to democracy". Psychotherapy association congress at 1994.

Pocius Virginijus. Rimvydas Augis. "Lithuania and Psychoanalysis: A long Way to Europe". Psychoanalysis in Europe, bulletin 33, autumn 1989.

Shaffer David, M.D. "Teen suicide in the United States of America and Lithuania."

Conference on Suicide Treatment and prevention, Vilnius 1999.