History and Contemporary Trends in Clinical Psychology in Slovakia

As an introduction, let me begin with a few notes on the history of Czechoslovakia, which was founded in 1918 after the disintegration of the Austro-Hungarian monarchy. This so-called First Republic was, with the exception of the years during World War II, a democratic European state. Between 1948, when the Communists came to power, and the "Velvet Revolution" of 1989, the country was under Soviet dominion, which significantly shaped not only the socio-economic but also the spiritual atmosphere of society. The victory of democracy in Czechoslovakia has, paradoxically, led to a revival of nationalist tendencies. Beginning on January 1,1993, Czechoslovakia divided itself into two independent states, the Czech Republic and Slovakia. Today, the two Republics have 15.5 million inhabitants, of which 9.8 million are ethnic Czechs, 4.8 million are Slovaks and the rest are comprised of the national minorities: .5 million Hungarians, Gypsies, Ukrainians and Germans.

At this point I would like to introduce a few process-oriented views on the separation of Czechoslovakia. The 1989 revolution was

called "velvet." It had a totally peaceful character; millions of people in the squares called for love and forgiveness, and no one wanted to lynch either the Communists or the secret police. Underneath this apparently peaceful revolution simmered forty years of frustration, concealed nationalism, anti-Semitism, aggression, hatred and longing for revenge against the repressors. The intellectuals and artists leading the revolution did not perceive this underground sentiment and lost contact with the political reality of the country. Consequently, they were unpleasantly surprised by the results of the elections in 1992.1

History of psychology in Czechoslovakia

Until the middle of this century, psychology in Czechoslovakia was shaped solely at the universities. The most influential universities have been Charles University, founded in 1348 and located in Prague, in the Czech Republic, and Comenius University in Bratislava, the capital of Slovakia. The introduction of applied psychological disciplines, particularly

l Editors* note: In the 1992 elections, the previously liberal

Vaclav Havel, shifted strongly to the right

political climate, characterized by the presidency of

clinical, educational, organizational and industrial psychology, was marked by the 1950s atmosphere of ideological dictatorship and dogmatism.

During the Communist era psychology was officially considered a "bourgeois pseudo-science." Psychology, along with cybernetics, genetics and psychotherapy (particularly Freudian psychoanalysis) was evaluated as purely speculative and, in the case of psychoanalysis, suitable only for hysterical middle-class women. The only accepted psychological theory during the Communist era was the Pavlovian conditioned reflex theory. This theory was used to explain all psychic phenomena, the psychology of learning, and the impact of psychological interventions such as hypnosis.

Since the 1960s, the spiritual atmosphere has become more liberal. Clinical and counseling psychologies in particular have been given a definite place in psychology, and psychological services have been broadly applied. Even though clinical and counseling psychologies became more widely known, the Communist government's neglect of psychology in general has been apparent in the low wages paid in state psychological institutions and in the poorly funded research grants in psychology.

At present in Slovakia, there are about 1200 active psychologists. Most of them work as clinical psychologists in health institutions (20%), as counseling psychologists in education and psychological centers (18%), in marital counseling centers (5%) and in state institutions for scientific research (15%). As a consequence of the political and economic developments of recent decades, practically all psychologists are state employees; they are rarely found in private practice or in private firms.

With the ratio of psychologists to inhabitants approximately 200 psychologists per million inhabitants, Slovakia has the highest percentage of psychologists among the post-Communist countries. The ratio of psychologists represents approximately one half of the ratio in well-developed European countries and about one third of the U.S. ratio (according to

I.U.P. statistics). The ratio of women among the members of the Slovak psychological society continues to grow, with women representing more than 70 percent. General interest in psychology is enormous. For example, there are over 700 psychology applicants to Comenius university, from which, after two rounds of entrance examinations, only 50 can be admitted.

Contemporary trends in clinical psychology

Of all the practical applications of psychology, clinical psychodiagnostics has the longest history and the greatest social acceptance. Psychology has often been associated with testing, with counseling being seen as a secondary function. This is probably due to the normative, quantifying or "marking" methodology of psychodiagnostics. Practically all the important performance tests, including the Wechsler scale, personality inventories such as the MMPI, Cartel 16 PF, and Eysenck's inventories, were standardized for the Czech population during the 1970s and 1980s. The projective tests, i.e. the Rorschach and, in the last ten years, the Hand-Test (TAT), enjoy a special reputation in Czechoslovakia. Every clinical psychologist working at a psychiatric clinic must master the Rorschach method, since the majority of our psychiatrists believe that the most differentiated diagnosis can be achieved through this test. The greatest portion of clinical research concerns test methodology. My dissertation, for instance, dealt with the use of projective methods, rating scales and performance methods in differential diagnosis of depressive states.

In the realm of psychotherapy, the situation is still more complex, since various ideological influences have played a greater role. Behavioral psychotherapy has had the greatest level of acceptance. This is due to the fact that classical behaviorism has its theoretical roots in Pavlov's theory of conditioning. The explana-tive and interpretative schemes of behavioral psychotherapy are so lucid and clear that it has gained acceptance by materialist psychologists. However, in the last ten years, not just in Czechoslovakia, but in the world, the behavioral-cognitive orientation has gained preva-

History and Trends in Clinical Psychology in Slovakia

lence, especially for treating depression. The work of Beck, Lewinsohn, Rehm and Lazarus has been applied in Czechoslovakia as well as in the rest of the world.

In spite of disfavor on the part of the official, biological orientation in psychiatry and Marxist psychology, group dynamic psychotherapy, inspired by the work of M. Jones, Yalom, Bat-tegay and others, is highly popular in Czechoslovakia. Due to censorship, training in group psychotherapies has developed under illegal conditions. The training lasts roughly five years and includes 500 hours of personal experience in the techniques. In the last 25 years hundreds of psychologists and psychiatrists have gone through this training.

The literature on dynamic and humanistic psychotherapy, from Freud and Jung to contemporary authors, has been secretly translated and disseminated, as have the works of dissident authors. In the past, spreading dissident literature was extremely dangerous. A psychologist friend of mine was imprisoned for a year for translating George Orwell's 1984 and circulating it among his acquaintances. It is a paradox that in the country where Freud was born, it has been not just difficult but almost impossible to get training in psychoanalysis. In Czechoslovakia there are estimated to be only 10 to 20 psychoanalysts, all living in Prague, who are licensed to train others.

The revolution of 1989 resulted in a fundamental shift in psychology. Dozens of titles by previously banned authors have been published. Furthermore, psychotherapists of various theoretical orientations are organizing training in their methods. In Slovakia, for example, long-term training is now available in person-centered psychotherapy, Gestalt therapy and systemic psychotherapy. In Bohemia, a new center for transpersonal psychology is being established, and training in holotropic breath-work is being organized by Prague native Stanislov Grof. I am organizing training courses in Process Oriented Psychology. Process Oriented Psychology has become, as an optional seminar, a component of the pre-graduate study program in the Department of Psychology at Comenius University in

Bratislava. Post-revolutionary changes are reflected in the structure and content of psychology curricula at the universities. Our graduate students now have a choice of optional seminars on individual psychotherapy including Rogerian, humanistic, process-oriented, etc.

One positive consequence of this liberalization is the increased availability of psychotherapy. This is apparent not only in state mental health institutions but also in private practice, even though the majority of private practices are still part-time. It is interesting to note the difficulty my colleagues and I have charging clients for private practice. In Western psychotherapy, the therapists's paid services are an inevitable part of the therapeutic relationship. During the era of Communism, in the framework of the so-called free state health service, it was forbidden to take money from the client, even for therrapy hours spent with him/her beyond "office hours/' Even now, coming from this background, I feel uneasy and guilty when I tell a client the cost of a session.

Another side-effect of liberalization is the emergence of popular healers, spiritual therapies and charlatans who take advantage of the short-comings of the state health care system by advertising cures for all illnesses, from hypochondria to cancer. I myself have been working with a client whom a "healer" diagnosed with cancer and then attempted to cure. My client became depressed and attempted suicide. In order to protect clients, a team from the Slovak Psychotherapeutic Society is currently developing guidelines regulating the practice of psychotherapy. These guidelines will be based on contemporary European norms, especially Austrian Law.

Future trends and needs

In spite of the political changes connected with the division of Czechoslovakia, which I consider to be an historical error, there is no longer a threat that society will be closed to outside input. Clinical psychology will remain open to the influences of new trends and currents of thought from the West.

The economic problems of our state will probably curtail the growth of clinical psychology, so that the number of clinical psychologists will not be comparable to that of Western countries. However, some changes in the structure of the institutions in which psychologists work may be expected, as well as in the types of problems encountered. The number of psychologists in private practice and the number of specialized private clinics oriented to outpatient services are expected to grow. We may also see growth in institutions providing psychotherapeutic services to clients, which will also serve as centers for education and training in psychotherapy. As for social and health problems, we expect a sharp increase in drug problems and juvenile delinquency. These areas have previously played only a minor role in Slovakia, compared to alcohol addiction. More psychologists will probably be dealing with psychosomatic problems.

If the West is interested in helping Eastern European countries develop in the field of psychology, material is not nearly as helpful as current information. Eastern European psychologists, whether university psychologists or those in private practice, need to gain experience, both positive and negative, from countries which have 30 to 40 years head start in the practical application of clinical psychology. Donations of material and technical help are not necessarily the most effective steps that can be taken: if someone receives a fish, he will eat for a day, but if he learns how to fish, he will eat for a lifetime.

Anton Heretic, Ph.D., is a clinical and forensic psychologist. He is an Assistant Professor and currently heads the Department of Psychology at Comenius University in Bratislava. He is working with psychodiagnostics and psychotherapy at a psychiatric clinic and in private practice, and developing a training program for Process Work in Slovakia.

History and Trends in Clinical Psychology in Slovakia