Marek Konopczyński: In whose interest is the new act on the profession of psychotherapist?

A report by "Duży Format" about Dr. Wiola Rebecka, certified by the Polish Society for Psychoanalytic Psychotherapy, exposed a problem that, until now, had rarely entered public debate. Dr. Rebecka held prestigious affiliations and certifications, yet patients reported experiencing harm instead of help. In response, the therapist resorted to a desperate defense of attack and intimidation, filing complaints with Polish institutions and even the FBI. This case demonstrated that a certificate from a recognized and respected institution does not protect either the patient or the public from pathologies.

Now imagine a completely everyday situation. A ten-year-old child begins experiencing sudden anxiety attacks, periods of disorientation, and visual hallucinations. The parents, terrified, seek help and consult a certified psychotherapist. Instead of referring the child to a neurologist and psychiatrist, the therapist proposes intensive therapy based on "emotional unblocking." Sessions cost several hundred złoty each, and after a year, the family has spent over several thousand złoty. Meanwhile, the real cause is temporal lobe epilepsy, which requires pharmacological treatment and specialized EEG diagnostics. Without proper help, the child is at risk of worsening the condition and seriously endangering their health.

Sounds absurdly dangerous? Members of Parliament are currently working on a bill that not only fails to solve such problems, but will actually exacerbate them. The draft bill on the psychotherapy profession, currently being considered by the Sejm (paper no. 1345), would allow individuals with neither medical nor clinical training to practice – completing a four-year private psychotherapy school is sufficient, with no specialized education required. Furthermore, the bill introduces the concept of "psychotherapeutic diagnosis" into Polish law, even though such a thing doesn't exist in science. This is a loophole to explain disturbing neurological or psychiatric symptoms in emotional, psychological, or theological terms, without the need for a medical consultation.

The consequences will be serious. In the situation described earlier, if, terrified by the effects of unscientific "therapy," they attempt to file a complaint, they will learn that, under the (new) law, neither the Patient Ombudsman nor a medical court will hear their case, but a professional self-government composed of the same schools that previously profited from the therapist's training. In practice, aggrieved patients will be forced to write to an institution that has a vested interest in ensuring that the value of their own certifications and the interests of the professional group are not undermined. In the medical system, patients have the right to control by independent bodies; here, they will remain within the closed circle of private "guilds" that simultaneously act as trainer, employer, market regulator, and judge in the cases of aggrieved patients.

Therefore, the Supreme Medical Council warns that the bill, in its current form, does not guarantee patient safety. The Polish Psychological Association adds that the bill, in practice, serves the interests of psychotherapy schools, not the interests of individuals in crisis. Meanwhile, the Commissioner for Human Rights emphasizes that the bill's provisions regarding children are particularly dangerous – they open the door to conducting therapy for minors without the involvement of a court or a child psychiatrist.

The problem with the new project has another dimension – economic. Polish psychotherapy is currently a market worth tens, if not hundreds, of millions of złoty. This market is growing rapidly, as, as we know, the waiting lists for psychiatrists, therapists, and psychologists are getting longer and longer.

Gestalt training costs around 57,000 PLN, at the Psychoeducation Laboratory 80,000 PLN, and at INTRA over 70,000 PLN. However, this is just the beginning of the costs. Candidates must also undergo mandatory self-therapy (several dozen to over a hundred hours, each session paid for out of pocket), regular supervision (from 200 to 400 PLN per hour), and often perform unpaid work at a training center. The total cost of becoming a psychotherapist typically exceeds 100,000 PLN. If such a harmful bill is passed, these prices will only skyrocket – that's how an oligopoly economy works.

At the same time, there's no news of concrete action that would establish a "public option," meaning a free or simply low-cost vocational training system organized by public institutions. This problem was supposed to be addressed by Dr. Łukasz Müldner-Nieckowski, who was appointed national consultant for psychotherapy last year. His role was primarily to coordinate work on state-funded training, specializing in psychotherapy. The lack of progress may be explained by the fact that the consultant comes from groups that support the bill, and thus have a vested interest in ensuring the minimum number of places in non-commercial vocational training.

The proposed model de facto cements the lack of access to the profession of therapist for the poor. This often refers to those who have made their lives a mission by choosing a "non-business" education and career path in education, psychological assistance, resocialization, or social welfare. Instead, it rewards those who, after years of working in completely different fields, feel the need for a life change and replace corporate videoconferencing with the provision of varying (unfortunately, often scientifically unverified) quality "psychocounseling." There's nothing inherently wrong with such choices. However, good intentions are not enough. A mere 60 hours of paid psychology and medicine classes provided by commercial entities, as proposed by the bill's authors, will not replace years of specialized study in clinical diagnostics, neurology, or psycho- and sociopathology.

The draft bill actually strengthens this mechanism. Private schools are to have a virtual monopoly on education, certification, and market oversight. It is schools, de jure or de facto, that profit-driven companies will arbitrarily decide who can become a therapist. They are the ones who profit from training, supervision, and self-therapy. Ultimately, they will "pursue" those practicing this profession without first purchasing their certificates. The state is to refrain from regulating fees or providing independent scientific or institutional oversight. As a result, we are witnessing a bold push by interest groups to privatize the therapeutic care system. Patients seeking help in crisis become clients of a closed market for certifications and training.

Worse still, the draft bill stipulates that professional chambers—created directly by the community of psychotherapy schools that have reached an agreement—will decide on the disciplinary liability of therapists. In practice, this means that a patient who suffers harm is not referred to an independent body, but to the association that previously issued the therapist's certificate and profits from it. This is a reverse situation from the medical system, where doctors are overseen by professional liability advocates and medical courts, and patients have a real avenue of appeal. Here, patient complaints will be handled by private institutions, often with financial and personal ties to the therapists they would be penalizing. Moreover, we shouldn't expect much from these proceedings. The proponents and lobbyists of the new law avoid references to "empirically verified theories" like the devil avoids holy water. Instead, they want to enshrine in the law an undefined compliance with "psychotherapeutic trends"—of course, those they represent.

The problem we learned about in the high-profile report doesn't concern "illegal, unlicensed therapists." The greatest threat lies with therapists who possess all the necessary certifications yet operate without real supervision and clinical expertise. If the bill is passed in its current form, it will make this state of affairs the norm.

Therefore, it is essential to clearly define detailed requirements for psychotherapy schools at the admissions stage. Access should be granted to individuals with a relevant education—psychology, pedagogy, rehabilitation, social work, behavioral science, or family studies—with mandatory classes and exams in clinical psychology and basic psychiatry, preferably in medical facilities.

If we truly want to protect patients, we must reverse the logic of the law. First, enrollment in psychotherapy schools should be limited solely to those with a foundation in psychology and human development, such as psychology, pedagogy, rehabilitation, or social work.

Secondly, the concept of "psychotherapeutic diagnosis", which is absent from science, should be removed from the draft law or it should be clearly stated that it cannot replace a medical diagnosis made by a psychiatrist or neurologist.

Thirdly, with regard to children, strict criteria known from the Mental Health Protection Act must be introduced – with guaranteed participation of the court, legal guardian and child psychiatrist, so that the youngest patients are not left alone with a person without clinical training.

Fourth, it is necessary to separate roles within the system: those who train cannot also certify, and those who certify should not supervise. Oversight of the process must be state-sponsored, transparent, and inclusive of both the scientific and medical communities.

Fifthly, the complaints system must be based on a public register and a real right of the patient to report a case, with full equality of position vis-à-vis institutions such as the Patient Rights Ombudsman.

Finally, financial transparency should be an absolute standard: the obligation to publish all costs and exam results, a ban on combining functions in schools and professional self-government, and a precise definition of allowable training costs.

Poland needs a law on patient protection in psychotherapy, not a law protecting a free market (from state and academic oversight) for schools and certifications. Otherwise, tragedies like the ones described by "Gazeta Wyborcza" will repeat themselves. And the most vulnerable—children, people in mental health crisis, patients without expert knowledge—will remain defenseless against a system designed to protect not them, but the interests of training corporations.