Psychological Care in Lebanon: Lessons Learned

Psychology studies have been established in Lebanon since the 1950s in academic institutions offering courses in psychology within Philosophy degree, then BA in psychology. For a while, these studies were only theoretical, with little window into the practice of the profession.[1] Nine universities currently offer a master's degree in clinical and educational psychology, and 4 offer a Ph.D degree. The master's degree curricula mandatory include 400 hours of practicum. The programs are Western based following the American or French model. The profession of clinical and educational psychology obtained their official recognition in 2017 by the issuance of the license to practice law (8/2017) and the establishment of the Lebanese Order of Psychologists (LOPsy) in 2022, Law (254-2022). LOPsy’s mission is to enhance the practice, safeguard its ethics, and the best interests of the patient. These milestones are unique in the Arab countries and constitute the pillar of the professionalization of psychologists and psychotherapists, including psychoanalysts. Psychological care, essentially psychotherapy, began to take shape in the 1970s with the growing influence of psychoanalytic practice and the foundation of the first Psychoanalytical Society in 1980.[2] Later, during the 1990s–2000s, the cognitive behavioral therapy approach and other more contemporary orientations and models of care started to gain ground. As of the 2010s, psychotherapy training centers started flourishing. The turmoil of the successive waves of wars, economic collapses, and endemic implosion of the state led to the expansion of mental health initiatives on one hand and to the brain drain of experts’ psychologists on the other. Local and international NGOs, private hospitals, private clinics, and, more recently, the National Mental Health Program, established in 2014, constitute the backbone of psychological services. Some schools and universities have established students’ counseling centers offering psychological care to their students. The Ministry of Education has developed social–emotional learning programs, a child protection framework, and some public schools have developed inclusive education services. Research in psychology and mental health has taken shy steps based on the work of scholars in the main academic institutions, and some research centers, such as the Institute for Development, Research, Advocacy, and Applied Care, founded in 1997. The Syrian crisis of 2011 had a toll on Lebanon with the influx of more than one million refugees. International NGOs, in collaboration with local and external universities, expanded their research into the refugee population. The landscape of published research has been focusing on trauma and the prevalence of psychiatric disorders. The effort to have a legal framework protecting the rights of individuals with psychiatric disorders has started in 1983 with the Lebanese Act (72-9/9/1983) “WelfareActandProtectionandTreatmentofMentallyIllPatients,” the Lebanese Act no 673-16/3/1998 “NarcoticDrugsandPsychotropicSubstancesandPrecursors,” The Lebanese Act no 220-29/5/2000 “Rights of the Persons with Disabilities,” and lately the Lebanese Act no 574-11/2/2004 “Patients’ Rights and Informed Consent.” Despite the presence of the above Acts, although they need reviews and revisions, Lebanon is still not capable of enforcing and implementing human rights and protective laws for individuals with disabilities and mental health disorders.[3] Mental health services are concentrated in Beirut and its surroundings; most of these services are paid out of pocket with no insurance coverage, and the prevalence of mental health professionals is still below the World Health Organization’s recommendations, with a ratio of 3.3 psychologists per 100.000 persons.[4] The problem of affordability, accessibility, and availability is still prevalent, despite the rising needs and initiatives. Psychologists in Lebanon are simultaneously victims and service providers, like all other healthcare providers. When war hits, they must act outside their classical framework in chaotic and volatile conditions. In addition, psychologists are members of the social mosaic of Lebanon. Their mental representations reflect the fragmentation of this society, its stereotypes and stigmas. Their core competencies and professional ethics are challenged: confidentiality in the hallways of crowded shelters; neutrality in the face of atrocities; voluntary and unpaid services in times of crises; cultural sensitivity and use of specific terminologies inherent to each subgroup of Lebanese citizens; favoring group instead of individual interventions; and managing self-care despite all odds. These dilemmas invite us to deepen our reflection about the psychologists’ preparedness and question the university curricula as well as the continuous education training programs and psychotherapy approaches. It became obvious that adopting the Western model of care has its limitations. Cultural adjustment and cultural innovations are needed for psychological care to fit the unique needs of the population of Lebanon, even more, the unique profile of populations living under major social and political strains. New professional postures are to be developed, such as favoring group interventions, gaining deep knowledge about the subcultures of Lebanon, and understanding the historical paths that led to the fragmentation of the social net. Social psychology, anthropology, and community psychology concepts could be judicious additions to the curricula. Research aiming at developing culturally sensitive care, particularly in the field of trauma work, is to be given priority. Public debates among psychologists about extracting common denominators among the diversity of practice and theoretical backgrounds will enrich the field. Psychologists of Lebanon, practitioners and scholars, are pioneers and acknowledged leaders among their colleagues practicing in Arab countries. Maintaining this role comes with a permanent insightful reflection, the drive and expertise to further enhance competencies and professional ethics, and the transmission of knowledge and skills from senior psychologists to junior ones. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.