site.btaPsychotherapy in Bulgaria: Development in 20th Century and Contemporary Issues

August 4, 2025, marks 19 years since the passing of prominent Bulgarian psychiatrist and psychotherapist Georgi Kamenov (later known in New York as George Kamen). His name became known to the Bulgarian public through the film Adaptation (1979), in which Kamenov served as the prototype for the main character, Dr. Bankov. The film raised the issue of psychotherapy in Bulgarian public discourse for the first time.

In an exclusive interview with the Bulgarian News Agency, Dr. David Ieroham, psychiatrist, psychotherapist, and university lecturer in psychiatry, psychotherapy, and artistic psycho-social practices, discusses the development of the psychotherapeutic profession in Bulgaria and its role in contemporary Bulgarian society.

The Roots of Bulgarian Psychotherapy 

The origins of the profession trace back to the early 20th century, though it saw limited development despite the flourishing psychoanalysis of Freud, Jung, and their followers at the time.

Psychotherapy in Bulgaria has an old history, Dr. Ieroham tells BTA. “In the 1920s, a group took an interest in psychoanalysis [a psychological society founded in 1921]. It wasn’t widely spread because Bulgarian psychiatry was modeled after the German school, which was conservative, focused on terminology, disciplined, and left little room for human connection or speech,” he notes.

In Bulgaria, different scholars publish articles concerning psychotherapy in literary and philosophic journals. However, according to the 2023 Psychology Conference Proceedings, there is almost no record of Bulgarians receiving psychoanalytic training or engaging with international communities developing at the time. Still, two Bulgarian psychiatrists stood out during this period - Nikola Krustnikov and Kiril Cholakov. Both developed their own hypnosis methods, aimed at re-experiencing psychological trauma to treat specific neuroses, according to the Neofit Rilski Southwest University Psychology Yearbook.

With the onset of communist rule, interest in psychotherapy declined. It was deemed a “bourgeois pursuit” and was almost non-existent in the next two decades.

The 1970s: A Revival Era 

“In the late 1960s and early 1970s, there was a wave of changes globally regarding human rights and the human psyche,” Dr. Ieroham says, referencing the 1968 student protests for human rights and personal freedom in Paris, Berlin, London, and Montreal, among other places.

With the global thought reform, psychotherapy gained a more central role in psychiatry. The focus began to shift from merely medicating patients to improving the living conditions and treatment in hospitals.

“In Western Europe, there was a reform which aimed to decentralize psychiatric care - to move patients out of large, isolating institutions and into smaller, polyclinic settings. Patients were encouraged to live near their families and reintegrate into society, which naturally required more than just medication. That’s how psychotherapy became more prominent,” Dr. Ieroham explains. 

These ideas reached Bulgaria as well, yet the reforms were slower and on a much lower scale. Psychotherapy did not exist as a regulated institutional practice. “In Bulgaria, there was a deafening silence on the subject, a certain level of repression. Psychotherapy was viewed with suspicion, and those who practiced it were often belittled or mocked,” recalls Dr. Ieroham.

At the time, he was working as a psychiatrist at the Karlukovo Psychiatric Hospital, where he noticed growing interest in psychotherapy among Bulgarian doctors influenced by global changes.

“In a hospital like Karlukovo, the staff was almost always young people who had just graduated university. There, we were a group of young, like-minded people. We were interested in philosophy, in human nature and society. Working in psychiatric hospitals makes you wonder what the patients think, how do they think, how do they perceive the world? You can’t explain everything through brain chemistry alone, which was the prevailing Marxist belief at the time,” Dr. Ieroham tells BTA.

The development of psychotherapy in the 1970s was meagre and discreet. Some psychiatrists, driven by pure compassion and interest in their patients, made attempts at psychotherapy.

“There were some people who were interested in psychotherapy. The idea was to humanize the treatment of the mentally ill, which at the time could not even be classified as humane. The conditions in the psychiatric wards were the same as today – poor and neglected. The main priority was not to provide care for the patients but to keep them ‘calm’, unproblematic and this happened mainly through sedative medication,” he says.

Georgi Kamenov is an example of a psychiatrist who tried this unpopular approach with his patients. He implemented psychotherapeutic methods in his psychiatric work. Based on his practice, the film Adaptation shows a group of patients in a psychiatric hospital in Sofia and their conversations with psychiatrist Dr. Bankov, who tries to understand their problems, as well as treat them.

“Georgi Kamenov was a consultant on the film, although they later removed his name from the credits. But the important thing is that the film was released, and it showed that group psychotherapy exists,” adds Dr. Ieroham.

Kamenov emigrated to the United States because of political pressure and the dismantling of his therapy groups. The director, Vulo Radev, wasn’t assigned another film project until 1989, writes Prof. Plamen Panayotov in his article Psychoanalytic Themes in the Film Adaptation.

Early Attempts at Psychotherapy 

Despite the lack of recognition for the profession, therapeutic initiatives emerged in some hospitals. One more well-known group was formed by Kamenov’s students after his emigration in 1982. They met every Friday to discuss cases, hence their name – The Friday Collegium.

“This group included Vladimir Nikolov, Lubcho Zhivkov, Toma Tomov, Rumen Georgiev, Zheni Georgieva. Some of them worked in psychiatry, others were students. They mainly talked to Kamenov’s patients, and they read. They had even translated a large volume of Irvin Yalom’s work on group therapy. I believe they held some group therapy sessions as well,” says Dr. Ieroham.

He mentions, however, that the psychotherapeutic community did not form around one single group. “I don’t want to feed into the mythology. If we look at it objectively, I do not think that one person or group started the movement. For example, there were also people at Radnevo Psychiatric Hospital who were doing theatre and a festival with the patients. Another colleague in Pleven, Dr. Barkashki, was practicing hypnosis.”

Despite these efforts, due to the repressive nature of the communist system in Bulgaria, no organized psychotherapeutic community could form. “In the totalitarian era, relationships were broken, unnatural, and people lived in fear. There wasn’t space for sharing ideas,” Dr. Ieroham states.

Finding study materials and textbooks was also a challenge. Gathering information required a lot of searching. “You could find psychiatric textbooks in the National and Medical libraries. Occasionally, you could find a chapter on psychotherapy in some Western psychiatric textbook.”

“Some managed to acquire materials from abroad. In Budapest, there was a big bookstore with American titles, where you could find Freud’s teachings in English. East Germany and Belgrade also had American bookstores. Whoever went there tried to bring back a book,” Dr. Ieroham says. 

The efforts of pre-communism Bulgarian psychiatrists also aided young Bulgarian psychotherapists in the 1970s and 1080s. “There were, nevertheless, Bulgarian contributions, such as Krustnikov’s and Cholakov’s methods, which were well-known and studied in universities,” Dr. Ieroham tells BTA.

Establishment of International Connections 

In the mid-1980s, when the regime became a bit “less oppressive”, efforts began to formally train Bulgarian therapists.

“Things got more serious when people started seeking formal training. George and Vasso Vassiliou, therapists from Athens, came here - they had an institute and were connected to systemic and family approach, which aimed to improve the functioning of communities, of school and the family. George gave lectures here,” Dr. Ieroham notes.

He shares his memories from the Greek therapist’s first visit: “They were hosted by Sofia University’s Psychiatry Department - Prof. Temkov and Prof. Marina Boyadzhieva, who had a keen interest in psychotherapy. At the time, Boyadzhieva was director of the Suhodol University Psychiatric Clinic near Sofia, where I worked with several colleagues from the Friday Collegium. [In 1984,] Vassiliou offered to demonstrate family therapy.”

Ieroham recalls the experience vividly: “A week before Vassiliou’s visit, Boyadzhieva said to me: ‘We need to present a family in Vassiliou’s session. You are interested in your patients’ families; you invite their parents and talk to them. You will present one of your patients.’ I was anxious that I would be criticized. Still, I invited the parents of a patient with alcohol addiction, explained that an American professor will consult them, but there will be an audience because he will demonstrate techniques for students, and they agreed.”

The open session attracted big interest in the Bulgarian psychological community. “It was a very interesting moment. On the day of the demonstration, streams of students and psychologists walked the narrow rural road from Suhodol village to the clinic. They sat around him and filled the hall. Watching George Vassiliou conduct a family session was incredibly powerful, especially during totalitarian times.”

Soon after, Vassiliou invited Ieroham for training in Athens - one of the few such experiences granted outside the Eastern Bloc. “With the right connections, you could travel. If you ask me how they allowed me to travel - Marina Boyadzhieva had connections. When I told her they would not let me go to Greece, she went out of her office for a bit and started dialing the phone. After some calls, she came to me and said: ‘Go get your passport tomorrow’.”

Bulgarian therapists soon realized they needed supervision of their work. Vassiliou’s visits then became regular. By the late 1980s, Bulgarian therapists were being invited for trainings in Greece and a psychotherapeutic society had started forming.

“There was a society forming around Rumen and Zheni Georgievi. We gathered at each other’s homes, and we had discussions. We practiced psychotherapy but only in hospitals,” says Dr. Ieroham.

Transition to Democracy 

Due to the growing interest and early efforts in the mid-1980s, the fall of the communist regime in 1989 marked a boom in the field.

“After 1989, educators from various schools came to Bulgaria - French psychoanalysts, psychodramatists. The 1990s saw a need to organize this process, so the Bulgarian Psychotherapy Association (BPA) was created,” Dr. Ieroham explains. 

Professional training began, private practices and organizations opened. Emigrated therapists like Kamenov (USA) and Nikola Kolev (Sweden) returned for visits. Bulgarians received training and certification abroad.

The Question of a Bulgarian Psychotherapy Act 

Around 2000, countries like Germany and Austria passed laws for psychotherapy, which aimed to regulate the competences of therapists.

In Bulgaria, this problem is unresolved. Bulgarian Psychotherapy Association (BPA) and the European Association for Psychotherapy both require a university degree and specialized psychotherapy training. But without a specific law, these are not mandatory in Bulgaria -despite attempts to pass a bill in 2012.

“In Bulgaria, some therapists believe that there should be a law which regulates, like, BPA requirements for education, and further trainings. But we couldn’t gather the energy to bring attention to that bill on a political level,” Dr. Ieroham notes.

He argues that the law would guide people to the most suitable therapy method for them. It is good to have some regulations so that people know which practices constitute psychotherapy and which ones do not. What is psychoanalysis, what is group therapy, psychodrama, so that people can choose and also to be able to differentiate between methods which are viable and some which are not scientifically proven.

Psychotherapy and the Social Issues in Bulgarian Society 

Dr. Ieroham sees a lack of psychological intervention during serious psychosocial crises - like road fatalities. “When people die in crashes, their families are exposed and interviewed. But here we see some serious traumas form, and nobody works with them to address the psychological consequences.”

Violence is another major issue with little public understanding of therapy’s role. “In recent cases with students fighting in schools, we often hear, ‘psychologists are working with the victim.’ This is the most impersonal way to describe psychotherapy. Why not say: ‘This specialist is working with this exact child on this specific problem’?” Dr. Ieroham asks.

A lack of public awareness on the topic hinders social harmony. Dr. Ieroham also highlights the issues with racism, sexism, and homophobia in Bulgaria. No one talks about the Roma community or the treatment of minorities. Yet psychotherapy and social work could address these gaps, he states.

Accessibility

There is progress in the democratization of psychotherapeutic services, but it is still not enough. “Psychological services exist in schools, universities, certain institutions, and companies. But this remains a chaotic and underdeveloped process” Dr. Ieroham tells BTA. 

Therapy remains financially inaccessible for many people. According to Dr. Ieroham, it is not enough to have therapists in the country. The profession needs to be institutionalized, integrated into communities and covered by the media for it to reach the widest possible specter of people regardless of age, gender, socioeconomic origins, profession. This is essential in order to have a democratic society, he believes.