The first approach interprets psychotherapy as a sphere of scientific knowledge about treatment methods that affect the state and functioning of the body in the areas of mental and somatic activity. Another vector understands psychotherapy as a special type of interpersonal interaction in which clients are provided with professional assistance through psychological means in solving problems or difficulties of a psychological nature that arise. Consequently, the key goal of the second approach is not a cure for mental disorders, but assistance in the process of formation of consciousness and personality, in which the psychotherapist appears as the client’s companion, friend and mentor.
Psychotherapy as a scientific discipline must have its own theory and methodology, its own categorical apparatus and terminology, etc., in a word, everything that characterizes an independent scientific discipline. At the same time, the diversity of directions and currents, schools and specific methods of psychotherapy, based on various theoretical approaches, leads to the fact that at present there is not even a single definition of psychotherapy. There are about 400 of them in the literature. Some of them clearly classify psychotherapy as medicine, others focus on psychological aspects. The Russian tradition is that psychotherapy is defined, first of all, as a method of treatment, i.e. falls within the purview of medicine. Foreign definitions of psychotherapy largely emphasize its psychological aspects.
Psychotherapeutic intervention, or psychotherapeutic intervention, is a type (type, form) of psychotherapeutic influence, which is characterized by certain goals and a choice of means of influence corresponding to these goals, i.e. methods. The term psychotherapeutic intervention can denote a specific psychotherapeutic technique, for example, clarification, clarification, stimulation, verbalization, interpretation, confrontation, teaching, training, advice, etc., as well as a more general strategy of behavior of the psychotherapist, which is closely related to the theoretical orientation (formerly everything, with an understanding of the nature of a particular disorder and the goals and objectives of psychotherapy).
Psychology and medicine use different types of interventions. All types of interventions used in medicine are divided into four groups: medications (pharmacotherapy), surgical, physical (physiotherapy) and psychological (psychotherapy).
Psychological interventions, or clinical psychological interventions, constitute the essence of psychotherapeutic intervention. From the point of view of these authors, clinical and psychological interventions are characterized by: I) choice of means (methods); 2) functions (development, prevention, treatment, rehabilitation); 3) target orientation of the process to achieve change; 4) theoretical basis (theoretical psychology); 5) empirical testing; 6) professional actions.
Let us consider the main characteristics of clinical and psychological interventions.
Methods of clinical and psychological interventions are psychological means that the psychotherapist chooses. They can be verbal or non-verbal, focus more on either cognitive, emotional or behavioral aspects and are implemented in the context of relationships and interactions between the patient or patients (those who need help) and the psychotherapist (those who receive this help). renders).
Typical psychological means are conversation, training (exercises) or interpersonal relationships as a factor of influence and influence.
The functions of clinical and psychological interventions are prevention, treatment, rehabilitation and development. Clinical and psychological interventions that perform the function of treatment (therapy) and partially rehabilitation are essentially psychotherapeutic interventions.
The goals of clinical and psychological interventions reflect a goal orientation towards achieving certain changes. Clinical and psychological interventions can be aimed both at more general, distant goals, and at specific, closer goals. At the same time, psychological means of influence must always clearly correspond to the goals of influence.
The theoretical validity of clinical psychological interventions lies in its relationship with certain psychological theories of scientific psychology. Empirical testing of clinical and psychological interventions is primarily related to the study of their effectiveness; they should always be carried out by professionals.
The goal of psychotherapy common to most psychotherapeutic approaches can be formulated as follows: the overall goal of psychotherapy is to help patients change their thinking and behavior in such a way as to become happier and more productive. When working with patients, this goal is differentiated into a number of tasks, namely:
1) the therapist helps the patient to better understand his problems;
2) eliminates emotional discomfort;
3) encourages free expression of feelings;
4) provides the patient with new ideas or information about how to solve problems;
5) assists the patient in testing new ways of thinking and behaving outside the therapeutic situation.
In resolving these problems, the therapist uses 3 basic techniques.
1. First of all, the therapist provides psychological support. Fundamentally, this means listening sympathetically to the patient and providing sound advice in a crisis situation. Support also involves helping the patient recognize and use their strengths and skills.
2. The second method of therapy is to eliminate maladaptive behavior and form new, adaptive stereotypes.
3. Finally, the therapist promotes insight (awareness) and self-disclosure (self-exploration), as a result of which patients begin to better understand their motives, feelings, conflicts, and values.
Despite differences in theories, goals and procedures, psychological treatment boils down to one person trying to help another (even in the case of group psychotherapy, in which each participant is a kind of therapist to another member of the group). .
An integrated approach to the treatment of various diseases, taking into account the presence of three factors in the etiopathogenesis (biological, psychological and social), necessitates the need for corrective actions aimed at each factor corresponding to its nature. This means that psychotherapy, as a primary or additional type of therapy, can be used in a comprehensive treatment system for patients with a wide variety of diseases. Indications for psychotherapy are determined by the role of the psychological factor in the etiopathogenesis of the disease, as well as the possible consequences of a previous or current disease.
The most significant indication for psychotherapeutic work with a specific patient is the role of the psychological factor in the occurrence and course of the disease. The more pronounced the psychogenic nature of the disease (i.e., the more pronounced the psychologically understandable connection between the situation, the person and the disease), the more adequate and necessary the use of psychotherapeutic methods becomes.
Indications for psychotherapy are also determined by the possible consequences of the disease. The concept of “consequences of the disease” can be specified. They may be associated with clinical, psychological and socio-psychological problems.
First of all, this is a potential secondary neurotization - a manifestation of neurotic symptoms provoked not by primary psychological causes, but by a psychotraumatic situation, which is the underlying disease.
Secondly, it is the individual’s reaction to the disease, which can either contribute to the treatment process or hinder it. An inadequate personality reaction to an illness (for example, anosognosic or, conversely, hypochondriacal) also needs to be corrected by psychotherapeutic methods.
Thirdly, psychological and socio-psychological consequences are possible. A serious illness that changes the patient’s usual lifestyle can lead to a change in social status; the impossibility of realizing and satisfying relationships, attitudes, needs, and aspirations that are significant to the individual; to changes in family and professional spheres; narrowing the circle of contacts and interests; decreased performance, activity level and motivational components; lack of self-confidence and decreased self-esteem; formation of inadequate stereotypes of emotional and behavioral response.
Fourthly, in the process of a chronic disease, a dynamic transformation of personal characteristics is possible, i.e. the formation during the course of the disease of personal characteristics (increased sensitivity, anxiety, suspiciousness, self-centeredness) that require corrective influences.
It is quite obvious that in each specific case, indications for psychotherapy are determined not only by nosological affiliation, but also by the individual psychological characteristics of the patient, including his motivation to participate in psychotherapeutic work.
Group and individual psychotherapy are the two main forms of psychotherapy. The specificity of group psychotherapy as a therapeutic method lies in the targeted use for psychotherapeutic purposes of group dynamics for therapeutic purposes (ᴛ.ᴇ. the entire set of relationships and interactions that arise between group members, including the group psychotherapist).
The key directions, or approaches, in psychotherapy are three: psychodynamic, phenomenological (existential-humanistic), behavioral (cognitive-behavioral).
The psychodynamic approach states that human thoughts, feelings and behavior are determined by unconscious mental processes. Freud compared a person's personality to an iceberg: the tip of the iceberg is consciousness, but the main mass, located under water and invisible, is the unconscious.
The dynamic direction in psychotherapy is based on depth psychology - psychoanalysis. Today, within the framework of the dynamic direction, there are many different schools, but the common thing that unites the views of representatives of this approach is the idea of unconscious mental processes and psychotherapeutic methods used for their analysis and awareness.
Existential psychotherapy views the psyche from the perspective of nature. The concept of “existence” comes from the Latin word existere, meaning “to stand out, to appear.” In Russian translation, it means a process associated with emergence or formation. For this reason, existential methods in psychotherapy are associated with psychological work at the ontological level (from the Greek ontos - “being”), aimed at helping patients defend and affirm their model of existence, despite the limitations that life imposes.
Existence is a specific form of existence, characteristic only of man, as opposed to all things. The difference here is that human existence is conscious and meaningful. At the same time - and this is important for psychotherapeutic practice - various life troubles, mental trauma, improper upbringing (which does not give the child a feeling of love and security) can “cloudy” human existence, making him a weak-willed “automatic machine”, living unconsciously and meaninglessly. The consequence of this “turbidity of being” is a variety of disorders from the field of “minor psychiatry” and psychosomatics. It is noteworthy that “major” mental disorders (studied in detail by one of the founders of existential psychology, Karl Jaspers), as well as severe, incurable somatic diseases, are often considered as an “existential challenge” that, if treated correctly, can lead the patient not to “cloudiness” ”, but, on the contrary, to the “clarification” (Jaspers’ term) of existence.
The arsenal of psychotherapeutic techniques used by humanistic psychotherapists is extremely wide. At the same time, it is safe to say that they give preference to conversational methods, because It is in free conversation that the emergence of that very “existential communication” is possible. However, especially in the early stages of treatment, humanistic psychotherapists can use any other methods, including hypnosis - if this helps to free oneself from specific factors that “cloud” the patient’s existence.
The most important areas of the humanistic “family”: Dasein analysis (existential psychoanalysis according to Binswanger), gotherapy (existential analysis according to Frankl), client-centered counseling according to C. Rogers, Gestalt therapy, transactional analysis.
Behavioral psychotherapy is based on behavioral psychology and uses the principles of learning to change cognitive, emotional and behavioral structures. Behavioral psychotherapy includes a wide range of methods. The development of methodological approaches within this direction reflects the evolution of the goals of behavioral psychotherapy from external to internal learning: from methods aimed at changing overt forms of behavior, directly observable behavioral reactions (based mainly on classical and operant conditioning) to methods aimed at changing more deep, closed psychological formations (based on theories of social learning, modeling and cognitive approaches).
In general, behavioral psychotherapy (behavior modification) is aimed at managing human behavior, retraining, reducing or eliminating symptoms and bringing behavior closer to certain adaptive forms of behavior - replacing fear, anxiety, anxiety with relaxation until the reduction or complete elimination of symptoms, which is achieved in the process of learning through the use of certain techniques.
Book table of contents open close
1. Profession and its role in a person’s life. Professionally important qualities
2. The concept of professiogram and psychogram. Professionalism and professional competence.
3. The relationship between academic (scientific), everyday and practical psychology
4. The importance of reflection in the life of a psychologist
5. The main areas of activity of a modern psychologist
6. Psychodiagnostics as one of the areas of practical psychology
7. Contents of psychological assistance in the process of psychological correction
8. Characteristics of psychological counseling as a type of psychological assistance
9. Features of psychotherapy as a type of psychological assistance
10. Concept of psychological assistance service
11. Basic qualities of professional activity of a qualified psychologist
12. Tasks of interaction between the client and the psychologist (social, ethical, moral, actually psychological)
13. Dialogue in the context of the professional activity of a practical psychologist. Features of deep communication
14. Values and value orientations of a practical psychologist as the basis of his personal and professional self-development
Psychotherapy as a type of psychological assistance: concept, goals and objectives. Interdisciplinary aspects of psychotherapy: psychotherapy and psychological counseling, psychotherapy and psychiatry, psychotherapy and psychological correction. Models of psychotherapy. Main directions of psychotherapy. Forms of psychotherapy: individual, group, family. Qualification requirements for a psychotherapist. Possibilities and limitations of using psychotherapy in the activities of a practical psychologist.
Psychotherapy as a type of psychological assistance:
A special type of interpersonal interaction in which patients are provided with professional assistance through psychological means in solving their problems and difficulties of a psychological nature;
A tool that uses verbal techniques and interpersonal relationships to help a person modify attitudes and behaviors that are intellectually, socially, or emotionally negative;
Long-term interpersonal interaction between two or more people, one of whom specialized in the correction of human relationships;
Personalized technique, which is a cross between the technique of planned changes in a person's attitudes, feelings and behavior, and the cognitive process, which, unlike any other, brings a person face to face with his internal conflicts and contradictions.
Although quite general, Kratochvil’s definition to some extent unites these two approaches: “Psychotherapy is the purposeful streamlining of the disturbed activity of the body psychological means."
The phases of the psychotherapeutic process are: readings, creating a therapeutic relationship and explaining goals, reenactment of therapeutic learning, assessment before and after the end of therapy.
Accordingly, each of the phases has its own goals.
The “reading” phase has the following objectives:
establishing diagnosis;
choice of therapy method;
if necessary, a medical examination;
informed consent.
The next phase - “creating a therapeutic relationship and explaining goals” - is aimed at:
role structuring;
creating expectations for positive changes;
explanation of etiology if necessary.
In the “playing out therapeutic learning” phase, the following goals are pursued:
mastering skills and abilities;
analysis of motives of behavior;
restructuring of the self-image.
The goals in the last phase of the psychotherapeutic process are:
psychodiagnostics of goal achievement;
guarantee of results.
All of these goals are achieved through various means:
1) interview/history;
2) personality and clinical tests;
3) showing empathy;
4) explanation of the “rules of the game”;
5) therapeutic contact;
6) use of psychotherapeutic techniques;
7) continuous monitoring and evaluation of the course of therapy;
8) diagnosis and reduction in the number of sessions
Main directions of psychotherapy.
Abroad, the most widespread three psychotherapeutic directions:
1. psychoanalytic;
2. behaviorist;
3. existential-humanistic(non-directive psychotherapy, Gestalt therapy, etc.).
In recent years, the following main areas have been identified in domestic psychotherapy:
1. person-oriented (reconstructive) psychotherapy (Karvasarsky);
2. suggestive psychotherapy;
3. behavioral psychotherapy;
4. emotional stress psychotherapy (Rozhnov).
There is an almost unlimited number of classifications of psychotherapeutic treatment methods. One of them, developed by I. Z. Velvovsky et al. (1984), is given below in some abbreviation.
1. Psychotherapy in the natural state of wakefulness (rational-associative forms and techniques; emotion-based, nal-pituitary and game methods; training-volitional forms; suggestive forms).
2. Psychotherapy in special conditions of the higher parts of the brain (hypnosis-rest according to K.K. Platonov; suggestion in hypnosis; post-hypnotic suggestion; various forms of autohypnotic techniques; methods of autogenic training; relaxation according to Jacobson; narco-hypnosis; hypnosuggestion during electric sleep, etc.).
3. Psychotherapy for stress caused by: 1) mental means - fear, acute positive or negative experience; 2) pharmacological (nicotinic acid, etc.) or pain (dolorin, etc.) agents; 3) physical agents (cauterization with a thermal cautery); 4) “attack by surprise”, through an ethereal mask, according to A. M. Svyadosch, enhanced hyperpnea, according to I. Z. Velvovsky and I. M. Gurevich.
Of the variety of psychotherapy methods among practitioners, the following are now the most common:
1. suggestive psychotherapy (suggestion in a state of wakefulness, natural sleep, hypnosis, emotional stress psychotherapy, drug psychotherapy);
2. self-hypnosis (autogenic training, Coue method, Jacobson method);
3. rational psychotherapy;
4. group psychotherapy;
5. play psychotherapy;
6. family psychotherapy;
7. conditioned reflex psychotherapy. Psychoanalysis, transactional analysis, Gestalt therapy, etc. are increasingly used.
Models of psychotherapy.
There are two models in modern psychotherapy: medical and psychological.
IN medical model the main emphasis is on knowledge of nosology, syndromology, and clinical picture of disorders. The main target of this model is a symptom, the search for and elimination of the cause of which is practically not done. The patient’s activity is reduced to a minimum - to faith in the doctor and the treatment being carried out. In this model of psychotherapy, the psychotherapist takes the position of an expert who knows and understands the “naive” patient better. As is known, this model of psychotherapy was the only one in the USSR, where the penetration of the psychological understanding of psychotherapy, declared “bourgeois,” was not allowed. One of the manifestations of this fact was and is the establishment of a medical monopoly on psychotherapy. Unfortunately, psychologists can still carry out psychotherapeutic activities only under the guise of far-fetched terms: psychological correction, psychoprophylaxis, family counseling, etc. It is obvious that these terms are artificial, at least from the point of view of describing the work of psychologists in the real psychotherapeutic process .
Along with the medical model of psychotherapy, similar to the use of medicine (although we in no way want to belittle its importance!), there is, develops and, which seems strange and incomprehensible to many “naturalists”, the psychological direction in psychotherapy or, others, turns out to be therapeutically effective words, psychological model.
This direction is primarily associated with the understanding of psychotherapy as a “world of fairy tales and metaphors,” a world to which the laws of natural science are not applicable. Along this path, the medical model of “delivery of care” becomes inadequate and useless. In this case, the definition of psychotherapy as “the impact on the psyche and soma of a person through the psyche” gives way to such metaphors of psychotherapeutic contact as:
“interaction” – when not only the psychotherapist is active, but also the client himself (in this case, the term “patient” is inappropriate, since the client is not a passive object of manipulation by the psychotherapist);
“coexistence” – when the idea of not the active coexistence of the psychotherapist and the client in psychotherapeutic contact is emphasized, but the exchange of emotions and meanings;
“internal comprehension” - when the client moves in the internal space along a trajectory determined by him;
“unconditional love” – when the client and psychotherapist enter into a special relationship of psychological intimacy, filled with love and acceptance.
In this second path of development of psychotherapy, theory often lags behind the actual psychotherapeutic process. Knowledge is certainly a prerequisite for an effective process, but it does not replace it. Meanwhile, even within the framework of psychological models of psychotherapy, for example in psychoanalysis, knowledge (theory) is often the main beacon of the psychotherapeutic process. This leads to the fact that the psychotherapist can tell everything about the client - the features of his ego-object relationships in childhood, trauma, features of the processes of coping and defense, etc., but cannot convey the client’s vital spirit. There is a feeling that you are in a preparation room in which there is no living person, and the psychotherapist does not convey his real emotions and experiences regarding the client. The client “died” and turned into some kind of scheme, model within the framework of “detective genre” psychotherapy. Theory-oriented psychotherapy becomes an enjoyable intellectual pastime. But it is quite obvious that the psychotherapist’s “knowledge” of the client, no matter how perfect and accurate it may be, does not guarantee change in the client. “Knowledge” does not trigger an internal process for the client. Above it (or below it) there must be something important, but eluding conceptualization - this is difficult to teach, but without this depth psychotherapy is impossible. Metaphors for this over-or adjustment are “intuition”, “empathy”, “personality of the psychotherapist”, etc. C. G. Jung once noted that the personality of the psychotherapist is the best formula for psychotherapy itself.
In the same way, Rogerian therapists are always wary of accusations of technicalism, and those conditions for psychotherapeutic change in the client that the psychotherapist must create are not techniques, but certain personal dispositions. The psychological model is focused on spreading psychological culture and thinking to the sphere of helping patients and people with psychological problems. On the one hand, the insufficient effectiveness of purely medical psychotherapy is becoming increasingly obvious, and doctors are beginning to become interested in psychological models of psychotherapy, psychological ways of thinking, and psychological culture. On the other hand, recently a lot of patients have appeared with pre-nosological forms of disorders that doctors had not previously dealt with, but psychologists have not dealt with them either. Now these people have become the object of attention of both. A characteristic feature of the psychological model of psychotherapy is the conviction that no one can solve his problem for the patient (client). The psychotherapist only accompanies the client into the problem, into the depth of his experiences, and helps the person find a resource for change and solutions to his problems.
Despite the apparent gap between the medical and psychological models of psychotherapy, they are united by a focus on helping the client. Therefore, every therapist needs to know both models, since in order to relieve anxiety, phobias, etc., there is often no need to go into deep personal experiences, especially since not all clients have the desire to work at this level.
Psychological counseling and psychotherapy as types of psychological assistance: similarities and differences.
It is difficult to draw a clear line between these two areas of work of a psychologist. They are a process psychological assistance to a person in becoming a productive, developing personality, capable of self-knowledge and self-support, choosing optimal behavioral strategies and their use in real interpersonal interaction, overcoming emerging difficulties, a responsible and conscious attitude towards one’s life . The main task of the psychologist in carrying out this work is to create conditions under which this will become possible.
1. When talking about the relationship between counseling and psychotherapy, they usually resort to the idea of two poles of a continuum. At one extreme, the work of a professional concerns mainly situational problems that are solved at the level of consciousness and arise in clinically healthy individuals. This is where the counseling area is located. At the other pole is a greater desire for a deep analysis of problems with a focus on unconscious processes and structural restructuring of the personality. This is where the field of psychotherapy is located. The area between the poles belongs to activities that can be called both counseling and psychotherapy.
In addition, there are specific features of psychological counseling that distinguish it from psychotherapy:
2. Counseling is focused on a clinically healthy person; these are people who have psychological difficulties and problems in everyday life, complaints of a neurotic nature, as well as people who feel good, but who set themselves the goal of further personal development;
3. Counseling is focused on healthy aspects of the personality, regardless of the degree of impairment; this orientation is based on the belief that “a person can change, choose a satisfying life, find ways to use his inclinations, even if they are small due to inadequate attitudes and feelings, delayed maturation, cultural deprivation, lack of finances, illness, disability, old age "(Jordan et al.; cited in: Myers et al., 1968);
4. Counseling is more often focused on the present and future of clients; in psychotherapy, work is done with the past, problems repressed into the unconscious are worked out;
5. Counseling usually focuses on short-term assistance (up to 15 meetings), etc.
Psychotherapy(from the Greek psyche - soul and therapeia - treatment) literally translated as “treatment of the soul.” Currently, the term does not have an unambiguous interpretation. With all the diversity of interpretations, two approaches can be traced: clinical and psychological.
In the first approach, psychotherapy is considered as a field of scientific knowledge about treatment methods that affect the state and functioning of the body in the areas of mental and somatic activity. In the second approach, psychotherapy is defined as a special type of interpersonal interaction in which clients are provided with professional assistance through psychological means in solving their problems or difficulties of a psychological nature. Thus, the main goal of the second approach is not a cure for mental disorders, but assistance in the process of formation of consciousness and personality, in which the psychotherapist appears as the client’s companion, friend and mentor.
Psychotherapy as a scientific discipline must have its own theory and methodology, its own categorical apparatus and terminology, etc., in a word, everything that characterizes an independent scientific discipline. However, the diversity of directions and currents, schools and specific methods of psychotherapy, based on various theoretical approaches, leads to the fact that currently there is not even a single definition of psychotherapy. There are about 400 of them in the literature. Some of them clearly classify psychotherapy as medicine, others focus on psychological aspects. The domestic tradition is that psychotherapy is defined, first of all, as a method of treatment, that is, it falls within the competence of medicine. Foreign definitions of psychotherapy largely emphasize its psychological aspects.
Psychotherapeutic intervention, or psychotherapeutic intervention, is a type (type, form) of psychotherapeutic influence, which is characterized by certain goals and the choice of means of influence, that is, methods, corresponding to these goals. The term psychotherapeutic intervention can denote a specific psychotherapeutic technique, for example, clarification, clarification, stimulation, verbalization, interpretation, confrontation, teaching, training, advice, etc., as well as a more general strategy of behavior of the psychotherapist, which is closely related to the theoretical orientation (primarily , with an understanding of the nature of a particular disorder and the goals and objectives of psychotherapy).
Psychology and medicine use different types of interventions. All types of interventions used in medicine are divided into four groups: medications (pharmacotherapy), surgical, physical (physiotherapy) and psychological (psychotherapy).
Psychological interventions, or clinical psychological interventions, constitute the essence of psychotherapeutic intervention. From the point of view of these authors, clinical and psychological interventions are characterized by: I) choice of means (methods); 2) functions (development, prevention, treatment, rehabilitation); 3) target orientation of the process to achieve change; 4) theoretical basis (theoretical psychology); 5) empirical testing; 6) professional actions.
Let us consider the main characteristics of clinical and psychological interventions.
Methods of clinical and psychological interventions are psychological means that the psychotherapist chooses. They can be verbal or non-verbal, focus more on either cognitive, emotional or behavioral aspects and are implemented in the context of relationships and interactions between the patient or patients (those who need help) and the psychotherapist (those who receive this help). renders).
Typical psychological means are conversation, training (exercises) or interpersonal relationships as a factor of influence and influence.
The functions of clinical and psychological interventions are prevention, treatment, rehabilitation and development. Clinical and psychological interventions that perform the function of treatment (therapy) and partially rehabilitation are essentially psychotherapeutic interventions.
The goals of clinical and psychological interventions reflect a goal orientation towards achieving certain changes. Clinical and psychological interventions can be aimed both at more general, distant goals, and at specific, closer goals. However, psychological means of influence must always clearly correspond to the goals of influence.
The theoretical validity of clinical psychological interventions lies in its relationship with certain psychological theories of scientific psychology. Empirical testing of clinical and psychological interventions is primarily related to the study of their effectiveness; they should always be carried out by professionals.
The goal of psychotherapy common to most psychotherapeutic approaches can be formulated as follows: the overall goal of psychotherapy is to help patients change their thinking and behavior in such a way as to become happier and more productive. When working with patients, this goal is differentiated into a number of tasks, namely:
1) the therapist helps the patient better understand his problems;
2) eliminates emotional discomfort;
3) encourages free expression of feelings;
4) provides the patient with new ideas or information about how to solve problems;
5) assists the patient in testing new ways of thinking and behaving outside the therapeutic situation.
When solving these problems, the therapist resorts to three main methods.
1. First, the therapist provides psychological support. First of all, this means listening sympathetically to the patient and giving him sound advice in a crisis situation. Support also involves helping the patient recognize and use their strengths and skills.
2. The second method of therapy is to eliminate maladaptive behavior and form new, adaptive stereotypes.
3. Finally, the therapist promotes insight (awareness) and self-disclosure (self-exploration), as a result of which patients begin to better understand their motives, feelings, conflicts, and values.
Despite differences in theories, goals and procedures, psychological treatment boils down to one person trying to help another (even in the case of group psychotherapy, in which each participant is a kind of therapist to another member of the group). .
An integrated approach to the treatment of various diseases, taking into account the presence of three factors in the etiopathogenesis (biological, psychological and social), necessitates the need for corrective actions aimed at each factor corresponding to its nature. This means that psychotherapy, as a primary or additional type of therapy, can be used in a comprehensive treatment system for patients with a wide variety of diseases. Indications for psychotherapy are determined by the role of the psychological factor in the etiopathogenesis of the disease, as well as the possible consequences of a previous or current disease.
The most significant indication for psychotherapeutic work with a specific patient is the role of the psychological factor in the occurrence and course of the disease. The more pronounced the psychogenic nature of the disease (that is, the more pronounced the psychologically understandable connection between the situation, personality and disease), the more adequate and necessary the use of psychotherapeutic methods becomes.
Indications for psychotherapy are also determined by the possible consequences of the disease. The concept of “consequences of the disease” can be specified. They may be associated with clinical, psychological and socio-psychological problems.
Firstly, this is a possible secondary neurotization - a manifestation of neurotic symptoms caused not by primary psychological causes, but by a psychotraumatic situation, which is the underlying disease.
Secondly, it is the individual’s reaction to the disease, which can either contribute to the treatment process or hinder it. An inadequate personality reaction to an illness (for example, anosognosic or, conversely, hypochondriacal) also needs to be corrected by psychotherapeutic methods.
Thirdly, psychological and socio-psychological consequences are possible. A serious illness that changes the patient’s usual lifestyle can lead to a change in social status; the impossibility of realizing and satisfying relationships, attitudes, needs, and aspirations that are significant to the individual; to changes in family and professional spheres; narrowing the circle of contacts and interests; decreased performance, activity level and motivational components; lack of self-confidence and decreased self-esteem; formation of inadequate stereotypes of emotional and behavioral response.
Fourthly, in the process of a chronic disease, a dynamic transformation of personal characteristics is possible, that is, the formation during the course of the disease of personal characteristics (increased sensitivity, anxiety, suspiciousness, self-centeredness) that require corrective influences.
Of course, in each specific case, indications for psychotherapy are determined not only by nosological affiliation, but also by the individual psychological characteristics of the patient, including his motivation to participate in psychotherapeutic work.
Group and individual psychotherapy are the two main forms of psychotherapy. The specificity of group psychotherapy as a therapeutic method lies in the targeted use of group dynamics for therapeutic purposes (that is, the entire set of relationships and interactions that arise between group members, including the group psychotherapist).
There are three main directions, or approaches, in psychotherapy: psychodynamic, phenomenological (existential-humanistic), behavioral (cognitive-behavioral).
The psychodynamic approach states that human thoughts, feelings and behavior are determined by unconscious mental processes. Freud compared a person's personality to an iceberg: the tip of the iceberg is consciousness, but the main mass, located under water and invisible, is the unconscious.
The dynamic direction in psychotherapy is based on depth psychology - psychoanalysis. Currently, within the framework of the dynamic direction, there are many different schools, but the common thing that unites the views of representatives of this approach is the idea of unconscious mental processes and psychotherapeutic methods used for their analysis and awareness.
Existential psychotherapy views the psyche from the perspective of nature. The concept of “existence” comes from the Latin word existere, meaning “to stand out, to appear.” In Russian translation, it means a process associated with emergence or formation. Therefore, existential methods in psychotherapy are associated with psychological work at the ontological level (from the Greek ontos - “being”), aimed at helping patients defend and approve their model of existence, despite the limitations that life imposes.
Existence is a specific form of existence, characteristic only of man, in contrast to all things. The difference here is that human existence is conscious and meaningful. However - and this is important for psychotherapeutic practice - various life troubles, mental trauma, improper upbringing (which does not give the child a feeling of love and security) can “cloudy” human existence, making him a weak-willed “automatic machine”, living unconsciously and meaninglessly. The consequence of this “turbidity of being” is a variety of disorders from the field of “minor psychiatry” and psychosomatics. It is noteworthy that “major” mental disorders (studied in detail by one of the founders of existential psychology, Karl Jaspers), as well as severe, incurable somatic diseases, are often considered as an “existential challenge” that, if treated correctly, can lead the patient not to “cloudiness.” ”, but, on the contrary, to the “clarification” (Jaspers’ term) of existence.
The arsenal of psychotherapeutic techniques used by humanistic psychotherapists is extremely wide. However, it is safe to say that they give preference to conversational methods, because It is in free conversation that the emergence of that very “existential communication” is possible. However, especially in the early stages of treatment, humanistic psychotherapists can use any other methods, including hypnosis, if this helps to free oneself from specific factors that “cloud” the patient’s existence.
The most important areas of the humanistic “family”: Dasein analysis (existential psychoanalysis according to Binswanger), logotherapy (existential analysis according to Frankl), client-centered counseling according to C. Rogers, Gestalt therapy, transactional analysis.
Behavioral psychotherapy is based on behavioral psychology and uses the principles of learning to change cognitive, emotional and behavioral structures. Behavioral psychotherapy includes a wide range of methods. The development of methodological approaches within this direction reflects the evolution of the goals of behavioral psychotherapy from external to internal learning: from methods aimed at changing overt forms of behavior, directly observable behavioral reactions (based mainly on classical and operant conditioning) to methods aimed at changing more deep, closed psychological formations (based on theories of social learning, modeling and cognitive approaches).
In general, behavioral psychotherapy (behavior modification) is aimed at managing human behavior, relearning, reducing or eliminating symptoms and bringing behavior closer to certain adaptive forms of behavior - replacing fear, anxiety, restlessness with relaxation until the reduction or complete elimination of symptoms, which is achieved in the process of learning through the use of certain techniques.
1. Psychotherapy: concept, goals and objectives.
2. Interdisciplinary aspects of psychotherapy: psychotherapy and psychological counseling, psychotherapy and psychiatry, psychotherapy and psychological correction.
1. Psychotherapy: concept, goals and objectives
The term psychotherapy was first introduced at the end of the 19th century. D. Tuke. In his book, “Illustrations of the Influence of the Mind on the Body,” which he published in 1872, one of the chapters is titled: “Psychotherapy.” The term psychotherapy became commonly used only in the 90s. XIX century in connection with the development of hypnosis techniques.
The variety of directions and currents, schools and specific methods of psychotherapy, based on various theoretical approaches, leads to the fact that at present there is not even a single definition of psychotherapy. There are about 400 of them in the literature. Some of them clearly classify psychotherapy as medicine, others focus on psychological aspects.
As an example of a medical approach to understanding psychotherapy, we can cite the following definitions, which necessarily include such concepts as therapeutic effects, patient, health or illness. Psychotherapy is “a system of therapeutic effects on the psyche and, through the psyche, on the human body”; “the process of therapeutic influence on the psyche of a patient or a group of patients, combining treatment and education,” etc.
However, the term psychotherapy did not become a purely medical concept. Psychotherapists who are not doctors by education or occupation activities, they put forward a different - philosophical and psychological - model of psychotherapy, which is based on the primary meaning of this word - “healing by the soul” (psychotherapy - from the Greek. psyche– soul and therapy- treatment).
The main goal of this approach is not a cure for mental disorders, but assistance in the process of formation of consciousness and personality, in which the psychotherapist appears as the patient’s companion, friend and mentor. The conditions necessary for the successful work of a psychotherapist are not so much the presence of a special (medical) education that allows him to make the correct diagnosis and prescribe one or another method of treatment, but rather a non-judgmental attitude towards the client and acceptance of him as he is, compassion and empathy for him, as well as sincerity and honesty of behavior. The consequence of this understanding of psychotherapy is the spread of its methods in various fields in pedagogy, social work, applied psychology, etc.
As definitions that largely capture psychological approaches and include such concepts as interpersonal interaction, psychological means, psychological problems and conflicts, relationships, attitudes, emotions, behavior, the following can be indicated: psychotherapy is “a special type of interpersonal interaction in which patients professional assistance is provided through psychological means in solving problems and difficulties of a psychological nature that arise”; “a tool that uses verbal techniques and interpersonal relationships to help a person modify attitudes and behaviors that are intellectually, socially, or emotionally negative,” etc.
Although it is quite general, the definition of S. Kratochvil to some extent unites these two approaches: “Psychotherapy is the purposeful regulation of the disturbed activity of the body by psychological means.”
Emphasizing the versatility of psychotherapy, S. Leder points to possible ideas about psychotherapy:
1) as a method of treatment that affects the state and functioning of the body in the areas of mental and somatic activity;
2) as a method of exerting influence or influence that sets in motion the learning process;
3) as a method of instrumental manipulation serving the purposes of social control;
4) as a complex of phenomena occurring during the interaction and communication of people.
The first definition is based on the medical model, the second is associated with psychological concepts, the third with sociological concepts, and the fourth with philosophy. Models of psychotherapy will be discussed in more detail below.
The lack of clarity of definitions is explained by another circumstance: psychotherapists work in an environment that encourages diversity of approaches and passion in their numbers. At the dawn of the development of psychotherapy, the only recognized approach was psychoanalysis, then behavioral and humanistic approaches gained recognition. As a result, new areas of psychotherapy began to emerge with astonishing speed, making it even more difficult to establish the basic parameters of psychotherapy.
Having examined the issues on which there is agreement regarding the essence of psychotherapy, we can give the following definition of psychotherapy without regard to any particular theory: Psychotherapy is a process whose goal is to bring about change. This process occurs within a professional relationship characterized by contractual obligations between the parties involved, trust and empathy. During this process, the focus is on the client's personality, psychotherapy technique, or both. The result is lasting change in numerous areas of the client's life.
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Main
1. Abramova, G.S. Practical psychology: Textbook for university students / G.S. Abramova. – M.: Academic Project, 2001. – 480 p. 2. Bondarenko, A.F. Psychological assistance: theory and practice
Additional
1. Bityanova, M.R. Organization of psychological work at school / M.R. Bityanova. – M.: Perfection, 1998. – 298 p. 2. Vachkov, I.V. Psychology of training work: Content, organizational