Who doesn't benefit from psychotherapy? I don’t want anything: When vitality is at zero. Depression: signs, types and treatments

I recently went for the first time in my life in a kayak, a two-seater plastic boat where each rower controls a paddle with two blades. The oar is taken in the middle in both hands (elbows at right angles, shoulder width apart) and alternating strokes are made synchronously with the partner ("left", "right", "left", "right"...). In order to correct the course, you need to make several rows on one side only (if you want to turn right, row left, and vice versa).

As we sailed along the rocks, the waves periodically carried us to a dangerous shore and it became necessary to turn the kayak around a little. As soon as I saw that the rocks were getting a little closer, I began to actively row away from them, but the boat seemed to not listen to me and continued to rush towards the shore. I was silently angry at my partner, who seemed not to notice my efforts and dangerous course and continued to rhythmically alternate strokes. It seemed to me that it was because of him that it was so difficult for me to try to turn. My shoulders were already aching from the unusual load, and the rocks were getting closer. In desperation, I was about to shout to my partner to start turning too, but then suddenly the bow of the boat changed direction, and now we were being carried into the open sea. Probably, if someone looked at us from above, the zig-zag trajectory of our movement would look funny.

On the shore, in response to my surprised complaints, “It’s like she’s not listening to me, I don’t understand at all whether I’m rowing correctly! It’s like she’s turning on her own!” my partner explained to me that even such a small vessel has its own inertia: our acceleration plus the density of the water and sea current. There was an effect from my efforts, it just didn’t become visible right away. It turns out that waiting quick results(like on my usual scooter on the city asphalt), I made a lot of extra strokes, losing hope and the feeling that something depended on me here, and then this powerlessness was reinforced by a sudden (for me) sharp turn boats in the opposite direction and the need to correct the course again.

The feeling of complete disorientation, powerlessness, despair and exhaustion reminded me of the state that often visits a client during psychotherapy. “What’s going on and is anything changing?!” - a familiar question that sounds periodically in the head of a person who once again leaves the therapist’s office. “What am I doing here? What’s the point of this? I just walk, talk, spend money, but nothing changes in my life!”

A psychotherapist familiar with these devaluing complaints about own experience, sighs sympathetically. Sometimes, even knowing that many processes go on in the depths and are hidden from view, you lose patience and hope - changes happen so slowly and elusively, and sometimes everything changes in a different way and in the wrong place than you expected. Why is this happening?

Here, the well-known metaphor of the psyche as an iceberg in an endless ocean seems quite appropriate to me (although the image of the client as a person trying to row on an iceberg raises certain questions). And yet, try to imagine the degree of resistance and inertia (delayed result) when trying to move such a mass hidden under water.

A person who denies or is unaware of what percentage of his mental material is hidden from awareness and how powerful an influence it has on his life is doomed to rush around in despair, constantly giving up what he started, or to remain in the illusion of complete control.

If we develop this image, then the best thing a client can do for himself in therapy is:

If possible, stroke evenly in one direction, giving yourself the right to rest, but not forgetting about the original goal (say, not to freeze alone on your block of ice). That is, patiently and regularly attend sessions, making efforts to internal work;
Accompanied by a more experienced instructor (therapist), carefully dive and explore the scale and features of the underwater part of your iceberg (psyche). Of course, you won’t dive particularly deep, but you can get some idea;
Come to terms with reality: an iceberg is not a Ferrari, it will float slowly and with great effort; It will often feel like nothing is changing, and that's okay.
Trust the ocean and your own intuitive (unconscious) power. That is, do not try feverishly to control everything with the superficial mind, accepting that there is something much deeper and wiser;
To notice that life is not only about “when we arrive,” but also here and now. Moreover, our iceberg is with us forever. Look how beautiful it is.

Help, “fixing” a situation, healing from trauma, living through difficult feelings, identifying recurring scenarios and changing them - this is just a small list of sample requests from potential clients.

However, even before you step into this world called “psychotherapy,” it is important to understand how it helps a person, and whether psychotherapy will help specifically in your case.

Basic ideas for helping in psychotherapy

It is important to understand that today there are two areas of psychotherapy: medical (clinical) and non-medical (non-clinical). In the first case, the person who comes to the reception is patient, in the second – client.

Let's take a look at Wikipedia:

...the order of the Ministry of Health defines the specialty “psychotherapist”. This is the face with the highest medical education in the specialty “general medicine”, who received training in the specialty “psychiatry”. For brevity, they are often called simply “psychotherapist”.

At the same time, the word “psychotherapist” is used to designate persons who have received education in the field of one of the methods of psychotherapeutic practice. These are people with higher psychological (but not medical) education, which is similar to some European countries where “psychotherapists” are liberal arts education, not tied to medical.

1. If no appointment required medicines, then the most common choice is the second option.

One more point: how will the psychotherapist help? If you prefer clear schemes for solving problems, if you need a person who will “show the right way”, your choice is directive psychotherapy. If you are ready to accept its quality, then it is non-directive.

2. Both options have the right to exist, but what the help will be is up to you to decide.

Third nuance: group or personal work? Each direction has its pros and cons. One-on-one with a psychotherapist, you can raise very personal, deep questions and topics. But in a group you are freed from the “one glance” effect - that is, you can rely on several views at once.

3. If it is important for you that psychotherapy helps with “group” tasks (as I act in society, in a group), if a lot of feedback is important to you, it will be useful for you, and for solving personal problems – .

How does psychotherapy usually help?

1. Find a way out of the “mental refuge”, greater mental freedom.

Unless we are talking about disorders, but simply about the “average person”, exhausted by activities and experiences, then psychotherapy helps:

reconsider their (often too rigid, or irrelevant, or mutually conflicting) attitudes, beliefs, principles,
study different experiences(in a group, based on the knowledge of the psychotherapist),
clarify what is hidden behind certain concepts

For example, friendship: should it always be “strong”? Maybe, in some cases, a friendly relationship will be enough for you personally? Love: what do you mean by that? Are you sure that you can really live your whole life with one person? What are you ready to “put on the altar of love”, what can you give up in life for the sake of an ephemeral concept? Do you differentiate between love and infatuation, vigilance and total control, close relationships and erotic tension?

understand, to what extent you live your life, do you make choices about what is important to you in this life or not,
define, are you hiding in your Everyday life: in alcohol, in work, in reading, in thinking, in the pursuit of achievements, in relationships (“build a family”, “save your husband / wife”) from real life.

2. Live through the old things.

Previous experience is often “frozen”: then a person is faced with the same scenarios. A classic example is the joke “if the fifth husband hits you in the face.” And yes, it’s not about the face, but about an as yet undefined need.

For example, “to be a good man”, “do everything right”, “endure for the sake of something”, “build a family like your parents”, “make sure that all men / women are …”

Finding the “false path” along which a person again and again enters the next round of “walking in a circle” is a worthy task for psychotherapy. Find, realize the need (true) behind it, live out the feelings, the situation, And…

3. Try something new!

How much could you do in life if not... when you could... so that you would like and could...

Instead of once again dreaming of “going back to Paris”, it is quite possible to try a new experience in safe conditions. Often this experience becomes:

living aggression(it turns out that you can say: I don’t like you, move away! I don’t want / won’t! I want to understand you, finally! I get angry when you say this!)
adoption experience(it turns out that I can be accepted as I am, without the demands of “becoming the way I want you to be!”)
experience of non-evaluative judgments(step aside from “you are good / bad”, “you are suitable / you are not suitable”, “this is good / this is bad”)
experience of true intimacy(not to be confused with sexual, in which there may not be one): it turns out that you are not indifferent to someone, someone is not indifferent to you, you can live sad, joyful, interesting moments together,
interest in achievements: true instead of imaginary - if your parents wanted you to become an artist / lawyer / doctor / astronaut, it can sometimes be difficult to get to the one who feeds the true need to develop, be interested, do something and achieve important heights.

-Are you a psychologist?

-Yes.

- And what are you doing?

- In terms of?

- Any procedures, injections?

- No.

- Just talking?

-Yes.

- Well, at least you’re prescribing pills?

- No, I’m not a doctor, I’m a psychologist.

Phone conversation with a failed client

Currently, there is a certain demand for psychological assistance. This is due, firstly, (culturally and socially) to the increasing situation of uncertainty and the need for choice in modern world, and as a consequence of this - anxiety in modern man, secondly (psychologically) – by increasing the level of psychological culture of the population.

Of particular interest is the second factor – psychological, since the social and cultural factors that determine the need for psychological help have existed at all times. However, it is the emergence in the consciousness of a modern person of psychological culture - knowledge about psychology and psychological problems - that forms the latter's need for psychological help. For this reason, the first clients of the psychologist/psychotherapist after the appearance of these specialists were graduates of psychological faculties.

Psychological therapy“works” through a word that affects the client’s consciousness, in contrast to medicine, which “works” on physiological level and does not imply the patient’s involvement in healing process. Psychotherapy appeals to the client’s consciousness and presupposes a certain degree of activity, awareness, and reflexivity, that is, his involvement in the therapeutic process. Medicines act against the will of a person, regardless of whether he believes or not in their action. The impact of psychotherapy largely depends on the client’s faith in it. With some degree of convention, we can say that “Therapy is magic that works if you believe in it!”

Consequently, the client of a psychologist/psychotherapist has different requirements than the client of a doctor. If a patient needs to obediently and carefully follow the doctor’s orders for successful treatment, then there are more such requirements for the client of a psychologist/psychotherapist.

Defining a client as a person who has problems is incomplete. Not every person who has any difficulties can be classified as a client. Even if we accept the fact that every person has problems, then, perhaps, not all of them relate to problems of a psychological level. In turn, not every person who has psychological difficulties is aware of them as such.

We can consider such people as conditional or potential clients. This does not mean at all that they will rush to see you. And even if such a person ends up in your office, it is not a fact that he will automatically become your client. There are a number of other conditions, the presence of which will allow you to identify the person in your office as a client. Let's try to highlight these conditions. In my opinion they are the following:

3. Recognition of your problems as psychological problems;

4. Recognition of the fact that psychotherapy helps (the presence of elements of a psychological picture of the world);

5. Recognition of the psychologist/psychotherapist as a professional.

Only the presence of all the above conditions gives us grounds to define a person receiving an appointment with a psychologist/psychotherapist as a client. How the therapeutic contact will develop in the future depends to a large extent on the skill of the psychologist/therapist.

Let's consider examples of insufficiency (scarcity) of conditions:

1. Involuntary application for psychological help. Situation: Someone else brings (sends) a person to a psychologist (parents - child; spouse - spouse; teacher - student, etc.). Message – “Something is wrong with him... Do something with him)”;

3. Non-recognition of your problems as psychological problems. Situation: A person voluntarily comes to see a specialist, but believes that the problem he has is caused by non-psychological reasons. Message – “Give me advice, a recipe...”;

4. Not recognizing the fact that therapy helps. Situation: A person does not seek psychological help. Message – “I know your therapy...”

5. Failure to recognize the psychotherapist as a professional. Situation: A person turns to a specialist for competitive reasons. Message: “I know better...”

And one more thing, in our opinion, important condition: The client must pay for himself... Experience shows that if the client does not pay himself, then he does not accept responsibility for the therapy. Payment, as is known, creates additional motivation for work, and also gives the client a sense of autonomy from the psychologist/therapist.

Let's now try to give a working definition of a client.

A client is a person who voluntarily seeks psychological help from a specialist, identifies his problems as psychological problems, recognizes his contributions to their occurrence, and also recognizes the psychologist/therapist as a specialist who can help solve them.

Thus, a psychologist/psychotherapist will not help you if you:

Do you think that there are no psychological problems;

Don't believe in psychology/psychotherapy;

Do you think that Other people, circumstances, etc. are to blame for your problems;

Are not ready to actively engage in the process of solving their problems;

You expect ready-made advice, solutions, instructions, and recipes from a psychologist/psychotherapist.

For nonresidents, counseling and supervision via Skype is possible.

Skype
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