Cognitive-behavioral psychotherapy. Cognitive Psychotherapy

This method of psychotherapy appeals to consciousness and helps to get rid of stereotypes and preconceived ideas that deprive us of the freedom of choice and push us to act according to a pattern. The method allows, if necessary, to correct the unconscious, "automatic" conclusions of the patient. He perceives them as truth, but in reality they can greatly distort real events. These thoughts often become the source of painful emotions, inappropriate behavior, depression, anxiety disorders, and other illnesses.

Operating principle

Therapy is based on the joint work of the therapist and the patient. The therapist does not teach the patient how to think correctly, but together with him understands whether the habitual type of thinking helps him or hinders him. The key to success is the active participation of the patient, who will not only work in sessions, but also do homework.

If at the beginning therapy focuses only on the symptoms and complaints of the patient, then gradually it begins to affect the unconscious areas of thinking - deep-seated beliefs, as well as childhood events that influenced their formation. The principle of feedback is important - the therapist constantly checks how the patient understands what is happening in therapy, and discusses possible errors with him.

Progress

The patient, together with the psychotherapist, find out under what circumstances the problem manifests itself: how “automatic thoughts” arise and how they affect his ideas, experiences and behavior. In the first session, the therapist only listens carefully to the patient, and in the next they discuss in detail the patient's thoughts and behavior in numerous everyday situations: what does he think about when he wakes up? What about breakfast? The goal is to make a list of moments and situations that cause anxiety.

Then the therapist and the patient plan a program of work. It includes tasks to be performed in places or circumstances that cause anxiety - take the elevator, dine in a public place ... These exercises allow you to consolidate new skills and gradually change behavior. A person learns to be less rigid and categorical, to see different facets of a problem situation.

The therapist constantly asks questions and explains points that will help the patient understand the problem. Each session is different from the previous one, because each time the patient moves forward a little and gets used to living without the support of the therapist in accordance with new, more flexible views.

Instead of "reading" other people's thoughts, a person learns to distinguish his own, begins to behave differently, and as a result, his emotional state also changes. He calms down, feels more alive and free. He begins to be friends with himself and stops judging himself and other people.

In what cases is it necessary?

Cognitive therapy is effective in dealing with depression, panic attacks, social anxiety, obsessive-compulsive disorder, and eating disorders. This method is also used to treat alcoholism, drug addiction and even schizophrenia (as a supportive method). At the same time, cognitive therapy is also suitable for dealing with low self-esteem, relationship difficulties, perfectionism, and procrastination.

It can be used both in individual work and in work with families. But it is not suitable for those patients who are not ready to take an active part in the work and expect the therapist to give advice or simply interpret what is happening.

How long does therapy take? How much does it cost?

The number of meetings depends on the willingness of the client to work, on the complexity of the problem and the conditions of his life. Each session lasts 50 minutes. The course of therapy is from 5-10 sessions 1-2 times a week. In some cases, therapy can last longer than six months. A consultation with a cognitive psychologist costs from 2,000 to 4,000 rubles.

History of the method

1913. American psychologist John Watson publishes his first articles on behaviorism (eng. behavior - behavior). He urges his colleagues to focus exclusively on the study of human behavior, on the study of the connection "external stimulus - external reaction (behavior)".

1960s The founder of rational-emotional psychotherapy, the American psychologist Albert Ellis, declares the importance of an intermediate link in this chain - our thoughts and ideas (cognitions). His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various therapies, he came to the conclusion that our emotions and our behavior depend on the style of our thinking. Aaron Beck became the founder of cognitive-behavioral (or simply cognitive) psychotherapy.

Psychology has today a wide interest among ordinary people. However, the real techniques and exercises are carried out by specialists who understand what they use all the methods for. One of the areas of work with a client is cognitive psychotherapy.

Specialists of cognitive psychotherapy consider a person as an individual personality that shapes his life depending on what he pays attention to, how he looks at the world, how he interprets certain events. The world is the same for all people, but what people themselves think about it may differ in different opinions.

In order to know why certain events, sensations, experiences occur to a person, it is necessary to deal with his ideas, attitude, views and reasoning. This is what cognitive psychologists do.

Cognitive psychotherapy helps a person deal with their personal problems. These can be individual experiences or situations: problems in the family or at work, self-doubt, low self-esteem, etc. It is used to eliminate stressful experiences as a result of disasters, violence, wars. It can be used both individually and when working with families.

What is cognitive psychotherapy?

In psychology, many techniques are used on how to help a client. One of these areas is cognitive psychotherapy. What it is? This is a purposeful, structured, directive, short-term conversation aimed at transforming the inner "I" of a person, which is manifested in the sensation of these transformations and new behaviors.

That is why one can often come across such a name as cognitive behavioral therapy, where a person not only considers his situation, studies its components, puts forward new ideas for changing himself, but also practices new actions that will support new qualities and characteristics that he develops himself.

Cognitive Behavioral Therapy performs many useful functions that help healthy people transform their own lives:

First, a person is taught a realistic perception of the events that happen to him. Many problems are taken from the fact that a person distorts the interpretation of events happening to him. Together with the psychotherapist, the person reinterprets what happened, now being able to see where the distortion occurs. Along with the development of adequate behavior, there is a transformation of actions that become consistent with situations.
Second, you can change your future. It depends solely on the decisions and actions that a person makes. By changing your behavior, you can change your entire future.
Thirdly, the development of new models of behavior. Here the psychotherapist not only transforms the personality, but also supports it in these transformations.
Fourth, fixing the result. For a positive outcome to exist, you need to be able to maintain and maintain it.

Cognitive psychotherapy uses many methods, exercises and techniques that are applied at different stages. They are ideally combined with other directions in psychotherapy, supplementing or replacing them. Thus, the therapist can use several directions at the same time, if this helps in achieving the goal.

Beck's Cognitive Psychotherapy

One of the directions in psychotherapy is called cognitive therapy, the founder of which was Aaron Beck. It was he who created the idea, which is the main one in all cognitive psychotherapy - the problems that arise in a person's life are the wrong worldview and attitudes.

Various events happen in the life of each individual. Much depends on how a person perceives the promises of external circumstances. The thoughts that arise are of a certain nature, provoking the corresponding emotions and, as a result, the actions that a person performs.

Aaron Beck did not consider the world to be bad, but people's views of the world as negative and wrong. It is they who form the emotions that others experience, and the actions that are then performed. It is actions that affect how events unfold further in the life of each person.

Mental pathology, according to Beck, occurs when a person distorts external circumstances in his own mind. An example would be working with people who have suffered from depression. Aaron Beck found that all depressed individuals had the following thoughts: inadequacy, hopelessness, and defeatism. Thus, Beck brought out the idea that a depressive state occurs in those who comprehend the world through 3 categories:

Hopelessness, when a person sees his future exclusively in gloomy colors.
Negative view, when the individual perceives the current circumstances exclusively from a negative point of view, although for some people they may cause pleasure.
Reduced self-esteem, when a person perceives himself as helpless, worthless, insolvent.

Mechanisms that help in correcting cognitive attitudes are self-control, role-playing games, homework, modeling, etc.

Aaron Beck worked with Freeman mostly on people with personality disorders. They were convinced that every disorder is the result of certain beliefs and strategies. If you identify thoughts, patterns, patterns and actions that automatically appear in your head in people with a specific personality disorder, you can correct them by transforming your personality. This can be done by re-experiencing traumatic situations or by using the imagination.

In psychotherapeutic practice, Beck and Freeman considered important a friendly atmosphere between the client and the specialist. The client should have no resistance to what the therapist is doing.

The ultimate goal of cognitive psychotherapy is to identify destructive thoughts and transform the personality by eliminating them. What is important is not what the client thinks, but how he thinks, reasons, what mental patterns he uses. They should be transformed.

Methods of cognitive psychotherapy

Since a person’s problems are the result of his incorrect perception of what is happening, inferences and automatic thoughts, the validity of which he does not even think about, the methods of cognitive psychotherapy are:

Imagination.
Fight negative thoughts.
Secondary experience of childhood traumatic situations.
Finding alternative strategies for perceiving the problem.

Much depends on the emotional experience that the person has experienced. Cognitive therapy helps in forgetting or learning new things. Thus, each client is invited to transform old patterns of behavior and develop new ones. It uses not only a theoretical approach, when a person studies the situation, but also a behavioral one, when the practice of committing new actions is encouraged.

The psychotherapist directs all his efforts to identify and change the negative interpretations of the situation that the client uses. So, in a depressed state, people often talk about how good it was in the past and what they can no longer experience in the present. The psychotherapist suggests finding other examples from life when such ideas did not work, remembering all the victories over one's own depression.

Thus, the main technique is to recognize negative thoughts and modify them into others that help in solving problems.

Using the method of finding alternative ways of acting in a stressful situation, the emphasis is on the fact that a person is an ordinary and imperfect being. You don't have to win to solve a problem. You can just try your hand at solving a problem that seems problematic, accept a challenge, not be afraid to act, try. This will bring more results than the desire to win the first time.

Cognitive Psychotherapy Exercises

The way a person thinks affects how he feels, how he treats himself and others, what decisions he makes and actions he performs. People perceive the same situation differently. If only one facet stands out, then this significantly impoverishes the life of a person who cannot be flexible in his thinking and actions. This is why cognitive psychotherapy exercises become effective.

There are a large number of them. All of them can look like homework, when a person reinforces in real life new skills acquired and developed in sessions with a psychotherapist.

All people from childhood are taught to unambiguous thinking. For example, "If I can't do anything, then I'm a failure." In fact, such thinking limits the behavior of a person who is now not even going to attempt to refute it.

Exercise "Fifth column".

In the first column on a piece of paper, write down the situation that is problematic for you.
In the second column, write down the feelings and emotions that you have in this situation.
In the third column, write down the “automatic thoughts” that often flash through your mind in this situation.
In the fourth column, write down the beliefs that trigger these "automatic thoughts" in you. What attitudes are you guided by, because of what you think this way?
In the fifth column, write down the thoughts, beliefs, attitudes, positive statements that refute the ideas from the fourth column.

After identifying automatic thoughts, it is proposed to perform various exercises where a person will be able to change his attitudes by performing other actions, and not those that he did before. Then it is proposed to perform these actions in real conditions in order to see what result will be achieved.

Cognitive Psychotherapy Techniques

When using cognitive therapy, three techniques are actually used: Beck's cognitive psychotherapy, Ellis's rational-emotive concept, and Glasser's realistic concept. The client mentally argues, performs exercises, experiments, fixes models at the level of behavior.

Cognitive psychotherapy aims to teach the client to:

Identification of negative automatic thoughts.
Finding the connection between affects, knowledge and actions.
Finding arguments "for" and "against" automatic thoughts.
Learning to identify negative thoughts and attitudes that lead to wrong behavior and negative experiences.

For the most part, people expect a negative outcome of events. That is why he has fears, panic attacks, negative emotions, which make him not act, run away, fence off. Cognitive psychotherapy helps in identifying attitudes and understanding how they affect the behavior and life of the person himself. In all his misfortunes, the individual is guilty himself, which he does not notice and continues to live unhappily.

Outcome

Even a healthy person can use the services of a cognitive psychotherapist. Absolutely all people have some kind of personal problems with which he cannot cope on his own. The result of unresolved problems is depression, dissatisfaction with life, dissatisfaction with oneself.

If there is a desire to get rid of an unhappy life and negative experiences, then you can use the techniques, methods and exercises of cognitive psychotherapy, which transforms people's lives, changing it.

In the experiences of people, themes of hopelessness, a gloomy perception of the world and dissatisfaction with oneself often sound. Cognitive psychotherapy helps to identify established stereotypes through working with thinking and replacing "automatic" negative thoughts with positive ones. The patient is an active participant in the therapy process.

Cognitive Therapy - What is it?

Aaron Beck, an American psychotherapist, one of the founders of the direction in 1954, while studying depression in the framework of psychoanalysis, did not receive any encouraging reliable results. Thus, a new direction of psychotherapeutic assistance for panic attacks, depression, and various addictions appeared. Cognitive therapy is a short-term method aimed at recognizing negative thought patterns that lead a person to suffering and replacing them with constructive thoughts. The client learns a new perception, begins to believe in himself and think positively.

Methods of cognitive psychotherapy

The therapist initially negotiates and establishes a relationship based on cooperation with the patient. A list of target problems is formed in order of the significance of the study for the patient, automatic negative thoughts are revealed. Methods of cognitive-behavioral therapy cause positive changes at a fairly deep level, include:

struggle with negative thoughts (“this is pointless”, “this is useless”, “nothing good will come of this”, “unworthy of being happy”);
alternative ways of perceiving the problem;
rethinking or living a traumatic experience from the past that affects the present and the patient does not adequately assess reality.

Cognitive Psychotherapy Techniques

The therapist encourages the patient to actively participate fully in therapy. The goal of the therapist is to convey to the client that he is unhappy with his old beliefs, there is an alternative to start thinking in a new way, to take responsibility for his thoughts, state, behavior. Homework is required. Cognitive therapy for personality disorders includes a number of techniques:

Tracking and recording negative thoughts, attitudes when you need to take some important action. The patient writes down on paper in order of priority the thoughts that come up during the decision.
Keeping a diary. During the day, the thoughts that most often occur in the patient are recorded. A diary helps you keep track of thoughts that affect your well-being.
Testing the Negative Install in Action. If the patient claims that "he is not capable of anything," the therapist encourages small successful actions to begin with, then complicates the tasks.
Catharsis. Technique of living emotions from the state. If the patient is sad, in self-loathing, the therapist suggests expressing the sadness, for example, by crying.
Imagination. The patient is afraid or not confident in his abilities in order to perform an action. The therapist encourages you to imagine and try.
Three column method. The patient writes in columns: situation-negative thought-corrective (positive) thought. The technique is useful for learning the skill of replacing a negative thought with a positive one.
Recording the events of the day. The patient may believe that people are aggressive towards him. The therapist suggests keeping a list of observations, where to put "+" "-", during the day with each interaction with people.

Cognitive Therapy - Exercises

A stable result and success in therapy is ensured by the consolidation of new constructive attitudes and thoughts. The client completes homework and exercises that the therapist will assign him: relaxation, tracking pleasant events, learning new behaviors and self-change skills. Cognitive psychotherapy exercises for self-confidence are necessary for patients with high anxiety and in a state of depression from dissatisfaction with themselves. In the course of working out the desired “self-image”, a person tries on and tries different behaviors.

Cognitive therapy for social phobia

Fear and high unreasonable anxiety prevent a person from performing his social functions normally. Social phobia is a fairly common disorder. Cognitive psychotherapy for social phobia helps to identify the "benefits" of such thinking. Exercises are tailored to the specific problems of the patient: fear of leaving the house, and so on.

Cognitive Addiction Therapy

Alcoholism, drug addiction are diseases caused by a genetic factor, sometimes it is a behavior model of people who do not know how to solve problems and see stress relief in the use of psychoactive substances, without solving the problems themselves. Cognitive behavioral psychotherapy for addictions is aimed at identifying triggers (situations, people, thoughts) that trigger the mechanism of use. Cognitive therapy successfully helps a person cope with addictions through awareness of thoughts, working through situations and changing behavior.

Cognitive Behavioral Therapy - Best Books

People may not always be able to seek help from a specialist. Techniques and methods of well-known psychotherapists can help to independently move forward on the path to solving some problems, but will not replace the psychotherapist himself. Cognitive behavioral therapy books:

"Cognitive therapy for depression" A. Beck, Arthur Freeman.
"Cognitive psychotherapy of personality disorders" A. Beck.
"Psychotraining according to the method of Albert Ellis" A. Ellis.
"The practice of rational-emotional behavioral psychotherapy" A. Ellis.
"Methods of behavioral therapy" V. Meyer, E. Chesser.
"Guide to Cognitive Behavioral Therapy" S. Kharitonov.

Today, the correction of any psychological problems is carried out using a variety of techniques. One of the most progressive and effective is cognitive behavioral therapy (CBT). Let's see how this technique works, what it is and in what cases it is most effective.

The cognitive approach proceeds from the assumption that all psychological problems are caused by the thoughts and beliefs of the person himself.

Cognitive-behavioral psychotherapy is a direction that originates in the middle of the 20th century and today it is only being improved every day. The basis of CBT is the belief that it is human nature to make mistakes in the course of life. That is why any information can cause certain changes in the mental or behavioral activity of a person. The situation gives rise to thoughts, which in turn contribute to the development of certain feelings, and those already become the basis of behavior in a particular case. The behavior then creates a new situation and the cycle repeats.

A vivid example can be a situation in which a person is sure of his insolvency and impotence. In every difficult situation, he experiences these feelings, gets nervous and despairs, and, as a result, tries to avoid making a decision and cannot realize his desires. Often the cause of neurosis and other similar problems becomes an intrapersonal conflict. Cognitive-behavioral psychotherapy helps to identify the initial source of the current situation, depression and experiences of the patient, and then resolve the problem. The skill of changing one's negative behavior and stereotype of thinking becomes available to a person, which positively affects both the emotional state and the physical state.

Intrapersonal conflict is one of the most common causes of psychological problems.

CBT has several goals at once:

stop and permanently get rid of the symptoms of a neuropsychiatric disorder;
to achieve a minimum likelihood of recurrence of the disease;
help improve the effectiveness of prescribed drugs;
eliminate negative and erroneous stereotypes of thinking and behavior, attitudes;
solve problems of interpersonal interaction.

Cognitive behavioral therapy is effective for a wide variety of disorders and psychological problems. But most often it is used if the patient needs quick help and short-term treatment.

For example, CBT is used for deviations in eating behavior, problems with drugs and alcohol, inability to restrain and live emotions, depression, increased anxiety, various phobias and fears.

Contraindications to the use of cognitive-behavioral psychotherapy can only be severe mental disorders that require the use of medications and other regulatory actions that seriously threaten the life and health of the patient, as well as his loved ones and others.

Experts cannot say exactly at what age cognitive-behavioral psychotherapy is used, since this parameter will be different depending on the situation and the methods of working with the patient selected by the doctor. Nevertheless, if necessary, such sessions and diagnostics are possible both in childhood and in adolescence.

The use of CBT for severe mental disorders is unacceptable; special drugs are used for this

The main principles of cognitive-behavioral psychotherapy are the following factors:

The person's awareness of the problem.
Formation of an alternative pattern of actions and actions.
Consolidation of new stereotypes of thinking and testing them in everyday life.

It is important to remember that both parties are responsible for the result of such therapy: the doctor and the patient. It is their well-coordinated work that will achieve the maximum effect and significantly improve a person's life, bring it to a new level.

Advantages of the technique

The main advantage of cognitive-behavioral psychotherapy can be considered a visible result that affects all areas of the patient's life. The specialist finds out exactly what attitudes and thoughts negatively affect the feelings, emotions and behavior of a person, helps to critically perceive and analyze them, and then learn how to replace negative stereotypes with positive ones.

Based on the skills developed, the patient creates a new way of thinking that corrects the response to specific situations and the patient's perception of them, changes behavior. Cognitive Behavioral Therapy helps to get rid of many problems that cause discomfort and suffering to the person himself and his loved ones. For example, in this way you can cope with alcohol and drug addiction, some phobias, fears, part with shyness and indecision. The duration of the course is most often not very long - about 3-4 months. Sometimes it may take much more time, but in each case this issue is resolved on an individual basis.

Cognitive-behavioral therapy helps to cope with anxieties and fears of a person

It is only important to remember that cognitive behavioral therapy has a positive effect only when the patient himself has decided to change and is ready to trust and work with a specialist. In other situations, as well as in especially severe mental illnesses, such as schizophrenia, this technique is not used.

Types of therapy

The methods of cognitive-behavioral psychotherapy depend on the specific situation and the patient's problem, and pursue a specific goal. The main thing for a specialist is to get to the bottom of the patient's problem, to teach a person positive thinking and ways of behaving in such a case. The most commonly used methods of cognitive-behavioral psychotherapy can be considered the following:

Cognitive psychotherapy, in which a person experiences insecurity and fear, perceives life as a series of failures. At the same time, the specialist helps the patient develop a positive attitude towards himself, help him accept himself with all his shortcomings, gain strength and hope.
reciprocal inhibition. All negative emotions and feelings are replaced by other more positive ones during the session. Therefore, they cease to have such a negative impact on human behavior and life. For example, fear and anger are replaced by relaxation.
Rational-emotive psychotherapy. At the same time, a specialist helps a person to realize the fact that all thoughts and actions must be coordinated with life realities. And unrealizable dreams are the path to depression and neurosis.
Self control. When working with this technique, the reaction and behavior of a person in certain situations is fixed. This method works with unmotivated outbursts of aggression and other inadequate reactions.
Stop tap technique and anxiety control. At the same time, the person himself says “Stop” to his negative thoughts and actions.
Relaxation. This technique is often used in combination with others to completely relax the patient, create a trusting relationship with a specialist, and more productive work.
Self instructions. This technique consists in the creation by the person himself of a number of tasks and their independent solution in a positive way.
Introspection. In this case, a diary can be kept, which will help in tracking the source of the problem and negative emotions.
Research and analysis of threatening consequences. A person with negative thoughts changes them to positive ones, based on the expected results of the development of the situation.
Method of finding advantages and disadvantages. The patient himself or together with a specialist analyzes the situation and his emotions in it, analyzes all the advantages and disadvantages, draws positive conclusions or looks for ways to solve the problem.
paradoxical intention. This technique was developed by the Austrian psychiatrist Viktor Frankl and consists in the fact that the patient is invited to live a frightening or problematic situation over and over again in his feelings and did the opposite. For example, if he is afraid to fall asleep, then the doctor advises not to try to do this, but to stay awake as much as possible. At the same time, after a while, a person stops experiencing negative emotions associated with sleep.

Some of these types of cognitive-behavioral psychotherapy can be done on their own or can be done as "homework" after a session with a specialist. And in working with other methods, one cannot do without the help and presence of a doctor.

Self-observation is considered one of the types of cognitive-behavioral psychotherapy

Techniques of Cognitive Behavioral Therapy

Cognitive-behavioral psychotherapy techniques can be varied. Here are the most commonly used ones:

keeping a diary where the patient will write down his thoughts, emotions and situations preceding them, as well as everything exciting during the day;
reframing, in which, by asking leading questions, the doctor helps to change the patient's stereotypes in a positive direction;
examples from the literature, when the doctor tells and gives specific examples of literary characters and their actions in the current situation;
empirical way, when a specialist offers a person several ways to try out certain solutions in life and leads him to positive thinking;
role reversal, when a person is invited to stand "on the other side of the barricades" and feel like the one with whom he has a conflict situation;
evoked emotions, such as anger, fear, laughter;
positive imagination and analysis of the consequences of a particular choice of a person.

Psychotherapy by Aaron Beck

Aaron Beck- An American psychotherapist who examined and observed people suffering from neurotic depression, and concluded that depression and various neuroses develop in such people:

having a negative view of everything that happens in the present, even if it can bring positive emotions;
having a feeling of powerlessness to change something and hopelessness, when, when imagining the future, a person draws only negative events;
suffering from low self-esteem and reduced self-esteem.

Aaron Beck used a variety of methods in his therapy. All of them were aimed at identifying a specific problem both on the part of the specialist and the patient, and then looking for a solution to these problems without correcting the specific qualities of a person.

Aaron Beck is an outstanding American psychotherapist, creator of cognitive psychotherapy.

In Beck's Cognitive Behavioral Therapy for personality disorders and other problems, the patient and therapist collaborate in an experimental test of the patient's negative judgments and stereotypes, and the session itself is a series of questions and answers to them. Each of the questions is aimed at promoting the patient to find out and realize the problem, to find ways to solve it. Also, a person begins to understand where his destructive behavior and mental messages lead, together with a doctor or independently collects the necessary information and checks it in practice. In a word, cognitive-behavioral psychotherapy according to Aaron Beck is a training or structured training that allows you to detect negative thoughts in time, find all the pros and cons, change the behavior pattern to one that will give positive results.

What happens during a session

Of great importance in the results of therapy is the choice of a suitable specialist. The doctor must have a diploma and documents permitting activity. Then a contract is concluded between the two parties, which specifies all the main points, including the details of the sessions, their duration and number, conditions and time of meetings.

Therapy session must be conducted by a licensed professional

Also in this document, the main goals of cognitive-behavioral therapy are prescribed, if possible, the desired result. The course of therapy itself can be short-term (15 sessions per hour) or longer (more than 40 sessions per hour). After the end of the diagnosis and getting to know the patient, the doctor draws up an individual plan of work with him and the timing of consultation meetings.

As you can see, the main task of a specialist in the cognitive-behavioral direction of psychotherapy is considered not only to observe the patient, to find out the origins of the problem, but also explaining one's opinion on the current situation to the person himself, helping him to understand and build new mental and behavioral stereotypes. To increase the effect of such psychotherapy and consolidate the result, the doctor can give the patient special exercises and "homework", use various techniques that can help the patient continue to act and develop in a positive direction independently.