Methods of psychotherapeutic work. Psychotherapy with creative self-expression

Psychotherapy is the use of methods of psychological influence to treat the patient, to improve the client's sense of psychological well-being.

Traditional psychotherapeutic methods are divided into rational and suggestive psychotherapy.

Rational and explanatory psychotherapy are the most common psychotherapeutic methods. Explanatory psychotherapy is carried out, as a rule, in the form of a conversation with the patient. This method of psychotherapy was proposed by P. Dubois in 1913. Unlike other types of psychotherapy, it is not based on suggestion, but on logical reasoning. Sick in accessible form tells about the causes of the disease, with the help of persuasion, his wrong attitude to the arisen painful condition and psychotrauma.

In the work of a medical psychologist, a similar method of psychological assistance is called personality-oriented (reconstructive) psychotherapy. It is aimed at:

1) studying the personality of the patient, his emotional reactions, relationships, identifying the causes of the emergence and preservation of the neurotic state;

2) help the patient in awareness psychological reasons diseases, in changing attitudes to a traumatic situation;

3) correction of inadequate reactions and forms of behavior.

In the course of a psychotherapeutic conversation, direct or indirect questions are asked to the patient, the relationship of his condition with the patient is discussed with the patient. different situations life, features of its system of relations.

This method of psychotherapy is often carried out with a group of patients. The main form of interaction is a group discussion. The life problems of the group members are discussed. In this case, the psychotherapeutic effect is carried out by a group of patients on each member of the group under the constant supervision of a doctor or medical psychologist. The purpose of group psychotherapy is logical persuasion, reassurance, clarification. In progress group work other methods of psychotherapy are also used: role-playing, psycho-gymnastics, drawing methods and music therapy.

Suggestive psychotherapy is the impact on the patient's experiences through verbal suggestion. Suggestion in the waking state is the more effective, the more suggestible the patient is. Suggestive psychotherapy is carried out in a semi-darkened room. The patient is in comfortable posture sitting or lying down, relaxed, better with closed eyes. In this case, the patient should have a positive attitude and listen only to the psychotherapist.

Among all the methods of treatment of neuropsychiatric diseases, hypnotherapy was the first to appear. The term "hypnosis", meaning "sleep" in Greek, was proposed in 1841 by the English surgeon James Brad. Thus, the state of hypnosis was defined as dream-like. In 1866, Ambrose Liebeault's book "Sleep and Similar Conditions..." The author also considers hypnosis to be a kind of sleep - a suggested dream. Since the late 70s of the XIX century, the famous neuropathologist Jean Martin Charcot began to study the effect of hypnosis on patients suffering from hysteria.

Suggestion in a state of hypnosis is much more effective, since its action is not hindered by "criticism" from the consciousness, which in a hypnotic dream turns out to be largely turned off. Inhibition, which occurs in most of the cerebral cortex, increases the excitability of the remaining uninhibited point, where the words of the hypnotist are addressed. The action of words becomes especially effective. At the same time, it is important that the patient does not resist hypnosis, is passive and prone to submission, tuned in to the idea of ​​the need to fall asleep. The effect of treatment depends on the suggestibility of the patient. Practice has proven that suggestion carried out in a state of hypnosis is the most effective and lasts for a long time. The power of suggestion in hypnosis is great enough that it should only be carried out by specially trained physicians or clinical psychologists, with appropriate indications and with great care.

Relaxation sessions (neuromuscular relaxation) are often used as an aid in the treatment process. The main goal of relaxation classes is to achieve total relaxation muscular and nervous system, which contributes to the regulation of emotional and vegetative functions, reducing neuropsychic tension and personal anxiety. There are specially designed training systems that contribute to more successful relaxation. The best known are Jacobson's progressive muscle relaxation technique and Girdano and Everly's active neuromuscular relaxation technique. Medical psychologists teach people relaxation so that they can better cope with anxiety and excessive tension.

Autogenic training is also widely used in psychological practice. It is a person's use of self-hypnosis techniques. Autogenic training was proposed in its final form in 1932 by the German psychotherapist I.G. Schultz. In our country, it became widespread only in the 1970-80s. Psycho therapeutic effect auto-training is associated with self-hypnosis, carried out during muscle relaxation. This method can be used to relieve neuropsychic tension, emotional self-regulation, psychological adjustment, for self-hypnosis of certain thoughts and states. Autogenic training and relaxation are considered the most accessible methods of psychotherapy.

Psychoanalysis is a method of psychotherapy widely used in the world. However, in Russia it has not yet received wide distribution. Psychoanalysis was discovered by the Austrian physician Sigmund Freud. Psychoanalysis was called the theory of mental life, as well as the method of healing the soul, developed by him. In the process of treatment, the psychoanalyst helps the patient to penetrate thoughts and experiences hidden from consciousness. He tries to remove the symptoms of the patient, freeing him from unnecessary doubts, unjustified feelings of guilt, painful self-accusations, false judgments and unreasonable impulses. A full course of psychoanalysis is always a lengthy process, usually lasting at least one year with regular meetings with the psychoanalyst (three to six sessions a week, each lasting about an hour).

Psychoanalysis is used mainly for the treatment of neuroses, although it can also be used to solve life problems normal people. In recent decades, psychoanalysis has become widespread. At the same time, many of its offshoots arose, united by the concept of "depth psychology".

Nowadays almost all psychoanalysts are doctors. The most great danger is to treat a patient who is on the verge of psychosis, if the analyst is not aware of his true state. The analyst must also be careful in distinguishing neurosis from certain diseases of the brain and hormonal disorders, so as not to treat only psychological methods patients who need surgical treatment or special medications. To avoid such errors, psychoanalysts need a thorough training in medical psychiatry. Non-medical psychoanalysts solve this problem by hiring consultants and requiring a thorough medical examination of the patient before starting treatment.

Psychoanalysis is now widely recognized by society in Western Europe and America, there are educational institutes and faculties at universities that provide full-time professional training for psychoanalysts. For many decades there has been an International Psychoanalytic Association, and national associations of psychoanalysts have also been established. Psychoanalysis gained special authority in the USA and Germany. In Germany, for example, psychoanalytic therapy is officially recognized by public health insurance organizations, and the analyst is thus remunerated according to a certain rate scale for his work (Thome and Kahele, 1996, p. 12).

Many other methods of psychotherapy are also used in working with patients: collective and group psychotherapy, behavioral, game, psychodrama, art therapy, music therapy, family psychotherapy, transactional analysis, gestalt therapy (Rozhnov (ed.), 1979; Karvasarsky, 1998) . Mastering each of these methods requires special training. In total, there are currently more than 400 independent methods of psychotherapy (Karvasarsky (gen. ed.), 1998, p. 449).

The psychotherapist must know the psychotherapeutic ideas and methods of work created in different psychotherapeutic schools. The main ones are: psychoanalysis, analytical psychology K.G. Jung, individual psychology of A. Adler, body psychology of W. Reich, gestalt therapy of F. Perls, behaviorism of B. Skinner, humanistic approach of C. Rogers, transpersonal psychology of S. Grof and K. Wilber.

Each psychotherapeutic approach claims to be effective in treating almost all areas of psychopathology. The situation regarding psychotherapy, which is unique for the practical healthcare system, is that the patient turns to the doctor for help, and the choice of therapy depends not on the diagnosis or other objective characteristics of the patient's condition, but on which school of psychotherapy the doctor considers himself to be. Therefore, it is important that psychotherapists in their work be able to rely on ideas and methods developed in different psychotherapeutic schools, or be able to choose or combine them on their own.

Methods of psychotherapy

Methods of psychotherapy

The need for psychotherapeutic intervention during the treatment and rehabilitation of people addicted to alcohol and drugs is due to the very nature of the disease, which causes severe disorders at all levels and in all areas of life - physical, psychological, spiritual, social.
If drug therapy is aimed at treating physical dependence on alcohol and drugs, then psychotherapy affects the patient's personality in order to treat mental dependence. In addition, doctors, psychotherapists and psychologists strengthen a person’s attitude to continue treatment and completely refrain from using drugs and alcohol, prepare him for possible difficulties socio-psychological adaptation and talk about ways to overcome them.

Body Oriented Psychotherapy

Body-oriented psychotherapy allows you to work with the patient's problems (a syndrome of "frozen" feelings, psycho-emotional stress) through procedures body contact. The body is the shortest road to the unconscious, and therefore to the origins of problems. After completing a course of body-oriented psychotherapy, patients increase their self-confidence and self-esteem. A kind of bridge is being built between actions and emotions. A person becomes more open, sociable, stress-resistant.

Body-oriented psychotherapy allows patients to better understand the sensual part of their personality, provides an opportunity to master the necessary skills of self-control and understand the basic principles and benefits of a sober life. In addition, the methods used can be relevant in the treatment of psychosomatic disorders caused by unresolved emotional problems. You need to understand that this is not a therapeutic medical massage, where mainly pain and muscle tension are relieved at the place where the massage therapist “applied hands”, and not manual therapy, aimed at working with the musculoskeletal system and the muscular corset. This is a completely independent technique, which includes a non-contact effect on the body ( breathing practices, physical exercise).

There are no strict contraindications to body-oriented psychotherapy. But, as with other methods, this technique requires caution in the presence of a psychiatric patient.

Psychotherapeutic help

As part of psychotherapeutic assistance, psychologists conduct interviews in order to determine the patient's internal personal attitudes to refuse to use psychoactive substances; identifying the main causes and triggers of use; revealing "false" attitudes and beliefs of the patient that contribute to the continuation of his addictive behavior, or the resumption of use after a long period of sobriety. At this time, issues of intra-family relations are discussed, since family members can be unwitting "provocateurs" of the use of alcohol and drugs, etc.

rehabilitation work

During rehabilitation work, the most effective is the eclectic approach in psychotherapy, i. combination various methods psychotherapeutic help.

Personal psychologist

Each patient during treatment is accompanied by a personal psychologist who advises his ward on all issues of concern to him. Group classes help a person to understand that everything that happens to him (his fears, an uncomfortable state) is the norm and you just need to survive it. And in a personal conversation with a psychologist, a person works out the problems that led him to use, which prevent him from enjoying life. Often the patient himself does not realize what exactly worries him and only experienced specialist can help him figure it out.

Autogenic training

Autogenic training is a psychotherapeutic method of treatment that combines elements of self-hypnosis and self-regulation of impaired body functions. It is used for active self-regulation in the treatment of addictions to psychoactive substances, its purpose is to combat emotional overstrain and restore autonomic disorders.

Art therapy

Art therapy is a direction of psychotherapy based on the use of visual arts. Art therapy methods are addressed to the healthy part of the personality; due to its metaphorical, figurative nature, art therapy allows you to overcome verbal difficulties in expressing your problems, allows you to gently but effectively work with your experiences, and not only share them, see them, but also realize and form your attitude towards them. Classes are easily accepted by patients, the methods of psychotherapy used in the “lessons” contribute to increasing interest in one’s inner life, the formation of positive self-esteem, the development of creative abilities, the ability to solve social problems, as a rule, which do not have an unambiguous solution, which is productive in working with any kind of addictions .

suggestive therapy

Suggestive therapy is based on the principles of suggestion and persuasion aimed at prohibiting the use of alcohol and drugs. The prohibition is fixed by creating a stable fear of the inevitable severe and grave consequences for the patient, which will certainly arise if the patient violates this prohibition.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy is aimed at changing life values, behavioral stereotypes, habitual emotional reactions. The methods of psychotherapy used form the patient's new worldview, based on more adequate views of the surrounding reality and self-image. Directly in the process of treatment, the patient learns rational thinking.

Gestalt therapy

The goal of Gestalt therapy is to develop in the patient more easy access to his own needs, feelings and experiences, developing his ability to manage destructive emotions (fear, guilt, resentment, aggression, etc.), and the ability to interrupt unwanted contacts, restore the ability to maintain relationships in conflicts with a significant object, etc.

Method of group psychotherapy

In order to increase the effectiveness of the impact of psychotherapeutic methods, the method of group psychotherapy is widely used. Group classes have the main advantage - in groups it is much more effective to resist attempts to justify one's use for any of its members. A common problem in the form of psychoactive substance use links the interests and goals of patients. In this case, it becomes much easier for each participant in group psychotherapy to start talking and discussing their difficulties, problems, asking questions and getting answers and advice. Thus, patients have the opportunity to look at themselves and their problems "from the outside", not to feel their loneliness and powerlessness. Collaboration above various issues and aspects of life helps patients participating in group therapy sessions to assess themselves differently, to look at their behavior. Achieving a special atmosphere of trust and mutual respect contributes to the development of a different lifestyle, with certain attitudes towards recovery. Such aspirations allow you to believe in yourself and your abilities.

Cinema therapy

One type of group psychotherapy is film therapy. This method allows you to combine art and psychology into a powerful tool for self-knowledge and personal growth. It happens that a person is uncomfortable talking about his problems and about himself, but he can quite calmly and sincerely talk about the heroes of the film - empathize with them, take their side, or vice versa - consider their judgments and actions to be erroneous. In other words, unlike other methods of psychotherapy that require voicing problems in the first person, here you can easily discuss the actions of others. An experienced psychologist sees a person's personal problems in this "mirror" and helps him to speak them out.

Family Psychotherapy

Much attention in the treatment of addictions to alcohol and drugs is paid to methods of family psychotherapy, the main tasks of which are: identifying the main conflicts of spouses, reconstructing family relationships, working with codependency, adapting the family to sobriety, strengthening the patient's attitudes to sobriety, etc.

What happens to our patients through psychotherapy methods?

The patient's attitude towards himself and his illness changes;
the patient begins to see meaning in recovery;
there is a clear motivation to change the lifestyle;
the pathological craving for drugs and alcohol disappears;
patients improve the atmosphere in the family.

Medical psychology is mainly concerned with the diagnosis of psychological disorders, however, it is important not only to notice the patient's psychological problems, but also to help him cope with them. This can be done with the help of psychotherapeutic techniques, and by prescribing psychotropic drugs. Any doctor should not only know these two methods, but also be willing to use them.

Sometimes, unfortunately, noticing the psychological difficulties in his patients, the doctor notices that he himself has found himself in similar situations more than once and he managed to overcome all the problems without outside help. This thought calms the doctor and allows him to do nothing.

Indeed, some patients are highly resistant to stress and overcome it without any special psychological correction, but this cannot justify the passivity and callousness of the doctor when the patient needs his support and sympathy.

One of the most significant problems clinical psychology is the provision of psychological support. It is necessary for healthy people (clients) with a variety of everyday problems in crisis situations, as well as patients (patients) with various somatic and mental illnesses, having psychological problems, neurotic and psychosomatic disorders, as well as characterological and personality deviations.

Traditionally, there are three types of psychological assistance:

psychological counseling,

Psychocorrection,

Psychotherapy.

They represent an impact on various aspects of the personality and have different purposes and methods, can be used separately and in combination.

The main goal of psychological counseling is to inform the client (patient) about his individual characteristics in order to form a personal position, worldview and outlook on life. Counseling helps a person to act on his own, learn new behavior, promotes personality development.

At psychological counseling an analysis of the mental state of the client (or patient) is carried out using various methods of psychological diagnostics (tests, experiments). He is provided with interpretations of their results, which contributes to the resolution of the psychological problems facing a person, the formation of new approaches to solving these problems, as well as the expansion of his general psychological culture and personal growth.

The task of psychological correction is the correction (adjustment) of those personality traits that are not optimal for the client (patient), the development and mastery of skills adequate for the individual and effective mental activity that contributes to personal growth and adaptation of a person in society.

Psychological correction is based on counseling and involves a targeted psychological impact on the client (or patient), the formation of an adequate mental state, mental comfort, harmonization of his relationship with the social environment.

Psychotherapy sets the main task of stopping psychopathological symptoms, through which it is supposed to achieve internal and external harmonization of the personality. Psychotherapy is a system of methods of purposeful psychological influence on a patient (through words, emotional relationships, joint activities) in order to improve his health and increase resistance to stress.

Psychotherapy in the narrow sense of the term implies the relief of painful clinical manifestations in a patient who is in a state of crisis, frustration, stress or mental illness.

In a broad sense, the term "psychotherapy" refers to all types of targeted psychological impact on the individual (counseling, correction and therapy).

It is believed that psychotherapy belongs to the field of activity of a psychiatrist, since the psychotherapist must take into account a whole range of features - from the individual psychological characteristics of the patient to his somatic status, take into account the mandatory indications and contraindications for psychotherapy. There are practically no contraindications for counseling, and psychocorrection occupies an intermediate position between counseling and psychotherapy (the term itself psychological correction originated in the 70s of the XX century, when psychologists began to work actively in the field of group psychotherapy. Since psychotherapy is a medical practice, the spread of the term psychocorrection was aimed at overcoming this situation: the doctor is engaged in psychotherapy, and clinical psychologist- psychological correction).

Basic psychotherapeutic techniques

We can say that psychotherapy exists as long as it exists human civilization. Shamans were the prototype of modern psychotherapists. Psychotherapy developed especially rapidly in the late 19th and early 20th centuries. A huge number of new methods of psychotherapy have been proposed, and there is hardly a specialist who would be familiar with all these methods. In most civilized countries, psychotherapy is considered as one of the most complex areas of medicine and psychology.

The central figure in psychotherapy is the patient, with his individual characteristics, unmet needs, his unique life situation and specific environment (family, friends, colleagues). The doctor must never forget that he must help the patient move in the direction that the person has chosen of his own free will. You can not treat the patient like a blind, helpless kitten who needs to be taught life. It is impossible to ignore the interests of the patient's personality, treat them arrogantly ...

It is wrong to consider psychotherapy only as a process of influence of a doctor on a patient. It is almost impossible to "re-educate" an adult personality, and attempts to interfere in the patient's inner world are often perceived by the patient as aggression (psychotherapeutic intervention) and cause resistance on his part.

It is more correct to consider psychotherapy as a process of interaction between a doctor and a patient. In this sense, the psychotherapist must possess such qualities as the ability to find mutual language with others, the ability for emotional empathy, a rich inner world, one's own life experience.

The literature contains a huge number of methods of psychotherapy.

There is no generally accepted classification of psychotherapy methods. From a practical point of view, it is important to highlight some of the main features that distinguish one type of psychotherapy from another. As in medicine in general, it is common to classify treatments into symptomatic And pathogenetic.

Symptomatic methods of psychotherapy are focused on the elimination or weakening of individual symptoms of the disease, the management of the physiological functions of the body, and the optimization of the patient's behavior. These methods include rational psychotherapy, suggestive methods (in the waking state or in a state of hypnosis), methods of behavioral therapy (flooding, implosion, aversion, systematic desensitization), relaxation methods (neuromuscular relaxation according to Jacobsen, auto-training), methods of biological feedback communications and many other private methods (art therapy, psycho-gymnastics, etc.). Pathogenetic psychotherapy involves the elimination of the causes and mechanisms of the development of the disease. It is considered more effective than symptomatic, especially in long-term results. However, there are large differences in the ideas of psychologists about the goals and methods of treatment, associated with differences in theoretical views on the normal structure of the personality and the pathogenesis of diseases.

Methods of psychotherapy can also be divided into expressive(to express - express, express) and supportive(to support - support, save). These concepts are closely related to the concept of defense mechanisms. Expressive methods make it possible to identify and expose the subconscious mechanisms underlying the patient's illness, which prevent him from getting rid of the internal conflict. Expressive methods are needed to encourage the patient to take active steps (to agree to an operation, to dissolve a burdensome marriage, to change a job to a more appropriate one). It should not be forgotten that the opening, breaking of protective mechanisms is very painful, and care should be taken and the real possibilities of a person to endure this additional stress should be weighed. Supportive methods, on the contrary, strengthen the existing defense systems in a person, support the existing self-deception in him for the sake of maintaining calmness and a sense of security. The disadvantage of such methods is that they prevent the patient from seeing reality, keep him from active action. However, if the doctor himself does not see a real way out of the situation (incurable diseases, inoperable tumors, injuries incompatible with life), the only thing he can do is take care of maintaining the calm of the patient and his loved ones.

The division of psychotherapy methods into activating And relaxation. Activating (energizing) methods are aimed at increasing the desire for action, struggle, self-realization (for example, during the period of rehabilitation after an injury, heart attack or stroke, one often has to insist on a more active involvement of the patient in activities, training impaired motor and mental skills). Soothing (relaxation) methods are aimed at relieving internal tension and anxiety. They are especially useful in the acute period of experiencing stress. They are used to treat diseases associated with internal stress ( hypertonic disease, peptic ulcer, insomnia).

In addition, distinguish directive And non-directive methods. Directive methods consist in the fact that the doctor actively imposes his proposed way out of the situation, does not allow the patient to express his opinion, acts from the height of his authority. In most cases, excessive directiveness is seen as a shortcoming of psychotherapy, since it relieves the patient of responsibility for recovery, subordinates him to the will of the doctor, and can ignore his true needs. However, in extreme situations, when the patient's behavior is disorganized by excessive anxiety ( emergency hospitalization, preparation for surgery, life-threatening situation), a directive approach can be useful. In the process of recovery and rehabilitation, non-directive methods are becoming increasingly important, which are based on questioning the patient, studying his opinion, independent search and comparison of several ways out of the situation. Such methods develop independence in the patient, confidence that he himself is able to help himself if necessary.

Psychotherapy can be individually or in Group. Group techniques are useful for complex impact on the personality of the patient, revealing such traits that hinder adaptation in society and serve as a source of psychosomatic disorders. In the group, immaturity, egocentrism, and fear of taking responsibility are most clearly revealed. Individual therapy allows you to discuss very intimate problems with the patient, to pay more attention to individual symptoms. It is also good for closed patients who are not inclined to communicate.

Apart from the obvious direct methods of psychotherapeutic influence, there are indirect methods that affect the state of health through the environment of a medical institution, the atmosphere in the ward, relationships in the medical team, the form of drug administration, additional treatment methods (physiotherapy, massage, exercise therapy).

Regardless of the specific method of psychotherapy, there are general phenomena which are indispensable elements of psychotherapy.

Establishing contact it could be considered essential condition success in psychotherapy. If the doctor has not been able to establish a trusting, frank relationship with the patient, then all further efforts are likely to be fruitless. It is difficult to overestimate the importance of the first meeting between a doctor and a patient in the formation of mutual understanding and trust. The busyness of the doctor often prevents him from talking in detail with the patient on the day of his admission to the clinic. Even if this could not be done immediately, at least the next day it is necessary to give the patient maximum attention. During the first conversation, it is necessary to allow the patient to speak on his own, not to attack him with questions. You should not expect that trust will develop instantly, but a sincere desire to listen to the interlocutor gradually leads to the desired effect.

Excessive closeness of the doctor and the patient can also damage the treatment (the conflict is more difficult to resolve if you are inside it). Therefore, the doctor must maintain a certain distance to the patient's problems. To take all the problems of the patient upon oneself means to take the position of a caring mother, that is, to remove from the patient all responsibility for his recovery. In psychotherapy, on the contrary, sometimes they try to emphasize the mutual obligations of the parties in the form of an oral or written contract, which stipulates the duration of treatment, the obligations and rights of the patient and the patient, the goals of the treatment, signs of the effect achieved.

Sigmund Freud was the first to pay attention to the phenomena transfer And countertransference in psychiatry. Transference (transfer) is an involuntary direction to the doctor of repressed feelings that the patient experienced for persons significant to him (parents, other family members). This is expressed in unexpected irritation, indignation, or, on the contrary, in signs of childish affection, humility, falling in love with a doctor. The expression of such feelings allows the patient to "react", that is, to get rid of the complexes that torment him. It is important not to take them as a true attitude towards the doctor, to show patience, sympathy, understanding, and also to encourage the patient to their reasonable analysis. Countertransference (countertransference) is a similar but oppositely directed phenomenon, when the doctor experiences irrational feelings for the patient, stemming from his personal (often childhood) experience. Examples of such feelings can be indignation, disgust, pity, admiration, love. Countertransference confirms that the doctor is also a human being and nothing human is alien to him. However, as a professional psychotherapist, he must actively overcome immature complexes in himself and strive for a reasonable attitude towards the patient (for this, Freud demanded that all psychoanalysts themselves undergo psychoanalytic therapy).

Since psychotherapy is designed to change a person, the efforts of the doctor are faced with resistance, that is, the unconscious desire of a person to keep everything as it was before. Resistance is noticeable in the way the patient increasingly uses psychological defenses, moves away from a deep analysis of the problem. Sometimes the patient actively avoids meetings with the doctor, hides from him, misses appointments, protecting himself from discussing painful topics. The very discussion of the fact of resistance can be helpful for recovery.

Resistance determines that the movement towards recovery in the process of psychotherapy is never smooth and consistent. On the contrary, characteristic jumps when the thought to which the doctor directed the patient comes to him in the form of insight (insight - understanding, insight) - a sudden insight or insight, intuitive understanding.

In psychology, there are many theories of personality that interpret and explain the nature of human behavior in different ways. Each of these theories corresponds to certain therapeutic methods. The literature describes many psychotherapeutic methods: psychoanalysis, behavioral (behavioral) therapy, Gestalt therapy, psychodrama, hypnosis, neurolinguistic programming, art therapy, transactional analysis, positive therapy, etc. Abroad, three psychotherapeutic areas have received the greatest recognition and development: psychoanalytic,humanistic And behavioral, to which we can add Gestalt therapy and cognitive therapy based on the relevant psychological theory.

Directions of psychology

Currently, there are 5 main approaches (models, paradigms) to the study of the human psyche:

Behaviorism;

Gestalt psychology;

Psychoanalysis;

Humanistic psychology;

Cognitive psychology.

Behaviorism

The founder is the American psychologist John Watson (J.B. Watson, 1878-1958). The scheme S - R proposed by him means that each situation (or stimulus S) corresponds to a certain behavior (or reaction R). He believed that with the help of this scheme, any human activity can be explained, and concepts related to consciousness should be excluded from scientific psychology.

Pretty soon, the limitations of this scheme for explaining behavior became clear. As a rule, S and R are in such a complex relationship that a direct connection between them cannot be established. In 1948, Tolman introduced an intermediate variable I (the mental processes of a given individual, depending on his heredity, past experience and the nature of the stimulus) and transformed the scheme into S - I - R.

Adherents of behaviorism believe that behavior is mainly conditioned reflex and is formed as a result of learning, that is, fixing certain reactions to certain stimuli. As a result, encouraged actions are committed more often, and punished - less often. Behaviorism is psychological basis behavioral psychotherapy. The goal of behavioral therapy is to eliminate pathological symptom by replacing non-adaptive behaviors with adaptive ones in the learning process.

Gestalt psychology

The word "gestalt" has no exact equivalent either in Russian or in English language. Very roughly, its meaning, depending on the context, can be conveyed by the words “image”, “form”, “structure”, “organized whole”, therefore, in psychological texts, the word “gestalt”, as a rule, is not translated.

The main position of Gestalt psychology is that the phenomenon as a whole is not just the sum of its parts. A single part does not give any idea of ​​the whole. Human behavior broken down into individual components, loses its meaning. Followers of Gestalt psychology try to convince behaviorists that the structural organization of behavior as a whole plays a more important role than individual actions.

One of the central concepts of Gestalt psychology is the relationship between figure and ground. These and other concepts of Gestalt psychology are reflected in Gestalt therapy created by the psychologist Fritz Perls (F.S.Perls).

In Perls' understanding, the figure acts as a dominant need. As a figure (gestalt) there can be desire, thought, feeling that prevail at the moment. As soon as the need is satisfied, the gestalt ends, loses its significance, recedes into the background - the background, giving way to a new gestalt.

Sometimes a need cannot be met. In this case, the gestalt remains incomplete, and therefore cannot be reacted and cannot give way to another. In the future, this becomes the cause of many problems. For example, if a person does not immediately express his anger or aggression, then later these feelings will not disappear, but will manifest themselves in other forms.

The goal of Gestalt therapy is to help the patient recognize their need, make it clearer (form a gestalt) and ultimately satisfy it (complete the gestalt). To be oneself, to fulfill one's needs, not imposed from outside, to live "here and now" - this is the path of a healthy person.

Psychoanalysis

None of the areas of psychology has gained such loud fame as psychoanalysis. The founder is the Austrian psychiatrist Sigmund Freud (S.Freud).

In mental life, Freud singled out 3 levels: consciousness, preconsciousness and the unconscious. The unconscious and preconscious are separated from the conscious by “censorship”, which pushes thoughts, feelings, concepts that are unacceptable to the individual into the unconscious, and also resists the unconscious, which seeks to manifest itself in consciousness.

The unconscious includes many instincts that are generally inaccessible to consciousness, and also supplanted by "censorship". These thoughts and feelings are not lost, but are simply not allowed to be remembered and therefore do not appear in the mind directly, but in a roundabout way - in slips of the tongue, slips of the tongue, memory errors, dreams.

The preconscious is the part of the unconscious that can become conscious.

Freud believed that only 1/7 of the mental life is conscious, and the remaining 6/7 are manifested in obsessions, vague anxieties, fears, dreams, etc.

The term "psychotherapy" refers to a wide range of approaches and methods, from one-on-one conversations to therapy using techniques such as role-playing or dancing to explore human emotions. Some therapists work with couples, families, or groups whose members have similar problems. Psychotherapy is carried out both for teenagers and children, and for adults.

Art therapy

Art therapy combines talking therapy and creative exploration through painting, crayons, pencils, and sometimes sculpture. Techniques can also include theatrical performances, puppet shows, and movement. Sand therapy involves clients choosing toys that represent people, animals, and buildings and lining them up in an allotted "theatre in a sandbox" space. An art therapist has a comprehensive psychological understanding of the creative process and emotional properties various art materials. In this case, art is the outer expression of our inner emotions. For example, in a painting, the relationships of sizes, shapes, lines, free space, texture, hues, shadows, colors, and distances reflect the subjective reality of the client.

Art therapy is particularly well suited to clients who have difficulty verbally expressing themselves. In non-clinical settings such as art studios and workshops, a focus on creative development can be especially helpful when working with children and adolescents, as well as with adults, couples, families, groups and communities.

Art therapy is also suitable for people who have experienced trauma, such as refugees, and people who have difficulty acquiring knowledge.

Attachment based psychotherapy

Attachment-based psychotherapy is a subset of relational psychoanalysis that explores related emotional attachments from birth onwards.

This type of therapy builds on a theory that explores early childhood development and early attachments—secure, anxious, avoidant, ambivalent, or disturbed—to understand how early life experiences of problematic attachments manifested later in adult life.

Who is suitable for this type of therapy?

By working through the attachment relationship with the therapist, clients have the opportunity to mourn past losses and consider the impact of important relationships on their lives in the present and past.

Behavioral Therapy

Behavioral therapy is based on the theory that learned behavior in response to past experiences can be forgotten or reformulated without focusing on the interpretation of unusual behavior.

Who is suitable for this type of therapy?

People with obsessive and compulsive disorders, fears, phobias and addictions can benefit from this type of therapy. The emphasis is on the client achieving goals and changing their behavioral responses to problems such as stress or anxiety.

Body Therapy

Body Therapy covers a range of integrated approaches. In the context of this type of therapy, it is considered how the human body and its emotional, mental, spiritual, social and behavioral aspects of life affect each other. The whole complex of interrelations between mind and body is taken into account.

Who is suitable for this type of therapy?

Various types of body therapy, such as integral body psychotherapy, bioenergetic analysis, biodynamic psychotherapy or biodynamic massage, will help resolve issues on different levels including body, emotions, mind and spirit. Many psychological problems (such as depression, eating disorders, panic attacks, and addictions) are known to have an effect on the body.

Brief Therapy

In the context of short-term therapy, a variety of psychotherapy techniques are used. It differs from other therapeutic approaches in that it focuses on a specific problem and involves the direct intervention of the therapist working with the client in an accelerated manner. Emphasis is placed on accurate observation, the client's nature is used, and temporary inclusion of faith in the unbelievable is encouraged to allow new perspectives and different points of view to be considered.

The primary goal is to help the client look at their current circumstances in a broader context. Brief therapy is considered solution-oriented, and therapists are more interested in the current factors that prevent change than in the causes of problems. It does not apply one specific method, but different approaches, which, together or separately, can have an end result. Short-term therapy is carried out for a short time, usually at a scheduled number of sessions.

Cognitive Analytical Therapy

Cognitive analytic therapy brings together theories that explore the links between language and thought, as well as historical, cultural and social influences on human actions. Clients are encouraged to use their own resources and develop skills to change destructive patterns of behavior and negative ways of thinking and acting.

This type of therapy is short-term (16 weeks), structured and guiding. For example, the client may be asked to keep a diary or use task schedules. The therapist works collaboratively with the client, focuses on changing behavior patterns, and teaches alternative problem-solving strategies. Attention is also given to understanding the links between childhood behaviors, social influences, and their impact on the client as an adult.

Dance Movement Therapy

Dance movement therapy is an expressive form of psychotherapy based on the belief that the body and mind are interconnected. Through movement and dance, the client has the opportunity to creatively explore emotional, cognitive, physical and social cohesion.

Therapists work on the principle that movements reflect the process of thinking and feeling of each individual person. By recognizing and justifying the client's movements, the therapist encourages him to develop a new emotional experience obtained through certain adaptive movements that contribute to the solution of psychological problems.

Dance movement therapy can be practiced individually with a therapist or in a group. The client does not need to be a trained dancer to benefit from this type of therapy, as movement is an integral part of our being.

drama therapy

Drama therapy refers to the intentional use of theatrical techniques such as role-playing, theatrical play, pantomime, puppetry, speech, myths, rituals, storytelling, and other improvisation-based techniques that promote creativity, imagination, learning skills, intuitive understanding and personal growth. This extremely versatile approach provides an expressive form of therapy that can be used in a wide variety of settings, including hospitals, schools, psychiatric clinics, prisons, and organizations.

Drama therapy provides opportunities for individuals or groups to explore personal and/or community issues in a creative setting, to calmly reflect on existing beliefs, attitudes, and feelings, and to find alternative ways actions. The therapist encourages clients to introspect, reflect on, and express feelings about themselves and others.

existential psychotherapy

Existential psychotherapy helps the client to realize the meaning of life through the willingness to face it and the problems associated with it. From an existential point of view, there is no essential or predetermined meaning in life, a person is completely free and responsible for everything, so the meaning must be found or created. This can cause a sense of meaninglessness in life, so this type of therapy explores the client's experience of the human condition and seeks to clarify the person's understanding of values ​​and beliefs by directly expressing what was previously unspoken. The client is given the opportunity to live more authentically and purposefully, while accepting the limitations and contradictions of human life.

This type of therapy is considered a serious study of what a person is in general, and often it entails a painful process of directly confronting those aspects of human life that people usually try to avoid.

Family Therapy

Family therapy is a branch of psychotherapy that focuses specifically on family relationships. It is built on the premise that the problem is within the family as a whole, and not within the individual within the family. Also, this type of therapy includes therapy for couples and systemic family therapy.

Family therapy encourages change and development, as well as the joint resolution of family conflicts and problems. Emphasis is placed on how families interact with each other, the importance of a strong family for mental health and well-being. Regardless of what is the source of the problem or who exactly it is related to, the therapist seeks to involve the entire family in the process of achieving right decisions looking for constructive ways how family members can support each other through direct involvement. An experienced therapist is able to influence the conduct of dialogues in such a way as to best use the strength and wisdom of the family as a whole, taking into account the wider economic, social, cultural, political and religious context in which the family lives, and taking into account the various views, beliefs, points of view and the personal stories of each individual member.

(In this case, the family refers to long-term active relationships within the family, ties within which may or may not be blood).

Gestalt therapy

Gestalt is a German word meaning the whole and the sum of all parts, a symbolic form or combination of elements that make up a whole.

Gestalt therapy is a psychotherapeutic method that is based on the belief that people have a natural desire for health, but outdated patterns of behavior and dominant ideas can create blocks that interrupt natural cycle wellness thereby leading to interaction with others.

Gestalt therapy refers to what is happening at a given moment in time, making conscious a person's idea of ​​himself, his reactions and interactions with other people. The belief that being wholly in the here-and-now creates in the client the potential for further experiences, enthusiasm, and the courage to live life to the fullest. The therapist who works with this method monitors how clients avoid contact in the here-and-now, how they avoid changes and certain behaviors or symptoms that clients find undesirable or unsatisfactory. In the process of communication, an experienced Gestalt therapist delivers effective cues that help the client become aware not only of what is happening and being said, but also of what body language is saying and how repressed feelings are expressed. Gestalt techniques often involve acting out scenarios and debriefing dreams.

Group Analysis

Group analysis combines the results of psychoanalytic analysis with the study of interpersonal interaction in a social context. The goal of therapy is to achieve a better integration of the client into his network of relationships, that is, in the family, team and society. The emphasis of group analysis is on the relationship between the individual and the rest of the group, with particular attention to social nature human experience through an interactive approach. Group analysis can be applied to many areas of human relations, such as teaching, learning, and organizational consulting.

The theory is based on the premise that, within a carefully selected group, general composition which reflects societal norms, profound and lasting changes can occur. Group analysis sees the group as an organic whole, and the therapist's role is to support the group rather than take an active role. The group becomes a dynamic self-sustaining whole and functions within the framework of a socio-cultural context, which in turn affects the process.

Group psychotherapy

Group psychotherapy is a branch of psychotherapy designed to help people who would like to improve their ability to cope with life's difficulties and problems, but in a group situation.

In the context of group therapy, one or more therapists work with a small group of clients at the same time. While this group was originally created with the goal of reducing cost and increasing productivity, participants soon realize positive therapeutic effects that could not be achieved with a one-on-one therapist. For example, interpersonal problems are well understood within the group. Group therapy is based not on one psychotherapeutic theory, but on many, and often revolves around conversations. It may also include other approaches such as psychodrama, movement work, body psychotherapy or constellations.

The goal of group psychotherapy is to support solutions to emotional difficulties and encourage the personal development of group members. The totality of past experiences and experiences outside the therapeutic group, plus the interaction between group members and the therapist, constitutes the material upon which therapy is carried out. Such interaction may not necessarily be entirely positive, as the problems that clients have in their Everyday life, will inevitably be reflected in the communication within the group. However, it provides valuable opportunities to work through these issues in a therapeutic setting where experiences are summarized and can then be interpreted into real life. An experienced therapist knows how to select the right group members to support the group process.

Humanistic Integral Psychotherapy

Humanistic integral psychotherapy works with a full range of influences that contribute to the development of a person and his relationships with other people and society.

During the implementation of humanistic integral psychotherapy, both the client and the psychotherapist are actively involved in the formation of processes for evaluating, correcting and analyzing the results. This approach focuses on the importance of the client having the capacity for self-regulation, self-actualization, responsibility and choice to facilitate the process of change. The therapist helps the client realize his potentials. The therapist also considers the impact of the outside world on the client's inner world when evaluating the importance of the social, cultural, and political realms of experience.

Humanistic Integral Psychotherapy is available in various areas of the public, private and voluntary sectors and is suitable for individual people, couples, children, families, groups and organizations.

Hypnotherapy

Hypnotherapy uses hypnosis to induce a deep state of relaxation and altered consciousness, during which the unconscious mind is particularly capable of perceiving new or alternative possibilities and ideas.

In the field of hypnotherapy, the unconscious is considered a resource for well-being and creativity. When assessing this area of ​​the mind through hypnosis, opportunities open up for building a health orientation in the body.

Hypnotherapy can be used to change the behavior, attitudes, and emotions of the client, as well as to treat pain, anxiety, stress-related illnesses, and bad habits which will contribute to personal development.

The British Council for Psychotherapy considers hypnotherapy to be a subset of hypnopsychotherapy. This means that any specialist registered with the British Council for Psychotherapy is qualified to work with problems that are within the competence of a hypnotherapist, but additional training is required to work at a deeper level with more complex emotional and psychological problems.

Jungian analysis

Jungian analysis is a specialized form of psychotherapy that works with the unconscious. The analyst working in this direction and the client work together to expand the consciousness of the client in order to move towards psychological balance, harmony and wholeness. Jungian analysis assesses deep motivations in the client's psyche, thoughts and actions that are beyond conscious understanding. The analyst seeks to achieve deeper and more lasting changes in the client's personality. They do this by emphasizing what happens during the sessions and in the inner and outer experience of the client's life. Jungian analysis seeks to synchronize conscious and unconscious thoughts in order to build new values ​​and deal with psychological pain and suffering.

Neurolinguistic Psychotherapy and Counseling

Neuro-Linguistic Psychotherapy was developed from Neuro-Linguistic Programming. Neurolinguistic psychotherapy is universal and is based on many areas of psychology and psychiatry. This theory is based on the belief that we ourselves build a model of our reality (a personal map of the world), based on our experience and how we imagine it. Each person uses their own map to guide themselves through life. The models used can bring about change that promotes implementation and success, and at other times can be limiting and holding back.

Neuro-Linguistic Psychotherapy explores the thought patterns, beliefs, values, and experiences behind problems or goals. It helps people make appropriate adjustments to reorganize their world, which reduces limiting beliefs and decisions, helps break through emotional and behavioral loops, and generates new resources through expanding the existing skill base. This gives the person a sense of greater control and, as a result, greater ability to create the life they desire.

Neurolinguistic psychotherapists work with a wide range psychological problems, and they determine how a unique therapeutic program will be put together, an individualized system of therapy, which often, if necessary, combines different therapeutic approaches in order to enhance the results of therapy.

Object Relations Therapy

Object relations therapy is based on the theory that one's ego exists only in relation to other objects, internal or external. In object relations, the self is seen as self-developing and existing in the context of relationships, primarily with parents, but also in relation to home, art, politics, culture, and so on. This theory is based on the belief that man is a social being. Therefore, contact with others is a basic necessity, and our inner world is a changeable dynamic process, consisting of unchanging and moving models, conscious and unconscious. These dynamics affect how we perceive and experience reality.

The therapist working in this field actively interacts with the client, supporting him in the analysis of irrational ideas by actively experiencing the real relationship between the therapist and the client. This provides an opportunity to revisit essential relationship issues such as loss, intimacy, control, dependency, independence, and trust. Although there may be various interpretations and confrontation, the main goal is to work out the initial irrational components of the client's emotional world.

Personal counseling

Personal counseling is based on the assumption that the person who seeks support in solving a problem enters into an open relationship with a therapist who allows the client to freely express their emotions and feelings. This type of therapy is also called client-centered psychotherapy or Rogers therapy.

Who is suitable for this type of therapy?

Personal counseling is suitable for clients who would like to work on specific psychological habits or patterns of thought. The therapist assumes that the client is the best judge of their own experience and is therefore able to achieve their potential for growth and problem solving. The therapist working in the context of personal counseling provides an enabling environment to ensure that this potential is manifested through unconditional positive attitude and empathic understanding, which enables the client to come to terms with negative feelings and open up inner resources of strength and freedom to make the necessary changes.

Psychoanalysis

Psychoanalysis deals with the study of the mind, being a systematic body of knowledge about human behavior and a method of treating psychological and emotional illnesses.

Regular psychoanalysis sessions create an environment in which unconscious patterns can be brought to the conscious level in order to be modified. The client-analyst relationship has an important influence on the client's unconscious behavior patterns and in itself becomes a central focus in which the client's behavioral patterns are highlighted in the context of the real-time relationship of the sessions.

Freudian psychoanalysis is special type psychoanalysis, in which a person undergoing a session of psychoanalysis expresses thoughts in words using methods such as free association, fantasies and dreams. The analyst interprets them to give the client the right idea of ​​solving important issues and problems in the client's life.

Who is suitable for this type of therapy?

Freud believed that unwanted thoughts from early childhood suppressed by the unconscious mind, but continue to influence our feelings, thoughts, emotions, and behavior. These repressed feelings often surface in adulthood in the form of conflicts, depressions, and the like, as well as in dreams and creative activities. These unconscious aspects are explored in the sessions through the intervention of the analyst, who speaks openly about the client's painful defenses, desires, and guilt.

Psychodynamic psychotherapy

Psychodynamic psychotherapy is a term that includes therapies of an analytical nature. In essence, it is a form of depth psychology that focuses on unconscious and past experiences to determine current behavior.

The client is asked to talk about his childhood relationships with parents and other significant people. The main emphasis is placed on the disclosure of the unconscious content of the client's psyche in an attempt to reduce mental stress. The therapist tries to exclude his personality from the picture, in fact, becoming a blank canvas onto which the client transfers and projects deep feelings about himself, parents and other significant characters in his life. The therapist continues to focus on the dynamics between client and therapist.

Psychodynamic psychotherapy is usually less intense and shorter than psychoanalysis, and it relies more on the interpersonal relationship between client and therapist than other forms of depth psychology. This direction is used in individual psychotherapy, group psychotherapy, family psychotherapy, as well as for understanding and working with organizational and corporate environments.

Psychosynthesis

Psychosynthesis is based on the involvement of the past in the context of the awakening of one's own "I". Psychosynthesis is considered a form of existential psychology with spiritual goals and concepts, and is sometimes described as a "psychology of the soul".

Psychosynthesis seeks to integrate or synthesize a higher, spiritual level of consciousness with the level at which thoughts and emotions are experienced. Through drawing, movement and other techniques, other aspects of the personality are manifested and expressed. Assagioli used the term "superconscious" to describe the realm of the psyche that contains our greatest potentials, the source of our individual development path. He believed that the suppression of this potential can lead to psychological disorders, as painful as the suppression of childhood trauma. Assagioli insisted that psychosynthesis should be included in the experiential understanding of psychology and sought to maintain a balance between rational and conscious therapeutic work along with the integration of spiritual experience.

Psychotherapy and psychoanalysis of relationships

Relationship therapy is a broad way of understanding a person's motivation and the therapy process. Therapists who use this approach understand that interpersonal relationships are one of the main motivations for people, but as a result, they also bring many people to therapy.

It can be said that therapists, using a variety of techniques, are treating within a relational approach if they prioritize how their clients are related to others when working to understand their own personalities. In addition to the importance of understanding how previous relationships have influenced the current ones, the therapist advocates such a line of communication when, as a result of the relationship between the therapist and the client, a space is created where the dynamic of the relationship arises, which is further discussed, comprehended and corrected. The therapist can use the dynamics that arise spontaneously within the therapeutic relationship in order to shed more light on the dynamics in the client's relationship and therefore help him understand himself better. How much the therapist trusts the therapy regarding his position in the relationship depends greatly on his own personality and qualifications. The privilege in the relationship, however, is usually given to the client.

Relationship Counseling

Relationship counseling helps people recognize and work through or resolve troubling differences and recurring patterns of suffering in the context of existing relationships. The therapist explores the client's feelings, values, and expectations by engaging them in conversations, discussions of solutions to problems, and consideration of alternative and new possibilities.

Who is suitable for this type of therapy?

Relationship counseling is suitable for family members, couples, employees or employers in a work setting, professionals and their clients.

Solution Focused Brief Therapy

Solution-focused brief therapy deals with a specific problem and promotes positive change rather than dwelling on the problem itself or past problems. Clients are encouraged to pay positive attention to what they do well, their strengths and resources, and to set and achieve goals. This method is focused more on finding solutions rather than solving problems. This type of therapy is short-term, only three or four sessions are enough.

Systemic therapy

Systemic therapy is a general term for areas of therapy dealing with people in relation to each other, group interactions, patterns and dynamics.

Systemic therapy has its roots in family therapy and systemic family therapy, but deals with problems practically, not analytically. It does not seek to determine the cause or provide a diagnosis, but rather seeks to identify and deal with ossified patterns of behavior in the group or family. The role of the therapist in systemic therapy is to offer constructive clues to promote change in the relationship system, to pay attention to existing relationship patterns, rather than to analyze causes such as subconscious impulses or childhood trauma.

Who is suitable for this type of therapy?

Systemic therapy can also be used in corporate settings and is currently being widely adopted in the fields of education, politics, psychiatry, social work and family medicine.

Transactional Analysis

Transactional analysis is an integral approach in psychology and psychotherapy based on two concepts. Eric Berne believed that, firstly, our personality is divided into three parts or three ego states: child, adult and parent. Secondly, these parts communicate with each other in transactions (units of communication), and within each social transaction one of the parts dominates. Therefore, by recognizing these roles, the client can choose which part to use and thus adjust his behavior. Berne's transactional analysis as a form of therapy works with the term " inner child” to describe unmet needs from childhood.

Transpersonal Psychotherapy

Transpersonal psychotherapy refers to any form of counseling or psychotherapy where the emphasis is on the transpersonal, transcendent, or spiritual aspects of the human experience. Transpersonal psychotherapy is often seen as an accompanying technique in other schools of psychology such as psychoanalysis, behaviorism, and humanistic psychology.

Transpersonal psychotherapy focuses on aspects such as spiritual self-development, mystical experiences, trance experiences and other metaphysical experiences in life. Just as in psychosynthesis, the main goal of transpersonal psychotherapy is not only to alleviate suffering, but also to integrate the physical, mental and spiritual aspects of the client's well-being. Therapy includes exploring and emphasizing the potential of the client, developing internal resources and creative abilities.

Psychological methods of influence in psychotherapy include, first of all, linguistic communication, which, as a rule, is realized during a specially organized meeting of a psychotherapist with a patient or a group of patients.

Great importance is also given to the means of non-verbal communication. In general, the psychological tools of psychotherapy include such means and forms of influence that can affect the patient's intellectual activity, his emotional state and behavior.

Classification of methods of psychotherapy according to Aleksandrovich: 1) methods that have the nature of techniques; 2) methods that determine the conditions that contribute to the achievement and optimization of the goals of psychotherapy; 3) methods in the sense of the tool that we use in the course of the psychotherapeutic process; 4) methods in the meaning of therapeutic interventions (interventions).

There are methods of psychotherapy that reveal the causes of conflicts, and methods that do not reveal them (meaning the different positions of psychotherapists regarding unconscious complexes and conflicts). Methods that reveal the causes of conflicts are basically identical to psychoanalysis or methods oriented towards psychoanalysis; they suggest that the unconscious component of the personality plays an important role.

For practical application of certain methods of psychotherapy, their classification according to their goals matters. Wahlberg distinguishes 3 types of psychotherapy: 1) supportive psychotherapy, the purpose of which is to strengthen and support the patient's defenses and develop new, better ways of behaving to restore peace of mind; 2) retraining psychotherapy, the purpose of which is to change the patient's behavior by supporting and approving positive forms of behavior and disapproving negative ones. The patient must learn to make better use of the possibilities and abilities available to him, but this does not aim to really resolve unconscious conflicts; 3) reconstructive psychotherapy, the purpose of which is the awareness of intrapsychic conflicts that served as a source of personality disorders, and the desire to achieve significant changes in character traits and restore the full value of the individual and social functioning of the individual.

The most famous and widespread psychotherapeutic methods are: suggestive (hypnosis and other forms of suggestion), psychoanalytic (psychodynamic), behavioral, phenomenological-humanistic (for example, gestalt therapy) used in individual, collective and group forms.

Verbal and non-verbal methods of psychotherapy. This division is based on the predominant type of communication and the nature of the material received. Verbal methods are based on verbal communication and are aimed primarily at the analysis of verbal material. Non-verbal methods are based on non-verbal activity, non-verbal communication and concentrate on the analysis of non-verbal products.

Verbal methods of group psychotherapy usually include group discussion and psychodrama, non-verbal methods include psycho-gymnastics, projective drawing, music therapy, choreotherapy, etc.

Formally, the division of group psychotherapy methods into verbal and non-verbal is justified, however, almost any interaction in a group includes both verbal and non-verbal components. Accounting and analysis of non-verbal behavior and interaction in the process of using verbal methods (for example, group discussion) allows you to more fully and adequately reveal the content of a particular verbal communication. In connection with the development of psychotherapeutic areas based primarily on direct emotional experiences, there has been a partial identification of the term "verbal" with the terms "rational", "cognitive", "cognitive" and the opposition of the last three concepts to "non-verbal", "emotional", "experienced (in the sense of direct experience).

The distinction between the methods of group psychotherapy is largely conditional and is expedient only from the point of view of the predominant type of initial communication.

Psychotherapeutic Persuasion. The method most conducive to the formation of a connection with the patient creates a system of their relationships that has an impact on the emotional side of the activity, on the intellect and personality of the patient as a whole.

Such an impact provides the widest connections between the words spoken by the doctor, with the patient's experience, with his ideas about the disease, life attitudes and can prepare him for a reasonable processing of everything said by the doctor, can contribute to the assimilation of the doctor's words. Using the method of psychotherapeutic persuasion, the doctor can influence not only the patient's ideas and views on the disease, but also influence the personality traits. In this influence, the doctor can use criticism of the patient's behavior, his inadequate assessment of the situation and others, but this criticism should not offend and humiliate the patient. He should always feel that the doctor understands the difficulties of the patient, sympathizes and respects him, the desire to help.

Misconceptions about the disease, about relationships with others, about the norms of behavior are formed in a person over the years and multiple dissuasion is required to change them. The arguments given by the doctor should be clear to the patient. When persuading the patient to change the current situation, it is necessary to take into account his real possibilities, attitudes, ideas about morality, etc. The conversation conducted with the patient should evoke an emotional reaction in him, contain an element of suggestion, should be aimed at active stimulation, at restructuring his behavior.

Using this method, the doctor in a form accessible to the patient can report on the causes of the disease, the mechanisms of occurrence painful symptoms. For clarity, the doctor can use the demonstration of drawings, tables, graphs, give examples from life and literature, but he must always take into account the principle of the strength and accessibility for the patient of the facts that are reported.

If the doctor uses an unknown term or speaks of incomprehensible patterns, then the patient may not ask what this means, being afraid to show his illiteracy or lack of culture. Conversations that are not sufficiently understood by the patient, instead of benefit, usually cause harm, since the patient, who is affectively attuned to his illness, tends to evaluate the incomprehensible words of the doctor not in his favor.

Suggestion. Presentation of information perceived without critical appraisal and influencing the course of neuropsychic and somatic processes. By way of suggestion, sensations, ideas, emotional states and volitional impulses are evoked, and it also affects autonomic functions without active participation personality, without logical processing of the perceived. The main means is the word, the speech of the suggestor (the person making the suggestion). Non-verbal factors (gestures, facial expressions, actions) usually have an additional influence.

Suggestion used in the form of heterosuggestion (suggestion made by another person) and autosuggestion (self-hypnosis) is aimed at relieving emotional neurotic symptoms, normalizing a person’s mental state during periods of crisis, after exposure mental trauma and as a way of psychoprophylaxis. It is effective to use suggestive methods of psychotherapy to remove psychological maladaptive types of an individual's response to somatic disease. Use indirect and direct methods of suggestion. With indirect resort to the help of an additional stimulus.

Classification of suggestion: suggestion as self-hypnosis; suggestion direct or open, indirect or closed; suggestion is contact and distant.

In medical practice, appropriate methods of suggestion are used in the waking state, in the state of natural, hypnotic and narcotic sleep.

Suggestion in the waking state is present in varying degrees of severity in every conversation between a doctor and a patient, but it can also act as an independent psychotherapeutic effect. Suggestion formulas are usually pronounced in an imperative tone, taking into account the patient's condition and the nature of the clinical manifestations of the disease. They can be used to improve general well-being(sleep, appetite, working capacity, etc.), and the elimination of individual neurotic symptoms. Usually suggestion in reality is preceded by an explanatory conversation about the essence of therapeutic V. and the patient's conviction of its effectiveness. The effect of suggestion is the stronger, the higher in the eyes of the patient is the authority of the doctor making the suggestion. The degree of realization of the suggestion is also determined by the characteristics of the patient's personality, the severity of the mood, the belief in the possibility of influencing some people on others with the help of means and methods unknown to science.

Suggestion in the waking state. With this method of psychotherapeutic influence, there is always an element of persuasion, but suggestion plays a decisive role. With some hysterical disorders, a therapeutic effect can be obtained (single). For example, a suggestion is carried out in the form of an order: “Open your eyes! You can see everything well!” etc.

suggestive methods. Suggestive methods include various psychological impact with the help of direct or indirect suggestion, i.e., verbal or non-verbal influence on a person in order to create a certain state in him or induce him to certain actions.

Suggestion may be accompanied by a change in the patient's consciousness, the creation of a specific attitude to the perception of information on the part of the psychotherapist. The provision of a suggestive impact implies that a person has special qualities of mental activity: suggestibility and hypnotizability.

Suggestibility is the ability to uncritically (without the participation of the will) perceive the information received and easily succumb to persuasion, combined with signs of increased gullibility, naivety and other features of infantilism.

Hypnotic ability is a psychophysiological ability (susceptibility) to easily and freely enter a hypnotic state, to succumb to hypnosis, that is, to change the level of consciousness with the formation of transitional states between sleep and wakefulness. This term refers to the individual ability to be subjected to hypnotic influence, to achieve a hypnotic state of one or another depth.

Hypnotizability of the patient is important for determining the indications for various types of suggestion. P. I. Bul (1974) notes the dependence of hypnotizability on the patient's suggestibility in reality, the characteristics of the patient's personality, the environment in which the hypnotherapy session takes place, the experience of the psychotherapist, his authority and degree of mastery of the hypnotization technique, as well as the degree of the patient's "magical mood".

Hypnosis is a temporary state of consciousness, characterized by a narrowing of its volume and a sharp focus on the content of suggestion, which is associated with a change in the function of individual control and self-awareness. The state of hypnosis occurs as a result of special effects of the hypnotist or purposeful self-hypnosis.

The French neurologist J. Charcot interpreted hypnotic phenomena as a manifestation of an artificial neurosis, that is, a disease of the central nervous system and psyche. His compatriot Bernheim argued that hypnosis is an inspired dream.

Hypnosis is considered as partial sleep, which is based on a conditioned reflex inhibitory process in cortical cells. At the same time, with the help of a report (verbal communication between a doctor and a patient), it is possible to evoke various reactions from the body of a person in a state of hypnosis. This is possible because the word, thanks to the entire previous life of an adult, is connected with all external and internal stimuli that come to the large hemispheres of the brain, signals about all of them, replaces them all, and therefore can cause all those actions, reactions of the body that cause these irritations. Having revealed the physiological mechanisms of sleep, transitional states and hypnosis, I. P. Pavlov gave a scientific explanation for all the phenomena that for centuries were considered mysterious and enigmatic. The teachings of IP Pavlov about signal systems, about the physiological power of words and suggestion became the basis for scientific psychotherapy.

There are three stages of hypnosis: lethargic, cataleptic and somnambulistic. With the first one, a person experiences drowsiness, with the second - signs of catalepsy - waxy flexibility, stupor (immobility), mutism, with the third - complete detachment from reality, sleepwalking and suggested images. The use of hypnotherapy is justified in hysterical neurotic, dissociative (conversion) disorders and hysterical personality disorders.

Rational psychotherapy is a method that uses the patient's logical ability to compare, draw conclusions, and prove their validity.

In this, rational psychotherapy is opposite to suggestion, which introduces information, new attitudes, prescriptions, bypassing the criticality of a person.

“Rational psychotherapy I call that which has as its goal to act on the patient's world of ideas directly and precisely through convincing dialectics” - this is how Dubois defines rational psychotherapy. The purpose of the impact of rational psychotherapy is a distorted "internal picture of the disease", which creates an additional source of emotional experiences for the patient. The removal of uncertainty, the correction of inconsistency, inconsistency in the patient's ideas, primarily those relating to his illness, are the main links in the impact of rational psychotherapy.

Changing the patient's misconceptions is achieved by certain methodological techniques. The essential quality of rational psychotherapy is its construction on logical argumentation, it can be traced in all its modifications and distinguishes it from other methods of psychotherapy.

stand out various options rational psychotherapy. With some, the patient is brought to a certain programmed result, while the psychotherapist is highly active in argumentation, refuting the patient’s incorrect arguments, prompting him to formulate the necessary conclusions. An important role in such a situation can be played by the Socratic dialogue technique, in which questions are asked in such a way that they suggest only positive answers, on the basis of which the patient himself draws conclusions. In rational psychotherapy, there is also an appeal to the patient's logical thinking, a significant role is also assigned to response, behavioral learning.

The main forms of rational psychotherapy are:

1) Explanation and clarification, including the interpretation of the essence of the disease, the causes of its occurrence, taking into account possible psychosomatic connections, previously, as a rule, ignored by patients, not included in the "internal picture of the disease"; as a result of the implementation of this stage, a clearer, more definite picture of the disease is achieved, which removes additional sources of anxiety and opens up the patient the opportunity to more actively control the disease himself; 2) persuasion - correction of not only the cognitive, but also the emotional component of the attitude towards the disease, contributing to the transition to the modification of the patient's personal attitudes; 3) reorientation - the achievement of more stable changes in attitudes: the patient, primarily in his attitude to the disease, associated with changes in his system of values ​​and taking him beyond the limits of the disease; 4) psychogogy - reorientation of a broader plan, creating positive prospects for the patient outside the disease.

Hypnotherapy. A method of psychotherapy that uses the hypnotic state for therapeutic purposes. The widespread use of hypnotherapy reflects its therapeutic effectiveness in various diseases.

The main complications of hypnosis is the loss of rapport, hysterical fits, spontaneous somnambulism, the transition of deep somnambulistic hypnosis into hypno.

The success of the treatment depends on the characteristics of the patient's personality, also the increased suggestibility, his readiness for such a conversation, on the authority of the doctor, on the patient's belief in him.

Hypnotherapy from the time of Delirium to the present, to induce hypnotic sleep, uses the method of verbal suggestion and sometimes fixing the gaze on a shiny object, later, for greater effect, they began to use monotonous monotonous stimuli that affect visual, auditory and tactile analyzers.

Autogenic training. An active method of psychotherapy, psychoprophylaxis and psychohygiene, aimed at restoring the dynamic balance of the system of homeostatic self-regulating mechanisms of the human body, disturbed as a result of stress. The main elements of the methodology are muscle relaxation training, self-hypnosis and self-education (autodidactics). The activity of autogenic training resists some negative aspects hypnotherapy in its classical model - the patient's passive attitude to the treatment process, dependence on the doctor.

As a therapeutic method, autogenic training was proposed for the treatment of neuroses by Schultz in 1932. In our country, it began to be used in the late 50s. The therapeutic effect of autogenic training, along with the development of a trophotropic reaction as a result of relaxation, characterized by an increase in the tone of the parasympathetic division of the autonomic nervous system and contributing to the neutralization stressful condition, is also based on a weakening of the activity of the limbic and hypothalamic regions, which is accompanied by a decrease in general anxiety and the development of anti-stress tendencies in trainees (Lobzin V.S., 1974).

There are two stages of autogenic training (according to Schultz): 1) the lowest stage - relaxation training with the help of exercises aimed at causing a feeling of heaviness, warmth, mastering the rhythm of cardiac activity and breathing; 2) the highest stage - autogenic meditation - the creation of trance states of various levels.

The lowest level, autogenic training, consists of six standard exercises that are performed by patients in one of three postures: 1) sitting position, "coachman's position" - the trainee sits on a chair with his head slightly lowered forward, hands and forearms lie freely on the front surface of the thighs, legs are freely spaced; 2) lying position - the trainee lies on his back, his head rests on a low pillow, his arms, slightly bent at the elbow joint, lie freely along the body with palms down; 3) reclining position - the trainee sits freely in the chair, leaning on the back, hands on the front surface of the thighs or on the armrests, legs freely apart. In all three positions, complete relaxation is achieved, for better concentration, the eyes are closed.

Conducting classes can be collective, 4-10 people in a group. Before the start of the training, the doctor conducts an explanatory conversation, talks about the features of the nervous vegetative system about its role and manifestations in human life. In an accessible form for the patient, an explanation is given for the features of motor reactions and especially the state of muscle tone, depending on mood. Examples of muscle tension are given for various emotional states. At the same time, it is necessary that the patient clearly learn the difference between the functions of the autonomic nervous system and the animal. He must understand that he can move voluntarily and cannot make the stomach or intestines move. He must learn to manage some autonomic functions in the process of autogenic training.

Training by patients is carried out - lying, reclining or sitting. Depending on the disease, the training posture is chosen. Autogenic training requires long work with patients, since it takes two weeks to practice one exercise. As a rule, the doctor meets with patients twice a week to check how the exercises are being mastered, and explains new ones. The patient must independently conduct three sessions per day. After the patient has mastered the lower level, one can proceed to directed self-hypnosis against painful disorders.

Usually the effect is achieved after many months of home training. Highest level training helps the patient manage their emotional experiences.

Autogenic training can be shown in those cases in which it is necessary to teach a rapidly exhausted patient to restore working capacity, reduce or relieve mental stress, functional disorders internal organs and in those cases when it is necessary to teach the patient to control himself. It is used for stuttering, neurodermatitis, sexual disorders, for labor pain relief, elimination or mitigation of preoperative and postoperative emotional layers.

Autogenic training refers to activating psychotherapy, since when using it, a person himself is active and has the opportunity to verify his abilities.

Group psychotherapy (collective). A psychotherapeutic method, the specificity of which lies in the purposeful use of group dynamics, i.e., the entire set of relationships and interactions that arise between group members, including a group psychotherapist, for therapeutic purposes.

Collective hypnotherapy was proposed by V. M. Bekhterev. With collective hypnotherapy, suggestibility is enhanced through mutual suggestion and imitation. This must be taken into account when selecting a group for collective hypnotherapy. It is desirable that among the patients there are highly hypnotizable and convalescent, who would have a positive influence on the rest. The use of collective hypnotherapy makes it possible to implement therapeutic suggestions for most patients during one session. This type of psychotherapy is widely used in outpatient practice.

Fundamentally, group psychotherapy is not an independent direction in psychotherapy, but is only a specific method, when using which the main instrument of psychotherapeutic influence is a group of patients, in contrast to individual psychotherapy, where only a psychotherapist is such an instrument.

Music therapy. A psychotherapeutic method that uses music as a remedy.

The therapeutic effect of music on the human body has been known since ancient times. First attempts scientific explanation of this phenomenon belong to the 17th century, and extensive experimental studies - to the 19th. S. S. Korsakov, V. M. Bekhterev and other famous Russian scientists attached great importance to music in the system of treating the mentally ill.

Art therapy is a method of psychotherapy, which consists in the use of art as a therapeutic factor. The value of the method increases in connection with the increasing role of art in the life of a modern person: a higher level of education and culture determines the interest in art.

The question of whether art therapy belongs to occupational therapy or psychotherapy is decided differently by various authors, since various types of therapeutic effects are combined in art therapy classes.

When using art therapy, patients are offered a variety of arts and crafts activities (woodcarving, chasing, modeling, burning, drawing, making mosaics, stained glass, all kinds of crafts made of fur, fabrics, etc.).

Bibliotherapy - therapeutic effect on the psyche of a sick person by reading books. Treatment by reading is included as one of the links in the system of psychotherapy. The methodology of bibliotherapy is a complex combination of bibliology, psychology and psychotherapy - this is how V. N. Myasishchev defined it.

Start using book reading with therapeutic purpose refers to the century before last, the term began to be used in the 20s. last century in the USA. The definition adopted by the US Hospital Libraries Association states that bibliotherapy is “the use of specialized

but selected reading material as a therapeutic tool in general medicine and psychiatry with the aim of solving personal problems through directed reading.

Functional training. This is a variant of psychotherapy in the waking state. In the treatment of patients who, for example, are afraid to go out because of fear that something will happen to the heart or they may die suddenly, a complex system of training is used. For example, by gradually expanding the area on which the patient decides to take walks, the doctor convinces the patient by walking with him or giving him the task to walk or drive a certain segment of the path. In further work, the achieved successes are used and the complication of tasks is built on them. This training should be seen as an activating and stimulating psychotherapy. The main task of psychotherapy is the restoration of the activity lost by the patient, the restoration of his ability to complete active life, which is always associated with a correct assessment of a person's capabilities. Psychotherapeutic training has as its task both “a direct impact on the nervous dynamics, and the restructuring of the patient's attitude to the functions being trained, to himself as a whole.

Play psychotherapy - the study of children's play through observation, interpretation, structuring, etc., made it possible to realize the uniqueness of the way a child communicates with the world around him. Thus, the game was put at the basis of the method of treatment of emotional and behavioral disorders in children, called play psychotherapy.

Children's lack of verbal or conceptual skills to the extent necessary prevents the effective use of psychotherapy in relation to them, almost entirely based on pronunciation, as is the case in adult psychotherapy. Children cannot freely describe their feelings, they are able to express their experiences, difficulties, needs and dreams in other ways.