Psychotherapy and its types. Types of psychotherapy and their brief description. Psychotherapy and medications

Psychotherapy

What is psychotherapy? This is a therapeutic conversation, during which a professional psychotherapist or psychologist-psychotherapist helps the patient to understand and solve problems. Psychotherapy is the only method of treating mental disorders that considers a person as an indivisible whole, studies his essence and uses only an individual approach.

To choose a good psychotherapist, you need to pay attention to several important points:

  • specialized medical or psychological education
  • work experience from 3-5 years
  • participation in educational events and conferences of the psychotherapeutic community

It is also important that the specialist answers the client’s questions as fully as possible, does not have a bad reputation on the Internet, and follows a moral and ethical code.

The goal of psychotherapy is to understand, bring to the surface and defeat what prevents a person from being happy. The psychotherapist does not make decisions for the person and does not impose his opinion on him, but helps him understand what the client really wants and how this can be achieved. Psychotherapy involves working on oneself, but when a person begins to get rid of the first uncertainty, anxiety and fears, it immediately becomes easier for him to move towards a new, fulfilling life.

Exists a large number of methods, schools and directions in psychotherapy. Below we will talk about some popular techniques.

Psychotherapy methods

The psychotherapist faces several important tasks during the session:

  • help the client understand their problems
  • create an emotionally comfortable environment
  • use psychotherapeutic methods to make a person “react”, “let go” of his feelings and emotions
  • give the patient ideas where to look for answers to questions
  • help a person adapt outside the therapy room and try out new ways of behavior and thinking

The choice of psychotherapy technique is based on an individual approach and clinical picture diseases. Should be considered:

  • personality traits and the degree of criticism of one’s condition
  • causes of the disorder
  • capabilities of the specialist and the office or clinic where the therapy is performed

All psychotherapeutic methods help in four main areas:

  1. Understand the reasons - hypnosis, psychoanalysis, gestalt therapy, existential therapy
  2. Develop good habits and get rid of bad ones - cognitive behavioral therapy (CBT), rational, reconstructive personality psychotherapy
  3. Solve the problem in a non-standard way, without a classical conversation - art therapy, body-oriented therapy, hypnosis
  4. Overcome problems when communicating in a team or within a family - group, family psychotherapy, psychodrama

Types of psychotherapy and their description

Common types of psychotherapy:

  • cognitive-behavioral
  • reconstructive-personal
  • psychoanalysis
  • body-oriented
  • rational
  • group
  • family
  • psychodrama
  • gestalt therapy
  • Ericksonian hypnosis
  • existential
  • sand therapy

Cognitive behavioral psychotherapy. A method that requires full inclusion and readiness for action from the doctor and the patient. A psychotherapist helps to understand incorrect attitudes and stereotypes in a person’s thinking and behavior that prevent him from doing right choice and force them to act according to a pattern. One of the main advantages of the method is its short duration; 10-15 sessions are enough to achieve the effect. Indications for use: depression, anxiety disorders, obsessive-compulsive disorder, disorders eating behavior, alcoholism.

Reconstructive-personal psychotherapy. The doctor helps the client realize the real sources of his problems and switch from external reasons to internal ones, as well as to reconstruct relationships within the individual himself. As a result, adequate self-awareness is formed and its scope expands. The method is suitable for treating addictions, neurotic disorders, personality disorders, panic states and phobias.

Psychoanalysis. Identification of previously unreacted situations, an attempt to realize repressed complexes and gain access to the unconscious. Since this access is difficult, Freud identified the main paths to its content: free associations, slips of the tongue, slips of the tongue, erroneous actions and dreams. Psychoanalysis is suitable for people prone to self-reflection and the search for meaning.

Body-oriented psychotherapy. A technique that is suitable for all people, since it is based on an appeal to human nature, to his body. It is especially useful for those who find it difficult to formulate a problem in words. Body-oriented psychotherapy allows you to bypass the usual mechanisms of human psychological defense, identify and work through hidden and disguised psychological problems.

Rational psychotherapy. The method is based on explaining to the client true reasons and mechanisms of disorder or elimination of logical errors in judgment. The specialist helps to build the correct logical connections and form a competent understanding of the problem. It is used for neuroses, psychasthenia, alcoholism, drug addiction and behavioral problems in adolescents.

Group psychotherapy. A form of psychotherapy in which a specially designed group of people meet regularly to achieve a specific result. First of all, group psychotherapy helps socialization and solves communication problems. The method is widely applicable for neuroses, depressive and anxiety states, psychosomatic disorders, as well as sleep and eating disorders.

Family psychotherapy. Psychological therapy of the family and each individual member. Aimed at creating healthy interpersonal relationships and eliminating emotional problems. Suitable for families where there are problems with understanding between spouses or in case of child-parent conflicts, as well as if there is a mentally ill person in the family.

Psychodrama. A term that hides the form of theater, the spontaneity of acting and the depth of psychoanalysis. The method helps, through a game that takes place with the participation of other group members, to teach the client to solve personal problems. The participant has the opportunity to be both an actor and a playwright of the situation, learn to act out fantasies, fears and conflicts in order to cope with them in everyday life. Psychodrama is effective when working with children and adolescents.

Gestalt therapy. Gestalt is a holistic image of a situation from the past; it always has a beginning and an end. Breakfast, a walk with the dog, an argument in the subway, choosing a gift, falling in love, a conversation with a random person - all these are gestalts. In this concept, one of the main reasons for the formation of neuroses is the accumulation of unclosed gestalts. Accordingly, therapy closes them and removes obstacles to the formation of new ones. In the process of Gestalt therapy, the patient re-experiences the interrupted Gestalt and gets the opportunity to close it, thereby getting rid of the causes of the development of neurosis.

Ericksonian hypnosis. A special type of hypnosis, without suggestions and continuous sleep. This is a trance state, one in which every person happens several times a day (to be in the clouds, not to think about anything). The psychotherapist achieves this state using various methods and communicates with the patient, who himself, during the conversation, realizes the problems and looks for ways to solve them. Hypnosis is contraindicated in patients in an acute psychotic state.

Existential psychotherapy. A type of psychotherapy that helps a person understand deep-seated issues and understand how his life works and what factors influence it. In the process of work, issues of life and death, the meaning and meaninglessness of existence, loneliness and love are considered. The method helps you learn to perceive your life as fully as possible and take an active position in it. Existential psychotherapy is suitable for anyone interested in these issues and can be combined with other types of psychotherapy.

Sand therapy. Modern psychotherapy, one of the types of art therapy. Allows you to look into yourself, relieve internal tension, and find new ways of development. With the help of a small sandbox and various objects, a person builds a certain picture, and in the process of therapy he has the opportunity to change and rebuild it. The method is suitable for children and adults. It is versatile, reliable and informative.

Psychotherapy is a system therapeutic effects on the mental sphere and the entire body of the patient, his behavioral reactions. In a narrow medical sense, psychotherapy is one of the treatment methods along with physiotherapy, reflexology, physical therapy. In a broader sense, this concept includes the correction of the patient’s behavioral reactions, the organization of his work and life, with the goal of preventing the impact of psychotraumatic factors on a person. In this case, psychotherapy is inextricably linked with the concepts of mental hygiene and psychoprophylaxis.

The specificity of such therapy is that the result is achieved with the help of informational and emotional factors influencing a person’s personality.

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    Types of psychotherapeutic techniques

    Like any therapeutic technique, psychotherapy has varieties and modifications, each of which is used in strictly defined cases and pursues a specific goal.

    Psychotherapeutic intervention

    A synonym for the name of this method is psychotherapeutic intervention.

    In various contexts, the term “psychotherapeutic intervention”, which has the nature of a technique, denotes either a general strategy of behavior and tactics of a psychotherapist or a separate psychotherapeutic technique used when working with a patient, for example:

    • confrontation;
    • clarification;
    • clarification;
    • stimulation;
    • interpretation;
    • learning;
    • training;
    • adviсe.

    The group of techniques called psychotherapeutic intervention is heterogeneous and consists of three main directions: psychoanalytic, behavioral and experimental (humanistic). Each has its own concept of illness and health, defined therapeutic purposes, as well as the plane and volume of the intervention and the corresponding means and techniques.

    Clinical and psychological intervention

    This method concerns the areas of prevention, treatment, rehabilitation and development.

    Clinical and psychological intervention consists of a set of means, among which the psychotherapist selects the most effective ones. They can be verbal and non-verbal. To a greater extent, these means are oriented towards cognitive aspects or towards the emotional sphere.

    The most typical psychological means within this method are: training (exercises), conversation or interpersonal relationships that influence the patient. Objectives of clinical and psychological intervention: prevention, treatment, rehabilitation and development, for example:

    • eradicating the fear of public speaking;
    • memory and attention training;
    • training of certain communication skills; etc.

    Psychological counseling

    Traditionally, several approaches to psychological counseling are used:

    • A problem-oriented direction, the task of which is to focus on the analysis of the external causes of the problem and ways to resolve them.
    • Person-centered counseling - analysis of individual personal reasons the emergence of conflicts and other problematic situations, as well as finding ways to prevent their occurrence in the future.
    • Consulting aimed at determining the availability of resources to solve a problem.

    Conditions for the effective use of psychotherapeutic techniques

    The positive impact of psychotherapy is due not only to the specialist’s academic knowledge. Achieving a positive effect is possible under certain conditions.

    The table shows the prerequisites for the successful use of psychotherapeutic techniques:

    Prerequisites for the effectiveness of psychotherapy techniques

    Note

    Positive expectation of both parties - psychotherapist and patient

    It has been established that the effectiveness of treatment depends on the patient’s expectation of a positive result

    Establishing a strong and reliable therapeutic alliance

    Productive work with a psychotherapist is based on mutual trust, respect, as well as the specialist’s sincere interest in the person seeking help and understanding of the patient’s problem

    Hawthorne effect

    A pattern has been identified: the psychotherapist’s particularly active attention to the patient and his problems entails an improvement in the condition of the person seeking help.

    The ability to liberate emotions and reduce emotional stress during a psychotherapy session

    The patient gains the opportunity to discuss his problem in detail with the person from whom he expects help.

    Cognitive learning

    The therapist's interpretations and explanations provide the patient with a basis for understanding the causes of his problems. This condition also helps to find ways to solve the problem.

    Suggestion (hidden and explicit)

    Suggestion is a factor present in any type of psychotherapy

    Identification

    The basis of identification is the unconscious desire to perceive the psychotherapist as an object to follow. Therefore, the patient gradually adopts some of the specialist’s values ​​and behavioral reactions.

    Operant conditioning

    This is a type of development of conditioned reflex connections with the help of the psychotherapist demonstrating his approval or disapproval, encouragement or condemnation various forms behavior and emotional reactions of the patient. Demonstration can be both obvious and hidden

    Corrective emotional experience

    The specialist looks at the patient’s problems more realistically and objectively, and often more empathetically, than the patient’s environment

    Acquiring new behavioral reactions (more adaptive) and consolidating them for use in real life

    To practice response methods, unique training, rehearsals and homework are used.

    Desensitization (reduced sensitivity) in relation to traumatic circumstances

    The desensitizing effect is achieved through repeated reference to experienced events that traumatized the patient. As a result, the severity negative emotions associated with negative experiences gradually fades away

    Indications for psychotherapy

    The use of psychotherapeutic settings helps with complex treatment the following pathological conditions:

    • tendency to panic attacks;
    • alcoholism;
    • obesity;
    • some types of depression.

    The need and adequacy of psychotherapeutic influence is determined by the degree of connection between the disorder and the situation with the patient’s personality.

    Methods and approaches

    Modern psychotherapeutic practice uses a number of methods and approaches of psychocorrection, starting with the classical ones:

    • rational therapy;
    • behavioral therapy;
    • classical transactional analysis.

    Examples of the most modern, innovative techniques are:

    • family psychotherapy;
    • integrative transactional analysis.

    Classification of psychotherapeutic techniques:

    • integrative transactional analysis;
    • techniques of classical hypnosis;
    • client-centered therapy according to K. Rogers;
    • rational psychotherapy;
    • psychotherapy with a cognitive-behavioral direction;
    • use of Socratic dialogue technique;
    • Gestalt therapy;
    • meditative breathing techniques.

    The whole variety of psychotherapeutic techniques is successfully used within the framework of different approaches in psychotherapy. Thus, the personal approach implies the perception of the person seeking help as a single, holistic personality, taking into account all its characteristics and has three main directions:

    • studying the client’s personality, its specifics, development and occurrence of disorders in order to optimize psychotherapeutic influences;
    • taking into account personality characteristics when using any psychotherapeutic techniques;
    • orientation of psychotherapeutic influence on personality change.

    An individual approach is similar to a personal one, but may have a more limited scope, for example, when it is necessary to take into account only certain personal or somatic characteristics of the patient.

    The behavioral (behavioral) approach consists of correcting unwanted behavioral stereotypes. The specialist analyzes the patient’s behavioral reactions in detail, then analyzes the factors that trigger the undesirable symptom. After this, together with the patient, a step by step plan actions to change or eliminate these factors and consolidate the changed behavior. The approach is clearly prescriptive.

    Cognitive - based on the idea that the mechanisms of the occurrence of problems and the formation of symptoms are determined by mental activity patient, internal organization mental processes. The task of a psychotherapist is to change the response to external circumstances by reprogramming thinking.

    Classification of psychotherapy

    Depending on the classification principle, the following types of psychotherapy are distinguished:

    Freudian psychotherapy

    Sigmund Freud is the developer of the principles of psychotherapeutic intervention. He also developed the method of free associations and determined the basic mechanisms of many emotional disorders, including psychoneuroses. In line with Freud's psychoanalysis, there are 4 fundamental principles approach:

    1. 1. Dynamic - explaining everything mental processes from the point of view of the interaction and collision of psychological forces. These processes can enhance and suppress, counteract each other or create a compromise formation. At the same time, they have a certain focus. Instinctive drives most powerfully influence mental dynamics.
    2. 2. Economic principle. It was based on the quantitative aspect of Newtonian mechanics. Freud often emphasized the importance of conserving energy in psychological processes and attributed to the expressions of instinctive drives charges of a certain amount of energy.
    3. 3. Topographical (structural) principle. In Freud's work, the ego and superego acquire the Newtonian parameters of real objects: extension, weight, movement and location. They can influence each other, interact or resist.
    4. 4. Genetic. The psychogenetic approach in psychoanalysis is based on the experience and behavioral reactions of the individual from the point of view of his individual development and experience.

    Z. Freud has another definition in psychotherapy: “the child’s situation.” The patient is equated to a child, from whose “antics” those around him suffer. This position lacks everything that seems normal to an adult:

    • awareness of pathology;
    • voluntary decision to therapy;
    • the will to recover.

    Adler's psychotherapy

    Alfred Adler's system is called individual psychology.

    Like Freud's psychoanalysis, this technique psychocorrection is limited to the biographical level.

    The difference is this: if Freud was interested in the history of the origin of neuroses and the cause-and-effect relationships that caused the disease, then Adler was more interested in the result to which the pathological process would lead, and the goals that motivate the patient. In his opinion, the main principle of the formation of neurosis is the desire to “become a perfect person.”

    Individual psychology pays great attention to morphological and (or) functional disorders various organs. They are the obstacles in the quest for superiority. And they also become incentives to overcome difficulties. With a favorable outcome, the defect is overcome and function is restored; in less successful cases - the formation of neurosis.

    Jungianism

    Jungian analytical psychology states that unconscious areas people are always in balance and maintain themselves in this state. Psychological disturbances and disorders, according to the theory, are a consequence of imbalance. By recognizing his complexes (with the help of a therapist) and establishing control over them, the patient will be able to get rid of his problems as a result of therapy.

    Pezeshkian positive psychotherapy

    One of the most important features human personality, according to the definition of the positive theory of Pezeshkian, are abilities, both innate (basic) and formed in the process of development.

    A psychotherapist is required to stimulate the patient’s mental reserves and abilities, and not to eliminate disorders and deviations. Positive psychotherapy is based on a meaningful assessment of the conflict and step-by-step treatment, which is based on the patient’s self-help.

Studies conducted in the USA and other countries show that psychological disorders are detected in 14–20% of children, i.e. every fifth or seventh child. These rates vary by gender, age, ethnic origin and location. For example, children aged 6–11 years are more likely to have behavioral problems than other age groups.

Psychological disorders in children are identified by various methods, including using a variety of tests, specially organized conversations (interviews) and by observing the child’s behavior. Parents and teachers are important sources of information. To the most common disorders childhood include attention deficit hyperactivity disorder, conduct disorder, oppositional disorder (disobedience, negativism, provocative behavior), extreme anxiety, separation anxiety (separation from mother or someone close), depression and learning disorders (including learning disabilities, mental retardation, autism and other syndromes). In addition, children may need psychotherapeutic help, even if they do not have psychological disorders, - for example, in situations where a child is a victim of sexual abuse, divorce or parental neglect of the child.

Unlike adults, who usually seek help themselves, a child is most often referred to a psychotherapist by parents or teachers. In many cases, an appeal to a child psychotherapist is due to the fact that the child is seriously upsetting adults in some way, violates the rules of behavior, or has poor contact with peers. Most of these children exhibit behavioral problems or impulsivity, inattention, and other manifestations of attention deficit disorder ( cm. HYPERACTIVITY). Such child behavior disorders have a serious impact on his immediate environment. On the contrary, children with anxious and depressive disorders They suffer first of all themselves and often do not know how to attract the attention of those who can help them.

Professionals involved in child psychotherapy need a good knowledge of the normal course of mental development. Many of the same childhood problems that are considered disorders are also found in children without any abnormalities. The difference may lie in the severity of the problem, the surrounding circumstances, or the suitability of a particular emotional state or behavior of a given stage of development. Level social adaptation the child should be assessed taking into account behavioral variations within normal development. For example, children's fears in early childhood and in later periods differ in nature, and the presence of certain fears is normal for a certain age. The characteristics of the child’s family are no less important; in some cases, it is the parents who need help.

Types of psychotherapy.

Child psychotherapy is carried out using various methods, but, as a rule, it involves the establishment of interpersonal contact, trusting relationships and verbal communication with the child, as well as the presence of a certain theoretical approach that guides the psychotherapist in his work. Conversations, play, role-playing, rewards for good deeds, discussion of positive examples of behavior, and aids – Board games, teaching aids, toys. The therapist's entire attention is usually focused on how the child feels, thinks, and acts.

The approaches used in child psychotherapy differ both in the type of problems it is aimed at and in the volume of psychotherapeutic assistance itself; the main ones are psychodynamic therapy, behavioral and cognitive-behavioral therapy and family psychotherapy.

Psychodynamic therapy, focused on resolving unconscious conflicts, was one of the first to appear. Since the possibilities of verbal therapy in case of small child are very limited, they have been developed game forms impact. Play therapy releases pent-up emotions and allows the child to express feelings that would otherwise remain hidden. By inviting the child to draw, play with toys, or write stories, the therapist penetrates his world, making every effort to uncover the internal conflict that causes behavioral or emotional disturbances.

Behavioral psychotherapy for children aims to teach the child adaptive ways of behavior. To do this, the therapist provides the child with the opportunity to learn and practice new patterns of behavior, and also tries to encourage the child and reward him for the desired behavior. This approach is focused on the process of a child’s activity, during which they try to instill new skills, overcome fears, relieve depression or facilitate social interactions. For example, the fear of speaking in public can be overcome by preparing the child for verbal communication and giving him the opportunity to practice. The therapist should observe the child's actions and provide feedback, assessing their results and rewarding success.

Cognitive-behavioral psychotherapy is aimed at developing adaptive behavior and uses reward reinforcement, as is typical for behavioral therapy itself, but also takes into account cognitive processes, i.e. features of perception and thinking of this child. In other words, attention is paid to how the child perceives and processes the information received during psychotherapy. The cognitive-behavioral approach is focused on the learning process, the psychological preparation of the child for various unforeseen circumstances and the selection of examples of behavior that he could follow; At the same time, this approach involves observing how the child comprehends what he is taught.

A family approach to psychotherapy can use any of these strategies, but it focuses on the family as a whole, not just the child. At the same time, the child is considered as a product of the entire system of relationships in the family, and it is with this system that the emergence and development of the child’s maladjustment is associated. Treatment thus involves interaction with all family members.

When is psychotherapy needed?

There are no hard and fast rules here, except that the decision must be made in the best interests of the child. As mentioned, many emotional and behavioral difficulties that occur in childhood and adolescence are part of normal development and do not require therapeutic intervention unless they occur too frequently or are not too severe at a particular point in the child's development. Only when the severity of psychological and behavioral problems exceeds the boundaries of the norm can one think that they are maladaptive, i.e. entail undesirable consequences for the child. For example, if a ten-year-old child has no friends, does not talk on the phone, is afraid to sleep in a room alone, and often refuses to go to school, then the child's behavior can be considered maladaptive; It is in such cases that psychotherapy is indicated.

The decision about whether a child needs psychotherapeutic help is usually made jointly - by parents, psychotherapist and child. When any facts are learned from sources such as school or other family members, teachers and relatives should also be involved in the discussion of this issue. Sometimes it is the parents’ inability to handle the child, their personal psychological problems or problems family relations lead to serious difficulties for the child. Consulting various sources of information can help determine whether treatment is needed and help you choose the right psychotherapeutic approach.

Treatment process.

A child’s visits to a psychotherapist by themselves do not provide the desired result. It is important that the child feels comfortable with the therapist and actively participates in the treatment process. Many psychotherapists argue that the child’s involvement in the psychotherapeutic process is the key to improving his condition.

The nature of psychotherapeutic assistance depends on the disorder that has arisen in the child. Behavioral disorder and deviant (crime-related) behavior respond best to individual and family psychotherapy. In this case, individual therapy instills new behavioral skills, and the change environment achieved by working with the whole family. In another situation, the child may be prescribed weekly individual psychotherapeutic sessions, and sometimes participation in special school programs. Some children require hospitalization, in which case psychotherapy is carried out within the walls of a medical institution.

The duration of therapy varies. For example, behavioral or cognitive behavioral therapy takes several months, while psychodynamic therapy lasts longer, often several years. Various studies confirm the effectiveness of both behavioral psychotherapy and its combination with cognitive psychotherapy. It has also been established that the vast majority of children who need psychotherapy feel significantly better after treatment.


Medical psychology mainly deals 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 be proficient in these two methods, but also be willing to use them.

Sometimes, unfortunately, noticing psychological difficulties in his patients, the doctor notices that he himself has more than once found himself in similar situations and managed without outside help overcome all problems. This thought calms the doctor and allows him to remain inactive.

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 to provide psychological assistance. It is necessary healthy people(clients) with a variety of everyday problems, in crisis situations, as well as patients (patients) with various somatic and mental illness with psychological problems, neurotic and psychosomatic disorders, as well as characterological and personality deviations.

Traditionally, there are three types of psychological assistance:

Psychological consultation,

Psychocorrection,

Psychotherapy.

They represent an impact on various aspects of the personality and have various purposes and methods can be used separately or 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 act on his own, learn new behavior, and promotes personality development.

During psychological counseling, an analysis of the mental state of the client (or patient) is carried out using various methods psychological diagnostics (tests, experiments). He is provided with interpretations of their results, which helps resolve the issues facing the person. psychological problems, 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 to correct (correct) those personal characteristics that are not optimal for the client (patient), development and mastery of skills that are adequate for the individual and effective mental activity, promoting 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, and harmonization of his relationships with the social environment.

Psychotherapy’s main goal is to relieve psychopathological symptoms, through which it is assumed to achieve internal and external harmonization of the personality. Psychotherapy is a system of methods of targeted psychological impact on the 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 in a state of crisis, frustration, stress or mental illness.

In a broad sense, the term “psychotherapy” refers to all types of targeted psychological influence on an individual (consulting, 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 characteristics - from the individual psychological characteristics of the patient to his somatic status, take into account 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 psychological correction itself arose in the 70s of the 20th century, when psychologists began to actively work in the field of group psychotherapy. Since psychotherapy is a therapeutic practice, the spread of the term psychocorrection was aimed at overcoming this situation: the doctor is engaged in psychotherapy, and the clinical psychologist is engaged in psychological correction).

Basic psychotherapeutic techniques

We can say that psychotherapy has existed as long as human civilization has existed. As a prototype modern psychotherapists there were shamans. Psychotherapy developed especially rapidly in the late 19th and early 20th centuries. It was suggested great amount new methods of psychotherapy and there is hardly a specialist who would be familiar with all these methods. In most civilized countries, psychotherapy is considered 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 should never forget that he must help the patient move in the direction that the person has chosen of his own free will. You cannot treat a patient like a blind, helpless kitten who needs to be taught how to live. You cannot ignore the interests of the patient’s personality or treat them arrogantly...

It is incorrect 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 the doctor and the patient. In this sense, a psychotherapist must have 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 psychotherapy methods.

There is no generally accepted classification of psychotherapy methods. From a practical point of view, it is important to highlight some basic features that distinguish one type of psychotherapy from another. As in medicine in general, it is usually customary to divide treatment methods into symptomatic And pathogenetic.

Symptomatic methods of psychotherapy are focused on eliminating or weakening individual symptoms of the disease, managing the physiological functions of the body, and optimizing the patient’s behavior. These methods include rational psychotherapy, suggestive methods (in a waking state or in a state of hypnosis), methods of behavioral therapy (flooding, implosion, aversion, systematic desensitization), relaxation methods (neuromuscular relaxation according to Jacobsen, autotraining), methods of biological feedback and many other private techniques (art therapy, psycho-gymnastics, etc.). Pathogenetic psychotherapy involves eliminating the causes and mechanisms of disease development. It is considered more effective than symptomatic treatment, 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 personality and the pathogenesis of diseases.

Psychotherapy methods can also be divided into expressive(to express – express, express) and support(to support – support, save). These concepts are closely related to the concept 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 action (agree to an operation, dissolve a burdensome marriage, change a job to one more consistent with his character). We should not forget that the opening and breaking of defense mechanisms is very painful, and one should be careful and weigh the real possibilities of a person to endure this additional stress. Supportive methods, on the contrary, strengthen the existing defense systems in a person, support existing self-deception in him for the sake of maintaining calm and a sense of security. The disadvantage of such methods is that they prevent the patient from seeing reality and keep him from taking 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 to take care of maintaining the peace 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, it is often necessary to insist on a more active involvement of the patient in activities, training impaired motor and mental skills). Calming (relaxation) methods are aimed at relieving internal tension and anxiety. They are especially useful in acute periods of stress. They are used to treat diseases associated with internal tension ( hypertonic disease, peptic ulcer, insomnia).

In addition, there are directive And non-directive techniques. 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, and acts from the height of his authority. In most cases, excessive directiveness is considered as a disadvantage of psychotherapy, since it removes responsibility for recovery from the patient, subordinates him to the will of the doctor, and may ignore his true needs. However, in extreme situations, when the patient’s behavior is disorganized by excessive anxiety (emergency hospitalization, preparation for surgery, situation life-threatening), 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, independently searching and comparing several ways to get out of the situation. Such methods develop in the patient independence, confidence that he is able to help himself if necessary.

Psychotherapy can be carried out individually or in Group. Group techniques are useful for a comprehensive impact on the patient’s personality, revealing those traits that interfere with 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 and pay more attention to individual symptoms. It is also good for withdrawn patients who are not inclined to communicate.

Besides the obvious direct methods of psychotherapeutic influence, there are also indirect methods that influence health status through the environment medical institution, the atmosphere in the ward, relationships in the medical team, the form of drug administration, additional therapeutic techniques (physiotherapy, massage, physical therapy).

Regardless of the specific method of psychotherapy, there are general phenomena that are essential elements of psychotherapy.

Making contact it could be considered the most important condition success of psychotherapeutic work. If the doctor has not been able to establish a trusting, frank relationship with the patient, then all further efforts will most likely be fruitless. It is difficult to overestimate the importance of the first meeting between doctor and patient in the formation of mutual understanding and trust. The doctor’s busy schedule often prevents him from having a detailed conversation 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 let the patient speak on his own, without attacking 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.

Being too close between doctor and patient can also be detrimental to treatment (conflict is more difficult to resolve if you are inside it). Therefore, the doctor must maintain a certain distance from the patient’s problems. Taking on all the patient’s problems means taking the position of a caring mother, that is, removing all responsibility for his recovery from the patient. 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 responsibilities and rights of the patient and the patient, the goals of the treatment, and signs of the achieved effect.

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 suppressed feelings that the patient experienced towards 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, or falling in love with the 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 for a true attitude towards the doctor, to show patience, sympathy, understanding, and also to encourage the patient to analyze them intelligently. Countertransference (countertransference) is a similar, but oppositely directed phenomenon, when the doctor experiences irrational feelings towards 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 must actively overcome immature complexes within himself and strive for a reasonable attitude towards the patient (for this, Freud demanded that all psychoanalysts themselves undergo psychoanalytic therapy).

Since psychotherapy is intended to change a person, the doctor’s efforts collide with resistance, that is, a person’s unconscious desire to keep everything as it was before. Resistance is noticeable as the patient increasingly uses psychological defenses, moves away from a deep analysis of the problem. Sometimes the patient actively avoids meeting with the doctor, hides from him, skips scheduled visits, protecting himself from discussing painful topics. Just discussing 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, they are characteristic sharp jumps when the thought to which the doctor directed the patient appears to him in the form of insight (insight - understanding, insight) - sudden illumination or epiphany, intuitive understanding.

In psychology, there are many personality theories that interpret and explain the nature of human behavior in different ways. Each of these theories corresponds to certain therapeutic methods. Many psychotherapeutic methods are described in the literature: psychoanalysis, behavior 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 can be added Gestalt therapy and cognitive therapy, based on 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 S–R scheme he proposed 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.

Quite soon the limitations of this scheme for explaining behavior became clear. As a rule, S and R are in such complex relationships that a direct connection between them cannot be established. In 1948, Tolman introduced the 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 develops as a result of learning, that is, the consolidation of certain reactions to certain stimuli. As a result, rewarded actions are performed more and more often, and punished actions are performed less often. Behaviorism is psychological basis behavioral psychotherapy. The goal of behavioral therapy is to eliminate a pathological symptom by replacing maladaptive behaviors with adaptive ones during the learning process.

Gestalt psychology

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

The main position of Gestalt psychology is that a phenomenon as a whole is not simply the sum of its parts. A separate part does not give any idea of ​​the whole. Human behavior, broken down into individual components, becomes meaningless. 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 psychologist Fritz Perls (F.S. Perls).

In Perls's understanding, the figure acts as a dominant need. The figure (gestalt) can be a desire, thought, feeling that prevails in this moment. As soon as the need is satisfied, the gestalt is completed, loses its significance, moves into the background - the background, giving way to a new gestalt.

Sometimes a need cannot be satisfied. In this case, the gestalt remains incomplete, and therefore cannot be responded to and cannot give way to another. This later 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 become aware of his need, make it clearer (form a Gestalt) and ultimately satisfy it (complete the Gestalt). To be yourself, to realize your own needs and not those imposed from outside, to live “here and now” is the path of a healthy personality.

Psychoanalysis

No branch of psychology has become as famous as psychoanalysis. Founder – Austrian psychiatrist Sigmund Freud (S. Freud).

IN mental life Freud distinguished 3 levels: consciousness, preconscious and unconscious. The unconscious and preconscious are separated from the conscious by “censorship,” which displaces thoughts, feelings, and concepts unacceptable to the individual into the area of ​​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 repressed by “censorship.” These thoughts and feelings are not lost, but simply not allowed to be remembered and therefore appear in consciousness not directly, but in a roundabout way- in slips of the tongue, typos, errors of memory, dreams.

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

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

When many of us hear the word “psychotherapy,” we associate it with a white office and a man in a robe of the same color, diligently writing something down in his notebook. This is not to say that this picture is so implausible, but there are many various types individual and group psychotherapy, in which the patient-therapist relationship looks very different. Let's take a look at these approaches to broaden our horizons.

Main types of psychotherapy

The main task of a psychotherapist is to improve the patient’s quality of life, and this requires deep personal contact, since a person simply cannot open up without trusting the doctor. To create the necessary atmosphere, specialists use a variety of means, selecting the most effective method work.

If we consider the methods in terms of the number of participants, we can distinguish individual and group types of psychotherapy. The rationality of use depends on the specific situation. For example, in groups it can help when people need to understand that their problem is not unique, examples of other people successfully resolving similar situations. Also, group sessions will help, if necessary, to see the full picture of interpersonal relationships. then family psychotherapy is used, which is a type of group approach. Such sessions can help with disagreements between spouses; individual therapy in such cases is ineffective, since the specialist needs to know the opinions of both partners in order to make an objective judgment. In addition, there are specific types psychotherapy that involves only family communication, for example, the method of systemic constellations.

There is another classification of types of psychotherapy that considers not the number of participants in a session, but the methods of influence used to reveal problems and resolve them. These include the following areas:

This list is constantly updated as different people require different approaches. For someone the best way is a heart-to-heart conversation with a psychotherapist, someone can find peace in dancing or painting, and someone is able to find a way out of the current situation by looking at it through the prism of a fairy tale.

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