Lecture
1 Medical and non-medical approach to psychotherapy
2 General idea of the forms, methods and techniques of psychotherapy.
3 Ethical principles and rules in psychotherapy.
In the literature there are many definitions of the concept of "psychotherapy". This is due to the fact that psychotherapy has not yet emerged as a single science with a single conceptual apparatus, terminology, theory.
The meaning of the term “psychotherapy” is translated from Greek with soul healing or soul healing. The term psychotherapy was introduced in 1872 by D. Tuke in the book "Illustrations of the Influence of the Mind on the Body" and became widely popular since the end of the nineteenth century.
The medical model of psychotherapy is understood as a complex therapeutic verbal and non-verbal effects on emotions, judgments, and self-consciousness of a person. Such psychotherapy is used in many mental, nervous and psychosomatic diseases.
The psychological model of psychotherapy can be considered as a direction of activity of a practical psychologist. Psychotherapy is understood as the provision of psychological assistance to healthy people (clients) in situations of various kinds of psychological difficulties, in case of a need to improve the quality of their own lives.
The most important task of a psychologist is not to relieve or alleviate the symptoms of the disease, but to create conditions for the optimal functioning of the personality and its development. WHO states in the Declaration: “Health is not the absence of illness or physical disability, but in a state of general good physical, mental and social well-being.” The WHO Declaration states:
psychotherapy is a special discipline in the humanities, the occupation of which is a free and independent profession;
psychotherapeutic education requires a high level of theoretical and clinical training;
guaranteed variety of psychotherapeutic methods;
Education in the field of one of the psychotherapeutic methods should be carried out integrally: it includes theory, personal therapeutic experience and practice under the guidance of a supervisor, and broad ideas about other methods are acquired at the same time;
Access to such education is provided through various preliminary training, in particular in the humanities and social sciences.
Psychological counseling is a professional attitude of a qualified counselor to a client, which is usually presented as a “personality-personality”, although sometimes more than two people participate in it. The purpose of counseling is to help clients understand what is happening in their living space and meaningfully achieve their goal based on informed choice when solving problems of an emotional and interpersonal nature. Psychological counseling helps to learn new behavior, promotes personal development, it focuses the client’s responsibility, i.e. it is recognized that an independent, responsible individual is capable of making independent decisions in appropriate circumstances, and the consultant creates conditions that encourage the client’s willful behavior.
Psychotherapy is a special kind of interpersonal interaction, in which patients receive professional help with psychological means to solve their mental problems or difficulties. S. Leder points to possible ideas about psychotherapy:
as a method of treatment that affects the state and functioning of the body in the areas of mental and somatic activity;
as a method of exerting influence or influence, setting in motion the process of learning;
as a method of instrumental manipulation that serves the purpose of social control;
as a complex of phenomena occurring during the interaction and communication of people.
Psychocorrection is a directed psychological impact on certain psychological structures in order to ensure the full development and functioning of the individual.
Bramer and Shostrom, speaking of the relationship between counseling and psychotherapy, resort to the concept of the two poles of the continuum. At one extreme, the work of a professional affects mainly situational problems solved at the level of consciousness and arising from clinically healthy individuals. Here is the area of counseling. At the other extreme, there is a great desire for an in-depth analysis of problems with a focus on unconscious processes, the restructuring of the personality. Here is the area of psychotherapy. The area between the poles belongs to an activity that can be both psychotherapy and psycho-counseling.
Distinctive features of psycho-counseling (Gelzo. Frets, Blocher):
orientation to a clinically healthy individual who has psychological difficulties and problems in everyday life, neurotic complaints interested in the further development of the personality;
on the healthy side of the personality, regardless of the degree of the violation, a person can change, choose a life that satisfies his life, find ways to use his inclinations;
on the present and the future of the client;
short-term assistance;
on the problems arising in the interaction of personality and environment;
value-added participation of the consultant is emphasized, although the imposition of values on customers is rejected;
on behavior change and development of the client’s personality.
Today there is a tendency of convergence of medical and psychological psychotherapy. This is manifested in the fact that doctors are interested in Western schools and technicians, and in blurring the boundaries of the medical territory, in the penetration of psychologists into this territory.
2 There are many psychotherapeutic areas, methods, so many definitions are based on certain theoretical concepts, excluding approaches of a different kind. One of the generally accepted definitions is the following: "Psychotherapy is the treatment of various diseases with the help of psychological methods."
If this definition seems to someone to be too “medical”, limiting a wide range of areas of psychotherapy, then we can cite another edition: “Psychotherapy is the use of psychological means to restore the disturbed activity of the body.”
Psychological means primarily include speech, but, oddly enough, silence, then emotions and emotional relationships, facial expressions, various types of learning, manipulation in the environment. Depending on how wide the concept of “psychological means” is, psychotherapy is distinguished in a broad and narrow sense. Psychotherapy in the broad sense of the word includes sociotherapy, environmental treatment, occupational therapy; psychotherapy in the narrow sense is limited to the impact of the psychotherapist (or psychotherapeutic group) on the patient.
The goal of psychotherapy that is common to most psychotherapeutic approaches can be summarized as follows: the general goal of psychotherapy is to help patients change their thinking and behavior so that they become happier and more productive.
When working with patients, this goal is differentiated into a number of tasks, namely:
1) the therapist helps the patient to better understand their problems;
2) eliminates emotional discomfort;
3) encourages the free expression of feelings;
4) provides the patient with new ideas or information on how to solve problems;
5) helps the patient to test new ways of thinking and behavior outside of the therapeutic situation.
In solving these problems, the therapist resorts to three main methods.
1. First, the therapist provides psychological support. First of all, it means sympathetically listening to the patient and giving him balanced advice in a crisis situation. Support is also to help the patient realize and use his strengths and abilities.
2. The second method of therapy is to eliminate maladaptive behavior and the formation of new, adaptive stereotypes.
3. Finally, the therapist promotes insight (awareness) and self-disclosure (self-expansion), with the result that patients begin to better understand their motives, feelings, conflicts, and values.
Despite the differences in theories, goals and procedures, psychological treatment boils down to the fact that one person is trying to help another. All methods of treatment (not only psychological, but any therapeutic, surgical, etc.) have some common basic features or components.
1. A person who suffers and seeks relief from his problem. This is a client, or a patient.
2. A person who, through training or experience, is perceived as able to assist. This is a therapist, or healer.
3. The theory that is used to explain the patient's problems. In medicine, the theory includes, for example, infectious factors, other biological processes. In some cultures, the theory may include a factor of curse or obsession with evil spirits. In psychology, theory includes psychodynamics, principles of learning, or other mental factors.
4. A set of procedures for solving patient problems. These procedures are directly related to the theory.
5. A special social relationship between the client and the therapist that helps alleviate the client’s problems. The therapist seeks to create an atmosphere that allows the patient to look at the solution of their problems with optimism. He believes that the methods used by the therapist will help him, as a result of which he is motivated to work on solving problems. Attitude is a factor characteristic of all forms of treatment. In medicine, an improvement in a patient’s physical or mental condition is usually associated with medication or surgery, but the effectiveness of the treatment depends in part on the patient’s expectations and faith in the treatment. Using a set of specific procedures, most psychotherapists also try to create a positive attitude, because it increases the chances of successful treatment. Some therapists emphasize the relationship factor to a greater extent than other factors (we will see this in the example of Rogers’s client-centered psychotherapy).
Distinguish between clinically-oriented psychotherapy, aimed primarily at alleviating or eliminating the existing symptoms, and personality-oriented, which seeks to help a person change his state toward the social environment and his own personality.
In clinically-oriented psychotherapy, methods such as hypnosis, autogenic training, various types of suggestion and auto-suggestion are traditionally used.
In personality-oriented psychotherapy, there is a huge variety of methods and techniques based on conceptual models of many schools and movements.
In psychotherapy, the following general tasks can be distinguished, combining psychotherapeutic methods of different directions and content:
research of client’s psychological problems and assistance in solving them;
improving subjective well-being and improving mental health;
the study of psychological patterns, mechanisms and effective ways of interpersonal interaction to create the basis for effective and harmonious communication with people;
development of self-awareness and self-research of clients for correction or prevention of emotional disorders based on internal and behavioral changes;
promoting the process of personal development, the realization of creative potential, the achievement of an optimal level of life and a sense of happiness and success.
The main purpose of the psychotherapeutic impact is to help patients make the necessary changes in their lives. The psychotherapeutic influence, without creating new qualities in the personality, brings the existing ones in line with the changed life situation. Such alignment and ensures the success of psychotherapy minor mental disorders.
Types of psychotherapy have different "targets" of psychotherapeutic effects. Thus, the “target” in bioenergy analysis is the body, and in client-centered therapy, experiences, experiences, in cognitive therapy, non-adaptive thoughts and other images of imagination, etc.
Psychotherapeutic approaches can be divided into problem-oriented and customer-oriented. The implied installation of type 1 psychotherapy is the installation on the mandatory immersion of the patient in the problem. If the patient does not want to do this, it is interpreted as resistance to therapeutic effects. Do not enter and do not delve into the problem is considered ineffective.
In client-oriented psychotherapy, the patient is free to choose what to talk with the therapist and how much time to devote to therapy. If the client does not talk about his problem, it is not viewed as resistance, but as the client’s legal right to talk only about what he wishes.
Psychotherapy has structural components:
stages of psychotherapy;
principles of primary counseling and basic techniques of psychotherapeutic intervention;
verbal and non-verbal psychotherapeutic work;
the creation and use of metaphors in the process of psychotherapeutic counseling;
requirements for the identity of the psychotherapist;
ethics of the psychotherapist.
Consider a 5-step model of the process of psychotherapy:
establishing contact and orientation of the client to work,
gathering information about the client, solving the question “what is the problem?”
awareness of the desired result, the answer to the question “what do you want to achieve?”
development of alternative solutions, which can be designated “what else can we do about this,”
generalization by the psychologist in the form of a summary of the results of interaction with the client.
Interviews, tests, observation of behavior, results of self-observation, and specific techniques for describing a problem are used to investigate a client’s problem. To collect information, use the following structure: demographic data (gender, age, occupation, marital status); history of the problem; receiving psychotherapeutic help; education, relationships with classmates, colleagues, stressors, job satisfaction; health, diseases, sleep disorders, appetite, the use of drugs; social development - important life events, memories, current life situation, daily routine, work, activities, communication, hobbies, values, beliefs; family, marital status, relationship with the opposite sex, sex; response stereotypes.
All the wealth and diversity of customer requests can be reduced to 4 main strategies for their attitude to the situation. They may want to: change the situation, change themselves to adapt to the situation, get out of the situation, find new ways to live in this situation.
The technique of therapeutic intervention - a certain kind of reaction from the consultant, aimed at achieving the intermediate and final goals of psychological counseling.
We list these techniques:
reward is the minimum means to maintain the client’s statement of his own history, to confirm the client’s own history, recognition and understanding of what the client has said;
repetition - reproduction of what was said by the client or selective emphasis on certain elements of his message;
question - an invitation to tell, a means of gathering information, clarifying or researching customer experience;
clarification - the return of the essence of the cognitive content of the client's statement, the understanding by the client of its own inner world, interaction with the outside world;
confrontation is a reaction in which opposition to a client’s defensive maneuvers or irrational notions is manifested, unconscious and unchangeable, revealing and demonstrating contradictions or discrepancies between various elements of his mental experience;
interpretation - the process of giving additional meaning or a new explanation to the inner experiences or external events of the client or linking between themselves disparate ideas, emotional reactions and actions;
summation - a statement that in a short phrase collects the main ideas of the client’s story, establishes a certain sequence and summarizes the result achieved during the conversation;
Reflection of feelings is a reflection and verbal designation of a client's emotions in order to facilitate their response and comprehension;
informing - providing information in the form of explanations, statements of facts or opinions of one's own will;
advice (recommendation) - expressing to the client his own opinion, based on his own vision of the situation, suggesting to the client whether or not to do something;
conviction involves taking into account the position, opinions, objections of the client, which the therapist is trying to overcome with the help of personal influence, challenge and manipulation;
парадоксальная реакция – создание необычной перспективы к альтернативному и рациональному для клиента восприятию ситуации или способу реагирования на нее;
обратная связь – описание клиента, которое помогает ему узнать, как другие воспринимают его, как они реагируют на его поведение, обратная связь описательна, безоценочна и своевремена, предоставление точной и конкретной информации, направленность на поведение, которое клиент способен исправить;
самораскрытие – разделение с клиентом собственного опыта, предоставление информации о себе, событиях из собственной жизни, выражение в отношениях с клиентом испытываемых чувств и желаний, фантазий;
a directive is a way to involve the client in the process of researching or modifying their own feelings, knowledge or behavior, a proposal to take certain actions during the sessions, to perform certain tasks in between.
3
In the system of regulation of professional activity, ethical principles play a significant role. They secure rights and responsibilities. The type of relationship of participants in the psychotherapeutic process. Professional communities authorize a system of norms that the psychotherapist is obliged to know and is guided by in his work. We describe the principles. Ensuring compliance with professional ethics in the psychotherapeutic process.
1. Ответственность – психотерапевт принимает на себя ответственность за организацию, ход и результат психотерапии. Его работа строится на основе учета интересов клиента. Однако не вся ответственность за решение проблемы возлагается на психотерапевта. С самого начала клиент должен понимать, что его продвижение будет зависеть от него, и этот путь он должен пройти сам, опираясь на знания, опыт и поддержку психотерапевта.
2. Конфиденциальность – соблюдение интересов клиента требует хранить в тайне происходящее во время сеанса. Психотерапевт не должен предоставлять информацию о клиенте должностным лицам. Соблюдение данного принципа вызывает доверие к специалисту, способствует установлению хороших терапевтических отношений. Если клиент сообщил информацию о возможной опасности для жизни, здоровья, благополучия, то психотерапевт должен принять меры для ее предотвращения.
3. Отношение к клиенту должно базироваться на принятии клиента таким, какой он есть. Тогда он становится способным принять себя.
Правила работы психотерапевта:
Не навреди – неосторожное использование диагностических данных, поспешные выводы и рекомендации, необдуманное применение методик может нанести вред психическому состоянию и жизни конкретного человека, семьи, коллектива.
Не используйте информацию, полученную от клиента – необходим строгий контроль над полученной информацией.
Не советуйте – мастерство психотерапевта прямо обратно пропорционально количеству даваемых советов.
Не предлагайте свои услуги, ждите, когда об этом попросят – предлагая свои услуги, психотерапевт рискует попасть в треугольник: преследователь – Избавитель – Жертва. Из одной роли можете перейти в другую, выбраться из него трудно.
Делайте выводы и выбирайте методы работы, не противоречат научным данным – все результаты работы должны быть научно обоснованы, всесторонне взвешены.
Профессионально растите – овладение новейшими технологиями, постоянное обновление средств и методов работы.
Ориентируйтесь в своей работе на ценность другого человека – психотерапевт создает обобщенный образ другого человека – счастливого, творческого, уверенного в себе, терпимого.
Literature.
Основная литература.
Ежова Н.Н. Рабочая книга практического психолога. – Ростов н/Д: Феникс, 2008.
Малкина-Пых И.Г. Справочник практического психолога. – М.:Эксмо, 2008.
Настольная книга практического психолога. / Comp. С.Т. Посохова, С.Л. Соловьева. – М.: АСТ: ХРАНИТЕЛЬ; СПб.: Сова, 2008.
Дополнительная литература.
Фейдимен Д., Фрейгер Р. Теория и практика личностно-ориентированной психологии. – М., 1995.
Адлер А. Практика и теория индивидуальной психологии. – М. 1995.
Сидоренко Е.В. Экспериментальная групповая психология. – СПб., 1993.
Адлер А. Индивидуальная психология./ История зарубежной психологии. 30-60-е годы XX в. (тексты). – М., 1986.
Vitels S. Freud: his personality, teaching and school. Chapter X. A. Adler. - L., 1991.
Draykurs R., Zoltz V. Happiness of your child. - M., 1986.
Christensen OK, Thomas K.R. Draycurs and the search for equality. - M., 1992.
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The basics of psychotherapy
Terms: The basics of psychotherapy