The theoretical foundations of group personality-oriented (reconstructive) psychotherapy lie in Myasishchev’s theory of relationships. V. N. Myasishchev pointed out that the concept of “relationship” opens the door to the world of synthetic categories, among which he considered communication to be one of the most important - the process of interaction between people, which is a necessary prerequisite for the formation and development of personality. Since this process always takes place in the conditions of one group or another, we cannot fail to take into account the importance of the role of the group in the formation of an individual system of relations.
According to the views of the outstanding Russian psychologist L. S. Vygodsky, higher mental functions develop initially between people as an interpsychic category, and only then in the individual as an intrapsychic one. From the very first days of his life, being a member of a wide variety of social groups (starting with the nuclear family and successively being included in ever wider and differentiated groups, such as preschool, school, professional, friendly, etc.), a person learns the norms of these groups , learns to take certain positions in them, perform certain roles, correlate one’s own tendencies with the requirements of the group, etc. The internalization of these norms, roles, positions leads to the development and formation of personality as an individual system of socially significant relationships. If this development occurs under unfavorable conditions, then the range of a person’s social behavior, and therefore his system of relationships, will be narrowed, inadequate, and in a subjectively difficult situation will not be able to provide him with full functioning and development.
The roots of neurosis, like personality traits, are laid in early childhood. The family, therefore, is the primary model of a social group in which the child begins to form as an individual, acquires his first interpersonal communication skills, and his first experience of emotional perception and experience. If this experience turns out to be unfavorable (and this happens as a consequence of a breakdown in family relationships), the child begins to develop inadequate attitudes and forms of emotional response. Depending on the degree and strength of expression, these primary disorders can significantly complicate the possibility of subsequent correction through participation in social groups that are new to the individual, and often, according to the “vicious circle” principle, they can even intensify, ultimately leading to a pronounced neurotic conflict, which always manifests itself not only in the individual, personal problems of a patient with neurosis, but also in his disturbed interpersonal relationships - relationships with other people.
From this point of view, it takes on special significance the possibility of targeted use of the group to influence its individual participants, and especially valuable for psychotherapeutic practice is the ability to achieve changes not only in external, behavioral reactions, but also in the characteristics of emotional perception and response, value orientations and, ultimately, in the patient’s system of relationships.
In a psychotherapeutic group, each patient models his real life situation, uses his usual behavioral stereotypes, and implements characteristic relationships and attitudes. Here he gets the opportunity to look at himself from the outside, understand the unproductive nature of his behavior and communication, and in a psychotherapeutic setting come to change broken relationships, acquiring skills of full communication, abandoning neurotic defense mechanisms, mastering other, more adequate forms of emotional response and behavior.
Thus, the group psychotherapeutic process covers not only the individual problems of the patient in its direct expression, but also the refraction of individual problems in real relationships that develop in the group: with other members of the group, with the group as a whole, with the psychotherapist (B. D. Karvasarsky, V A. Murzenko). The specificity of group psychotherapy lies in the conscious and purposeful use of the entire set of relationships and interactions that arise among group members (including the psychotherapist), that is, there is a purposeful use of group dynamics for therapeutic purposes.
Three strata of group structures, according to A.V. Petrovsky, can simultaneously be considered as three levels of group development, specifically three levels of group cohesion. At the first level, cohesion is expressed by the development of emotional contacts. At the second level (which corresponds to value-orientation unity), further unity of the group occurs, and now this is expressed in the coincidence of the basic system of values associated with the process of joint activity. At the third level (which corresponds to the “core” layer of intragroup relations), the integration of the group, and therefore its cohesion, is manifested in the fact that all its members begin to share the common goals of group activity.
Purpose The goal of a group psychotherapist is to transform a diffuse group into a psychotherapeutic team. A team is a community of people in which interpersonal relationships are mediated by the socially valuable and personally significant content of joint activities. Therefore, the task of the psychotherapist is not only to create a “psychotherapeutic atmosphere” conducive to resolving the problems of individual participants (which is usually the emphasis), but also to form, in the process of group communication, some group-wide values that mediate it, which, being internalized , could become “new” personality traits that ensure the process of subsequent rehabilitation.
Subject the joint activity of all members of the psychotherapeutic team is the system of relationships of each of its members. Correction of inadequate relationships, the formation of a socially acceptable system of relationships for each member of the group is socially and personally significant in the subject of joint activities of all.
Objectives of person-oriented (reconstructive) psychotherapy
The goals and objectives of personality-oriented (reconstructive) psychotherapy are formulated in general terms for both individual and group psychotherapy, but are solved using the means used in each of these forms. Taking into account the three planes of expected changes, the tasks of person-oriented (reconstructive) psychotherapy can be formulated as follows (G. L. Isurina).
1. Cognitive sphere (cognitive aspect, intellectual awareness). The psychotherapy process should help the patient realize:
The relationship between psychogenic factors and the occurrence, development and maintenance of neurotic disorders;
What situations cause tension, anxiety, fear and other negative emotions that provoke the appearance, fixation and intensification of symptoms;
The connection between negative emotions and the appearance, fixation and intensification of symptoms;
Features of your behavior and emotional response;
How his behavior is perceived by others, how others evaluate certain characteristics of behavior and emotional response and how they react to them, what consequences this behavior has;
The existing discrepancy between one’s own self-image and the perception of others;
Own motives, needs, aspirations, attitudes, characteristics of behavior and emotional response, as well as the degree of their adequacy, realism and constructiveness;
Characteristic defense mechanisms;
Internal psychological problems and conflicts;
Deeper causes of experiences, modes of behavior and emotional reactions starting from childhood, as well as the conditions and features of the formation of one’s system of relationships;
Your own role, the extent of your participation in the emergence, development and maintenance of conflict and traumatic situations, as well as how you could avoid their repetition in the future.
In general, the tasks of intellectual awareness within the framework of person-oriented (reconstructive) psychotherapy are reduced to the following three aspects: awareness of the situation-person-illness connections; awareness of the interpersonal plan of one’s own personality; awareness of the genetic (historical) plan.
2. Emotional sphere. The psychotherapy process should help the patient:
Receive emotional support from a psychotherapist or group, experience positive emotions associated with acceptance, support and mutual assistance;
To experience, within the framework of the psychotherapeutic process, those feelings that he often experiences in real life, to reproduce those emotional situations that he had in real life and which he could not cope with;
Experience the inadequacy of some of your emotional reactions;
Learn to be sincere in your feelings towards yourself and other people;
Become more free to express your own positive and negative emotions;
Learn to more accurately verbalize and understand your own feelings;
Reveal your problems with the accompanying experiences (often previously hidden from yourself or distorted);
Modify the way you experience, react emotionally, perceive yourself and your relationships with others;
Make emotional adjustments to your relationships.
In general, the tasks of person-oriented (reconstructive) psychotherapy in the emotional sphere cover four main aspects: accurate recognition and verbalization of one’s own emotions, as well as their acceptance; reliving and becoming aware of past emotional experiences; direct experience and awareness of the experience of the psychotherapeutic process and one’s own; developing a more emotionally favorable attitude towards oneself.
3. Behavioral sphere. The psychotherapy process should help the patient:
See your own inadequate behavioral stereotypes;
Acquire skills for more sincere, deep and free communication;
Overcome inappropriate forms of behavior that manifest themselves during psychotherapy, including those associated with avoiding subjectively difficult situations;
Develop forms of behavior associated with cooperation, responsibility and independence;
To consolidate new forms of behavior, in particular those that will contribute to adequate adaptation and functioning in real life;
Develop and consolidate adequate forms of behavior and response based on achievements in the cognitive and emotional spheres.
In the most general form, the focus of personality-oriented (reconstructive) psychotherapy in relation to the behavioral sphere can be formulated as the task of forming effective self-regulation based on adequate, accurate self-understanding and a more emotionally favorable attitude towards oneself.
Thus, the tasks of person-oriented (reconstructive) psychotherapy focus on three components of self-awareness: self-understanding, attitude towards oneself and self-regulation, and the overall goal can be defined as the formation of adequate self-awareness and expansion of its scope (G. L. Isurina).
Mechanisms therapeutic effect of personality-oriented (reconstructive) psychotherapy.
The following can be considered as the main mechanisms of the therapeutic effect of person-oriented (reconstructive) psychotherapy: corrective emotional experience, confrontation and learning (G. L. Isurina).
Corrective emotional experience. This concept includes several aspects, and above all emotional support. Emotional support means for the patient his acceptance by the psychotherapist (or psychotherapist and group), recognition of his human value and significance, the uniqueness of his inner world, the willingness to understand him based on his relationships, attitudes and values. Constructive processing of the content of feedback and the formation of adequate self-understanding presupposes the patient’s acceptance of new information about himself, which often does not correspond to his own ideas.
Acceptance of a patient by a psychotherapist (or group) promotes the development of cooperation, facilitates the patient’s assimilation of psychotherapeutic norms, increases his activity and responsibility in the psychotherapeutic process, and creates conditions for self-disclosure.
Confrontation. Confrontation is understood as a “collision” of the patient with himself, with his problems, conflicts, attitudes, characteristic emotional and behavioral stereotypes and is carried out mainly due to feedback between the participants in the psychotherapeutic process.
Feedback in group psychotherapy is more multifaceted than in individual therapy, since it is carried out between each member of the group and the group as a whole. Feedback allows a group member to understand and appreciate the significance of his own role in typical interpersonal conflicts and through this to better understand his neurotic problems and the characteristics of his relationships in the past and present.
Learning. Learning within the framework of person-oriented (reconstructive) psychotherapy is carried out both directly and indirectly. Group psychotherapy provides more favorable conditions for the implementation of this mechanism. The group acts as a model of the patient’s real behavior, in which he exhibits typical behavioral stereotypes, and thus creates conditions for the patient to study his own interpersonal interaction and behavior, and allows him to identify constructive and non-constructive elements in it that bring satisfaction or cause negative experiences.
A group situation is a situation of multifaceted, real, emotional interpersonal interaction, which greatly facilitates the abandonment of inappropriate behavioral stereotypes and the development of full communication skills. These changes are positively reinforced in the group, the patient begins to feel his ability to make changes that bring satisfaction to himself and are positively perceived by others.
Psychotherapeutic direction, which is a further development of Myasishchev’s teachings about neuroses and their psychotherapy. According to its basic theoretical principles, person-oriented (reconstructive) psychotherapy can be classified as a psychodynamic direction in psychotherapy.
Developed in the Department of Neuroses and Psychotherapy of the Psychoneurological Institute named after. V.M. Bekhterev. The emergence of person-oriented (reconstructive) psychotherapy as an independent direction in psychotherapy can be dated back to the early 70s and includes: 1) the concept of personality as a system of relationships between an individual and the environment; 2) the biopsychosocial concept of neurotic disorders, within which neurosis is understood primarily as a psychogenic disease caused by a violation of relationships that are significant for the individual; 3) a system of person-oriented individual and group psychotherapy, the main goal of which is to achieve positive personal changes (correction of a disturbed system of relationships, inadequate cognitive, emotional and behavioral stereotypes), which leads to both an improvement in the patient’s subjective well-being and the elimination of symptoms, and to recovery full functioning of the individual.
The theory of person-oriented (reconstructive) psychotherapy contains ideas about its goals and objectives, mechanisms of therapeutic action, specifics and stages of the psychotherapeutic process, features of interaction between the patient, psychotherapist and group, methodological approaches and techniques, etc.
Initially, the goals and objectives of person-oriented (reconstructive) psychotherapy were formulated as follows:
1) a deep and comprehensive study of the patient’s personality: the specifics of the formation, structure and functioning of his system of relationships, the characteristics of his emotional response, motivation, needs;
2) identification and study of etiopathogenetic mechanisms that contribute to the emergence and maintenance of a neurotic state and symptoms;
3) the patient’s achievement of awareness and understanding of the cause-and-effect relationships between the features of his system of relationships and his disease;
4) change and correction of the disturbed system of relationships of a patient with neurosis;
5) if necessary, assistance to the patient in a reasonable resolution of his psychotraumatic situation, changing his objective position and the attitude of others towards him.
The further development of person-oriented (reconstructive) psychotherapy, which is largely associated with the widespread use of group psychotherapy, made it possible, based on an analysis of practical work experience and scientific research in this area, to more clearly and specifically formulate the main theoretical principles of this psychotherapeutic system as a whole in relation to individual, and to its group forms, and above all its goals and objectives, as well as ideas about the mechanisms of therapeutic action.
The objectives of personality-oriented (reconstructive) psychotherapy, formulated at the beginning, essentially reflect the step-by-step nature of the psychotherapeutic process - from studying the personality of the patient and the patient, through awareness, to the correction of disturbed personality relationships - and focus the psychotherapeutic process primarily on cognitive aspects. However, person-centered (reconstructive) psychotherapy does not simply include three planes of change (cognitive, emotional and behavioral) as its tasks - the process of psychotherapy itself is based on the balanced use of cognitive, emotional and behavioral mechanisms.
The goals and objectives of any psychotherapeutic direction focused on personal changes arise from ideas about the specifics of personality disorders, which, in turn, are determined by the personality concept. That is why, within the framework of a specific direction, the goals and objectives of psychotherapy are formulated in general terms for both individual and group psychotherapy, but are solved using their own means.
The tasks of person-oriented (reconstructive) psychotherapy, taking into account the three planes of expected changes, can be formulated in more detail as follows:
1. Cognitive sphere (cognitive aspect, intellectual awareness).
The psychotherapy process should help the patient realize:
The relationship between psychogenic factors and the occurrence, development and maintenance of neurotic disorders;
What situations cause tension, anxiety, fear and other negative emotions that provoke the appearance, fixation and intensification of symptoms;
The connection between negative emotions and the appearance, fixation and intensification of symptoms;
Features of one’s behavior and emotional response in various situations, their repeatability, degree of adequacy and constructiveness;
How his behavior is perceived by others, how others react to certain characteristics of behavior and emotional response and how they evaluate them, what consequences such behavior has;
The existing discrepancy between one’s own self-image and others’ perception of oneself;
Own needs, aspirations, motives, relationships, attitudes, as well as the degree of their adequacy, realism and constructiveness;
Characteristic protective psychological mechanisms;
Internal psychological problems and conflicts;
Deeper causes of experiences, modes of behavior and emotional reactions starting from childhood, as well as the conditions and features of the formation of one’s system of relationships;
Your own role, the extent of your participation in the emergence, development and maintenance of conflict and traumatic situations, as well as how you could avoid their repetition in the future.
In general, the tasks of intellectual awareness in person-oriented (reconstructive) psychotherapy come down to three aspects: awareness of the connections “personality - situation - illness”, awareness of the interpersonal plan of one’s own personality and awareness of the genetic (historical) plan. It should be emphasized that the first stage of awareness, which is conventionally designated as “situation-person-illness,” is not decisive for its own psychotherapeutic effect. Rather, it creates a more sustainable motivation for the patient’s active and conscious participation in the psychotherapeutic process.
The central target of therapy is intrapsychic conflict, which arises as a result of blocking any area of relationships that is important for the further development of a person. This blockage usually occurs relatively early in childhood development. Therefore, one side of the intrapsychic conflict is an unfulfilled attitude, one might say, an unfulfilled need. This relationship, under favorable circumstances, could become the basis for the formation of new relationships associated with the expansion of the individual's social interactions. These potentially possible relationships would correspond to the new nature of the demands placed on the individual and would give him the opportunity to flexibly adapt to increasingly complex tasks. But since a person has stopped in his psychological development, then in this problematic area of relationships his psychological resources are insufficient to cope with a new social task. And in this area of the relationship he is potentially vulnerable. Let us assume that the individual had blocked relationships related to the manifestation of initiative. At the stage of their formation, the child was punished, stopped, and not encouraged for showing independence and initiative, even if not always productive. Subsequently, such a child will develop favorably only in those areas of relationships in which initiative and personal responsibility are not required from him. In other areas where independence is required, it is dysfunctional. Therefore, he may have a paradoxical reaction. The child is promoted to a higher social position, for example, to lead a group of fellow students, but instead of rising, he reacts with anxiety, a decrease in mood, and in terms of behavior, he demonstrates not the most productive actions and decisions. Similar reactions and behavior can be observed in an adult who has a similar Achilles heel. Thus, unresolved intrapsychic conflict makes a person potentially maladaptive in those areas that it affects.
The second side of the intrapsychic conflict is motivation, which prevents the realization of a significant need or relationship. It is clear that the blocks that stopped the formation of a significant relationship were real and insurmountable for the child, and they were recorded in his psyche as insurmountable, associated with intense negative emotions. Subsequently, a collision with persons or situations that are somewhat reminiscent of them, associated with them, causes increased anxiety and stops actions to realize a significant current need (the first side of the intrapsychic conflict).
The resolution of an intrapsychic conflict does not involve the suppression and destruction of the opposite side, but the creation of such interaction in which each of the parties would receive conditions for full development and constructive interaction with each other.
Carrying out therapy involves solving several problems:
1. Identification of significant symptom-related intrapsychic conflict.
2. Awareness of its essence (the content of opposing motives), conscious acceptance of those that can be accepted, rejection of those that cannot be accepted.
3. Through the prism of a new understanding of one’s motives, modification of relationships, first of all, in the most significant problem areas, including attitudes towards illness.
In other words, the main task of pathogenetic psychotherapy is to clarify life relationships that played a pathogenic role, deprived a given person of the ability to adequately process the current situation and caused overstrain and disorganization of nervous activity, the restructuring of maladaptive relationships, and the formation of new productive relationships in the problem area.
In a more detailed form, the tasks of personal reconstructive psychotherapy can be formulated as follows:
1. A deep and comprehensive study of the patient’s personality: the specifics of the formation, structure and functioning of his system of relationships, the characteristics of his emotional response, motivation, needs.
2. Identification and study of etiopathogenetic mechanisms that contribute to the emergence and maintenance of a neurotic state and symptoms.
3. Achieving the patient's awareness and understanding of the cause-and-effect relationships between the features of his system of relationships and his disease.
4. Awareness of his active role in maintaining irrational ways of resolving neurotic conflict.
5. Assisting the patient in a reasonable resolution of his traumatic situation, correcting inappropriate behavior patterns, acquiring the skill of productively resolving problem situations.
Carrying out personal reconstructive psychotherapy includes a number of mandatory stages:
1. Creation of a psychotherapeutic alliance.
The start of the therapy itself is preceded by the stage of collecting an anamnesis. In addition to the usually collected anamnesis, for the diagnostic qualification of the patient’s condition, the therapist already at this stage identifies areas of relationships in which the patient has difficulties. Draws attention to the repetition of unproductive strategies of behavior in problem situations, the level of generalization of such strategies, whether they cover one sphere of relations, for example production, or several. To better identify such problematic situations, it is advisable to ask the patient to recall 3-5 situations relating to different age periods (childhood and early school years, adolescence and youth, the period of maturity) in which he experienced difficulties. Already at this stage it is possible to assume which basic (ontogenetically earlier) relationship is violated and manifests itself in these problematic situations. At the same stage, connections are noted between exacerbations of symptoms and aggravation of the traumatic situation. With the help of these and some other techniques, the patient is gradually brought to the psychogenic model of the disease. It is important that he at least partially accepts this concept of illness.
2. The next stage is the conclusion of a psychotherapeutic contract. It involves introducing the client to the concept of pathogenetic therapy, describing the goals of therapy, the timing of its implementation, the obligations and responsibilities of the parties. The patient is informed that the goal of therapy is the formation of new, full-fledged relationships that make it possible to function adaptively in problem areas, through their formation to fill those gaps, those deficits in connections with the environment that did not allow productive development and functioning. The patient is provided with brief information about the intrapsychic conflict, its role in the emergence of problematic situations, and the main stages of the procedure. The information is given in the most simplified form so that it guides rather than programs the patient.
3. Diagnostic stage of psychotherapy, identification of potential targets of psychotherapy.
Subsequently, various treatment options are possible:
1) Therapy that begins and focuses directly on the symptoms.
2) Therapy that works on the most typical problem situation associated with symptoms.
3) Therapy focused on the latest most pressing traumatic situation associated with exacerbation of symptoms.
4) Therapy focused on the ontogenetically earliest situation similar to the last traumatic situation.
There are other options for getting started.
The first treatment option is described in detail in the PhD thesis of our applicant E.V. Tsareva. It involves the following stages.
Stage of body-oriented psychotherapy. The goal of this stage was a cathartic response to emotions associated with symptoms (the technique of segment-by-segment “opening of the shell” by W. Reich); acquiring sensitivity in differentiating bodily and psychological sensations associated with symptoms (basic technique: amplification (strengthening) and response of emotions associated with the symptom, which in turn allows you to begin to distance yourself from the manifestations of the disease).
Art therapy stage. Its goal was to further distance the patient from the symptoms and disidentify with them, to deepen the clarification of the leading emotions associated with the symptom and the meaningful psychological meaning of the symptoms. Thus, the clarification of the unconscious, repressed part of the intrapsychic conflict began.
The stage of working with focal, intrapersonal conflict associated with symptoms. The goal of this stage was to understand the meaningful meaning of intrapersonal conflict, polar tendencies, and motives. The main technique used at this stage was the “intrapersonal collision” technique.
Integration stage. The goal of this stage is the acceptance of previously unconscious, incomplete motives, reformulation of the personal meaning of each of the parties creating an intrapersonal conflict.
During the treatment course at all its stages, two interconnected psychological processes are constantly carried out:
- awareness;
– reconstruction of personality relationships.
Awareness, insight lies in the gradual expansion of the patient’s sphere of self-awareness, his understanding of the true sources of his own neurotic disorders.
Reconstruction of personality relationships is manifested in the correction of damaged ones and the development of new relationships at the cognitive, emotional and behavioral levels.
Pathogenetic psychotherapy is based on the balanced use of cognitive, emotional and behavioral mechanisms.
1. Objectives of pathogenetic psychotherapy in the cognitive sphere:
a) awareness of the connections “personality – situation – illness”;
b) awareness of the interpersonal plan of one’s own personality;
c) awareness of the genetic (historical) plan.
It should be emphasized that the first stage of awareness, which is conventionally designated as “personality - situation - illness,” is not decisive for the actual psychotherapeutic effect. Rather, it creates a more sustainable motivation for the patient’s active and conscious participation in the psychotherapeutic process.
The process of psychotherapy should help to realize in the cognitive sphere (cognitive, intellectual awareness):
a) the connection between psychogenic factors and the emergence, development and maintenance of neurotic disorders, that is, to understand the connection between negative emotions and the appearance, fixation and intensification of symptoms;
b) features of one’s behavior and emotional response in various situations, their repetition, the degree of adequacy and constructiveness;
c) how his behavior is perceived by others, how others react to certain features of his behavior and emotional response and how they evaluate them, what consequences such behavior has;
d) existing discrepancies between one’s own image of “I” and the perception of oneself by others;
e) own needs, aspirations, motives, relationships, attitudes, as well as the degree of their adequacy, realism and constructiveness;
f) characteristic protective psychological mechanisms;
g) internal psychological problems and conflicts;
h) deeper causes of experiences, modes of behavior and emotional reactions, starting from childhood, as well as the conditions and features of the formation of one’s system of relationships;
i) one’s own role, the extent of one’s participation in the emergence, development and maintenance of conflict and traumatic situations, as well as how they can be resolved.
2. Objectives of pathogenetic psychotherapy in the emotional sphere:
a) accurate recognition and verbalization of one’s own emotions, as well as their acceptance;
b) experiencing and awareness of past emotional experience;
c) direct experience and awareness of the experience of the psychotherapeutic process;
d) formation of a more emotionally favorable attitude towards oneself.
In the emotional sphere, the psychotherapy process should help the patient:
a) receive emotional support from a psychotherapist or group, experience positive emotions associated with acceptance, support and mutual assistance;
b) experience, within the framework of the psychotherapeutic process, those feelings that he often experiences in real life, reproduce those emotional situations that he had in real life and which he could not cope with;
c) experience the inadequacy of some of your emotional reactions;
d) learn to be sincere in expressing feelings towards other people;
e) become more free in expressing one’s own positive and negative emotions;
f) learn to more accurately understand and accept, as well as verbalize your own feelings;
g) reveal your problems with the accompanying experiences (often previously hidden from yourself or distorted);
h) modify the way of experiencing, emotional response, perception of oneself and one’s relationships with others;
i) make emotional correction of your relationships.
3. The objectives of pathogenetic psychotherapy in the behavioral sphere are the formation of effective self-regulation based on adequate, accurate self-understanding and a more emotionally favorable attitude towards oneself.
In the behavioral sphere, the psychotherapy process should help the patient:
a) see your own inadequate behavioral stereotypes;
b) acquire more adequate communication skills;
c) overcome inappropriate forms of behavior that manifest themselves in the process of psychotherapy, including those associated with the fear of subjectively difficult situations;
d) develop forms of behavior that will contribute to adequate adaptation and functioning in real life;
e) develop and consolidate adequate forms of behavior and response based on achievements in the cognitive and emotional spheres;
f) consolidate new forms of behavior, in particular those that will contribute to favorable adaptation.
Thus, the tasks of pathogenetic psychotherapy focus on three components of self-awareness: self-understanding, attitude towards oneself, self-regulation.
The general goal can be defined as the formation of adequate self-awareness and the expansion of its scope.
The textbook “Psychotherapy” was prepared by employees of the Military Medical Academy named after. S. M. Kirov and the St. Petersburg Medical Academy of Postgraduate Education.
This manual is intended for students of the faculty of postgraduate and additional education, as well as for doctors, graduate students, residents, interns in the specialties of Psychiatry, Psychotherapy and related disciplines (narcology, psychophysiology, suicidology, medical psychology, etc.).
The central target of therapy is intrapsychic conflict, which arises as a result of blocking any area of relationships that is important for the further development of a person. This blockage usually occurs relatively early in childhood development. Therefore, one side of the intrapsychic conflict is an unfulfilled attitude, one might say, an unfulfilled need. This relationship, under favorable circumstances, could become the basis for the formation of new relationships associated with the expansion of the individual's social interactions. These potentially possible relationships would correspond to the new nature of the demands placed on the individual and would give him the opportunity to flexibly adapt to increasingly complex tasks. But since a person has stopped in his psychological development, then in this problematic area of relationships his psychological resources are insufficient to cope with a new social task. And in this area of the relationship he is potentially vulnerable. Let us assume that the individual had blocked relationships related to the manifestation of initiative. At the stage of their formation, the child was punished, stopped, and not encouraged for showing independence and initiative, even if not always productive. Subsequently, such a child will develop favorably only in those areas of relationships in which initiative and personal responsibility are not required from him. In other areas where independence is required, it is dysfunctional. Therefore, he may have a paradoxical reaction. The child is promoted to a higher social position, for example, to lead a group of fellow students, but instead of rising, he reacts with anxiety, a decrease in mood, and in terms of behavior, he demonstrates not the most productive actions and decisions. Similar reactions and behavior can be observed in an adult who has a similar Achilles heel. Thus, unresolved intrapsychic conflict makes a person potentially maladaptive in those areas that it affects.
The second side of the intrapsychic conflict is motivation, which prevents the realization of a significant need or relationship. It is clear that the blocks that stopped the formation of a significant relationship were real and insurmountable for the child, and they were recorded in his psyche as insurmountable, associated with intense negative emotions. Subsequently, a collision with persons or situations that are somewhat reminiscent of them, associated with them, causes increased anxiety and stops actions to realize a significant current need (the first side of the intrapsychic conflict).
The resolution of an intrapsychic conflict does not involve the suppression and destruction of the opposite side, but the creation of such interaction in which each of the parties would receive conditions for full development and constructive interaction with each other.
Carrying out therapy involves solving several problems:
1. Identification of significant symptom-related intrapsychic conflict.
2. Awareness of its essence (the content of opposing motives), conscious acceptance of those that can be accepted, rejection of those that cannot be accepted.
3. Through the prism of a new understanding of one’s motives, modification of relationships, first of all, in the most significant problem areas, including attitudes towards illness.
In other words, the main task of pathogenetic psychotherapy is to clarify life relationships that played a pathogenic role, deprived a given person of the ability to adequately process the current situation and caused overstrain and disorganization of nervous activity, the restructuring of maladaptive relationships, and the formation of new productive relationships in the problem area.
In a more detailed form, the tasks of personal reconstructive psychotherapy can be formulated as follows:
1. A deep and comprehensive study of the patient’s personality: the specifics of the formation, structure and functioning of his system of relationships, the characteristics of his emotional response, motivation, needs.
2. Identification and study of etiopathogenetic mechanisms that contribute to the emergence and maintenance of a neurotic state and symptoms.
3. Achieving the patient's awareness and understanding of the cause-and-effect relationships between the features of his system of relationships and his disease.
4. Awareness of his active role in maintaining irrational ways of resolving neurotic conflict.
5. Assisting the patient in a reasonable resolution of his traumatic situation, correcting inappropriate behavior patterns, acquiring the skill of productively resolving problem situations.
Carrying out personal reconstructive psychotherapy includes a number of mandatory stages:
1. Creation of a psychotherapeutic alliance.
The start of the therapy itself is preceded by the stage of collecting an anamnesis. In addition to the usually collected anamnesis, for the diagnostic qualification of the patient’s condition, the therapist already at this stage identifies areas of relationships in which the patient has difficulties. Draws attention to the repetition of unproductive strategies of behavior in problem situations, the level of generalization of such strategies, whether they cover one sphere of relations, for example production, or several. To better identify such problematic situations, it is advisable to ask the patient to recall 3-5 situations relating to different age periods (childhood and early school years, adolescence and youth, the period of maturity) in which he experienced difficulties. Already at this stage it is possible to assume which basic (ontogenetically earlier) relationship is violated and manifests itself in these problematic situations. At the same stage, connections are noted between exacerbations of symptoms and aggravation of the traumatic situation. With the help of these and some other techniques, the patient is gradually brought to the psychogenic model of the disease. It is important that he at least partially accepts this concept of illness.
2. The next stage is concluding a psychotherapeutic contract. It involves introducing the client to the concept of pathogenetic therapy, describing the goals of therapy, the timing of its implementation, the obligations and responsibilities of the parties. The patient is informed that the goal of therapy is the formation of new, full-fledged relationships that make it possible to function adaptively in problem areas, through their formation to fill those gaps, those deficits in connections with the environment that did not allow productive development and functioning. The patient is provided with brief information about the intrapsychic conflict, its role in the emergence of problematic situations, and the main stages of the procedure. The information is given in the most simplified form so that it guides rather than programs the patient.
3. Diagnostic stage of psychotherapy, identification of potential targets of psychotherapy.
Subsequently, various treatment options are possible:
1) Therapy that begins and focuses directly on the symptoms.
2) Therapy that works on the most typical problem situation associated with symptoms.
3) Therapy focused on the latest most pressing traumatic situation associated with exacerbation of symptoms.
4) Therapy focused on the ontogenetically earliest situation similar to the last traumatic situation.
There are other options for getting started.
The first treatment option is described in detail in the PhD thesis of our applicant E.V. Tsareva. It involves the following stages.
Stage of body-oriented psychotherapy. The goal of this stage was a cathartic response to emotions associated with symptoms (the technique of segment-by-segment “opening of the shell” by W. Reich); acquiring sensitivity in differentiating bodily and psychological sensations associated with symptoms (basic technique: amplification (strengthening) and response of emotions associated with the symptom, which in turn allows you to begin to distance yourself from the manifestations of the disease).
Art therapy stage. Its goal was to further distance the patient from the symptoms and disidentify with them, to deepen the clarification of the leading emotions associated with the symptom and the meaningful psychological meaning of the symptoms. Thus, the clarification of the unconscious, repressed part of the intrapsychic conflict began.
The stage of working with focal, intrapersonal conflict associated with symptoms. The goal of this stage was to understand the meaningful meaning of intrapersonal conflict, polar tendencies, and motives. The main technique used at this stage was the “intrapersonal collision” technique.
Integration stage. The goal of this stage is the acceptance of previously unconscious, incomplete motives, reformulation of the personal meaning of each of the parties creating an intrapersonal conflict.
During the treatment course at all its stages, two interconnected psychological processes are constantly carried out:
- awareness;
– reconstruction of personality relationships.
Awareness, insight lies in the gradual expansion of the patient’s sphere of self-awareness, his understanding of the true sources of his own neurotic disorders.
Reconstruction of personality relationships is manifested in the correction of damaged ones and the development of new relationships at the cognitive, emotional and behavioral levels.
Pathogenetic psychotherapy is based on the balanced use of cognitive, emotional and behavioral mechanisms.
1. Objectives of pathogenetic psychotherapy in the cognitive sphere:
a) awareness of the connections “personality – situation – illness”;
b) awareness of the interpersonal plan of one’s own personality;
c) awareness of the genetic (historical) plan.
It should be emphasized that the first stage of awareness, which is conventionally designated as “personality - situation - illness,” is not decisive for the actual psychotherapeutic effect. Rather, it creates a more sustainable motivation for the patient’s active and conscious participation in the psychotherapeutic process.
The process of psychotherapy should help to realize in the cognitive sphere (cognitive, intellectual awareness):
a) the connection between psychogenic factors and the emergence, development and maintenance of neurotic disorders, that is, to understand the connection between negative emotions and the appearance, fixation and intensification of symptoms;
b) features of one’s behavior and emotional response in various situations, their repetition, the degree of adequacy and constructiveness;
c) how his behavior is perceived by others, how others react to certain features of his behavior and emotional response and how they evaluate them, what consequences such behavior has;
d) existing discrepancies between one’s own image of “I” and the perception of oneself by others;
e) own needs, aspirations, motives, relationships, attitudes, as well as the degree of their adequacy, realism and constructiveness;
f) characteristic protective psychological mechanisms;
g) internal psychological problems and conflicts;
h) deeper causes of experiences, modes of behavior and emotional reactions, starting from childhood, as well as the conditions and features of the formation of one’s system of relationships;
i) one’s own role, the extent of one’s participation in the emergence, development and maintenance of conflict and traumatic situations, as well as how they can be resolved.
2. Objectives of pathogenetic psychotherapy in the emotional sphere:
a) accurate recognition and verbalization of one’s own emotions, as well as their acceptance;
b) experiencing and awareness of past emotional experience;
c) direct experience and awareness of the experience of the psychotherapeutic process;
d) formation of a more emotionally favorable attitude towards oneself.
In the emotional sphere, the psychotherapy process should help the patient:
a) receive emotional support from a psychotherapist or group, experience positive emotions associated with acceptance, support and mutual assistance;
b) experience, within the framework of the psychotherapeutic process, those feelings that he often experiences in real life, reproduce those emotional situations that he had in real life and which he could not cope with;
c) experience the inadequacy of some of your emotional reactions;
d) learn to be sincere in expressing feelings towards other people;
e) become more free in expressing one’s own positive and negative emotions;
f) learn to more accurately understand and accept, as well as verbalize your own feelings;
g) reveal your problems with the accompanying experiences (often previously hidden from yourself or distorted);
h) modify the way of experiencing, emotional response, perception of oneself and one’s relationships with others;
i) make emotional correction of your relationships.
3. Objectives of pathogenetic psychotherapy in the behavioral sphere– formation of effective self-regulation based on adequate, accurate self-understanding and a more emotionally favorable attitude towards oneself.
In the behavioral sphere, the psychotherapy process should help the patient:
a) see your own inadequate behavioral stereotypes;
b) acquire more adequate communication skills;
c) overcome inappropriate forms of behavior that manifest themselves in the process of psychotherapy, including those associated with the fear of subjectively difficult situations;
d) develop forms of behavior that will contribute to adequate adaptation and functioning in real life;
e) develop and consolidate adequate forms of behavior and response based on achievements in the cognitive and emotional spheres;
f) consolidate new forms of behavior, in particular those that will contribute to favorable adaptation.
Thus, the tasks of pathogenetic psychotherapy focus on three components of self-awareness: self-understanding, attitude towards oneself, self-regulation.
The general goal can be defined as the formation of adequate self-awareness and the expansion of its scope.
The goal is to make a person capable of resolving external and internal conflicts by reorganizing the system of his relationships. Therefore, such psychotherapy is called reconstructive.
The teachings of V.N. played a major role in the development of personality-oriented (reconstructive) psychotherapy as an independent direction. Myasishchev about neuroses and psychotherapy for this form of borderline mental pathology.
1) a deep and comprehensive study of the patient’s personality, the characteristics of his emotional response, motivation, the specifics of the formation, structure and functioning of the system of his relationships;
2) identification and study of etiopathogenetic mechanisms that contribute to both the emergence and maintenance of the pathological condition and symptoms;
3) the patient’s achievement of a conscious understanding of the cause-and-effect relationship between the features of his system of relationships and the disease;
4) assistance to the patient in a reasonable resolution of the traumatic situation, if necessary - changing his objective position and the attitude of others towards him;
5) changing the patient’s attitudes, correcting inappropriate reactions and behaviors, which is the main goal of psychotherapy and in turn leads to an improvement in both the patient’s subjective well-being and the restoration of the fullness of his social functioning.
In psychotherapy V.N. Myasishchev, which can be called pathogenetic, the achievement of these goals was carried out by the method of individual psychotherapy. Research in the recent period reflects a shift in emphasis from individual psychotherapy to group psychotherapy, which makes it possible to more effectively restore damaged personal relationships.
Individual psychotherapy is based on communication between the therapist and the patient. In this case, only a psychotherapist acts as an instrument of influence, which limits the range of real emotional interaction and real behavioral options, both quantitatively and qualitatively. This distinguishes individual psychotherapy from group psychotherapy, where the psychotherapeutic group is the instrument of influence; there is a situation of real emotional interaction, real behavior, which systematically includes patients with a wide range of different attitudes, attitudes, emotional and behavioral reactions, being in a relatively equal position in relation to to each other.
In the process of individual personality-oriented (reconstructive) psychotherapy, a certain sequence can be identified in the forms of behavior of the doctor. At the first meeting with the patient, he is minimally active, not directive, and contributes to the sincere disclosure of the patient’s emotional experiences and the creation of trusting contact. Then, increasing his activity, he begins to clarify the “internal picture of the disease”, the patient’s verbalization of all his ideas related to understanding the disease, expectations from treatment and prospects for recovery. When correcting the “concept” of the disease in a patient, the doctor discusses the data of his examinations with him, convinces him that the causes of neurosis do not lie in “organic” changes, and helps to grasp the connection between emotional factors and symptoms. During this period, the doctor provides the patient with relevant information and acts primarily as an expert. After the patient understands the connection between symptoms and provoking pathogenic situations, significant changes occur in the content of conversations. Their subject is no longer symptoms, but psychological problems, experiences and relationships of the patient’s personality. Gradually, during the discussion, a certain sequence of links of a new concept of the disease is built in the patient’s mind (symptoms - emotional factors or pathogenic situations - personal positions, or relationships - neurotic conflict - needs, or motives). The relationship with the patient deepens, the doctor becomes an assistant in the patient’s intensive work on his inner world. At the final stage of personality-oriented (reconstructive) psychotherapy, the doctor again increases his activity, and even directivity in testing and consolidating new ways of experiencing and behavior for the patient.
During the course of treatment, when using this method, at all its stages, two interconnected psychological processes are constantly carried out - awareness and reconstruction of personality relationships. The first process is awareness (insight), associated with the need for the patient to understand the true sources of his own neurotic disorders. The second - reconstruction of personality relationships - in accordance with the degree of awareness, manifests itself in the correction of disturbed ones and the development of new relationships at their cognitive, emotional and behavioral levels.
In the conditions of personality-oriented (reconstructive) psychotherapy, the doctor tries to expand the patient’s area of awareness in order to help understand the cause-and-effect relationships that gave rise to the mental disorder, verbalize his vague experiences and clarify those relationships that the patient himself had not previously connected in his consciousness.
Group psychotherapy. In recent decades, person-oriented (reconstructive) psychotherapy in group form has become widespread in medical practice. Its specificity lies in the targeted use of group dynamics for therapeutic purposes, i.e. the entire set of relationships and interactions that arise between group members, including the psychotherapist himself.
The relationships the patient enters into in the group largely reflect his real relationships in life. The use of group dynamics aims to ensure that each group member has the opportunity to express themselves, as well as to create an effective feedback system in the group.
In general terms, the goals of group psychotherapy are defined as the disclosure, analysis, awareness and processing of the patient’s problems, his intrapersonal and interpersonal conflicts and the correction of inadequate relationships, attitudes, emotional and behavioral stereotypes based on the analysis and use of interpersonal interaction. The goals of group psychotherapy focus on three components of self-awareness: self-understanding (cognitive aspect), attitude towards oneself (emotional aspect) and self-regulation (behavioral aspect), which allows us to define the overall goal of group psychotherapy as expanding the patient's sphere of self-awareness.
Positive therapy
Positive psychotherapy is one of the recognized methods of modern scientific psychotherapy, recognized in 1996 by the European Association of Psychotherapy and in 2008 by the World Council of Psychotherapy.
The method of positive psychotherapy itself was founded in 1968 by Professor Nossrat Pezeshkian. The method of Positive Psychotherapy refers to transcultural, psychodynamic psychotherapeutic methods with a humanistic point of view on the person. This conflict is ability-centered and ability-oriented. The name of the method comes from Lat. positum - “occurring”, “given”, “actual”.
Positive psychotherapy is a cross-cultural method that integrates, on the one hand, the philosophical and intuitive wisdom of the East, and on the other hand, the rational systematicity and scientific character of the West.
The method of positive psychotherapy is based on 3 principles, each of which has a specific methodological component:
1. The principle of hope corresponds to a positive approach to seeing a person’s abilities and capabilities.
2. The principle of balance corresponds to a meaningful differential analysis of the psychodynamics of the individual, the result of which is the harmonization of the primary and secondary actual abilities of a person.
3. The principle of self-help corresponds to a 5-step meta-model, used as a strategy for harmonization, adaptation and personal development - first, in the process of psychotherapy itself, and then, in the further process of a person’s self-help for himself and his environment: his partner, his family, his organization, his community, etc.
Five-step intervention technique in positive psychotherapy:
Stage 1. Observation (distancing).
At this stage, the patient talks about the symptoms that bother him, the conditions and time of their occurrence, the suspected causes, and how these symptoms affected his life. At this stage, the therapist listens carefully and asks clarifying questions. Particular attention is paid to exactly how the patient presents his problem: what is given more attention (balance model): sensations and reactions of the body, external factors; logical constructions and rationalizations; links to authoritative sources, opinions of others, etc.; heuristic ideas, questions of meaning, plans and/or idealizations. It is convenient to immediately structure information according to the balance sheet model.
Objectives: at this stage the patient should receive acceptance, understanding and support; an opportunity to see the situation from the outside.
Stage 2. Inventory.
At this stage, the psychotherapist asks questions regarding the balance model, helping to fill in the blank spots in the description of the situation, tries to localize the composition (participants (personal and/or subpersonal) of the actual conflict), content (actual abilities involved) and dynamics (the basic conflict is the source of emotional content and internal conflict) conflict.
Clues to the patient's feelings should be sought in all four areas of response. Often, it is not the presence, but the absence of a reaction in some area that can become important diagnostic evidence (repression, displacement, etc.)
Body/sensations. How do you feel, how does your body react in the described situation (when you remember it)? (eg, a lot of participation, fatigue, headache, heaviness in the stomach, pressure in the chest, etc.). Logic/Cognition. What do you think about your illness? (e.g., “it’s not curable,” “it’s a complicated case,” etc.) What do you think triggers the symptom? Personal experience/tradition. What does the problem remind you of? (for example, about unpleasant feelings because of your partner, about unfulfilled desires and aspirations, about unfairness, etc.). How have you dealt with similar difficulties before? Do you often have similar or other problems in similar situations? Future/fantasy. What will be the result of successful therapy for you? What will you do when the problem no longer exists? What worries you most? (for example: “if I don’t get help now, something terrible will happen”). Discussions, interpretations and interpretive questions should be avoided.
Tasks. At this stage, the patient, with the help of the psychotherapist’s questions, must find out what actual abilities constitute the content of his problem and understand the origin of these abilities (basic conflict).
The psychotherapist must demonstrate at this stage the ability to ask precise questions, determine the content, history, dynamics and possibilities - this presupposes the ability to see behind the emotional manifestations of transference and countertransference the content of the conflict, current abilities and patterns of relationships. This skill is provided mainly by the analytical and logical resources of secondary abilities (fairness, accuracy, order, openness). A systematic first interview and a structured five-step psychotherapy strategy provide a methodological basis for the manifestation of this ability.
Stage 3. Situational reinforcement.
At this stage, the psychotherapist talks about what opportunities the current situation opens up for the patient; it is appropriate to tell a story, parable or folk wisdom that comes to mind.
The psychotherapist demonstrates the ability to see beyond the presented problem, the ability to respond to a life situation (positive interpretation). A positive interpretation in this case is a meaningful concept of a symptom, based on an analysis of internal conflict from the point of view of the dynamics of manifested abilities. Encouraging the patient’s specific abilities and aspirations in specific situations gives him confidence in specific actions, creates a zone of emotional comfort in which it is easier to decide to test new behavioral models.
Objectives: At this stage it is important to strengthen the patient's confidence that he is able to cope with the situation, that now that he knows its content, the actual abilities he has demonstrated can be developed and this will help him. The patient receives emotional support and alternative experience of behavior in such situations through the use of stories and metaphors.
Stage 4. Verbalization.
Establishing a connection between the current situation and the history of the formation of the behavior patterns under consideration complements the dynamic picture and allows us to model possible alternative behavior options. The more different points of view are expressed, the more varied the shades of interpretation, the more effective this stage will be. Therefore, group members should be encouraged to speak out as fully as possible. If indicated and technically possible, it is recommended to role-play the conflict and model alternative behavior.
Objectives: this stage allows the patient to explore more deeply and holistically the source of their experiences and defenses that arose in the process of adaptation to living conditions and prevented them from adequately responding. The result is fertile ground for expanding the range of working hypotheses and possible therapeutic interventions.
At this stage, the therapist must demonstrate the ability to discuss the conflict and distribute responsibility for achieving change, which involves the active practice of openness and honesty, patience and courtesy in resolving conflicts, which is not possible without the use of affective-emotional resources in achieving change, for example, without a balance of openness and conscious responsibility for the manifestation of emotional reactions. The psychotherapist must be prepared to seek supervision or intervision in case of difficulties in determining the content and adequate psychotherapeutic response of the transference/countertransference.
Stage 5. Expanding goals.
The neurotic narrowing of one's horizons is purposefully destroyed. The client learns not to transfer the conflict to other areas of behavior, but to discover new goals that are still unknown to him. Therapy is based on two simultaneous and closely related processes: psychotherapy, when the relationship between the psychotherapist and the client comes to the fore, and self-help, when the client takes on “therapeutic” tasks, that is, becomes a psychotherapist, a psychologist for himself and your loved ones.
Expanding goals and life plans for the future should be seen not only as working with hope as a remedy, but also as caring about the environmental friendliness of the changes achieved in the process of psychotherapy in relation to the patient’s inner world, his environment and relationships.
Gestalt therapy
Gestalt therapy- this is the process of maintaining or restoring our ability to control images, to build them in adequate connection with the background. One of the main working terms used in Gestalt psychotherapy is “awareness”, immediate awareness - a form of awareness that is both motor and sensory, integrating the totality of all field indicators.
The theoretical discoveries of Gestalt psychology were applied to the practice of psychotherapy by Fritz (Frederick Solomon) Perls (1893-1970). In the 40s of the XX century. Psychoanalyst Frederick Perls, famous among professionals of his time, began to think about creating his own system of psychotherapy. At that time, he was not satisfied with many of the provisions of contemporary psychoanalysis, in particular the predominantly intellectual nature of processing the patient’s problems, orientation towards the past, and the patient’s passive position in the process of psychoanalytic treatment. The result of his joint reflections with colleagues, which included his wife Laura Perls, Isidore Frome, Paul Goodman, was the book “Gestalt Therapy”, published in 1951. The first part of this book, which is a practical guide to self-exploration, was repeatedly published on in Russian called “Workshop on Gestalt Therapy”.
To explain human behavior, Perls and his colleagues used ideas from Gestalt psychology, such as the concept of figure-ground dynamics, the idea of the integrity of the human organism, and the idea that the organism and its environment are a unified field. Perls also used some philosophical ideas - the ideas of phenomenology, a philosophical movement that arose at the beginning of the 20th century. and insisting on the need to explore things as they are presented in consciousness, and the ideas of existentialism about human freedom and responsibility, the existential meeting I - You.
Purpose Gestalt is not helping the client solve a specific problem with which he comes to the therapist. According to Gestalt, the existing cart is simply a symptom of the lifestyle that is the real problem. Gestalt therapy focuses on increasing a person's ability to maintain full contact and awareness of what is happening and thus help him gain the ability to make effective selection. What Gestalt means by "raising awareness" is not the achievement of insight. The point is to increase the client's ability to remain centered in the present moment and become aware of it. For this reason, Gestalt therapy is a type of “behavioral existentialism,” since its problem is to activate the client’s behavior to maintain full contact with himself and the situation.
Gestalt is an image created by a subject in contact with the environment, depending on his needs, desires or unfinished (at the moment) situations. The psychotherapist's task is to support a person's ability to form images, separate them from the background, allow them to unfold and come into contact, build and collapse. Construction - the destruction of gestalts - reflects the contact of the organism with the environment and has four phases, which in reality are not separated from each other.
1. Pre-contact is the background, the background, where the feeling of the body’s most urgent need at the moment begins to arise. Here a gestalt is formed “to make contact” with the environment.
2. Contacting. At this phase, a person carries out the function of choice - “yes” or “no” of entering the environment and makes a selection among the resources of the environment or rejects it.
3. Final contact. The environment recedes into the background, and a new image appears - the selected object. The subject establishes full contact with him. For example, in interpersonal relationships, the clearly identified “I” and “You” may be replaced by “We,” expressing love, hate, fear, horror, or any other contact situation.
4. Post-contact. In the phase of full contact, the boundary line opens in such a way as to admit the object of experience, and now it closes on this lived experience and assimilation begins. No more than an image, nothing relevant remains in the field.
The sequence of construction - destruction of gestalts, or the cycle of contact, is a way of describing insight, considering it in a dynamic manifestation. You can also describe it structurally, through the constituent private functions: “It” (a function manifested through sensations), “Personality” (reflects the idea of oneself and records experience), “Ego” (makes identification and rejection and puts into action the first two functions) . The Ego function must be healthy, restored and cleared of what prevents it from working and be harmoniously connected with other functions in a single insight.
