Basic approaches and methods of psychotherapy. Basic approaches and methods of psychotherapeutic work Treatment of depression with hypnosis

Psychological methods influences in psychotherapy include primarily linguistic communication, which, as a rule, is realized during a specially organized meeting between a psychotherapist and a patient or group of patients.

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

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

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

For practical application of certain methods of psychotherapy, their classification according to their goals is important. Volberg distinguishes 3 types of psychotherapy: 1) supportive psychotherapy, the purpose of which is to strengthen and support the patient’s existing defenses and develop new, better ways of behavior that allow recovery peace of mind; 2) retraining psychotherapy, the goal of which is to change the patient’s behavior by supporting and approving positive forms of behavior and disapproving negative ones. The patient must learn to better use his existing capabilities and abilities, but this does not set the goal of truly resolving unconscious conflicts; 3) reconstructive psychotherapy, the goal of which is to understand the intrapsychic conflicts that served as the source of personality disorders, and the desire to achieve significant changes in character traits and restore the fullness of individual and social functioning of the individual.

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

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

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

Formally, the division of group psychotherapy methods into verbal and nonverbal is justified, but almost any interaction in a group includes both verbal and nonverbal components.

Taking into account and analyzing nonverbal behavior and interaction in the process of using verbal methods (for example, group discussion) allows us to more fully and adequately reveal the content of a particular verbal communication. In connection with the development of psychotherapeutic trends, based primarily on direct emotional experiences, there has been a partial identification of the term “verbal” with the terms “rational”, “cognitive”, “cognitive” and the opposition of the last three to the concepts of “non-verbal”, “emotional”, “experienced” "(in the sense of direct experience).

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

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

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

Wrong ideas about the disease, about relationships with others, about behavioral norms are formed in a person over the years and to change them requires repeated dissuading. The arguments given by the doctor must be understandable to the patient. When persuading a patient to change the current situation, it is necessary to take into account his real capabilities, life attitudes, ideas about morality, etc. A conversation conducted with the patient should evoke an emotional reaction in him, contain an element of suggestion, and should be aimed at actively stimulating him and restructuring his behavior.

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

If a doctor uses an unknown term or talks about incomprehensible patterns, the patient may not ask what this means, for fear of showing his illiteracy or lack of culture. Conversations that are not sufficiently understandable to the patient usually cause harm instead of benefit, since the patient, who is emotionally attuned to his illness, tends to evaluate the doctor’s incomprehensible words not in his favor.

Suggestion. Presentation of information that is perceived without critical evaluation and influences the course of neuropsychic and somatic processes. Through suggestion, sensations, ideas, emotional states and volitional impulses are evoked, and also influence vegetative functions without the active participation of the individual, without logical processing of what is perceived. The main means is the word, the speech of the suggestor (the person making the suggestion). Non-verbal factors (gestures, facial expressions, actions) usually have an additional influence.

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

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

IN medical practice Appropriate techniques of suggestion are used in the waking state, in a state of natural, hypnotic and narcotic sleep.

Suggestion in the waking state is present to varying degrees of severity in every conversation between a doctor and a patient, but can also act as an independent psychotherapeutic influence. Suggestion formulas are usually pronounced in an imperative tone, taking into account the patient’s condition and character clinical manifestations diseases. They can be aimed both at improving general well-being (sleep, appetite, performance, etc.) and at eliminating individual neurotic symptoms. Usually, waking suggestions are preceded by an explanatory conversation about the essence of therapeutic treatment and convincing the patient of its effectiveness. The stronger the effect of suggestion, the higher the authority of the doctor making the suggestion in the patient’s eyes. The degree of implementation of the suggestion is also determined by the characteristics of the patient’s personality, the severity of the mood, and the belief in the possibility of influence of some people on others using means and methods unknown to science.

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

Suggestive methods. Suggestive methods include various psychological influences using direct or indirect suggestion, i.e. verbal or non-verbal influence on a person in order to create a certain state in him or encourage him to take certain actions.

Suggestion may be accompanied by a change in the patient’s consciousness, creating a specific mood for the perception of information on the part of the psychotherapist. Providing a suggestive effect implies that a person has special qualities of mental activity: suggestibility and hypnotizability.

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

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

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

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

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

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

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

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

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

“I call rational psychotherapy that which aims to act on the world of the patient’s ideas directly and precisely through convincing dialectics” - this is how Du Bois defines rational psychotherapy. The goal of rational psychotherapy is a distorted “internal picture of the disease,” creating an additional source of emotional experiences for the patient. Removing uncertainty, correcting inconsistency and inconsistency in the patient’s ideas, primarily regarding his illness, are the main links in the impact of rational psychotherapy.

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

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

The main forms of rational psychotherapy are:

1) Explanation and clarification, including interpretation of the essence of the disease, the causes of its occurrence, taking into account possible psychosomatic connections, previously, as a rule, ignored by patients, not included in the “internal picture of the disease”; as a result of the implementation of this stage, a clearer, more defined picture of the disease is achieved, removing additional sources of anxiety and opening up the opportunity for the patient to more actively control the disease; 2) persuasion – correction of not only the cognitive, but also the emotional component of the attitude towards the disease, facilitating the transition to modifying the patient’s personal attitudes; 3) reorientation - achieving more stable changes in the patient’s attitudes, primarily in his attitude towards the disease, associated with changes in his value system and taking him beyond the disease; 4) psychogogy - reorientation of a broader plan, creating positive prospects for the patient outside of the disease.

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

The main complications of hypnosis are loss of rapport, hysterical attacks, spontaneous somnambulism, and the transition of deep somnambulistic hypnosis to hypnosis.

The success of treatment depends on the patient’s personality characteristics; increased suggestibility, his preparedness for such a conversation, the doctor’s authority, and the patient’s faith in him are also important.

From the time of Delirium to the present day, hypnotherapy uses the method of verbal suggestion and sometimes fixation of the gaze on a shiny object to induce hypnotic sleep; later, for greater effect, they began to use monotonous, monotonous stimuli affecting the visual, auditory and tactile analyzers.

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

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

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

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

The lesson can be conducted collectively, with 4-10 people in a group. Before the start of the training, the doctor conducts an explanatory conversation, talks about the features of the nervous autonomic system, its role and manifestations in a person’s life. In a form accessible to the patient, an explanation is given for the characteristics of motor reactions and especially the state of muscle tone depending on mood. Examples of muscle tension in various emotional states are given. At the same time, it is necessary for the patient to clearly understand the difference between the functions of the autonomic nervous system and the animal one. He must understand that he can make voluntary movements and cannot force his stomach or intestines to move. He must learn to control some vegetative functions in the process of autogenic training.

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

Usually the effect is achieved after months of home training. The highest level of training helps the patient manage his emotional experiences.

Autogenic training can be indicated in cases in which it is necessary to teach a rapidly depleted patient to restore working capacity, reduce or relieve mental stress, functional disorders of internal organs, and in cases where it is necessary to teach the patient to control himself. It is used for stuttering, neurodermatitis, sexual disorders, for pain relief during childbirth, eliminating or softening preoperative and postoperative emotional layers.

Autogenic training refers to activating psychotherapy, since when using it, a person himself is active and has the opportunity to become convinced of his capabilities.

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

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

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

Music therapy. A psychotherapeutic method that uses music as a therapeutic agent.

The healing effect of music on the human body has been known since ancient times. The first attempts to scientifically explain this phenomenon date back to the 17th century, and widespread experimental studies- to XIX. S. S. Korsakov, V. M. Bekhterev and other famous Russian scientists attached great importance to music in the system of treating mentally ill patients.

Art therapy is a method of psychotherapy that involves using art as a therapeutic factor. The importance of the method is increasing due to the increasing role of art in the life of modern man: more high level education, culture determines interest in art.

The question of whether art therapy belongs to occupational therapy or psychotherapy is decided differently by different authors, since art therapy sessions combine therapeutic effects of various kinds.

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

Bibliotherapy is a therapeutic effect on the psyche of a sick person through reading books. Reading treatment is included as one of the links in the system of psychotherapy. The method of bibliotherapy is a complex combination of bibliology, psychology and psychotherapy - as defined by V. N. Myasishchev.

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

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

Functional training. This is a version of psychotherapy in the waking state. When treating patients who, for example, are afraid to go outside for fear that something will happen to their heart or they may suddenly die, a complex training system is used. For example, gradually expanding the area in which the patient decides to take walks, the doctor convinces the patient by walking with him or giving him the task to walk or drive a certain section of the path. In further work, the achieved successes are used and the complexity of tasks is built on them. This training should be considered as activating and stimulating psychotherapy. The main goal of psychotherapy is to restore the activity lost by the patient, restoring his ability to live a full active life, which is always associated with a person’s correct assessment of his capabilities. Psychotherapeutic training has as its goal both “a direct impact on nervous dynamics and a restructuring of the patient’s attitude towards the functions being trained, towards himself as a whole.

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

The lack of verbal or conceptual skills in children to the required extent does not allow the effective use of psychotherapy with them, which is almost entirely based on recitation, as is the case in psychotherapy for adults. Children cannot freely describe their feelings; they are able to express their experiences, difficulties, needs and dreams in other ways.

Psychotherapy is specially organized assistance to a person facing difficulties. There are many approaches to psychotherapy, each of which uses its own unique techniques aimed at harmonizing the client’s inner world and improving the quality of his life. Before starting psychotherapy, it is important to know about the features of its organization, for example, indications and contraindications, session duration, and the functions of the psychotherapist. For therapy to be effective, it is necessary to carefully choose a specialist and an approach in which it would be comfortable to work with your difficulties.

Basics of psychotherapy

Human life is very busy. It consists of many events that, to one degree or another, leave an imprint on the personality and put a person before a choice. Sometimes it can be difficult to cope with difficult feelings, the effects of stress, or making important decisions. A person may feel that the world too much pressure, and he is not able to resist this pressure, manage his life and be happy. In these and many other situations, psychotherapeutic work can help.

When a person comes to psychotherapy, he has a need to get out of the usual circle of behavioral and mental strategies, change his life, and fill it with new meaning. The therapist, using his personality, as well as special techniques and exercises, helps the client take control of his life, change his behavior and attitude towards the world and himself. As a result, a person’s very personality changes, and with it his life.

Sometimes for a person these changes can be the result of enormous efforts and mental labor. Therefore, the psychotherapist must be a highly professional in order to support and help the client in the process of self-knowledge and personality transformation.

Psychotherapy works with a wide range of human problems and difficulties. This type of assistance can be used in combination with other types of treatment to achieve the best effect.

More often different kinds Psychotherapy is used for the following problems:

– Neuroses

– Neurotic reactions

– Psychosomatic disorders

– Problems in children and adolescents

• Enuresis and encopresis
• Fears
• Tics and stuttering
• Difficulties at school
• Antisocial behavior
• Loss of a close relative

– Post-traumatic stress disorder resulting from:

• Natural Disasters
• Military action
• Terrorist acts
• Experienced violence
• Loss of a loved one
• Long-term serious illness

– Sexual problems in men and women

– Depressive disorder

– Phobias and anxiety, panic attacks

– Various types of addictions

– Vegetovascular disorders

– Crises (personal, age-related, professional, family, existential)

– Difficulties in family relationships

Contraindications to psychotherapy

There are few contraindications to psychotherapy, but failure to comply with these prohibitions can lead to unpleasant consequences for both the client and the therapist. This:

• Exacerbation of severe mental illness
• Severe organic diseases of the nervous system
• Moderate to severe mental retardation
• Alcohol or drug intoxication
• Lack of motivation and desire (if relatives insist on visiting a psychotherapist)

The integral components of psychotherapy are the therapist, the client and their relationship. Each of these elements has an impact on operational efficiency. Thus, the success of psychotherapy lies not so much in correct use There are as many necessary methods as there are in a properly constructed interaction.

The relationship between client and psychotherapist is governed by a code of ethics. However, its provisions are rather internal rather than external regulators. Because these rules represent the basics of psychotherapy and are mandatory for every professional.

One of the main prohibitions in psychotherapy is the ban on “dual relationships.” That is, the specialist cannot be in any relationship with the client other than a working one. Therefore, you cannot provide professional help to relatives, friends and lovers. In most forms of psychotherapy, the client-therapist relationship never extends beyond the office. That is, they meet only during a psychotherapy session at the appointed hour.

Here are some provisions of the psychotherapist code:

• Act in the interests of the client
• Comply with confidentiality conditions
• Act within the limits of your professional competence
• Treat the client with respect, regardless of his age, gender, nationality, sexual orientation, social status, physical capabilities and other reasons.
• Inform the client about the possible goals of the work, the peculiarities of organizing the therapeutic process, the methods used, and the qualifications of the specialist himself.

For psychotherapy to be successful, the client's input is also important. He is not a passive participant in the process and influences the result of the work.

Qualities of an effective client:

• Commitment to change
• Willingness to interact with a therapist in confidence
• Interest in the process of psychotherapy
• Willingness to overcome difficulties and face strong emotions

Few people know, but almost every psychotherapist has been in the client’s shoes. In most areas of psychotherapy, mandatory requirements for issuing a diploma are a certain number of hours of personal psychotherapy. It is very important for a specialist to work with his personal and professional difficulties. After all, a psychotherapist may accumulate negative states that need to be eliminated with the help of individual psychotherapy. Otherwise, they will have a destructive effect on the work process.

Each psychotherapy session follows a certain pattern, but the content of the conversation varies depending on the client’s request, his mood and mood for the conversation. To simplify greatly, during the session the client tells his story, the content of the problem, and the specialist asks questions. However, these questions do not come from the simple interest of the therapist, but are formulated in a special way and have specific goals. For example, a specialist may use specific psychotherapy techniques and questions to activate the client's internal resources. If we are talking about group psychotherapy, then the therapist monitors and guides the process, and the participants take turns speaking out and sharing their experiences.

At the first session, usually there is an introduction, a verbal contract and an initial interview. The client learns about the qualifications, features of the specialist’s work and talks about himself and his difficulties. The client and psychotherapist establish professional boundaries and discuss all the conditions for the upcoming work.

Payment for psychotherapy

Payment for a psychotherapy session is one of the most complex and controversial topics. However, any profession involves providing services in exchange for money. In this case, the client pays money for the specialist to spend his time working with him. In addition, money is important for the process of psychotherapy and affects its success. By giving an amount feasible for themselves, the client is more likely to get involved in the work, appreciates the process more and is more willing to strive for speedy changes. Payment for psychotherapy sets boundaries and creates distance between the client and the therapist.

The cost of a psychotherapy session varies on average from 500 to 6000 rubles for 60 minutes. The psychotherapist informs you about the cost of his work in advance, at the first meeting. In most cases, it depends on the qualifications of the specialist and his professional experience.

However, psychological assistance can be free. For example, there is civil service psychological assistance, which provides free consultations. Or in extreme situations there are specialists who provide short-term assistance to the victims. For example, during military operations, terrorist attacks or natural disasters. If we are talking about long-term psychotherapy, then it is advisable that the client pays for the sessions himself. This sets you up for work and change.

Psychotherapy methods

Various methods of psychotherapy are ways to help a client and include many techniques and techniques. The method depends on the direction of psychotherapy to which the specialist belongs.

Currently, there are more than 400 different methods of psychotherapy, many of which are effective and widespread. The method of working with the client and the understanding of the psyche and mental disorders depend on the method. Many scientists are making an attempt to analyze the main methods of psychotherapy and systematize them.

Soviet scientist and psychotherapist I.Z. Velvovsky and his colleagues developed the following classification, depending on the client’s condition:

• Psychotherapy while awake
• Psychotherapy in special states of brain functioning (hypnosis, autogenic training, relaxation)
• Psychotherapy in stress and acute trauma

Within each method of psychotherapy, there are many techniques that are used at a certain stage and when working with certain difficulties of the client. Complexes of methods associated general ideas and approaches to treatment, represents different areas of psychotherapy and schools.

Each direction and school has its own various psychotherapy techniques and exercises. However, they are all the basics of psychotherapy and are aimed at improving psychological state, reducing negative symptoms, achieving emotional comfort and improving quality of life.

The use of psychotherapy techniques depends on the direction of the therapist’s work at the moment:

• working with emotions and states,
• working with behavior
• working with an attitude to the problem,
• working with the problem itself.

During the work process, the specialist constantly checks whether the psychotherapy techniques he has chosen have the desired effect. If they turn out to be ineffective, the therapist changes the work strategy. Due to the wide range of psychotherapy techniques, the process becomes very flexible, and the specialist selects exercises and techniques depending on the specific situation and characteristics of the client.

Psychotherapy and medications

Only a psychotherapist with a higher medical education can prescribe medications. This is usually a psychiatrist who has received additional training as a psychotherapist. Such a specialist has knowledge of psychotherapy techniques, in addition to medical knowledge. He has the right to work with clients with mental disorders and, in parallel with psychotherapeutic assistance, prescribe pharmacological treatment. Thus, the therapist influences the disease and removes negative psychological consequences, negative emotions, and problems in interpersonal interaction.

The duration of psychotherapy depends on many factors, such as, for example, the characteristics of the problem, the personality of the client and the therapist, external events. Thus, it can range from one meeting to several years of weekly sessions. How long psychotherapy will last is determined jointly by the client and therapist. As they work, they take stock and redefine goals and approximate completion dates. Much depends on how much time is needed to research a topic that worries the client, understand all its nuances and find ways to resolve difficulties.

However, initially psychotherapy can be short-term or long-term, depending on the severity of the situation and the characteristics of the problem.

Short-term psychotherapy

On average, short-term psychotherapy lasts from five to ten sessions. It is aimed at working through one problem or specific symptom. This kind of psychotherapy does not bring global results, but is able to provide quick relief and quickly help the client. Most often, short-term therapy is resorted to in situations where an important decision needs to be made urgently, there is a conflict at work or anxiety before upcoming exams. Typically, these difficulties appear in the client’s life immediately before coming to a psychotherapist and do not yet have time to acquire many accompanying difficulties, stress, experiences and defense mechanisms. In such a situation, the psychotherapist does not dive deeply into the client’s life history, but gives specific exercises to resolve this situation.

Long-term psychotherapy

Long-term therapy can last from about six months and is aimed at deep personal changes. Here it is important not only to reduce the destructive impact of the problem, but also to understand its origins and develop coping strategies for the future. Long-term psychotherapy is suitable for people who have difficulties in various areas of life, have psychological trauma, problems that cannot be eliminated long time. The psychotherapist helps the client take a fresh look at his life and change existing stereotypes of behavior and reactions to ordinary situations.

There have been many studies on the effectiveness of psychotherapy, which have shown that therapy leads to better results than no intervention and placebo treatment. On average, studies have shown that a client who undergoes psychotherapy experiences greater improvements in quality of life than 80% of people who do not undergo therapy. Psychotherapy has demonstrated its effectiveness in treating depression, anxiety disorders, various addictions, eating disorders and other problems.

If we talk about the effectiveness of a particular type of psychotherapy, no significant difference was found. In order for work with a therapist to bear fruit in a particular case, you need to carefully select a highly qualified specialist and an approach that will be comfortable for you.

The result of psychotherapy

Many clients, coming to psychotherapy, expect a miracle, magical healing and instant disappearance of a symptom. However, after several meetings, he realizes that the psychotherapist is no magician, and his happiness is only in his own hands. From this moment deep work begins, which certainly bears fruit. As a result, personal changes inevitably occur and a different perspective appears on difficulties and on life in general.

The goal of any psychotherapeutic assistance is not just to relieve symptoms and temporarily alleviate the condition, but to improve the quality of life. The therapist and the client work together to find tools and ways to improve the quality of life. Thus, the client learns independently, without the help of a psychotherapist, to cope with difficult situations and conditions in the future.

However, having coped with one problem, the client may want to continue psychotherapy and formulate a new request. Then all conditions are discussed anew and new goals are set.

In general, counseling and psychotherapy overlap in many ways and have similar techniques and methods. Nevertheless, for each specific case it is necessary to choose your own type of assistance. The success of the work and long-term changes depend on this. Therefore, counseling and psychotherapy have their own indications and contraindications.

Psychological counseling is aimed at solving the client's everyday difficulties. A psychologist helps people who experience difficulties in interpersonal communication, at work, and in relationships with loved ones. If the client is at a crossroads, he needs to make a decision and weigh the pros and cons, he is in a collected and active state and is ready to act, psychological counseling is more suitable for him.

Psychotherapy is aimed at helping a person who has certain mental disorders or non-clinical but severe conditions, for example, mild depression, phobias, anxiety. In some cases, psychotherapy is used in conjunction with drug treatment. It focuses on the intrapersonal problems of a person. Psychotherapy is aimed at helping people in more serious conditions. Such clients feel powerless; they do not have the strength to quickly get together and solve all the difficulties. They expect salvation and healing from a specialist. First, they need to harmonize their internal state, and then deal with life’s difficulties.

Psychological counseling is aimed at:

• finding a way out of a difficult situation (professional, educational)
• resolving interpersonal conflict situations
• overcoming stress and increasing stress resistance
• change in attitude towards the problem
• decision making and others

Psychotherapy is aimed at:

• changing habitual behavior and thinking
• overcoming a personal crisis
• way out of depression
• overcoming severe conditions associated with the loss of a loved one
• additional help in the treatment of mental disorders

Types of psychotherapy

There are two types of psychotherapy: individual or group. In the first case, the psychotherapist and the client communicate one-on-one, and in the second, the specialist works with a group that interacts with him and with each other. In addition, child psychotherapy is distinguished as a separate type of psychotherapy. It is aimed at working with children and adolescents. All these types of psychotherapy are aimed at helping people with different problems and difficulties.

A specially organized form of interaction between client and psychotherapist is called individual psychotherapy. This type of psychotherapy includes various techniques, techniques and exercises. Often, individual psychotherapy involves the participation of a psychotherapist and a client. During a psychotherapy session, all the specialist’s attention is directed to the client, his difficulties and strengths. There are short-term (up to 20 sessions) and long-term (from 20 sessions) therapy. The duration of work, targets and features of the relationship between the client and the therapist within the framework of individual psychotherapy depend on the approach in which the specialist works.

Group psychotherapy

Unlike individual psychotherapy, group psychotherapy is designed for several participants. This type of psychotherapy is aimed at interpersonal interaction, sharing experiences and receiving feedback in response to one’s words and experiences. Group psychotherapy is often associated with Alcoholics Anonymous meetings, but the group can discuss a very wide range of problems and difficulties. During interaction, people talk about themselves and their difficulties, feelings and experiences, attitudes towards each other, dreams and plans for the future. The specialist monitors the process of group psychotherapy, creates conditions for safe work of clients, monitors the process, regulates it and guides it. Gradually the group turns into a unique team, where its own difficulties arise and are solved, where general process, to which each participant makes an equally important contribution.

Child psychotherapy is aimed at helping children and adolescents with symptoms of mental, borderline and psychosomatic disorders who have experienced a traumatic event, learning difficulties or behavioral difficulties.

Psychotherapy for children originates from the works of Freud, in which he described the use of psychoanalysis with young children. However, in his work he did not take into account the characteristics of age and used the same techniques as when working with adult patients. Since then, child psychotherapy began to develop as a separate direction, with its own specifics. Such famous scientists as M. Klein, A. Freud, D. Levy and others made a great contribution to the development of this direction.

Child psychotherapy can be focused on working only with the child, or it can also include parents, caregivers or teachers in the process. When working with children, psychotherapists use play methods and creativity. Through these processes, natural for the child, the specialist reveals the emotional, behavioral and other characteristics of the child. The therapist takes into account the stages of the child’s neuropsychological development and selects an individual approach to each child. Thanks to working with a psychotherapist, a child learns to express his strong feelings, overcome fears, interact with others, and manage his behavior.

Clinical psychotherapy

This area of ​​therapeutic practice, such as clinical psychotherapy, is used as part of helping a patient in a psychiatric clinic. This is not a mandatory procedure, but can be successfully used in conjunction with drug treatment as prescribed by a doctor. Clinical psychotherapy is most often used for borderline mental disorders and addictions.

The methods of clinical psychotherapy are extensive, but their application depends on the patient’s diagnosis and his personal characteristics. Work with the patient is aimed at removing or mitigating the side effects of drugs, alleviating difficulties in communication and changing attitudes towards oneself and one’s disease. As part of clinical psychotherapy, a specialist helps the patient activate internal resources and improve quality of life. A psychotherapist may be faced with very narrow practical tasks, for example, working with sleep disorders, adaptation to hospital conditions, or conflicts between patients. The clinic can provide both group and individual psychotherapy. Correctly selected methods and a friendly attitude of a specialist are the foundations of psychotherapy and psychocorrection.

Areas of psychotherapy

At the moment, there are many different schools and areas of psychotherapy, both in Russia and in the world. Their diversity and multidirectionality make it very difficult process their classification and systematization. But we can highlight the main areas of psychotherapy, which are the most common and have a scientific basis.

At the turn of the 19th and 20th centuries, Sigmund Freud developed a psychological theory from which the psychotherapeutic approach would later emerge. Freud and his colleagues saw a direct connection between behavior and psychological characteristics a person with internal unconscious processes, drives and conflicts, as well as a whole range of psychological structures described by them. These ideas became widespread and resulted in more than 20 concepts and approaches to working with the human psyche.

The main task of the analyst is to help the client in the process of psychotherapy become aware of his unconscious conflicts and childhood experiences. He and the client must also work through the conflict, finding out exactly how it affects the client’s behavior, relationships and, in general, the life of the client. To do this, specialists have many methods, for example, dream interpretation and the method of free association.

In addition, for individual psychotherapy to be effective, the psychoanalyst and the client must create a so-called therapeutic alliance. This is a trusting relationship between patient and therapist, a joint effort aimed at achieving a common goal.

The personality of the analyst and his professional skills are the foundations of analytical psychotherapy and determine its effectiveness. He must, together with the client, dive into the depths of his unconscious and at the same time interpret the discovered phenomena. Often this process can take many years of weekly meetings.

Client-centered psychotherapy

Client-centered psychotherapy is one of the most popular methods of psychotherapy. In the mid-20th century, the foundations of this area of ​​psychotherapy were laid by the famous American psychologist Carl Rogers. Rogers's main idea was that man is the expert of his own life. This approach has become an alternative to psychoanalysis, where the analyst is considered the undoubted authority. Despite criticism from analysts, client-centered psychotherapy has helped many people and gained incredible popularity. For his work, Carl Rogers was nominated in 1987 for Nobel Prize peace.

The main ideas of client-centered psychotherapy are unconditional acceptance, respect and a friendly attitude towards each person. Rogers believed that a proper relationship between client and psychotherapist, built on trust, is the most important condition for effective psychotherapy. The therapist must accept the person with all his characteristics and create favorable conditions that allow the client to develop.

The process of psychotherapy is a dialogue between the client and the therapist. The client chooses a topic that is interesting to him at the moment and, thanks to the psychotherapist’s special questions, explores it. The therapist is focused on the client, providing him with attention and acceptance. Thanks to such a trusting atmosphere, a person has the opportunity to talk about the most exciting and difficult topics without fear of condemnation. The client feels supported and has the strength to cope with his difficulties and finds ways to solve the problem.

Client-centered psychotherapy helps a person develop a stable adequate self-esteem, look at the world more realistically and trust it.

Perceiving the world, people, events, each of us receives a completely various information. We cannot cope with the enormous volume of data that comes through our sensory systems. Therefore, each person perceives information individually and chooses what is important specifically for him. As a result, we form our own unique view of the world.

The outstanding American psychologist Aron Beck, developing his direction of psychotherapy, came to the conclusion that it is the interpretation of events, that is, thoughts, that determine emotions, behavior and the characteristics of human existence. The scientist observed people with depression and realized that much of their suffering was associated with a negative perception of themselves, their lives and the world. Beck's observations formed the basis of cognitive psychotherapy, as a method of working with a person's thoughts and ideas about the world.

Years of practice have shown that this direction is suitable for eliminating a wide range of difficulties and symptoms and has practically no restrictions. A psychotherapist within the framework of cognitive psychotherapy helps the client look at things from different angles and expand his vision.

The methods with which cognitive psychotherapy works are varied. They are designed to help the patient learn to analyze and test their thoughts for truth, cope with maladaptive beliefs, and look at the world and their own experience from different angles. For example, a cognitive psychotherapy specialist works with a client’s irrational belief: “I couldn’t keep my husband, so there must be something wrong with me.” Because of this, her self-esteem suffers, negative emotions prevent a woman from concentrating on work, and accumulated stress leads to quarrels with relatives and friends. The therapist, together with the client, understands this and other beliefs of the client, their nature and impact on her life. As a result, the person who seeks help develops new ideas about the situation and new ways to solve their difficulties.

Behavioral psychotherapy

Behavioral psychotherapy was founded in the 20s of the twentieth century by students of John Watson, the founder of the behaviorist (behavioral) direction in psychology. At the very beginning of its development, behavioral psychotherapy was a set of methods aimed at teaching one or another behavior. It was based, among other things, on the doctrine of the conditioned reflex of the Russian physiologist I. P. Pavlov. Initially, the behavioral approach to counseling and psychotherapy arose to help people with behavioral and emotional disorders, such as fears and phobias.

There are many indications for the use of behavioral psychotherapy. It can help with phobias, panic attacks, psychosomatic disorders, eating and sleeping disorders, sexual problems, learning difficulties and hyperactivity in children.

The main goal of behavioral psychotherapy is to change the client’s habitual behavior, which will entail many deep-seated changes. Currently, elements and individual techniques of the behavioral approach use different types of psychotherapy when working with wide range difficulties.

Behavioral psychotherapy exercises are aimed at gradually training a particular skill. At the very beginning, the client and therapist together analyze habitual behavior, find interfering elements, formulate correct behavior and determine the stages of work. The client then practices the new behavior in small steps, receiving rewards from the therapist for good work. Such exercises are the basis of this type of psychotherapy and lead to significant changes. Thus, behavioral psychotherapy gradually helps the client integrate a new way of acting into his life and get rid of bad and destructive habits.

Behavioral psychotherapy and cognitive psychotherapy became the basis for the creation of a cognitive-behavioral direction that combines work with human thoughts and behavior. Certain methods in this area are effectively used in clinical psychotherapy and other approaches.

Existential psychotherapy, which originated in the twentieth century, did not seek to decompose the human psyche into separate parts and give the client a diagnosis. Its goal was to study a person in complex with his ideas about such global things as the meaning of life, death, loneliness, truth. In this regard, there is a very close interweaving of existential psychotherapy with philosophical ideas.

The existential approach to counseling and psychotherapy is aimed at helping a person find himself and his place in life. It does not aim to change his behavior or teach him to think differently, but only to understand his own goals and intentions. Thus, existential psychotherapy emphasizes individual freedom and the choice of life path.

Within the framework of existential counseling and psychotherapy, it is argued that all the client’s difficulties originate from the very nature of man, his constant search for the meaning of life. A person has to make decisions and take responsibility for them, face a contradictory world and interact with different people. Dealing with all this and your own feelings and experiences can be very difficult. Therefore, existential psychotherapy aims to bring the client to an awareness of life values ​​and change life in accordance with them.

The work is based on a confidential dialogue between the client and the therapist. At the same time, the specialist does not put pressure on the client and does not impose his opinion on him, but gently guides him with his questions to an awareness of his values, needs, beliefs and ideas about a harmonious and happy life.

One of the most famous adherents of existential psychotherapy of our time is Irvin Yalom. He is an ardent supporter of an individual approach to each person and each time he reinvents therapy for the client so that all carefully selected methods of psychotherapy are suitable for him. His books on existential psychotherapy, “When Nietzsche Wept,” “Mommy and the Meaning of Life,” “Schopenhauer as Medicine,” and others became bestsellers.

Systemic family psychotherapy

Systemic family psychotherapy is one of the youngest areas that continues to actively develop. The main difference between this approach is that the client is not one person, but a whole family or some family members. Even if one person comes to the reception, his whole family and relationships with close relatives are involved in the work. Systemic family psychotherapy emerged in parallel in Europe and America in the 1950s. Psychologists, anthropologists, doctors and mathematicians participated simultaneously in the development of this approach. It was based on the idea of ​​the family as a whole system, with its own structure, crises and internal connections.

Specialists working in family psychotherapy consider the problems of each family member as a result of difficulties in the functioning of the entire system and disturbances in interpersonal communication. The psychotherapist tries to identify disorders and their role. After all, even negative symptoms can be beneficial. For example, a family unites and becomes closer in the fight against alcoholism of one of the members. Therefore, within the framework of family psychotherapy, a specialist considers the entire family history, understands the relationships and role positions that family members occupy. In the process of work, the family is transformed, the behavior of family members changes, and subsequently family relationships change. For a therapist who works within the framework of family psychotherapy, it is important to analyze the usual ways of communication in the family, family rules. Then, together with the client or clients, a joint creative search for alternative interaction options occurs. As a result of therapy, the entire family system is harmonized.

Work with couples can also be carried out within the framework of group psychotherapy, and not just individually. This allows clients to share their story with others and look at other people's family models from the outside. This therapy is designed for 3-7 couples. Specialists use methods of group psychotherapy and family psychotherapy in their work. The group deals with, analyzes and solves various problems related to intra-family communication, raising children, everyday life and other aspects of married life.

Body-oriented psychotherapy is a very interesting direction of help that works with problems through motor and bodily exercises. The foundations of body psychotherapy were laid by Wilhelm Reich, a student of Sigmund Freud. He noticed that working with the body, with the muscle corset, helps in resolving many difficult situations. Reich compared muscle clamps to a protective shell that forms in response to negative external influences. These clamps are very closely connected with psychological defenses, with fears and conflicts that are repressed into the unconscious. The work of bodily psychotherapy is aimed, among other things, at getting rid of tensions and through this resolving psychological conflict.

Now this approach has many branches, approaches and schools. Some adherents of body psychotherapy work with a person’s vital energy, others through dance or other physical exercises. The main goal of body psychotherapy is to remove tensions, become aware of your body and express all your hidden feelings. The therapist supports the client, draws his attention to bodily tension and helps to connect it with certain experiences. However, body psychotherapy is used in conjunction with other psychotherapy methods to increase effectiveness.

Positive psychotherapy

The emergence of positive psychotherapy is associated with the name of the famous German neurologist, psychiatrist and psychotherapist Nossrat Pezeshkian. The researcher notes that the term “positive psychotherapy” comes from the Latin “positum” - “whole, united, given, really existing”, and not from “positivus” - “positive”. Thus, Pezeshkian emphasizes that for positive psychotherapy it is important to consider a person’s life, his characteristics and problems, as a totality, a unity of both positive and negative aspects.

The advantage of this approach is that it is accessible to many social and age groups, as well as to people different cultures. In its methods, positive psychotherapy integrates the wisdom of the East with the scientific and systematic approach of the West. A specialist works not with a person’s problems and illnesses, but with his current abilities. By actual abilities, positive psychotherapy understands the aspects of personality that a person uses in Everyday life. For example, these are punctuality, politeness, confidence, patience and others. The main goal of positive psychotherapy is to mobilize a person’s internal resources so that he can make sound and informed decisions in all life situations. The therapist’s work with the client is not aimed at fighting the world around him, but at accepting it in all its diversity.

Gestalt therapy has come a long way from an unknown theory to one of the most famous and authoritative approaches. Its founder is the outstanding psychiatrist and psychotherapist Frederick Perls. The term “gestalt” is understood as something holistic, not reducible to the sum of its parts. This type of psychotherapy allows the client to gain a holistic view of life and themselves.

The therapist helps the client focus on the present moment, begin living in the here and now, and develop self-awareness. With the help of special techniques, an attentive attitude to emotions and bodily sensations is formed. The client learns to be careful and caring towards himself, and also to live not in a world of fantasies and memories, but to live the present moment most fully.

Cognitive behavioral therapy is a type of treatment that helps patients become aware of the feelings and thoughts that influence their behavior. It is commonly used to treat a wide range of conditions, including addiction, phobias, anxiety and depression. Behavioral therapy, which is becoming very popular today, generally lasts a short time and is primarily aimed at helping people with a specific problem. In treatment, clients learn to change and identify anxious or destructive thought patterns that negatively influence their behavior.

Origins

How did cognitive or What made adherents of popular psychoanalysis turn to the study of various models of human cognition and behavior?

Who founded the first official laboratory dedicated to psychological research at the University of Leipzig in 1879, is considered the founder of experimental psychology. But it is worth noting that what was considered then experimental psychology is very far from today’s experimental psychology. In addition, it is known that current psychotherapy owes its appearance to the works of Sigmund Freud, known throughout the world.

At the same time, few people know that applied and experimental psychology have found fertile ground for their development in the United States. In fact, after Sigmund Freud arrived here in 1911, psychoanalysis managed to surprise even prominent psychiatrists. So much so that within a few years about 95% of the country's psychiatrists were trained in how to work in psychoanalysis.

This monopoly in the United States on psychotherapy lasted until the 1970s, while it lingered in specialized circles of the Old World for another 10 years. It is worth noting that the crisis of psychoanalysis - in terms of its ability to respond to various changes in the demands of society after the Second World War, as well as its ability to “cure” it - began in the 1950s. At this time, alternative ones were born. The main role played among them, of course, was cognitive behavioral therapy. At that time, few people dared to do exercises on their own.

Arose immediately in different parts light, thanks to the contribution of psychoanalysts who were dissatisfied with their tools of intervention and analysis, rational-emotive-behavioral therapy soon spread throughout Europe. In a short time it has established itself as a treatment method that can provide an effective solution various problems clients.

Fifty years have passed since J.B. Watson’s work on the topic of behaviorism, as well as the use of behavioral therapy, was published; only after this time did it take its place among the working areas of psychotherapy. But its further evolution took place at an accelerated pace. There was a simple reason for this: like other techniques that were based on scientific thought, cognitive behavioral therapy, the exercises of which are given in the article below, remained open to change, integrated and assimilated with other techniques.

It absorbed the results of research conducted in psychology, as well as in other scientific fields. This has led to new forms of intervention and analysis.

This 1st generation therapy, which was characterized by a radical shift from the psychodynamic therapy known, was quickly followed by a set of “innovations.” They already took into account previously forgotten cognitive aspects. This fusion of cognitive and behavioral therapy is next generation behavioral therapy, also known as cognitive behavioral therapy. It is still being taught today.

Its development is still ongoing, new treatment methods are emerging, which already belong to the 3rd generation of therapy.

Cognitive Behavioral Therapy: Basics

The basic concept suggests that our feelings and thoughts play a major role in shaping human behavior. So, a person who thinks too much about accidents runway, plane crashes and other air disasters, may avoid traveling by various air transport. It is worth noting that the goal of this therapy is to teach patients that they cannot control every aspect of the world around them, but they can take full control of their own interpretation of this world, as well as interaction with it.

IN Lately Self-administered cognitive behavioral therapy is being used increasingly. This type of treatment generally does not take much time, due to which it is considered more accessible than other types of therapy. Its effectiveness has been empirically proven: experts have found that it enables patients to cope with inappropriate behavior in its various manifestations.

Types of therapy

The British Association of Cognitive and Behavioral Therapists say it is a range of treatments based on principles and concepts derived from patterns of human behavior and emotion. They include a huge range of approaches to getting rid of emotional disorders, as well as self-help options.

Specialists regularly use the following types:

• cognitive therapy;
• emotional-rational-behavioral therapy;
• multimodal therapy.

Behavioral therapy methods

They are used in cognitive learning. The main method is behavioral rational-emotive therapy. Initially, a person’s irrational thoughts are established, then the reasons for the irrational belief system are clarified, after which the goal is approached.

Generally, general training methods are problem solving methods. The main method is biofeedback training, which is used mainly to get rid of the effects of stress. In this case, a hardware study of the general state of muscle relaxation occurs, as well as optical or acoustic feedback. Muscle relaxation with feedback is positively reinforced and then leads to self-soothing.

Cognitive-behavioral therapy: methods of learning and assimilation

In behavioral therapy, the postulate of education is systematically used, according to which correct behavior can be taught and learned. Learning by example is one of the most important processes. Methods of assimilation are focused mainly on after which people build their desired behavior. A very important method is imitation learning.

A model is systematically imitated in vicarious learning—a person or a symbol. In other words, inheritance can be induced by participation, symbolically or covertly.

Behavioral therapy is actively used when working with children. Exercises in this case contain reinforcing direct stimuli, for example, candy. In adults, this goal is served by a system of privileges and rewards. Prompting (support of the therapist setting an example) with success gradually decreases.

Unlearning methods

Odysseus in Homer's Odyssey, on the advice of Circe (the sorceress), orders himself to be tied to the mast of the ship in order not to be subjected to the singing of the seductive sirens. He covered the ears of his companions with wax. With overt avoidance, behavioral therapy reduces the impact, while some changes are made to increase the likelihood of success. For example, to negative behavior, alcohol abuse, an aversive stimulus is added, for example, a smell that causes vomiting.

Cognitive behavioral therapy exercises come in a wide variety. Thus, with the help of a device designed for the treatment of enuresis, it is possible to get rid of bedwetting - the mechanism for awakening the patient is immediately triggered when the first drops of urine appear.

Elimination methods

Elimination methods should combat inappropriate behavior. It is worth noting that one of the main methods is systematic desensitization to decompose the fear reaction using 3 steps: training deep muscle relaxation, compiling a complete list of fears, and alternating irritation and relaxation of fears from the list in increasing order.

Methods of confrontation

These methods use accelerated contacts with initial fear stimuli regarding peripheral or central phobias in various mental disorders. The main method is flooding (assault with various stimuli using firm techniques). The client is exposed to direct or intense mental influence of various fear stimuli.

Components of therapy

Often people experience feelings or thoughts that only strengthen them in an incorrect opinion. These beliefs and opinions lead to problematic behaviors that can impact all areas of life, including romantic relationships, family, school, and work. For example, a person who suffers from low self-esteem may have negative thoughts about himself, his abilities or appearance. Because of this, the person will begin to avoid social situations or give up career opportunities.

Behavioral therapy is used to correct this. To combat such destructive thoughts and negative behaviors, the therapist begins by helping the client establish problematic beliefs. This stage, also known as functional analysis, is important for understanding how situations, feelings, and thoughts can contribute to inappropriate behavior. This process can be challenging, particularly for clients struggling with over-introspection, although it can result in the insights and self-knowledge that are considered an essential part of the healing process.

Cognitive behavioral therapy includes the second part. It focuses on the actual behavior that is contributing to the problem. The person begins to practice and learn new skills, which can then be applied in real-life situations. Thus, a person who suffers from drug addiction is able to learn skills to overcome this craving and can avoid social situations that could potentially cause relapse, as well as cope with all of them.

CBT in most cases is a smooth process that helps a person take new steps towards changing their behavior. Thus, a social phobia may begin by simply imagining himself in a certain social situation that causes him anxiety. Then he can try to talk with friends, acquaintances and family members. The process of regularly moving towards a goal does not seem so difficult, while the goals themselves are absolutely achievable.

Using CBT

This therapy is used to treat people who suffer from a wide range of diseases - phobias, anxiety, addiction and depression. CBT is considered one of the most studied types of therapy, in part because the treatment focuses on specific problems and its results are relatively easy to measure.

This therapy is best suited for clients who are particularly introspective. For CBT to be truly effective, a person must be ready for it, he must be willing to spend time and effort analyzing his own feelings and thoughts. This kind of self-reflection can be difficult, but it is a great way to learn much more about influence. internal state on behavior.

Cognitive behavioral therapy is also great for people who need quick treatment, which does not involve the use of certain medications. Thus, one of the benefits of cognitive behavioral therapy is that it helps clients develop skills that can be useful today and later.

Developing self-confidence

It’s worth mentioning right away that self-confidence comes from various qualities: the ability to express needs, feelings and thoughts, in addition, to perceive the needs and feelings of other people, the ability to say “no”; in addition, the ability to start, end and continue conversations, while speaking freely in front of the public, etc.

This training is aimed at overcoming possible social fears, as well as difficulties during contacts. Similar influences are also used for hyperactivity and aggressiveness, for activating clients who have been receiving treatment from psychiatrists for a long time, and for mental retardation.

This training primarily pursues two goals: the formation of social skills and the elimination of social phobias. In this case, many techniques are used, for example, behavioral exercises and role-playing games, training in daily situations, operant techniques, model training, group therapy, video techniques, methods of self-control, etc. This means that with this training, in most cases we are talking about a program with using all possible methods in some sequence.

Behavioral therapy is also used for children. Special forms of this training were created for children with communication difficulties and social phobias. Peterman and Peterman proposed a compact therapeutic program that, along with group and individual training, also includes counseling for the parents of these children.

Criticism of CBT

Some patients at the beginning of treatment report that, regardless of the fairly simple awareness of the irrationality of some thoughts, just this awareness does not make the process of getting rid of it easy. It should be noted that behavioral therapy involves identifying these thought patterns, and it also aims to help get rid of these thoughts using a variety of strategies. These may include role-playing, journaling, distraction and relaxation techniques.

Now let's look at some exercises that you can do yourself at home.

Muscle progressive relaxation according to Jacobson

The lesson is conducted while sitting. You need to lean your head against the wall and put your hands on the armrests. First, you should create tension in all your muscles sequentially, and this should happen while inhaling. We instill in ourselves a feeling of warmth. In this case, relaxation is accompanied by a very fast and fairly sharp exhalation. The time for muscle tension is about 5 seconds, relaxation is about 30 seconds. In this case, each exercise must be done 2 times. This method is great for children too.

1. Arm muscles. Stretch your arms forward, spread your fingers in different directions. You need to try to reach the wall with your fingers.
2. Brushes. Clench your fists as tightly as possible. Imagine that you are squeezing water out of a squeezable icicle.
3. Shoulders. Try to reach your earlobes with your shoulders.
4. Feet. Use your toes to reach the middle of your shin.
5. Stomach. Make your stomach look like stone, as if you are repelling a blow.
6. Hips, legs. The toes are fixed and the heels are raised.
7. Middle 1/3 of the face. Wrinkle your nose, squint your eyes.
8. Upper 1/3 of the face. Wrinkle forehead, surprised face.
9. Lower 1/3 of the face. Fold your lips into a “proboscis” shape.
10. Lower 1/3 of the face. Move the corners of your mouth to your ears.

Self-instructions

We all tell ourselves something. We give ourselves instructions, orders, information for a specific solution to problems or instructions. In this case, the person may begin with verbalizations, which over time will become part of the entire behavioral repertoire. People are taught such direct instructions. Moreover, in a number of cases they become “counter-instructions” for aggression, fear, and others. In this case, self-instructions with approximate formulas are used according to the steps given below.

1. Preparing for a stressor.

• “It's easy to do. Remember the humor."
• “I can create a plan to deal with this.”

2. Responding to provocations.

• “As long as I remain calm, I am in complete control of the whole situation.”
• “Worrying won’t help me in this situation. I am absolutely confident in myself."

3. Reflection of experience.

• If the conflict is unresolvable: “Forget about the difficulties. To think about them is only to destroy yourself.”
• If the conflict is resolved or the situation was managed: “It wasn’t as scary as I expected.”

Founder: Sigmund Freud, Austria (1856–1939)

What is this? A system of methods with which you can dive into the unconscious, study it in order to help a person understand the cause of internal conflicts that arose as a result of childhood experiences, and thereby save him from problems of a neurotic nature.

How does this happen? The main thing in the psychotherapeutic process is the transformation of the unconscious into the conscious using the methods of free association, dream interpretation, analysis of erroneous actions... During the session, the patient lies on the couch, says everything that comes to mind, even what seems insignificant, absurd, painful , indecent. The analyst (sitting at the couch, the patient does not see him), interpreting the hidden meaning of words, actions, dreams and fantasies, tries to unravel the tangle of free associations in search of main problem. This is a long and strictly regulated type of psychotherapy. Psychoanalysis takes place 3–5 times a week for 3–6 years.

About it: Z. Freud “Psychopathology of everyday life”; "Introduction to Psychoanalysis" (Peter, 2005, 2004); "Anthology of modern psychoanalysis". Ed. A. Zhibo and A. Rossokhina (Peter, 2005).

Analytical psychology

Founder: Carl Jung, Switzerland (1875–1961)

What is this? A holistic approach to psychotherapy and self-knowledge based on the study of unconscious complexes and archetypes. Analysis frees a person's vital energy from the power of complexes and directs it to overcome psychological problems and personal development.

How does this happen? The analyst discusses his experiences with the patient in the language of images, symbols and metaphors. Methods of active imagination, free association and drawing, and analytical sand psychotherapy are used. Meetings take place 1–3 times a week for 1–3 years.

About it: K. Jung “Memories, Dreams, Reflections” (Air Land, 1994); "The Cambridge Manual of Analytical Psychology" (Dobrosvet, 2000).

Psychodrama

Founder: Jacob Moreno, Romania (1889–1974)

What is this? Study of life situations and conflicts in action, using acting techniques. The purpose of psychodrama is to teach a person to solve personal problems by playing out his fantasies, conflicts and fears.

How does this happen? In a safe therapeutic environment, with the help of a psychotherapist and other group members, significant situations from a person’s life are played out. Role-playing allows you to feel emotions, confront deep-seated conflicts, and perform actions that are impossible in real life. Historically, psychodrama is the first form of group psychotherapy. Duration - from one session to 2–3 years of weekly meetings. The optimal duration of one meeting is 2.5 hours.

About it:"Psychodrama: inspiration and technique." Ed. P. Holmes and M. Karp (Class, 2000); P. Kellerman “Psychodrama close-up. Analysis of therapeutic mechanisms" (Klass, 1998).

Gestalt therapy

Founder: Fritz Perls, Germany (1893–1970)

What is this? The study of man as an integral system, his bodily, emotional, social and spiritual manifestations. Gestalt therapy helps to gain a holistic view of oneself (Gestalt) and begin to live not in the world of the past and fantasies, but “here and now.”

How does this happen? With the support of the therapist, the client works with what he is experiencing and feeling now. By doing the exercises, he experiences his internal conflicts, analyzes emotions and physical sensations, learns to be aware of “body language”, the intonation of his voice and even the movements of his hands and eyes... As a result, he achieves awareness of his own “I”, learns to take responsibility for his feelings and actions. The technique combines elements of a psychoanalytic (translation of unconscious feelings into consciousness) and a humanistic approach (emphasis on “agreement with oneself”). Duration of therapy is at least 6 months of weekly meetings.

About it: F. Perls “The Practice of Gestalt Therapy”, “Ego, Hunger and Aggression” (IOI, 1993, Meaning, 2005); S. Ginger “Gestalt: the art of contact” (Per Se, 2002).

Existential analysis

Founders: Ludwig Binswanger, Switzerland (1881–1966), Viktor Frankl, Austria (1905–1997), Alfried Längle, Austria (b. 1951)

What is this? A psychotherapeutic direction based on the ideas of the philosophy of existentialism. Its initial concept is “existence”, or “real”, a good life. A life in which a person copes with difficulties, realizes his own attitudes, lives it freely and responsibly, and sees meaning in it.

How does this happen? An existential therapist does not just use techniques. His work is an open dialogue with the client. The style of communication, the depth of the topics and issues discussed leave a person with the feeling that he is understood - not only professionally, but also humanly. During therapy, the client learns to ask himself meaningful questions, to pay attention to what gives rise to a feeling of agreement with his own life, no matter how difficult it may be. The duration of therapy ranges from 3–6 consultations to several years.

About it: A. Langle “Life filled with meaning” (Genesis, 2003); V. Frankl “Man in Search of Meaning” (Progress, 1990); I. Yalom “Existential psychotherapy” (Klass, 1999).

Neurolinguistic programming (NLP)

Founders: Richard Bandler USA (b. 1940), John Grinder USA (b. 1949)

What is this? NLP is a communication technique aimed at changing habitual interaction patterns, gaining confidence in life, and optimizing creative potential.

How does this happen? The NLP technique works not with content, but with process. During group or individual training in behavior strategies, the client analyzes his own experience and models step by step effective communication. Classes range from several weeks to 2 years.

Family psychotherapy

Founders: Mara Selvini Palazzoli, Italy (1916–1999), Murray Bowen, USA (1913–1990), Virginia Satir, USA (1916–1988), Carl Whitaker, USA (1912–1995)

What is this? Modern family psychotherapy includes several approaches; What everyone has in common is working not with one person, but with the family as a whole. The actions and intentions of people in this therapy are perceived not as individual manifestations, but as a consequence of the laws and rules of the family system.

How does this happen? Various methods are used, including a genogram - a family “diagram” drawn from the clients’ words, reflecting the births, deaths, marriages and divorces of its members. In the process of compiling it, the source of problems is often discovered, forcing family members to behave in a certain way. Typically, family therapist and client meetings take place once a week and last several months.

About it: K. Whitaker, Midnight Reflections of a Family Therapist (Klass, 1998); M. Bowen “Family Systems Theory” (Cogito Center, 2005); A. Varga “Systemic family psychotherapy” (Speech, 2001).

Client-centered therapy

Founder: Carl Rogers, USA (1902–1987)

What is this? The most popular system of psychotherapeutic work in the world (after psychoanalysis). It is based on the belief that a person, when asking for help, is able to determine the causes and find a way to solve his problems - all he needs is the support of a psychotherapist. The name of the method emphasizes: it is the client who makes the guiding changes.

How does this happen? Therapy takes place in the form of a dialogue that is established between the client and the therapist. The most important thing about it is the emotional atmosphere of trust, respect and non-judgmental understanding. It allows the client to feel that he is accepted for who he is; he can talk about anything without fear of judgment or disapproval. Considering that the person himself determines whether he has achieved the desired goals, therapy can be stopped at any time or a decision can be made to continue it. Positive changes occur already in the first sessions, deeper ones are possible after 10–15 meetings.

About it: K. Rogers “Client-centered psychotherapy. Theory, modern practice and application" (Eksmo-press, 2002).

Ericksonian hypnosis

Founder: Milton Erickson, USA (1901–1980)

What is this? Ericksonian hypnosis uses a person’s ability to involuntary hypnotic trance - a state of mind in which it is most open and ready for positive changes. This is a “soft”, non-directive hypnosis in which the person remains awake.

How does this happen? The psychotherapist does not resort to direct suggestion, but uses metaphors, parables, fairy tales - and the unconscious itself finds the way to the right decision. The effect may occur after the first session, sometimes it takes several months of work.

About it: M. Erickson, E. Rossi “The Man from February” (Klass, 1995).

Transactional Analysis

Founder: Eric Berne, Canada (1910–1970)

What is this? A psychotherapeutic direction based on the theory of the three states of our “I” - childhood, adult and parental, as well as the influence of the state unconsciously chosen by a person on interaction with other people. The goal of therapy is for the client to become aware of the principles of his behavior and take it under adult control.

How does this happen? The therapist helps to determine which hypostasis of our “I” is involved in a particular situation, and also to understand what the unconscious scenario of our life is in general. As a result of this work, behavioral stereotypes change. The therapy uses elements of psychodrama, role-playing, and family modeling. This type of therapy is effective in group work; its duration depends on the client’s wishes.

About it: E. Berne “Games People Play...”, “What Do You Say After You Say “Hello” (FAIR, 2001; Ripol Classic, 2004).

Body-oriented therapy

Founders: Wilhelm Reich, Austria (1897–1957); Alexander Lowen, USA (b. 1910)

What is this? The method is based on the use of special physical exercises in combination with a psychological analysis of a person’s bodily sensations and emotional reactions. It is based on W. Reich’s position that all traumatic experiences of the past remain in our body in the form of “ muscle tension».

How does this happen? Patients' problems are considered in relation to the functioning of their body. The task of the person performing the exercises is to understand his body, to become aware of the bodily manifestations of his needs, desires, and feelings. Cognition and work of the body change life attitudes and give a feeling of fullness of life. Classes are held individually and in groups.

About it: A. Lowen “Physical dynamics of character structure” (PANI, 1996); M. Sandomirsky “Psychosomatics and bodily psychotherapy” (Klass, 2005).

Sometimes help is needed not only for the body, but also for the soul of a person. Depression, neuroses, phobias and anxiety disorders- this is not a complete list of problems that a psychotherapist can work with. You will learn about what psychotherapy is and what methods the doctor uses to help the patient in this article.

What it is?

In the 19th century, mental disorders were treated with methods that now seem barbaric. Unhappy patients psychiatric hospitals They were literally tortured: they were tied to beds for several weeks, doused with ice water, and electric shocks... Of course, such methods can hardly be called effective.The sick were not cured, but ended their lives in shelters and almshouses.

At the end of the 19th century, a revolution occurred in the treatment of mental disorders. Performed by a Viennese psychiatrist Sigmund Freud, who came to the conclusion that it is necessary to treat diseases of the soul using an innovative method - psychoanalysis. It was psychoanalysis that laid the foundation for psychotherapy as a separate direction in medical science. Freud talked with his patients, discussed their problems and looked for the preconditions for the formation of mental disorders in early childhood. And he managed to achieve enormous success. It turned out that the patient needs to experience the so-called catharsis, that is, cleansing of the senses, after which the symptoms of the disease subsided forever or for a long time.

Despite the fact that psychoanalysis is currently subject to criticism, it is impossible to deny that it was with it that the treatment of mental illness began. scientific direction, impossible. All modern methods of psychotherapy “grew” from psychoanalysis, like branches growing from a common trunk. Currently, there are dozens of psychotherapy methods, each of which is effective for treating a specific group of diseases.

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Types and methods of psychotherapy

All therapy methods are divided into group And individual .

As the name implies, group therapy is work in a group; in individual therapy, the psychotherapist interacts with the patient one-on-one.

A striking example group psychotherapy can be called groups Alcoholics Anonymous. The principle of such groups is that people who want to get rid of addiction get together, discuss their feelings, provide each other with support and share their experiences. Working in a group is a resource for the individual, thanks to which a person manages to cope with the desire to drink. In this format it is possible to work out family problems, various addictions (including drug addiction), work in personal growth groups is highly effective .

Individual Therapy helps when working on deep-seated problems that a person is not ready to share with others. The patient can tell the psychotherapist about his difficulties and problems, receive feedback and support from him.

Many people believe that the doctor gives ready-made solutions after studying the client’s problem. However, it is not. The specialist’s task is to help you find your goals and resources to achieve them, and not to offer a “recipe for happiness.” Working with a psychotherapist is a difficult process in which a person takes an active part.

Systemic family psychotherapy

In psychology, it is generally accepted that a family is not a group of disparate individuals, but an integral system. And the problem of one of the family members changes the entire system as a whole. There is also a feedback: systemic changes lead to changes in the inner world of each family member.

• Family therapy It is used not only to solve problems in the relationship of a married couple. It is often recommended when there are problems in a child who may not even be involved with the therapist.
• Family therapy is very effective if one of the family members suffers from any addictions (alcoholism, drug addiction, gambling addiction, etc.). Modern drug treatment centers often offer the services of family therapists: it has been proven that systemic treatment helps avoid the return of addiction and facilitates the patient’s rehabilitation after completion of treatment.

The main directions of modern psychotherapy

Typically, a psychotherapist specializes in one of the areas. Here are the main ones:

• body-oriented. This method can be called paradoxical, because the main work is done with the patient’s body, and changes as a result of therapy occur in the inner world. During treatment, you can get rid of muscle tension, which, according to body-oriented therapists, is a reflection of internal problems at the bodily level. Psychotherapy is often carried out in this way. excess weight: The therapist helps clients learn to better feel, love, and accept their bodies. Body therapy helps you become more free and relaxed, which is why it is recommended for people who have problems in the sexual sphere;

• cognitive-behavioral. Cognitive therapy is based on the fact that many of a person's problems arise due to errors in his thinking. Once these errors are corrected, positive behavioral changes occur. Cognitive therapy is effective for neuroses, especially phobias: a strong emotional reaction to a stimulus can disappear after the patient realizes that the object of his fear does not pose any threat. Close to the cognitive direction is rational therapy, which is also based on explaining to the patient the error of his judgment and changing his attitude towards problems;

• suggestive therapy. This method based on hypnosis and suggestion techniques. The therapist puts the patient into a trance and instills in him the necessary attitudes. Suggestive therapy is used to treat addictions and works best in combination with other therapies, such as cognitive behavioral therapy;

• transpersonal therapy allows you to explore the so-called transpersonal experience. Patients experience altered states of consciousness and comprehend religious experience. Transpersonal therapy has much in common with spiritual practices and is popular with people passionate about personal growth and development;
• existential therapy aims to work with the meaning of life. The method is based on the works of existentialist philosophers (Sartre, Camus, Kierkegaard). The existential method can be effective for depression, a sense of loss of meaning in life, and when the patient experiences loss;
• positive psychotherapy. This method focuses not on the patient's problems, but on what he can do, that is, on his resources. In positive therapy, it is believed that a person who has the opportunity to comprehend and overcome a problematic situation can be considered healthy.

There are currently many types of therapy for mental disorders in the world. And finding a good therapist is not easy. It is important that he has a good education, graduated from a specialized institution, for example, the Institute of Psychotherapy and Clinical Psychology.

It is equally important that the patient feels comfortable working with the therapist, that he has respect and trust in him. Only in this case are positive changes possible, which, ultimately, are the main goal of psychotherapeutic work.