A short course of psychotherapy. Psychological foundations of psychotherapy
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Treatment of neuroses
The pathogenetic method is psychotherapy aimed at resolving the neurotic conflict; drug therapy is auxiliary and symptomatic.
"Psychotherapy" ( psyche– soul and therapy– care, care, treatment) - “soul healing” or “soul healing.” The term “psychotherapy” was introduced in 1872.
Psychotherapy– directional system psychological impact on the individual, and through the psyche - on the entire organism and behavior. The impact may be verbal And non-verbal. The therapeutic effect of psychotherapy is achieved by the information and emotional charge it carries.
The main models of psychotherapy are medical And psychological.
IN medical model psychotherapy is divided into general And special
General psychotherapy– a method that every doctor should know; it does not require special training. It includes:
1. Organization of a protective regime of a medical institution, creation of a psychotherapeutic atmosphere (a medical institution begins with a registry or reception area; silence, smells, cleanliness, aesthetic design; differentiated care of patients according to their condition, a separate recreation area; conditions for meetings with relatives, walks; recreational evenings, movies, concerts, etc.) .
2. Individual approach to the patient, taking into account his personal characteristics (Find contact, win over, create trusting relationships, instill confidence in recovery, form an adequate attitude towards the disease).
3. Prevention of iatrogenic (watch your gestures, facial expressions, words; carefully provide information about the disease, its causes and prognosis).
4. Training in personal psychohygienic regime (work and rest schedule - active, gentle, number of hours for sleep, watching TV, computer, etc.; diet, psychohygienic aspects of marital relationships).
Special psychotherapy- a method of treatment, therefore it is carried out by a doctor with special training in the field of psychotherapy. Separate medical specialty along with psychiatry and addiction medicine.
Subject of influence – psychopathological symptoms and syndromes (usually borderline), painful personality anomalies.
Target– relief of painful manifestations.
Psychological model psychotherapy - area of activity practical psychologist . It does not require mandatory medical education. In this case, psychotherapy should be understood as “providing psychological assistance healthy people(to clients) in situations various kinds psychological difficulties, as well as in case of need to improve the quality of one’s own life.”
Psychotherapy is used both independently and in combination with other treatment methods.
Indications for psychotherapy:
neuroses, reactive states, psychopathy
· sexual disorders
· somatic diseases (correction of incorrect personality reactions to illness)
· drug addiction diseases
· psychoses during remission or sluggish course
Contraindications to psychotherapy: acute psychosis.
Psychotherapy methods are varied. The choice of method is determined by: 1) Personal characteristics of the patient; 2) Psychological mechanisms of the disease; 3) Type of disease and stage of its course.
The methods used are largely determined by the paradigm in which the psychotherapist works. You can select 3 main directions , which are based on various theoretical ideas about personality and its mechanisms.
1. Psychoanalytic (psychodynamic) direction.
The cause of neurosis is the conflict between the demands of the subconscious and social prohibitions (Id ß àSuperego). A symptom of neurosis is the result of repression of forbidden desires - sexual, aggressive.
The goal of psychotherapy is awareness of the unconscious conflict (insight), which leads to the elimination of the symptom due to the release of tension (catharsis). The main representative is psychoanalysis.
2. Behavioral (behaviorist) direction.
From the perspective of this approach, personality is behavior. A symptom of neurosis is maladaptive behavior. No pathological behavior - no neurosis. In this sense behavioral psychotherapy is symptomatic. The causes of maladaptive behavior are incorrect learning. To cure neurosis means to retrain the patient, to teach adaptive forms behavior. This is achieved by positive reinforcement of desired behavior and negative reinforcement of unwanted behavior. Methods flood/immersion, systematic desensitization, paradoxical intention, functional training, (operant conditioning in children).
Providing psychological assistance has its own characteristics. The main one is that the client (patient) has complete trust in the psychotherapist. To establish open and secure relationships between them, a system for organizing psychotherapeutic interaction has been developed, based on the following principles:
1. Confidentiality. No client would like to have their personal problems discussed strangers, especially when we're talking about about intimate aspects of relationships and being. In addition, it is possible that the information received may be abused by persons who received it by accident or who acquired it on purpose. A professional psychotherapist never discloses the names of his clients anywhere. Even in his own notes, he must use abbreviations or pseudonyms that make identification impossible. When giving examples in lectures or articles, you should also adhere to this principle. Professional associations and associations exclude from their membership psychotherapists who violated it,
2. Zinc-free. A person who seeks help should not be perceived as intellectually limited, defective or sick, or treated with prejudice. After all, psychotherapeutic assistance is a service that a specialist provides for money, and the client is a person who does not have certain mental self-regulation skills. Most clients fear that openness to the therapist will inevitably lead to a devaluation of their personality and show their weakness. The anxiety and feelings of guilt that accompany contacting a psychotherapist, although irrational, do not diminish from this. Therefore, at the first meeting, the therapist has to assure the visitor of his complete harmlessness. Among the clients there are evil, cruel, depraved people who also need help, and their negative qualities- a consequence of personal problems and troubles. The psychotherapist does not blame, evaluate or judge - he helps.
3. Empathy. This ability can be considered both as a basic installation and as a professional required quality therapist. Empathy- the ability to feel and experience the feelings and states of another, emotional understanding, cognitive decentering. It is one of the most important skills in psychotherapy. Without empathic understanding, it is difficult to implement an existential-humanistic approach or Dasein analysis; it plays an important role in Gestalt therapy and Rogerianism.
4. Attention, kindness and patience. These settings are characterized as general attitude therapist to the client, and the emotional coloring of his behavior during psychotherapeutic interaction.
Basic therapeutic guidelines form the code of ethics of a psychotherapist. compliance with them not only makes it easier for the patient to communicate with stranger(psychotherapist) in difficult life situation, but also serves as a guarantee of a professional attitude towards personal problems, asked for help.
Personality of the psychotherapist
The problem of a psychotherapist’s personality can be approached from two positions: to describe the requirements for such a specialist or to analyze personal qualities famous psychotherapists based on their works or the memories of colleagues. From them arise the ascetic 3. Freud, the hedonist F. Perls, the hermit philosopher K. Jung, the shocking J. Lacan, the merry fellow J. Haley, the prim M. Klein, the master of paradoxes M. Erikson. However, the second approach would lead to many contradictions - too different personalities there were classics of this science.
Among the requirements for a therapist, an important one is authenticity(Greek Authentikos - real) - the ability to be yourself, not to change your true essence, taking into account the situation. A true specialist must be so confident in himself that he does not resort to manipulation, cunning self-presentation strategies, and does not create the effect of an all-powerful sage. He is always authentic and sincere, real and frank, because these are the qualities that his clients lack. It is impossible to teach others what you cannot do yourself, because clients always notice the therapist’s weaknesses. And lost trust undermines professional reputation.
The required quality is congruence (Latin congruentia - correspondence) - the ability to correctly and accurately respond to the client’s words and actions, to “reflect” his aspirations and intentions. It is expressed in the ability to pose precise questions, not to rush and keep up with interpretations, to support the client in a timely manner or, conversely, to enter into confrontation with actions and thoughts. This trait is based on empathy and tolerance. Basically, it is congruence that determines the first impression of the therapist and influences the client’s decision about whether to deal with him.
An important role in professional activity speech skills play a role. According to Russian psychologist Alexander Bondarenko, the effectiveness of a psychotherapist’s speech is ensured by: clarity, eloquence, semantic richness, personal interest, rhythm, and influence.
Emotionally unstable, neurotic clients hope to achieve balance and harmony through therapy. Therefore, the psychotherapist must be harmonious personality. This applies to appearance, clothing, movements, communication style, and the interior of the office where he carries out therapy.
The therapist should adhere to a classic style of clothing and not overuse cosmetics, jewelry and household gadgets. The design of the office should indicate the reliability, self-confidence and professionalism of the specialist who works there. There should be extra things on the table, especially personal ones (photos of loved ones, souvenirs with inscriptions, etc.). Some hang awards and diplomas on the walls - this is bad form.
If the therapist has a computer on his desk, the area in which he speaks with clients should be separated. It is unacceptable to have a conversation when there is a monitor or laptop between the analyst and the patient; These devices can only be turned on when the session is over and the client has left the office. Voice recording of sessions occurs by mutual consent.
It is advisable to have hourglass for 55 minutes (this is the classic session duration proposed by Z. Freud), but he must stand in front of the analyst, and the patient can look at him only after finishing. You can also use regular Wall Clock, placed according to the same principle.
The age of the psychotherapist also plays a significant role: such a specialist cannot be young. Clients do not perceive even very successful and efficient young men and women in this role if they are under thirty. Ordinary people believe that only after forty years a person has sufficient experience to help others.
However, age should not be a barrier to work. In the West, the standards for professional training of a psychotherapist provide for training and internship for 10-15 years - which means that a specialist begins to work independently at 30-32 years old. Domestic young specialists can begin their activities with training work, work in social services or with teenagers, lead groups personal development, gradually gaining experience.
So, an exemplary psychotherapist is a calm, balanced middle-aged (or older) specialist who has a thorough vocational training, adheres ethical principles psychotherapy. Such a person is characterized by truthfulness, authenticity and inner harmony. She dresses classically, carries herself with gravity, has a fluent command of the language, and gives an impression of intellectual respectability.
Psychotherapy is a process in which a person, wishing to get rid of symptoms or problems encountered in his life, or seeking personal growth, implicitly or explicitly enters into a contract for a specific - verbal or non-verbal - interaction with a person (or several people) , acting as aid agents.
Its classification leads to a more complete understanding of psychotherapy.
Psychotherapy can be divided into conscious and unconscious. This is, on the one hand, a worldview, and on the other, the sum of technologies for influencing and interacting with people.
In psychotherapy, verbal and non-verbal aspects can be distinguished; it can be divided into direct and indirect. In turn, mediated psychotherapy can be divided according to the methods of mediation. It could be a placebo, biologically active additives, money and much more.
Multi-axis classification
In it, psychotherapy is considered along seven axes: the goal axis, the object axis, the model axis, the axis of the place of therapy in treatment, correctional or educational process, therapy duration axis, basic psychotherapy technologies axis, descriptive axis.
Target axis
Therapy can pursue the goals of treatment, prevention, development, diagnosis, problem resolution, etc.
Object axis
Therapy can have only three objects: the person, the family or the group.
Six models of therapy can be distinguished: medical, psychological, pedagogical, philosophical, social and undifferentiated.
In the medical model, psychotherapy is intended to treat, prevent, or diagnose disease. This is the most traditional and widespread model of psychotherapy. Great place in our country it is occupied by a section called “clinical psychotherapy”. This is a medical psychotherapy that uses the paradigms of psychotherapy, psychiatry and the clinical discipline where it is applied.
In the psychological model, psychotherapy is intended to resolve problems that do not reach the level of pathology, but affect the development of psychological functions, personal growth. The medical model often uses syndromic and nosological approaches to understanding disorders and diagnosing them. The psychological model uses the so-called problem approach. Each of them has its own advantages and disadvantages. We will dwell on their characteristics below.
The pedagogical model of therapy assumes its focus on the process of training, education and re-education.
In the philosophical model, psychotherapy is intended to achieve an understanding of one’s own personality, the world, and one’s place in the world. It influences the formation and change of worldview.
In the social or political model, psychotherapy technologies are used to manipulate a person or group, which may include the entire society.
Place axis
Let's consider this axis using the example of a medical model. Four options stand out here. In the first of them, psychotherapy only accompanies healing process, occupying only a secondary place. In another embodiment, psychotherapy occupies one of the important places in treatment along with other approaches. In the third option, psychotherapy is the main method, while others are auxiliary. In the fourth option, it is the only treatment method. The above also applies to correctional or educational processes.
Duration axis
There are four options: ultra-short (ultra-fast), short (fast), long-term (slow), ultra-long (ultra-slow) therapy.
Ultra-short therapy lasts minutes and hours and is aimed at resolving current, isolated problems and conflicts; She does not deal with deep personal problems. Its effect may be unstable. An example is neuro-linguistic programming.
Short therapy lasts for hours and days. Personal content is dealt with within the minimum required for solving actual problem. Its effectiveness is often more durable. Characteristically, it seems to launch a process of change that continues after completion of therapy. An example is the problem crystallization method.
Slow therapy lasts months. She deals with the personal content of problems. Works out a lot of details. Its effect develops slowly and is persistent. An example is transactional analysis.
Ultra-slow therapy lasts years. She deals with the conscious and unconscious of the client or patient. Dedicates a lot of time to achieving an understanding of the essence of experiences. Usually a large role is assigned to a person's early experience. The effect of ultra-slow therapy develops gradually and is long-lasting. In some cases, it depends on maintaining contact between the therapist and the patient. An example is classical psychoanalysis.
Here are the basic techniques and techniques of each approach. Such as suggestion, trance state, interview technologies in verbal psychotherapy, reframing, etc.
Descriptive axis
Researchers cite between 500 and 700 registered therapies worldwide. In our country, of course, there are much fewer of them. Thus, in the program of the “Winter Ten Day Festival in Krasnoyarsk” in 1995, only 26 methods were presented. These are classical psychoanalysis, transactional analysis, existential-humanistic psychotherapy, transpersonal psychotherapy, Ericksonian therapy and hypnosis, traditional hypnosis, intensive psychotherapeutic life, neurolinguistic programming, Gestalt therapy, rational-emotive therapy, music therapy, holotropic breathing, free breathing, body-oriented psychotherapy, play psychotherapy, problem crystallization method, complex non-drug therapy for diseases internal organs, bibliotherapy, art therapy, family psychotherapy, targeted modeling of emotions, video therapy, positional psychotherapy, rebirthing. Many of these methods seem to be quite new for our country.
NATIONAL PEDAGOGICAL UNIVERSITY
named after M.P.DRAGOMANOV
DEPARTMENT OF PSYCHOLOGY
ABSTRACT
On the topic: Basics of psychotherapy
DEVELOPED BY: KAMENEVA T.V.
CHECKED:
Kyiv 2009
INTRODUCTION
1. BASICS OF PSYCHOTHERAPY
2.1 Cognitive methods
2.2 Behavioral methods
2.3 Suggestive methods
2.4 Methods of self-hypnosis
2.5 Psychodynamic methods
2.6 Humanistic psychotherapy
CONCLUSION
LITERATURE
INTRODUCTION
The subject of psychology as a science is the study of the patterns of formation and appearance of the psyche. Psychology is divided into general and special, or applied. The latter includes: social psychology, pedagogical, clinical, psychotherapy...
Psychotherapy is a method of treating a patient with psychological influence.
In the abstract work we will consider the importance of psychotherapy as a direction practical psychology and as a profession of psychology. Methods of psychotherapeutic influence, working with various patients. Directions of personality-oriented psychotherapy, features and principles of humanistic, cognitive directions. Also methods of group psychotherapy, transaction therapy, gestalt therapy.
Psychotherapy in general includes many other techniques that can be used to help various categories sick. Most of them require appropriate qualifications of a psychotherapist and experience in using specific techniques. A psychotherapist must have both medical (primarily in the field of psychiatry) and psychological knowledge in order to conduct differential diagnosis detected disorders, determine indications for the use of certain psychotherapeutic methods and carry out psychotherapy in practice, avoiding side effects and complications.
1. BASICS OF PSYCHOTHERAPY
The term “psychotherapy” has a double interpretation, associated with its literal translation from Greek (psyche - soul and therapy - care, care, treatment) - “treatment of the soul” and “healing of the soul”. The term was introduced in 187 by W. Tuke (“Illustration of the influence of the mind on the body”) and began to be widely used from the end of the 11th century. However, to date there is no consensus on the boundaries, forms and methods of psychotherapy, the training of specialists in this field, and there is no generally accepted definition of it. Considering that psychotherapy in national science and practice traditionally belonged to medicine - it was considered as one of the methods of treatment and prevention of diseases (in 1985 it was separated into an independent medical specialty), the most consistent with its essence, we probably need to recognize the following definition: psychotherapy is the purposeful use of mental (psychological) methods for the treatment of diseases. It is usually considered as a complex therapeutic effect on the patient’s psyche, using his emotional reactions, cognitive, intellectual, volitional capabilities, conditioned reflex connections, and as a result, the entire body in order to eliminate painful symptoms, change his attitude towards his disease, his personality and the environment.
Since ancient times, cases of influence of certain individuals on mental condition other people. The basis for the treatment of a number of diseases by priests, “ therapeutic effect"conspiracies, "sacred dances" of shamans lie in the influence on the psyche through the mechanisms of suggestion. The expression has been preserved: “medicine rests on three pillars: the knife, the grass and the word,” i.e. Since ancient times, a word has been recognized to have the same power as a surgeon’s knife. Christian teaching tells us that the word has enormous power: “...life and death are in the power of the tongue...”
The development of psychotherapy as a scientifically based method begins in the 11th century and is associated with the names of Bernheim, Baudouin, Levenfeld, Moebius, as well as domestic doctors V.A. Manassein, S.P. Botkin, G.A. Zakharyin, S.S. Korsakov, V.M. Bekhterev, who expressed an opinion on the important role and possibilities of mental influence in the treatment of various diseases.
One of the most comprehensive definitions of the essence of psychotherapy belongs to M.Ya. Mudrova: “...knowing the mutual actions of the soul and body, I consider it my duty to note that there are also spiritual medicines that heal the body. They are exhausted from the science of wisdom, more often from psychology: with its art of comforting the sad, softening the angry, calming the impatient, frightening the sharp, making the timid bold, the hidden open, the desperate well-intentioned. This art communicates that firmness of spirit that overcomes bodily pain, melancholy, and tossing.”
An important contribution to the development of domestic and world psychotherapy was made by the works of I.P. Pavlov, his students and followers. Offering toria physiological mechanisms sleep, transitional states and hypnosis, Pavlov laid the foundations of one of the directions of scientific interpretation of many phenomena that for centuries were considered mysterious and enigmatic. Pavlov's teaching on signaling systems, physiological influence words and suggestions became the basis for scientific psychotherapy. In the West, the works of S. Freud, his students and followers played a special role in the development of psychotherapy.
Knowledge of the patient’s psychology, his personal characteristics and capabilities, his understanding of the disease and attitude towards it, gives the doctor the opportunity to purposefully use medical complex psychotherapeutic methods, which certainly increases the effectiveness medical care. The doctor’s word affects the patient no less, and sometimes even more, than medications. The aphorism “The doctor is bad, after a conversation with whom the patient does not feel better” should be remembered by every doctor who is at the patient’s bedside. Therefore, before starting the examination, it is necessary to get to know the patient by talking with him, and be sure to give him hope for recovery or at least to improve the condition. This is the first stages of psychotherapeutic assistance to the patient.
Psychotherapy is usually divided into general and private, or special.
By general psychotherapy or psychotherapy in the broad sense of the word, we understand the entire complex of mental factors influencing a patient of any profile in order to increase his strength in the fight against illness, creating a protective and restorative regime that excludes mental trauma. This psychotherapy serves auxiliary; it is necessary in any medical institution. In other words, every therapeutic effects should also include a psychotherapeutic component. Therefore, every doctor, regardless of his specialty, must also be a psychotherapist for his patient.
The famous domestic psychiatrist V.V. Kovalev, who studied mental disorders in somatic patients, he emphasized that psychotherapy carried out by the attending physician is especially effective.
The psychotherapeutic effect on the patient is exerted by the doctor’s behavior, conversation about the nature of the disease, the features of its treatment, medicinal purposes and recommendations. All this gives a psychotherapeutic effect only if the doctor’s behavior is subordinated main goal– formation in the patient of an adequate response to the disease and its maintenance throughout the diagnostic, treatment and rehabilitation process. This essentially constitutes the psychological and psychotherapeutic aspects of the work of the attending physician. Normalization of understanding of the disease, correct assessment and attitude towards it are achieved through an appeal to the patient’s personality, as well as by influencing the patient’s environment. The process of correction of somatonosognosia involves the maximum mobilization of the patient’s reserve capabilities for successful examination and treatment, the formation of endurance and courage in the fight against the disease and its consequences in order to quickly return to an active life.
When conducting psychotherapy, the doctor influences the patient’s personality and seeks to change the personal reactions that contributed to the onset of the disease. Personality characteristics patient and clinical manifestations diseases determine the tasks facing the doctor conducting psychotherapy, therefore it is necessary individual approach in every case.
The main goals of psychotherapy in general medical practice are:
· the patient's awareness of his role in successful treatment and rehabilitation;
· correction of incorrect reactions to illness (denial, retreat into illness, indifference, etc.);
· stimulation of the patient’s activity in overcoming the disease;
· creation of a system psychological support the patient and conditions for correcting an inadequate attitude towards the disease that interferes with effective treatment.
Psychotherapeutic influence must be exerted on all levels of somatonosognosia and components of the internal picture of the disease, while achieving the weakening of discomfort and pain, deactualization of the vital threat, its ethical, aesthetic, and intimate components.
2. PSYCHOTHERAPY METHODS AND TECHNIQUES
2.1 Cognitive methods
Cognitive methods are based on an appeal to the patient’s mind, his logic and personal values. These methods help establish contact between the doctor and the patient and make the relationship adequate. One of the first methods of psychotherapy based on logical argumentation was the method of rational (from the Latin ratio - reason) psychotherapy proposed in 191 by P. Dubois. It is based on psychotherapeutic persuasion through the use of logical argumentation in order to change the patient’s inadequate attitudes and assessments of his illness.
The technique of rational psychotherapy comes down to a conversation with the patient, during which the doctor explains to him accessible form the cause and mechanisms of the disease, explains that the existing disorders are reversible, calls on the patient to change his attitude to the events that concern him in the environment, to stop focusing on the symptom of the disease. The conversation conducted with the patient should be aimed at actively stimulating his efforts aimed at overcoming the disease and at restructuring his behavior. The effectiveness of conversations with the patient increases if an appropriate emotional reaction occurs.