Basics of psychotherapy. Theoretical foundations of psychotherapy

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

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 of practical psychology and as a profession of psychologist. 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 methods that can be used to help different categories of patients. 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 a differential diagnosis of 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 the mental state of other people have been known. The treatment of a number of diseases by priests, the “therapeutic effect” of spells, and the “sacred dances” of shamans are based on 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. By proposing a theory of the physiological mechanisms of sleep, transitional states and hypnosis, Pavlov laid the foundations for one of the directions of scientific interpretation of many phenomena that for centuries were considered mysterious and enigmatic. Pavlov's teaching about signaling systems, the physiological influence of words and suggestion 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 psychotherapeutic methods in the treatment complex, which, of course, 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 an improvement in his 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 effect must 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 dealt with mental disorders in somatic patients, 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, treatment prescriptions 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. The personal characteristics of the patient and the clinical manifestations of the disease determine the tasks facing the doctor conducting psychotherapy, therefore an individual approach is necessary in each 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 of psychological support for the patient and conditions for correcting an inadequate attitude towards the disease, which 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. PSYCHOTHERAPEUTIC 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 disease.

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.

The cognitive part of psychotherapy is aimed at identifying pathogenic (i.e. erroneous) thoughts, beliefs, assumptions, expectations that precede pathological (inadequate) feelings (depression, fear) or behavior. The psychotherapist corrects pathogenic, inadequate thoughts during the conversation (Socratic dialogue) by comparing reality with the patient’s ideas.

2.2 Behavioral methods of psychotherapy

Developed on the basis of behaviorism (from the English Behavior - behavior) - teachings about the formation, consolidation, disappearance of habits, skills, behavioral forms of response. The concept of behavioral psychology is based on the teachings of I.P. Pavlov about the role of reinforcement in the formation of certain types of behavior and the extinction of others. Behavioral psychotherapy is symptomatic and is structured as a process of extinction of unwanted behavior and modeling of new behavior; it is based on teaching and training that help reduce anxiety and fear when confronted with a frightening situation. 5

A variety of behavioral psychotherapy techniques are aimed at developing new (adequate) skills and forms of behavior instead of pathological ones. The most well-known methods of behavioral therapy are: systematic desensitization, paradoxical intention, aversive psychotherapy.

2.3 Suggestive methods

They come in a variety of shapes psychological impact on a person with the help of direct or indirect suggestion (from lat.suggestio - I suggest) in order to create a certain state in him or motivate him to certain actions. Both verbal (verbal) methods of suggestion and non-verbal (various stimuli acting on the visual, auditory and tactile analyzers) are used. A prerequisite for the successful use of suggestive methods is that the patient has sufficient suggestibility. Suggestibility is understood as a person’s tendency to perceive the information received insufficiently critically, to take it on faith and to easily succumb to outside influences. Increased suggestibility is especially characteristic of hysterical, infantile, primitive individuals and alcoholics.

Verbal suggestion, indirect suggestion, and hypnotherapy are used.

2.4 Methods of self-hypnosis and training-volitional forms of psychotherapy

The growth of culture and self-awareness of the population dictates the need to use various types of meaningful human self-influence on the psyche and through it on the entire body.

The undoubted advantage of the self-hypnosis method compared to suggestion and gynosuggestion is that the patient himself actively participates in the treatment process, and self-hypnosis sessions can be carried out in any environment and at any time.

In this group we should highlight the method of progressive muscle relaxation, autogenic training (AT) method.

2.5 Psychodynamic methods

These methods are based on concentrating the priority role of intrapsychic conflicts in the mechanisms of occurrence of mental conflicts in the mechanisms of occurrence of mental disorders, which are the result of a dynamic and often unconscious struggle of contradictory aspects within the individual; they are aimed at identifying and eliminating such conflicts.

Classical Freudian psychoanalysis is “talk therapy.”

Psychoanalytic psychotherapy is another type of therapy that uses the method of free association, transference reaction and resistance.

Art therapy also refers to psychodynamic therapy. Psychotherapists who practice art therapy draw on the ideas of Freud and Jung, who argued that artistic creativity expresses the unconscious. Proponents of this approach proceed from the fact that fantasies, “day dreams” and various phobias are easier for a person to express in drawings than verbally. The patient must use his own associations with the works in order to better understand himself. The second idea, which follows from the first, is that, having learned the strengths and weaknesses of his character, the patient can creatively soften his condition, since any creativity releases a large amount of positive energy, any creativity is healing.

2.6 Humanistic psychotherapy

Based on a phenomenological approach to the study of mental disorders and their correction.

Key points: 1) Treatment is a meeting of equal people, and not a medicine prescribed by a specialist;

2) Improvement in patients occurs on its own if the therapist creates the right conditions.

3) A prerequisite is to establish an attitude of acceptance and support.

4) Patients are fully responsible for choosing their own way of thinking and behavior.

Gestalt therapy (from German Gestalt - form, structure) is based on the fact that a person himself creates his own world. Therefore, the goal of Gestalt work is to develop his ability to creatively interact with the world around him, to become better aware of himself, his perceptions, feelings, behavior, to be able to make choices and accept responsibility for himself and his life.

CONCLUSION

A doctor of any specialty can and should spare no time in psychotherapeutic communication with patients within the framework of cognitive psychotherapy with elements of suggestion. Psychotherapy is closely intertwined with the practice of psychology, mental hygiene and psychoprophylaxis.

LITERATURE:

1. Clinical psychology. N.D. Lakosina, I.I. Sergeev, O.F. Pankova: Textbook for students. honey. Universities - 2nd ed. - M., 2005.

2. Zagalna psychology: Navch. companion / O. Skripchenko, L. Dolinska, Z. Ogorodniychuk and in. – K.: Prosvita 2005.

3. Social psychology. L.E. Orban-Lembryk: Navchalny pos_bnik – K.: Akademvidav 2005.

4. Man and the Christian worldview. Almanac, issue 6: Simferopol, 2001

PSYCHOLOGICAL FOUNDATIONS OF PSYCHOTHERAPY

The development of modern scientific psychotherapy is carried out on the basis of various theoretical approaches, analysis and generalization of the results of empirical studies of clinical, psychophysiological, psychological, socio-psychological and other aspects of studying the mechanisms and effectiveness of psychotherapeutic interventions. Without diminishing the significance at all clinical fundamentals psychotherapy, it should be emphasized that the psychological foundations of psychotherapy are of particular importance, since both the object of its influence (psyche) and the means of influence (clinical and psychological interventions) are psychological phenomena, i.e. psychotherapy uses psychological means of influence and is aimed at achieving certain psychological changes.
The significance of the theoretical and, above all, psychological foundations of psychotherapy is also due to the spread in last years many different methods that are quite widely used in psychotherapeutic practice, but do not always have an appropriate theoretical basis. Even if the method is justified to a certain extent theoretical concept it is not always fully recognized by professional psychotherapists.
However, it is theoretical concepts that reveal the content of the concepts of “norm” and “deviation” (“defect”, “pathology”) that determine the nature and specificity of psychotherapeutic influences and allow them to be purposefully and consciously implemented, and also create the basis for the professional training of psychotherapists. In medicine, there is a clear correspondence between ideas about normality and pathology and the system of influences (treatment), which logically follows from these ideas. However, in psychotherapeutic practice such a correspondence is not always visible, while only an understanding of general approaches and the presence of clear ideas about the theoretical basis on which psychotherapeutic influences are carried out create the conditions for effective psychotherapeutic practice.
And this is one of the most significant problems of modern psychotherapy in Russia, since this situation impedes both the creation of an effective system for training psychotherapists and psychotherapeutic practice itself. Psychotherapy as a scientific discipline must have its own theory and methodology, its own and terminology, everything that characterizes an independent scientific discipline. However, the diversity of directions and trends, schools and specific methods of psychotherapy, based on various theoretical approaches, leads to the fact that at present there is not even a single definition of it, and the number of methods is more than 500. Some of them clearly define psychotherapy as a field of medicine, others focus on psychological aspects. It should be noted that in the domestic tradition, psychotherapy is defined primarily as a method of treatment, while in the foreign tradition, its psychological aspects are emphasized to a greater extent. As an example medical approach To understand psychotherapy, the following definitions can be given, which necessarily include such concepts as therapeutic effects, patient, health or illness. Here psychotherapy is understood as “a system of therapeutic effects on the psyche and through the psyche on the human body”; “a specific effective form of influence on the human psyche in order to ensure and preserve his health”; "process therapeutic effects on the psyche of a patient or a group of patients, combining treatment and education,” etc.
Definitions that largely capture psychological approaches include such concepts as interpersonal interaction, psychological means, psychological problems and conflicts, cognitive processes, relationships, attitudes, emotions, behavior, etc. Psychotherapy is “ special kind interpersonal interaction in which patients receive professional help psychological means in solving problems and difficulties that arise psychological nature"; “a tool that uses verbal techniques and interpersonal relationships to help a person modify attitudes and behaviors that are intellectually, socially, or emotionally negative”; “a personalized technique that is a cross between a technique of planned changes in a person’s attitudes, feelings and behavior and a cognitive process that, unlike any other, brings a person face to face with his internal conflicts and contradictions”, etc. As a definition, which is quite general, but to some extent combines these two approaches, we can cite the definition of Kratochvil (S. Kratochvil): “Psychotherapy is the purposeful regulation of the disturbed activity of the body by psychological means.”
In definitions that can conventionally be called medical, psychotherapy is considered as a form of influence on the psyche (and through the psyche on the body), i.e., the object of influence is emphasized. The psychological approach focuses attention not so much on the object, but on the means of influence. Both positions are understandable. On the one hand, psychotherapy literally means treatment of the soul (from the Greek psyche - soul, therapeia - treatment), indicates the object of influence. On the other hand, in the Russian language, terms of similar origin (for example, physiotherapy, pharmacotherapy, etc.) draw attention not to the object, but to the means of influence (pharmacotherapy - treatment with medications). In this case, the term “psychotherapy” means treatment by psychological means. It can be hoped that the process of development of psychotherapy as scientific discipline will allow us to clarify its definition. However, it should be noted that the concept of “impact” is necessarily included in a variety of definitions of psychotherapy.
Psychotherapeutic influence is a type of clinical and psychological intervention (intervention), which is characterized by certain goals, the choice of means of influence (methods) corresponding to these goals, functions, theoretical validity, empirical testing and professional actions. It is obvious that theoretical validity is the core characteristic of a clinical-psychological (psychotherapeutic) intervention, since it is the theoretical approach that determines the goals and means, the nature and specificity of the psychotherapeutic effect.
The theoretical basis of psychotherapy is scientific psychology, psychological theories and concepts that reveal the psychological content of the concepts of “norm” and “pathology” and form a certain system of psychotherapeutic influences. The concept of norm is an idea of a healthy personality, i.e. a psychological concept that defines the main determinants of the development and functioning of the human personality. The concept of pathology is the concept of personality disorders, the concept of the origin of neurotic disorders, considering them within the framework of corresponding ideas about the norm.
With all the variety of psychotherapeutic approaches, there are three main directions in psychotherapy - psychodynamic, behavioral and “experiential” - corresponding to the three main directions of psychology (psychoanalysis, behaviorism and existential-humanistic psychology) and each of them is characterized by its own approach to understanding personality and personality disorders and logically connected with this own system of psychotherapeutic influences. Different areas of psychotherapy are not only different models of psychological intervention, but also different psychological theories, different concepts of personality, which, based on certain philosophical approaches with their own view of human nature and ways to understand it, influenced not only psychotherapeutic practice, the practice of psychological intervention, but also other types human activity. (See DYNAMIC DIRECTION IN PSYCHOTHERAPY, BEHAVIORAL PSYCHOTHERAPY, HUMANISTIC (EXISTENTIAL-HUMANISTIC, EXPERIENTIAL) DIRECTION IN PSYCHOTHERAPY).
Psychodynamic direction. Within the framework of the psychodynamic approach, based on ideas about the organization and mechanisms of functioning of the psyche and the emergence of neuroses, a treatment method was developed, which clearly corresponds to the psychological concept of psychoanalysis not only with the theory of psychoanalytic psychotherapy, but also with its practice.
The psychological concept, the concept of personality in psychoanalysis is the implementation of a psychodynamic approach, which involves considering the mental life of a person, the psyche from the point of view of the dynamics (interaction, struggle, conflicts) of its components (various mental phenomena, various aspects of personality) and their influence on mental life and behavior person. As the main determinant personal development and behavior here, unconscious mental processes are considered that act as driving forces that determine and regulate human behavior and functioning. In general, human mental life is viewed as an expression of unconscious mental processes. The content of the unconscious consists of instinctive impulses, primary, innate, biological drives and needs that threaten consciousness and are repressed into the area of the unconscious. Instincts are understood as motivating, motivational forces of the individual, as a mental expression of impulses and stimuli coming from the body (and, in this sense, biological), as a mental expression of the state of the body or the need that caused this state. The purpose of instinct is to weaken or eliminate excitation, to satisfy a need through certain appropriate behavior. This internal stimulation, from Freud S.’s point of view, is a source of mental energy that ensures human mental activity (in particular, behavioral activity). Therefore, instinctive impulses are considered as motivational forces, i.e., a person’s motivation is aimed at satisfying the needs of the body, at reducing tension and excitement caused by these needs.
Considering the problem of the organization of the psyche and the problem of personality, Freud created two models: topographical (levels of consciousness) and structural (personal structures). According to the topographic model, three levels can be distinguished in a person’s mental life: consciousness (what is realized by a person in this moment), preconscious (that which is not conscious at the moment, but can be conscious quite easily) and unconscious (that which is not conscious at the moment, and practically cannot be consciously realized by a person on his own; it includes instinctive impulses, experiences, memories, repressed into the unconscious as threatening consciousness). A more recent model of personality organization is structural. According to this model, personality includes three structures, three instances: Id (It), Ego (I) and Super-Ego (Super-I). The id is a source of psychic energy, operates in the unconscious and includes basal instincts, primary needs and impulses. The id operates according to the pleasure principle, i.e. tends to immediately relieve tension. The ego (mind) directs and controls instincts, carries out analysis internal states and external events and strives to satisfy the needs of the id, taking into account the demands of the external world. The super-ego is the moral aspect of the individual, conscience and ideal self. It is formed in the process of education and socialization of the individual through the internalization of social norms, values, behavioral stereotypes and exercises control over human behavior (self-control). Thus, the Id strives for an immediate release of tension and does not correlate with reality, the Super-Ego prevents the realization of these desires and seeks to suppress them (according to the moral and ethical principle), the Ego, on the contrary, contributes to the fulfillment of the desires of the Id, but seeks to correlate them with reality, with requirements and restrictions social environment(according to the principle of reality), thereby becoming an arena of struggle between primary needs (Id) and moral norms, rules, requirements, prohibitions (Super-Ego). The consequence of strong pressure on the Ego is anxiety as a signal of danger, accompanied by a certain level of tension. It is a function of the Ego and warns the Ego of impending danger, a threat, helping the personality to respond in such situations in a safe, adaptive way. Freud identified three types of anxiety: objective or realistic (associated with the influences of the external world), neurotic (associated with the influences of the id) and moral (associated with the influences of the superego). Neurotic anxiety is essentially the fear of punishment for the uncontrolled expression of id needs and arises as a result of the influence of id impulses and the danger that they will be recognized but cannot be controlled. Anxiety causes and activates defense mechanisms - certain techniques used by the Ego and aimed at reducing tension and anxiety. The function of defense mechanisms is to prevent awareness of instinctive impulses and to protect the ego from anxiety. They are unconscious and passive, largely distort reality and are directed inward - to reduce anxiety. In general, the action of defense mechanisms turns out to be ineffective, since they are not aimed at actively transforming and processing conflicts and problems, but only at displacing them into the unconscious, “removing” them from consciousness. Therefore, anxiety is reduced only for a short time and can lead to the development neurotic state.
The central content of the general concept of the psychological origin of neuroses within the framework of psychoanalysis is the idea of neurotic conflict. Freud viewed neurotic conflict as “experiences arising from the collision of at least two incompatible tendencies acting simultaneously as motives determining feelings and behavior.” From Freud's point of view, the essence of neurosis is the conflict between the unconscious and consciousness: “From the very beginning we notice that a person becomes ill because of the conflict that arises between the demands of instinct and the internal resistance that arises within against this instinct.” The conscious component is the norms, rules, prohibitions, requirements that exist in society and are elements of the Super-Ego. Unconscious - primary, instinctive needs and drives that make up the content of the id. Repressed into the unconscious, they do not lose their energy potential, but, on the contrary, retain and even strengthen it, and then manifest themselves either in socially acceptable forms of behavior (due to sublimation), and if this is impossible or insufficient, then in the form of neurotic symptoms. Thus, neurosis is a consequence of the conflict between the unconscious (which is formed by the repressed under the influence moral standards, rules, prohibitions, requirements, primary, biological needs and drives, primarily sexual and aggressive) and consciousness. However, it should be noted that different representatives of psychoanalysis have different understandings of the content of the unconscious and, consequently, the content side of the neurotic conflict.
Based on this understanding of the nature of neurotic disorders, the main task of psychotherapy within the framework of psychoanalysis is to become aware of the unconscious. The task of a psychotherapist-psychoanalyst is to reveal and translate unconscious tendencies, drives and conflicts into consciousness, and to promote awareness. The method itself is subordinated to this task. The psychoanalyst builds the process in such a way as to facilitate the manifestation and understanding of the unconscious, based on the theoretical concepts of psychoanalysis about the ways and means of its expression. This determines the content of the process, the degree of its structure, the strategy and tactics of the psychotherapist, his role, position, level of activity, intensity, frequency of sessions, etc. According to the psychological concepts of psychoanalysis, the unconscious finds its expression in free associations, symbolic manifestations of the unconscious, transference and resistance. To achieve awareness, the psychoanalyst analyzes precisely these mental phenomena. The behavior of a psychoanalyst is also determined by theoretical ideas about transference (as a projection) and its role in the process of psychoanalysis (as a way of projecting past significant relationships of the patient into the plane of psychotherapeutic interaction). It is these psychological ideas that determine Special attention to transfer. In order to create the conditions for transference, the psychoanalyst adheres to a certain behavioral strategy: he behaves emotionally neutral, thereby creating the conditions for projection.
The listed mental phenomena (free associations, symbolic manifestations of the unconscious, transference and resistance) are analyzed in the process of psychotherapy. The term analysis implies a series of procedures (confrontation, clarification, interpretation and overcoming), the central one of which is interpretation. The remaining procedures either lead to interpretation or are aimed at making it more effective. In the most general form, psychoanalysis can be defined as an interpretive (interpretive) analysis of various compromise formations of consciousness. For Freud, awareness itself true reasons diseases performs an important therapeutic function. However, also essential is the integration of the “I” of everything that was previously repressed and then realized in the process of psychoanalysis.
Thus, the main content of psychoanalysis as a psychotherapeutic system is the identification and awareness of the unconscious through the analysis of its symbolic manifestations, free associations, transference and resistance. At the same time, psychoanalysis clearly demonstrates the validity of each step of the psychoanalyst with certain theoretical concepts.
Behavioral direction. Behavioral psychotherapy is based on behavioral psychology and uses the principles of learning to change cognitive, emotional and behavioral structures. The development of methodological approaches within this direction is largely due to the complication of the traditional behaviorist “stimulus-response” scheme due to the introduction of intermediate variables - processes that mediate the influence of external stimuli on human behavior, and reflects the evolution of the goals of behavioral psychotherapy from external to internal learning: from methods aimed at changing open forms behavior, directly observed behavioral responses (based primarily on classical conditioning and operant conditioning) to methods aimed at changing deeper, closed psychological formations (based on social learning theories, modeling and cognitive approaches). Behavioral psychotherapy is essentially the clinical use of learning theories developed within the framework of behaviorism.
Behaviorism, being psychological basis behavioral psychotherapy and behavioral direction in medicine, focuses on behavior as the only psychological reality, which determines the approach to the problem of health and illness. Health and illness are the result of what a person has learned and what he has not learned; personality is understood as the experience acquired by a person throughout life. The norm within this approach is adaptive behavior, and clinical symptoms or personality disorders are considered as maladaptive behavior, as a learned maladaptive reaction. The focus is not so much on the disease as on the symptom, which is understood as a behavioral disorder. Thus, Wolpe J. defines neurotic behavior as a habit of maladaptive behavior in physiologically normal body; Eysenck (H. J. Eysenck) and (S. Rachman) - as learned patterns of behavior that, for some reason, are non-adaptive. Adaptation is the main goal of behavior, therefore behavior that does not ensure it is pathological. Behavioral disorders within the behavioral direction are acquired, i.e. they represent a learned incorrect reaction that does not provide the necessary level of adaptation.
In accordance with these ideas about norm and pathology, the main goal of psychological interventions and psychotherapy within the framework of the behavioral approach is learning, i.e., replacing maladaptive forms of behavior with adaptive ones (standard, normative, correct). Methodologically, learning is carried out on the basis of basic psychological models of learning developed by behaviorism. Various methods of behavioral psychotherapy concentrate the impact on individual elements and combinations of the traditional behaviorist scheme “stimulus-intermediate variables-response”. In accordance with this, within the framework of behavioral psychotherapy, three approaches can be distinguished, associated with three learning models.
The first approach is methodologically based on the classical paradigm of I.P. Pavlov, on classical conditioning and uses the “S->R” scheme and systematic desensitization or other symptom reduction techniques. In the classical Pavlovian scheme, reactions occur only in response to the influence of some stimulus, that is, an unconditioned or conditioned stimulus. The formation of a conditioned reflex occurs under conditions of contiguity and repetition. The experimenter influences the body with a conditioned stimulus and reinforces it with an unconditioned one. After a number of repetitions, the response is associated with a new stimulus; the previously neutral unconditioned stimulus causes a conditioned response. The result of learning according to this scheme is respondent behavior - behavior caused by a certain stimulus. Supplying reinforcements to in this case associated with the stimulus (S), therefore this type learning, during which a connection is formed between stimuli, is designated as type S learning. An example of such a methodological approach is the method of classical systematic desensitization by Wolpe. One can name a number of other phenomena associated with the name of I.P. Pavlov and used in behavioral psychotherapy: generalization of stimuli, discrimination of stimuli (stimulus discrimination), extinction.
The second approach is methodologically based on Skinner’s operant paradigm (Skinner V.F.) and uses the “R->S” scheme and various types of reinforcement. Skinner, one of the most prominent representatives of behaviorism, showed that the influence of the environment determines human behavior; he considers culture, the content of which is expressed in a certain set of reinforcement complexes, as the main factor in the formation of human behavior. With their help, you can create and modify human behavior in the desired direction. Behavior modification methods, which are used not only in psychotherapeutic practice, but also in the practice of, for example, educational influences, are based on this understanding. The terms “instrumental learning” and “operant conditioning” mean that the body’s response, which is formed by trial and error, is a tool for receiving reward and involves operating with the environment; behavior is a function of its consequences. According to the principle of operant conditioning, behavior is controlled by its outcome and consequences. Behavior modification is carried out by influencing its results and consequences. In accordance with the operant conditioning scheme, the experimenter, observing behavior, records random occurrences of the desired response and immediately reinforces it. Thus, the stimulus follows the behavioral response, using direct reinforcement through reward and punishment. The result of such learning is operant conditioning, or operant. Here it is not the stimulus that is reinforced, but the body's reaction (R), it is this that causes the reinforcing stimulus, therefore such learning is referred to as type R learning. Operant behavior (type R behavior) is behavior caused by reinforcement following the behavior. An example of such a methodological approach is such methods of behavioral psychotherapy as the “token system”, as well as some types of training.
The third approach is methodologically based on the paradigm of learning by models, social learning and uses a variety of systems of directive psychotherapy, the goal of which is to change numerous psychological parameters, considered as intermediate variables. In general, this type of learning is based on the idea that a person learns new behavior not only on the basis of his own, direct experience (as in classical and operant conditioning), but also on the basis of the experience of others, based on observation of other people, through modeling processes . Therefore, this type of learning is also called modeling or learning from models. Model learning involves learning through observation and imitation of social behavior patterns. This direction is associated, first of all, with the name of the American psychologist Bandura A., a representative of the mediator approach. Model learning has the following effects: A) the observer sees new behavior that was not previously in his repertoire, b) the behavior of the model strengthens or weakens the corresponding behavior of the observer, V) the behavior of the model has a reproduction function, that is, it can be learned by the observer. Observing a model contributes to the development of new reactions in the observer, facilitates the implementation of previously acquired reactions, and also modifies existing behavior. Bandura identifies three main regulatory systems of individual functioning: 1) antecedent stimuli (in particular, behavior of others that is reinforced in a certain way), 2) feedback (mainly in the form of reinforcement of the consequences of behavior) and 3) cognitive processes (a person represents external influences and the response to them symbolically in the form of an “internal model of the external world”) that ensure control of stimulus and reinforcement. If we again turn to the basic formula of behaviorism S->r->s->R, (where r-s or r-s-r-s ... -r-s are considered as intermediate variables), then it is obvious that here the decisive role in the learning process does not belong to the reinforcement of the stimulus or response organism, but the impact on intermediate (mediator) variables. Learning in this case is aimed at changing deeper, closed psychological formations. Depending on which psychological processes are considered as mediators (mainly cognitive and motivational processes), psychotherapeutic targets are determined. Currently, cognitive approaches have become very popular and widespread, where cognitive processes are considered as intermediate variables that play an important role in the development of disorders. As an example of such approaches, one can cite the views of Beck (A. T. Beck) and Ellis (A. Ellis).
Thus, Beck believes that psychological problems, emotional reactions and clinical symptoms arise due to distortions of reality based on erroneous premises and generalizations, i.e. between stimulus - S (situation, external event) and reaction - R (maladaptive behavior, emotion , symptom) the cognitive component (conscious thought) acts as an intervening variable. In emotional disorders, the cause of lasting emotions is cognitive flow, which is not based on reality, but on subjective assessment. The result of this are hypotheses that are not subject to any critical testing and are perceived as axioms, forming incorrect ideas about the world and oneself - maladaptive cognitions or automatic thoughts that contain a greater distortion of reality than ordinary thinking and, as a rule, a person does not understand their content and their impact on the emotional state. Automatic thoughts perform a regulatory function, but since they themselves contain significant distortions of reality, they do not provide adequate regulation of behavior, which leads to maladjustment. The most typical distortions or errors of thinking include filtering, polarized assessments, excessive generalization, generalization, personalization, erroneous ideas about control, and a number of others. It is emphasized that automatic thoughts are individual character, but there are also disorder-specific automated thoughts. Thus, depression is associated with a pessimistic view of oneself and one’s future, of the world around us, with thoughts about damage, losses in personal sphere, anxiety - with thoughts about danger, threat, that others will reject, humiliate, underestimate, phobias - with thoughts about dangerous events that need to be avoided, about the impossibility of overall control over the situation, etc. Automatic thoughts are specific and discrete , they are a kind of shorthand and are presented in a person’s mind in a collapsed form. The goal of cognitive psychotherapy is to find and reveal distortions in thinking and correct them. A person can be trained to focus on introspection and determine how thought connects a situation, circumstances with an emotional response.
From Ellis's point of view, between stimulus and response there is also a cognitive component - a person's belief system. Alice distinguishes two types of cognition - descriptive, or descriptive (information that a person has perceived in the world around him - pure information about reality), and evaluative (attitude to this reality, expressed in its generalized assessment - evaluative information about reality). Descriptive cognitions are related to evaluative ones, but the connections between them can be of varying degrees of rigidity. Flexible connections between descriptive and evaluative cognitions form a rational system of attitudes (beliefs), while rigid connections form an irrational one. A normally functioning individual is characterized by a rational system of attitudes - a system of flexible emotional-cognitive connections, which is probabilistic in nature and rather expresses a wish or preference. A rational system of attitudes corresponds to a moderate intensity of emotions. Although sometimes they are intense, they do not capture him for a long time and therefore do not block his activities and do not interfere with the achievement of goals. Irrational attitudes are rigid connections between descriptive and evaluative cognitions that are absolutist in nature (such as prescriptions, requirements, mandatory orders that have no exceptions). Irrational attitudes do not correspond to reality both in strength and quality of this prescription. The inability to implement irrational attitudes causes long-term emotions that are not adequate to the situation, which interfere with the normal functioning of the individual. From Ellis's point of view, emotional disorders are caused precisely by disturbances in the cognitive sphere - irrational beliefs or irrational attitudes.
Thus, all existing methods of behavioral psychotherapy are directly related to certain psychological theories of learning and represent their practical application. The behavior of the psychotherapist in this case is also completely determined by the theoretical orientation: if the goals of psychotherapy are to teach, then the role and position of the psychotherapist should correspond to the role and position of a teacher or technical instructor who actively involves the patient in joint work. The main function of the psychotherapist is to organize an effective, scientifically based learning process.
Humanistic (experiential) direction. This direction in psychotherapy is very heterogeneous, which is reflected in the variety of terms that are used to designate it, and is associated with the traditional inclusion in this direction of a wide variety of psychotherapeutic schools and approaches, which are united by a common understanding of the purpose of psychotherapy and ways to achieve it. In all these approaches, personal integration, restoration of the integrity and unity of the human personality is considered as the main goal of psychotherapy, which can be achieved through experiencing, awareness, acceptance and integration of one’s own subjective experience and new experience gained during the psychotherapeutic process. Moreover, these approaches are not always clearly based on humanistic psychology itself. However, taking into account the established tradition and the still more or less visible connection of most approaches within this direction with humanistic psychology, it is advisable to use the name “humanistic direction”.
Humanistic psychology is based on the philosophy of European existentialism and the phenomenological approach. Existentialism brought into humanistic psychology an interest in the manifestations of human existence and the formation of man; phenomenology is a descriptive approach to man, without preliminary theoretical constructs, interest in subjective (personal) reality, in subjective experience, the experience of direct experience (“here and now”) as the main phenomenon in the study and understanding of man. One can also find some influence from Eastern philosophy, which strives for the union of soul and body in the unity of the human spiritual principle. The subject of humanistic psychology is personality as a unique integral system, which is simply impossible to understand by analyzing individual manifestations and components. It is the holistic approach to man as a unique personality that is one of the fundamental provisions of humanistic psychology. The main motives, driving forces and determinants of personal development are specifically human properties - the desire to develop and realize one’s potential, the desire for self-realization, self-expression, self-actualization, to achieve certain life goals, to reveal the meaning of one’s own existence. The personality is seen as constantly developing, striving towards its “full functioning”, not as something given in advance, but as an opportunity for self-actualization.
The basic principles of humanistic psychology are formulated as follows: recognition of the holistic nature of human nature, the role of conscious experience, free will, spontaneity and human creativity, and the ability to grow. The most important concepts of humanistic psychology are: self-actualization (a process, the essence of which is the most complete development, disclosure and realization of a person’s abilities and capabilities, the actualization of his personal potential), experience (the personal world of a person’s experiences, the totality of internal and external experience, what a person experiences and “lives”), the organism (as the concentration of all experience), self-concept (self-perception, a more or less conscious stable system of ideas of the individual about himself, including physical, emotional, cognitive, social and behavioral characteristics), congruence - incongruence (the degree of correspondence between the perceived “I” and the actual experience of experiences, between a person’s subjective reality and external reality, between the real I and the ideal I). An important condition For the successful implementation of the need for self-actualization, the presence of an adequate and holistic image of “I” is necessary, reflecting the true experiences and needs, properties and aspirations of a person and formed in the process of accepting and realizing the whole diversity of one’s own experience (“openness to experience”). However, a person is often faced with his own experiences and experiences that may be more or less at odds with his self-image. A person’s ability or inability to process new experience and integrate it is associated with the peculiarities of the formation of the self-concept in the process of education and socialization, in particular with the need for positive acceptance (attention). The lack of unconditional acceptance on the part of parents forms a distorted self-concept that does not correspond to what is in the person's experience. An unstable and inadequate self-image makes a person psychologically vulnerable to extremely wide range own manifestations, which are also not realized (distorted or denied), which aggravates the inadequacy of the self-concept and creates the ground for the growth of internal discomfort and anxiety, which can cause increased psychological vulnerability or various mental disorders, in particular neurotic disorders.
Thus, within the framework of this approach, in the most general form, neurotic disorders are considered as a result of blocking the specifically human need for self-actualization, the inability to reveal the meaning of one’s own existence, and a person’s alienation from himself and from the world.
Various approaches within the humanistic direction are united by the idea of personal integration, restoration of the integrity and unity of the human personality. This goal can be achieved through experiencing, awareness, acceptance and integration of existing experiences and new experiences gained during the psychotherapeutic process. But there are different ideas about how in the course of psychotherapy the experience and awareness of experience occurs, promoting personal integration. In accordance with this, in the “experimental” direction, three main approaches are sometimes distinguished.
The basis for classifying a particular school as one of the branches of the “experiential direction” is essentially ideas about the ways and means of integrating experience. The main concept in this context is “encounter” as a contact of different worlds: a meeting with other people, a meeting with oneself, a meeting with the Supreme. The theoretical basis of the first approach is humanistic psychology itself. The main goal of psychotherapy is to help a person develop himself as a self-actualizing personality, to reveal the meaning of his own existence, and to achieve authenticity. This occurs due to the development in the process of psychotherapy of an adequate image of the “I”, self-understanding and new values. Therefore, the goal of psychological intervention is to create conditions that help a person go through a new experience that promotes personal integration, acceptance and awareness of oneself in all its diversity, overcoming incongruity, increasing authenticity and spontaneity, releasing hidden creative potential and the ability for self-development. The need to create conditions within which a person receives the best opportunities for acquiring and processing experience and its integration also determines the specific features of the psychotherapist’s behavior. The psychotherapist of this direction consistently implements in the course of his work with the patient three main variables of the psychotherapeutic process: empathy, unconditional positive attitude towards the patient and his own congruence. Empathy is understood as the ability of a psychotherapist to take the patient’s place, to “feel” into his inner world, to understand his statements as he himself understands it. Unconditional acceptance involves treating the patient as a person of unconditional value, regardless of what behavior he demonstrates, how it can be assessed, regardless of what qualities he possesses, regardless of whether he is sick or healthy. The psychotherapist's own congruence or authenticity means the truth of the psychotherapist's behavior, behavior consistent with who he really is. These three dimensions, known in the literature as the Rogers Triad, are clearly related to the psychological concept and, in essence, represent “methodological techniques” that contribute to the study of the patient and the achievement of necessary changes. Humanistic psychology, under the influence of the phenomenological tradition, considers cognition of another person only as a process of direct appeal to his subjective experience. This determines the role of empathy as a method of knowing another person. It makes no sense to study various individual elements, but it is necessary to try to understand a person as a kind of integrity. Empathy as “feeling” into the patient’s inner world, immersion in his subjective world, subjective experience, is a necessary way (“method”) of knowing the patient. An unconditional positive attitude towards the patient on the part of the psychotherapist compensates for the lack of unconditional acceptance on the part of the parents (a factor that prevented the formation of a holistic, adequate image of the “I” and caused a mismatch between the self-concept and experience) and creates the prospect of developing an adequate image of the “I”. The therapist's authenticity or congruence shows the patient the benefits of openness, spontaneity, and sincerity, helping him to free himself from "facades." The patient perceives such a relationship with a psychotherapist as safe, the feeling of threat is reduced, defense gradually disappears, as a result of which the patient begins to talk openly about his feelings. The experience, previously distorted by the defense mechanism, is now perceived more accurately, the patient becomes more “open to experience”, which is assimilated and integrated by the “I”, which helps to increase the congruence between experience and the Self-concept. The patient's positive attitude toward himself and others increases, and he becomes more mature, responsible, and psychologically adjusted. As a result of these changes, the ability for self-actualization is restored and gains the opportunity for further development, and the personality begins to approach its “full functioning.” Thus, within the framework of the humanistic approach itself, experiencing, awareness and integration of experience that contribute to personal development occur through interpersonal relationships, in the process of interaction (meeting) with a psychotherapist (or psychotherapeutic group).
Within the second approach, the integration of experience occurs through interaction (meeting) with oneself, with various aspects of one’s personality and one’s current state. It uses both verbal and numerous non-verbal methods, using concentration and awareness of various aspects ("parts") of one's personality, emotions, bodily stimuli and sensory responses. There is also an emphasis on movement techniques that promote the release of suppressed feelings and their further awareness and acceptance.
Within the framework of the third approach, the integration of experience occurs through communion (meeting) with the Highest spiritual principle. The focus here is the affirmation of the “I” as a transcendental or transpersonal experience, the expansion of human experience to the cosmic level, which ultimately, according to representatives of this approach, leads to the unification of man with the Universe (Cosmos). This is achieved through meditation (for example, transcendental meditation) or spiritual synthesis, which can be carried out through various techniques of self-discipline, will training and the practice of de-identification.
Thus, the experiential approach combines ideas about the goals of psychotherapy as personal integration, restoration of integrity and unity of the human personality, which is achieved through experiencing, awareness, acceptance and integration of experience. Here, the behavior of the psychotherapist and the techniques used are also completely determined by theoretical ideas about normality and pathology and the corresponding goals of psychotherapy.
To confirm the idea of continuity between the personal concept, the concept of pathology and the actual practice of psychotherapeutic work as a condition for the development and dissemination of a particular psychotherapeutic system, one can turn to another system of person-oriented (reconstructive) psychotherapy (see PERSONAL-ORIENTED (RECONSTRUCTIVE) PSYCHOTHERAPY KARVASARSKY, ISURINA, TASHLYKOV), which is essentially a type of psychodynamic direction. It is based on the psychology of relationships (the concept of personality) and the pathogenetic concept of neuroses (the biopsychosocial concept of neurotic disorders). Within the framework of this approach, personality is considered as a system of relationships between an individual and environment.
The central place in this definition is occupied by the concept of “attitude”, which is understood as an internal subjective attitude. Neurosis is a psychogenic disorder that occurs as a result of a violation of relationships that are particularly significant for the individual. Relationship disorders can be generally characterized as a distortion of the cognitive component due to its unconsciousness or insufficient degree of awareness and an excessive predominance of the emotional component, which leads to the inadequacy of the relationship and its inability to provide optimal regulation of personality functioning. Understanding neurosis as a psychogenic disease, i.e. a disease in the etiopathogenesis of which there is a psychologically understandable connection between the occurrence of disorders, the clinical picture and its dynamics, on the one hand, and the characteristics of the system of relationships, personal characteristics, as well as the nature and dynamics of the psychotraumatic pathogenic situation, on the other hand, it determines the orientation of psychotherapeutic influences on the correction of the personality and the reconstruction of its disturbed relationships.
Within the framework of the 3 main areas of psychotherapy, there is a variety of schools, but the main theoretical approaches in each of them are common. Only an understanding of general approaches, the presence of clear ideas about the theoretical basis, the psychological concept of norm and pathology, on the basis of which psychotherapeutic intervention is carried out, can ensure effective psychotherapeutic practice and help in mastering basic methods and skills practical work. Continuity between personal concepts, the concept of pathology and the actual practice of psychotherapeutic work is an indispensable condition for theoretically based psychotherapeutic approaches.

Psychotherapeutic encyclopedia. - St. Petersburg: Peter. B. D. Karvasarsky. 2000 .

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Personality of the psychotherapist

The problem of the personality of a psychotherapist can be approached from two positions: to describe the requirements for such a specialist or to analyze the personal qualities of 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, or create the effect of an all-powerful sage. He is always authentic and sincere, real and frank, because these are the qualities 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.

Speech skills play an important role in professional activity. 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, a psychotherapist must be a harmonious person. 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 a 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 personal development groups, gradually gaining experience.

So, an exemplary psychotherapist is a calm, balanced middle-aged (or older) specialist who has thorough professional training and adheres to 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.

Basics of psychotherapy. Theoretical foundations of psychotherapy

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