The concept of psychotherapy. Communication of psychotherapy with psychological correction and psychological counseling. Types and main directions of psychotherapy. The main types of psychotherapy

The term "psychotherapy" covers a wide range of approaches and methods. They range from one-on-one conversations to therapy sessions that use techniques such as role play or dance to help explore human emotions. Some therapists work with couples, families, or groups whose members have similar problems. Psychotherapy works with teenagers, children as well as adults. Below is a list of different types of psychotherapy and their benefits.

Art therapy combines therapy and creativity through paint, crayons, pencils, and sometimes modeling. Methods may also include theatrical production, puppet theater. Working with sand, for example, clients select toys depicting people, animals, and buildings and place them in a controlled sandbox theater space. The art therapist is trained in the psychological understanding of the creative process and the emotional attributes of various art materials. In this case, art is seen as an outward expression of our inner emotions. For example, in painting, size, shape, lines, space, texture, hue, tone, color, and distance all bring out the perceived reality of the client.

Art therapy can be especially effective for clients who have difficulty verbally expressing themselves. In institutions such as art studios and workshops, a focus on creative development can be helpful, especially when working with children and teenagers, as well as adults, couples, families, and groups.

Art therapy can be beneficial for both people who have experienced trauma and people with learning difficulties.

Behavioral therapy is based on the theory that current behavior is a response to past experience and can be learned or reformulated.

People with compulsive and obsessive disorder, fears, phobias and addictions can benefit from this type of therapy. The emphasis is on helping the client achieve goals and changing behavioral responses to problems such as stress or anxiety.

Brief therapy uses a variety of psychotherapy approaches. It differs from other therapeutic approaches in that it focuses on a specific problem and involves the direct intervention of a therapist who works more actively with the client. She emphasizes the use natural resources client, and also temporarily suspends disbelief, allowing new perspectives and multiple points of view to be considered.

The main goal is to help the client see their current circumstances in a larger context. Short-term therapy is seen as a solution to current factors that impede change, and not as a search for the causes of issues. There is no single method, but there are many ways that, singly or in combination, can ultimately be helpful. Short-term therapy, as a rule, takes place in a predetermined number of sessions.

Cognitive Analytical Therapy combines theories that explore the relationship between linguistics and thought, as well as the historical, cultural and social factors that influence how we function. Cognitive Analysis Therapy encourages clients to use their own resources and develop skills to change destructive behavior patterns and negative ways of thinking and acting.

The therapy is short, structured and directive, for example, the client may be asked to keep a diary or use progress charts. The therapist works in collaboration with the client, changing behavior patterns and learning alternative coping strategies. Attention is paid to understanding the relationship between childhood behaviors, social contributions and their impact on the client in adulthood.

Drama therapy uses theatrical techniques such as role playing, theatrical play, pantomime, puppetry, voiceovers, myths, rituals, storytelling, and other improvisational techniques to facilitate creativity, imagination, exploration, understanding, and personal growth. The extremely versatile approach provides an expressive form of therapy that can be used in a wide variety of settings, including hospitals, schools, and mental health centers.

Drama therapy provides an opportunity for individuals or groups exploring personal and/or social issues in a creative environment, and calmly reflect on established beliefs, attitudes, and feelings, find alternative ways actions in the world. Drama therapy encourages self-awareness, reflection and self-expression of feelings towards oneself and towards others.

Existential psychotherapy helps the client find the meaning of life and the desire to face himself and his problems. The existential belief that life has no ready answer or predetermined significance and the individual is completely free and fully responsible so that meaning must be found or created. This can cause a sense of meaninglessness in life, so therapy explores the client's experience, the person's condition, and aims to clarify understanding of individual values ​​and beliefs by clearly naming things that were not previously said aloud. The client accepts the limitations and contradictions of what it means to be human.

Family therapy is a branch of psychotherapy with a particular focus on family relationships. She works with the fact that the problem lies within the family, and not in one person. family therapy also called systemic family therapy.

Family therapy promotes change and development, and as a result, the resolution of family conflicts and problems. The emphasis is on how family members interact with each other, emphasizing the importance of family functioning for mental health and well-being. Regardless of the origin of any given issue or problem, the goal of the therapist is to involve the family in finding beneficial and constructive solutions for family members to support each other through direct participation. An experienced family therapist will be able to influence negotiations in a way that uses the strength and wisdom of the family as a whole, considering the broader economic, social, cultural, political and religious environment in which the family lives, and respecting each family member and their different views, beliefs, opinions.

Gestalt means the whole and the totality of all parts, and the symbolic configuration or form of the elements that make up the whole.

Gestalt therapy is a psychotherapeutic approach based on the belief that people have a natural desire for health, but old patterns and fixed ideas can create blocks.

Gestalt therapy proceeds from what is happening in the moment, bringing awareness to the individual's self-image, their reactions and interactions with other people. Being present in the here and now creates the potential in the client for more admiration, energy and courage to live immediately. The Gestalt therapist looks at how the individual resists contact in the here and now, how the person resists change, and at the behaviors or symptoms that the client sees as inappropriate or unsatisfactory. The Gestalt therapist helps the client come to an awareness not only of what is happening and what is being said, but also of body language and repressed feelings.

Group psychotherapy is a psychotherapy designed to help people who would like to improve their ability to cope with the difficulties and problems of life with the help of a group.

In group therapy, one or more therapists work with a small group of clients. Psychologists recognize a positive therapeutic effect that could not be obtained in individual therapy. For example - interpersonal problems are solved in groups.

The goal of group psychotherapy is to emotional support difficult decisions and stimulating the personal development of group members. The combination of past experiences and experiences outside the therapeutic group, the interaction between group members and the therapist, becomes the material through which therapy is carried out. These interactions may not only be perceived as positive, as the issues that the client faces in daily life are inevitably reflected in the interaction with the group. This provides an opportunity to work through problems in a therapeutic setting, producing an experience that can then be translated into "real life".

Hypnotherapy uses hypnosis to induce a deep state of relaxation and alteration of consciousness during which the subconscious mind is receptive to new or alternative points of view and ideas.

In the field of hypnotherapy, the subconscious mind is seen as a source of well-being and creativity. Addressing this part of the mind through hypnosis opens up possibilities for maintaining a healthy body.

Hypnotherapy can be used to change behavior, relationships, and emotions, as well as manage pain, anxiety, stress, and dysfunctional habits to promote personal development.

Jungian analysis is a psychotherapy that works with the unconscious. The Jungian analyst and client work together to expand consciousness to achieve psychological balance, harmony, and wholeness. Jungian analysis explores deep motives in the client's psyche, thoughts and actions that lie in the subconscious. The Jungian analyst seeks to achieve a profound change in the personality. Special attention is paid to what happens in the sessions, as well as the internal and external experience of the client's life. Psychotherapy aims to harmonize conscious and unconscious thoughts to eliminate psychological pain and suffering and create new values ​​and goals.

Neuro-Linguistic Psychotherapy was created from Neuro-Linguistic Programming. NLP is broad based and draws on many branches of psychology and psychotherapy. The foundation of NLP is the premise that we create our own model of reality (personalized map of the world) based on our experiences and how we imagine them from the inside. Each person uses their own maps to navigate through life. The models that are used can promote change that enhances fulfillment and success, or at times can be restrictive and prohibitive.

NLP explores the thought patterns, beliefs, values, and experiences behind problems or goals. It allows people to make appropriate adjustments to transform an appropriate worldview, which helps reduce limiting beliefs and decisions, overcome emotional and behavioral patterns, and create resources by expanding the person's existing skill base. This gives the individual a sense of control and therefore a greater ability to create life at will.

NLP psychotherapists work with a wide range of psychological problems.

Transactional analysis is an integrative approach in psychology and psychotherapy and relies on two concepts: First, we have three parts or “ego-states” of a person: a child, an adult and a parent. Secondly, these parts communicate with each other in "transactions" and, within each social interaction, one part dominates. Therefore, by recognizing these roles, the client will be able to regulate his behavior. This form of therapy works with the term "inner child" to describe unmet needs from childhood.

Therapy is based on acceptance and open-mindedness with the counselor, the assumption that the individual seeks support in resolving the problem and that this allows the client to freely express their emotions and feelings. This therapy is also called person-centered therapy or Rogers psychotherapy.

Counseling for clients who would like to address specific psychological habits and thought patterns. The client perceives the consultant as the best authority in his own experience and is therefore able to reach his potential for growth and problem solving. The client-centered counselor provides an enabling environment to allow this potential to arise through unconditional acceptance, positive attitude, and empathic understanding so that the client can come to terms with negative feelings and develop the inner resources, strength, and freedom to bring about change.

Let's try to informally describe the different types of psychotherapy, literally a little of each. This is sometimes necessary for those who want to choose and try one thing, while there are a lot of offers around, and they are all different. Art or psychodrama? Analysis or Jungian analysis? To help beginners - brief descriptions for a more comfortable acquaintance with different approaches.

Art therapy: you will cut, draw, create collages and paintings, play “with sand” (in a special mini-sandbox), etc. In any case, you will express yourself, those processes and interactions that are relevant to you. And to express almost directly from your unconscious. A type of psychotherapy for those who are ready to experiment and do not hesitate to draw in the stick-stick-cucumber style. Indeed, in the end, it is not the artistic value or integrity of the image that is important, but self-expression, with the results of which you can work.

Body-oriented approach: study the clamps, pay attention to how sensitively the body reacts to various processes (from irritation to tenderness), improve your health. The body “remembers” stresses, “remembers” insults inflicted even in the distant 5 years, and carries them with it. By at least your back will be straight, straighten your posture, learn to breathe deeper

Psychodrama: if you dreamed of playing on stage, if situations are important to you, and in your life some of them have not yet been played to their logical conclusion, try psychodrama. You will be offered to be your Disease, your Long-Dead Grandmother - what would she say to you, for example? A lot of discoveries and unexpected clues.

Psychoanalysis: initially, of course, it was a couch for the client and client free associations, in which the analyst did not interfere. Now it's progressive and nothing less effective method, able to work very hard and deeply on the changes you need. Do you want to become a choleric from a phlegmatic person or even learn how to choose a different style of communication, become very different compared to the current state? You are in such a type of psychotherapy as psychoanalysis, however, a long one - a “short” analysis is considered a year and a half, an “average” in time is seven years of work.

Gestalt therapy: communication, contact, “heard-didn’t hear”, you can-you can’t accept from the environment, ask for something for yourself. How the client breaks contact, how he refuses and even shirks dialogue, how he defends himself (which are characteristic of him). Pretty free face-to-face communication with a psychotherapist, open to new and mobile form of psychotherapy.

Jungian analysis: "shadow", fairy tales, stories, dreams - everything that has a plot and idea can fit in working with a Jungian therapist. As a rule, therapists have a particularly deep cultural knowledge, they are well aware of not only fairy tales, but also myths. “Oedipus Complex” or “Electra Complex” - this is here :)

Behavioral approach, cognitive therapy: cognitive behaviorists (“psychotherapy of behavior and cognition”, roughly speaking) argue that the head is a dark organ, and nothing is visible in it (just kidding). That is, it is not so important how exactly it is processed inside - it is important that this is included - this is the output. In many ways, a purely logical, mental approach. The only one paid for by insurance in European countries. They say it works great, does not scare clients with unknown things, but the effect often disappears after the work with a specialist is over. It touches on problems only superficially (and this is a minus), but it does not create unnecessary concepts and “bells and whistles” (“it happened to you because at the age of five you noticed that your uncle was looking at you askance, and at that moment a bird flew by” - completely excluded).

Systemic family constellations (systemic approach): consider systems as self-organizing, self-supporting integral formations. If the alcoholic or drug addict husband stops drinking or using in the clinic, and the wife does not change in response, either they will disperse, or he will start drinking again so as not to destroy the system. If parents cannot afford not to go to work, but really want to, children are likely to become seriously ill. If the mother loves her daughter very much and does not let go of herself, there is no need for the daughter to get married (destroy this couple, no matter how “crooked” it may be). A strong approach, often discoveries about oneself and one's system are very hard to perceive. After going to the “constellation” - even as a participant (for whom the constellation is done), even as a deputy (who participates as a “brother”, “boss” or “grandmother” of the main character of the constellation), it is very desirable to visit any other psychotherapist to assimilate personal experience.

Psychotherapy is one of the types of psychological assistance and psychological impact on the patient in order to relieve psychopathological (primarily neurotic and psychosomatic) symptoms. Psychotherapy belongs to the field of medical activity, because: a) it combines psychological and general medical knowledge in relation to indications and contraindications; b) imposes liability (including criminal liability) on the psychotherapist for improper or inappropriate (unqualified) use of methods and methods of psychotherapy.

Traditionally, there are three approaches to psychotherapy: psychodynamic, behavioral (behavioral) and phenomenological.

The goal of psychotherapy in the narrow sense of the term is to heal the patient from psychopathological symptoms within the framework of neurotic, characterological (personal) or psychosomatic disorders. The choice of a specific psychotherapeutic technique depends on a number of objective and subjective factors. Among the objective stands out:

* the nature of the psychopathological symptom (syndrome)

* etiopathogenesis of mental disorders

* individual psychological characteristics of the patient

Among the subjective parameters, importance is attached to: a) the individual psychological characteristics of the psychotherapist; b) the breadth of his psychotherapeutic knowledge and skills; c) situational moments (availability of time and appropriate place for a psychotherapeutic session).

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

There are at least 450 types of psychotherapy known, more than half of which are used in work with children and adolescents. A single systematization of such a wide and expanding list is practically unrealistic, and varies significantly from author to author. But, one way or another, most types of psychotherapy are correlated with three main areas:

• Cognitive-behavioral. The behavioral direction considers a person as a complex machine that responds with reactions to the influences of the external environment, refracting them through the prism of internal variables (mental maps, goals and needs). By working with ways of understanding and reinforcing correct behavior, psychotherapy occurs. This is behaviorism and the cognitive-behavioral approach.

• Psychodynamic. The psychodynamic direction proceeds from the fact that all the inner life that happens in us is a manifestation of the dynamics of internal impulses in their collision with ideas about reality, the play of the individual or collective unconscious, the manifestation of our inner nature, both realizing our instincts and pushing us to develop and self-actualization. Accordingly, this is psychoanalysis, Jungianism and a humanistic approach.

• Humanitarian. The humanitarian direction is united by faith in the inner freedom of a person, faith in the ability of a person to form his own relationships, meanings and life values, to be true to himself. First of all, it is an existential and spiritual approach.

Types of psychotherapy:

Individual psychotherapy - when it is carried out, the psychotherapist acts as the main instrument of therapeutic influence, and the psychotherapeutic process takes place in the system of relations "doctor-patient". Unlike individual, there are such types of psychotherapy as group (where the psychotherapeutic group acts as an instrument of therapeutic influence), collective and family. Individual psychotherapy is used in almost all areas of psychotherapy.

Family Psychotherapy - one of the youngest psychotherapeutic schools developing in recent times. This approach arose after the Second World War and developed in close cooperation with ... cybernetics, and this is its significant difference from other psychotherapeutic approaches. In this approach, a person is not an object of influence and a client. The client is the whole family, the whole family system, and it is she who, with this approach, becomes the object of psychotherapeutic influence.

Group psychotherapy - a form of psychotherapy in which a specially created group of people meets regularly and under the guidance of a psychotherapist to achieve such goals as resolving internal conflicts, relieving tension, correcting deviations in behavior, etc.

Psychodynamic psychotherapy - a type of treatment focused on the methodology of psychoanalysis and studying the impact of a person's past experience on certain forms of his behavior, which have acquired a permanent form. The psychodynamic direction proceeds from the fact that everything in us is a manifestation of the dynamics of internal impulses in their collision with ideas about reality, the play of the individual or collective unconscious, a manifestation of our inner nature, both realizing our instincts and pushing us to development and self-actualization.

Therapy of psychosomatic disorders - psychosomatic diseases - group painful conditions resulting from the interaction of mental and physiological factors.

Cognitive Behavioral Psychotherapy - one of the directions of modern psychotherapy, developed by Dr. Aaron Beck and based on the position of the determining role of cognitive processes (and first of all - thinking) in the emergence various kinds psychological problems and mental disorders (for example, depression). The system initially arose in confrontation with psychoanalytic trends in psychotherapy, but now there are clear trends towards their convergence.

Rational psychotherapy - rational psychotherapy - a method and techniques of psychotherapy that use logical persuasion as the main means of influencing the patient's world of ideas.

existential psychotherapy - existential psychotherapy grew out of ideas existential philosophy and psychology, focused not on the study of the manifestations of the human psyche, but on his very life in inextricable connection with the world and other people.

Holotropic Breathwork - holotropic breathing was developed in the 70s by Stanislav Grof, an American psychiatrist born in Czechoslovakia, and his wife Kristina as a legal alternative to psychedelic therapy (LSD psychotherapy) popular in the middle of the last century. Holotropic breathing is the only breathing technique for which a serious psychological theoretical base has been developed.

It is a postmodern practice, an alternative to academic psychology. Since therapists rarely find useful information in research, they are forced to develop their own body of knowledge. They do this not on the basis of the skills that are used in academic psychology, but on observations of the environment, using their own schemes to construct a system of knowledge that can be applied in practice.

Psychotherapy as a theoretical and applied direction of psychology

Psychotherapy has the following definitions:

• direction of practical psychology, based on a system of objective (scientific) knowledge about the possibility of psychological influence on the child and his adult environment;
• a system of active measures and influences aimed at correcting (changing) deviations (disorders, defects, disorders) in the mental development of a person, preserving its individuality, correcting the behavior of a child and adult members of his environment;
• a method of working with patients (clients) in order to provide them with assistance on the modification, change, weakening of the factors that interfere with their normal life.

The subject, purpose and objectives of psychotherapy

The subject of consulting activity of a specialist is determined by the symptoms and causes of deviations in the development and behavior of the client, therefore psychotherapy is focused on:

• human development (psychomotor, emotional, cognitive, personal, competence, communicative, etc.);
• behavioral reactions, actions, acts, manifestations;
• strengthening of arbitrary regulation;
• improving indicators of adaptation to an educational institution (including readiness for school, lyceum or college);
• stabilization of personal emotional state;
• structuring of thinking;
• memory activation;
• broadcasting development;
• regulation of psychomotor functions, etc.

The overall goal of psychotherapy is the return of the individual to inner well-being. The most important task that psychotherapy implies is to help people who are faced with their own inability to achieve goals and who experience frustration, deprivation, discouragement and anxiety in connection with this, draw up their own assets and liabilities and teach them how to use their abilities effectively, namely:

• recognize your own potential;
• use him;
• remove obstacles to its implementation (in particular, discard what prevents you from living with a sense of pleasure, joy and happiness).

The tasks of psychotherapy can be presented in the form of a list:

• information about certain psychological phenomena and features of the psyche and behavior;
• teaching (training) new actions, ways of making decisions, expressing feelings, etc. (these are programs aimed at activating life skills, communication skills in the field of human relations, solving problems, providing support in choosing a healthy lifestyle);
• development of the activity component of the personality: its skills, abilities and abilities;
• assistance in the formation of age-related psychological neoplasms (assistance in the formation of identity and in personal development);
• correction of emotions and behavior;
• optimization of the social situation of development;
• elimination (reduction) of anxiety, overcoming depression, stress and their consequences.

The history of the formation of psychotherapy

In ancient times, the first psychotherapists were shamans, magicians and sorcerers. Ceremonies, rituals, dances, divination, etc. helped people whose ailments were not so much physical as emotional. In the Middle Ages, the belief prevailed that mental illness was caused by evil demons and diabolical forces that took possession of a person. The birth of psychological science is marked by the emergence of researchers' interest in the laws of the functioning of the psyche, and subsequently by the emergence of ideas about emotions as the cause of mental disorders. At first, scientists were interested in:

• how a common person cognizes the world around;
• how a person plans his actions;
• how it actually works.

Subsequently, psychology came to the conclusion about the existence of individual differences (they are the subject of differential psychology and psychodiagnostics). Further, with the advent of the doctrine of emotions as the cause of mental disorders, the focus of attention shifted towards the uniqueness and unpredictability of a person who are not subject to typification. Then the scope of research shifted from individual differences to differences in the way people conduct discussion and dialogue. The next step is the inclusion in the context of the analysis of the social environment in which a person lives, as well as the society of which he is a member (the subject of social psychology).

Individual therapy arose simultaneously with the notion of a dyadic relationship between doctor and patient (“therapeutic alliance”). Counseling psychology emerged in the middle of the 20th century. At the first stages of its formation, there was a natural interest in the reality that the patient faces and which gives rise to problems and troubles that force him to see a doctor. Organizational psychology, family psychotherapy, etc., originated from here. Focusing on the dyad "consultant - client" set the task of developing norms and rules for their interaction.

Interdisciplinary connections of psychotherapy

Directions of psychotherapy (including counseling) are based on the following branches of psychological science:

• general, age, children;
• social, clinical and differential;
• personality psychology;
• psychodiagnostics (in particular, testology);
• counseling psychology.

According to traditional ideas about the psychological impact on a child in the context of successful ontogeny, we can say that psychotherapy is a set of the means and methods themselves, designed to create optimal opportunities and conditions for the full and timely development of the growing individual. In this context, the activities of a specialist are represented by: psychocorrection, psychoprophylaxis, psychohygiene (preservation and strengthening of neuropsychic health), psychorehabilitation.

Counseling psychology as a theoretical and methodological background and direction of psychotherapy

Theoretical and methodological psychotherapy is a consultative psychology, that is, a branch of systemic scientific and applied knowledge. As for providing assistance in the form of a conversation, it usually turns out to be:

• persons of different ages, including children;
• parents and teachers on development, training and education.

Psychological counseling is most often understood as mental help. healthy people, which is aimed at helping them cope with various internal and interpersonal difficulties that arise in the process of organized interaction. How kind medical practice this is a system of communicative interaction between a doctor and persons who turn to a specialist (at the request of the administration of the institution, parents, teachers), and the process may be limited to advisory assistance. Such counseling does not have a single understanding of its essence. It is divided into two groups. It:

• counseling as influence (directive psychotherapy);
• counseling as interaction (non-directive psychotherapy).

Psychological counseling, psychotherapy include: the activity of the client, the activity of the consultant and the result of this process - psychological neoplasms activated (formed) in the person who applied for help. It considers five main groups of questions:

• about the essence of the process that occurs between the client (a person who is in a difficult situation and needs specialized help) and the therapist (the person who provides this help);
• about personality traits, attitudes, knowledge, skills of a doctor;
• about the reserves, which are the internal forces of the client, provided that they can be activated;
• about the peculiarities of the situation that has developed in the life of the client and led him to the psychotherapist;
• about the methods and techniques that the consultant will use to provide assistance to the client.

Basic models of psychotherapy

In modern psychotherapy, there are two approaches to the essence of the therapeutic process - biomedical and psychological. There are also two basic models of psychotherapeutic influence - medical and psychological.

The biomedical model focuses on the somatic features of the client. It is assumed that only a specially trained psychiatrist or psychotherapist has the right to use it. This condition must be followed strictly. Here is what psychological psychotherapy includes:

• customer centered;
• "coexistence" (when the main thing is not the general activity interaction of the therapist and the client in the consultative process, but the exchange of thoughts and emotions);
• “internal comprehension” (when the client moves in his personal space along a trajectory that he himself determines);
• "unconditional acceptance" (the doctor and the patient enter into a special relationship of intimacy based on empathy, love, respect).

Particular importance is attached to the methodology of practical work. Methods of psychotherapy (in particular, those that are used according to the methodology of psychoanalysis), knowledge (theory) become the main guidelines for the consultative process. Most often, the doctor can tell everything about the patient: about the characteristics of his relationships in childhood, the processes of overcoming and protecting him, his trauma, etc., but he cannot convey his “vital spirit”.

Theory-oriented behavioral psychotherapy becomes the best means to achieve the goal within the framework of the behavioral model. On the other hand, this knowledge about the client does not guarantee that internal changes will take place in him, do not promise an "awakening" of his internal processes. This is possible only in the case of something important, something that is not subject to conceptualization, which is almost impossible to learn, but without which depth behavioral therapy cannot take place.

Psychological models

Within the psychological model, in turn, there are:

1. Socio-psychological model. This is the approach that is based on social impact, in which the development of social forms of behavior is possible.
2. A person-oriented model (client-centered), which provides for a special interpersonal interaction between the therapist and the client. The physician uses psychological theories and special communication techniques to solve personal problems of the client.

Directions of psychotherapy

In consultative practice, it is understood that illnesses, conflicts, stresses, problems are a reality of every person's life, and this must be accepted and recognized. Positive psychotherapy is the direction of maintaining and restoring the mental health of citizens. Its main purpose is to take care of the social, physical, spiritual health of a person, family and social group. In this regard, you need to understand that people are endowed with abilities, thanks to which they can find ways out of the most difficult problems and situations. Positive psychotherapy emphasizes a holistic vision of a person's life and an optimistic perception of its nature. The human being is a unity of body, mind, spirit and emotions. A doctor who works in this field will not seek to "diagnose", but will try to understand the patient in his life problems, due to which he developed diseases or disorders.

Cognitive psychotherapy is a direction that involves improving a person's understanding of the world around him and himself. The fact is that depression, for example, sometimes makes you perceive reality biased. According to practitioners, cognitive psychotherapy allows the client to remove negative thoughts and always think positively. Therefore, sadness disappears. In the classroom, the doctor reveals negative thoughts and helps to assess the real state of affairs. He will be the leader of the training on mastering new ways of understanding the world, and will also help to consolidate the ability to evaluate this or that event in a new way.

Group psychotherapy involves conducting classes in a team, where each member has a certain deviation. For example, this direction is used in the elimination of harmful addictions (tobacco, alcohol). At the same time, efficiency increases, since, being together, patients increase the influence on each other of the desire for treatment. Thus, group psychotherapy assumes that the group becomes not only an object of influence on the part of the therapist, but also itself affects each of its members.

Family psychotherapy uses a set of techniques that are focused not only on problematic family situations, but also aim to analyze the past of clients, reconstruct some events and the structure of relationships, etc. The current direction in development is the development of methodological foundations, relying on which will help to avoid accidents, fragmentation and intuition.

Clinical psychotherapy is a discipline whose goal is to eliminate various disorders and disorders, somatic diseases. This direction studies the mental and moral aspects of health: individual differences, the influence of environmental factors on the patient's condition and the course of treatment, mental characteristics of experiences. Theoretical basis this technique of psychotherapy: the biopsychosocial concept of pathology; research methods of medical psychology; the concept of the continuum "disease - health".

Features of bioenergy

In the last century body psychotherapy replenished with a new method of influence, which was called bioenergetics. One of the famous Dr. Reich's students, Alexander Lowen, developed this approach. Using a slightly different conceptual apparatus, for example, "bioenergy" instead of the concept of "organ", the doctor to a certain extent leveled the resistance of other therapeutic areas. His system has become more widespread in the United States than the analogous teaching of Reich. At the same time, he included in his concept the theory of breathing developed by the teacher, and part of his techniques aimed at achieving emotional relaxation through the use of blows, screams, tears.

Body-Oriented Psychotherapy, developed by Lowen, focuses on the concept of bioenergy. It unites the body and psyche in a functional way. Second important definition, on which body-oriented psychotherapy is based, is "muscle armor". It interferes with the spontaneous flow of energy through the human body, so there is a set of exercises to help get rid of it.

Basic methods of psychotherapy

The average patient, who has never encountered the work of psychotherapists, has a very vague understanding of what is happening in the session. There are many methods of psychotherapy. Let's learn about the main ones.

1. Art therapy. Today it is a very popular method. Art therapy is suitable for establishing psychological connection patient and psychotherapist. This method is very effective for almost any deviation. Especially often it is used when working with babies. With the help of art therapy, the patient reveals all his hidden problems to the therapist. The technique uses various techniques, such as dynamic synthetic drawing, metaphorical drawing, symbolic destruction of obsessions, and many others.
2. Autotraining. The beginning of the application of this method can be attributed to the 30s of the last century, but the basics are borrowed from ancient oriental developments. It is used in the treatment of adults only.
3. Suggestion. This method can be called the basis of treatment. Practically not a single case in psychotherapeutic practice is complete without suggestion. When applying suggestion, the consultant must take into account the various individual characteristics of the patient. For children, there is a special method called fixation.
4. Self-hypnosis. This method is related to many religious rites and meditation techniques. Before the patient begins to practice self-hypnosis, the therapist works with him, using the technique of suggestion.
5. Hypnosis. This method of psychotherapy causes the most controversy, but it is very effective. Used since the middle of the 20th century. In psychotherapy, there is a difference between hypnotherapy and hypnosis. There are also classical and Ericksonian methods. Hypnotherapy has enough wide list contraindications.
6. Game psychotherapy. play therapy more often used to treat babies. In this case, the following games are used: sociocultural, biological, interpersonal.
7. Rational psychotherapy. This is a technique in which the consultant convinces the client of something, applying logical explanations, citing facts. Rational psychotherapy is sometimes used instead of suggestive methods. The effectiveness of this technique depends directly on the charisma of the doctor. Rational psychotherapy is more often used in the treatment of adult patients.
8. Talk therapy. During the session, the patient speaks aloud about those problems that cause him the strongest feelings. During the pronunciation there is talk rethinking what's going on.
9. Desensitization. This method of psychotherapy is based on the fact that learned manipulations are replaced by others. To begin with, the client masters the technique of relaxation. He then conjures up an image in his mind that frightens him. After that, also in thoughts, a picture of calmness is presented. This goes on for about 30 minutes. Patients from 10 years of age can be treated with desensitization.

Psychotherapy is an effective method of curing many diseases, including somatic ones. It also relieves personal and social problems. However, a person who seeks help from a specialist must understand that miraculous healing he won't get. Psychotherapy is not a magic pill. In order to achieve the desired result, you need to work on yourself.

Definition of psychotherapy.

There is no single definition of psychotherapy that would be accepted by all psychotherapeutic schools and therapists. Differences in definitions are associated with theoretical attitudes, ways of interpreting the process of psychotherapy and tasks solved in the course of its implementation. In its most general form, psychotherapy can be understood as a psychological intervention aimed at helping to resolve emotional, behavioral and interpersonal problems and improve the quality of life.

The separation of psychotherapy as an independent field occurred about a century and a half ago within the framework of psychiatry as a branch of medicine based on the Pasteur paradigm, which assumed the pathognomonic unity of etiopathogenesis, symptoms, course and outcome of diseases, the specifics of treatment and prevention. This stimulated the development of psychotherapeutic methods with syndromic/nosologically oriented indications and contraindications.

The works of 3. Freud and G. Selye led to the understanding that the majority of painful manifestations are non-specific defensive reactions to a pathogenic factor, and stimulated the formation of a new paradigm of psychiatry (Yu. L. Nuller, 1992-1995). Within this paradigm, the orientation of psychotherapy also changed. The established models of psychotherapy are comparable both medical and psychological (see Table 1). Currently, there is an intensive process of developing a holistic (holistic) paradigm of psychotherapy, in which these models are not an alternative, but the poles of the psychotherapeutic space.

Approaches.

There are at least 450 types of psychotherapy known, more than half of which are used in work with children and adolescents. A single systematization of such a wide and expanding list is practically unrealistic, and the classification of psychotherapy types varies significantly from author to author. But one way or another, most types of psychotherapy are correlated with the main approaches.

psychodynamic approach.

It originates from the principles and methods of psychoanalysis, based on a dynamic understanding of mental phenomena "... as manifestations of the struggle of mental forces, as expressions of purposeful tendencies that work in accordance with each other or against each other" (3 Freud, 1915). The goal of psychotherapy is to understand and resolve internal emotional conflicts that arose in the earliest relationships, determine the subjective meaning of subsequent experience and are reproduced in later life.

The therapeutic relationship is used to bring out, explain and change these subjective meanings. The "therapist-patient" relationship is considered as a reflection of subjective meanings and emotional conflicts that go back to early experience. In the course of the therapeutic relationship, the patient unconsciously transfers to the therapist the meanings and feelings formed in early experience, which thus become available to awareness. In turn, the therapist may also unconsciously transfer his subjective meanings and feelings onto the patient. Awareness of the system of transferences and countertransferences, of emerging resistances, forms the main fabric of the psychodynamic approach.

It is represented by various schools: 3. Freud, A. Adler, K.G. Jung, K. Horney, J. Lacan and others, and in child psychotherapy - by the schools of A. Freud, M. Klein, G. Hack-Helmuth and others. Within the framework of this approach, one can consider the Gestalt therapy of F. Perls, transactional analysis E. Bern, psychodrama J. Moreno and other methods.

Behavioral (behavioral) approach.

The essence of this approach, which goes back to the theories of IP Pavlov and B. Skinner, is to modify behavioral stereotypes through the use of the principles of learning theory. Behavioral and emotional problems are understood to be reinforced as a result of the encouragement and reinforcement of maladaptive responses to environmental stimuli. The task of psychotherapy is to eliminate or modify them. A behavioral therapist answers 4 questions:

1. What behavior is the target for change and what in the observed behavior is subject to strengthening, weakening, support?
2. What events have supported and continue to support this behavior?
3. What changes in the environment and systematic interventions can change this behavior?
4. How can once-established behavior be maintained and/or extended to new situations in a limited amount of time?

The therapist does not seek to penetrate into the origins of the conflict (symptom, problem) - he changes the observed behavioral stereotypes. Psychotherapy begins with a detailed analysis of behavior. The purpose of the analysis is to get as detailed a scenario as possible. onset of a symptom, described in observable and measurable terms of what, when, where, under what circumstances, in response to what, how often, how much, etc. The factors that trigger and maintain the symptom are then analyzed together with the patient. Then a detailed plan is compiled and implemented in joint and independent work. step by step plan actions. Compared to the psychodynamic approach, this approach is clearly directive.

cognitive approach.

It goes back to the works of A. Beck and relies on ideas about the decisive role of thinking, cognitive (cognitive) processes in the origin of disorders. Like the psychodynamic approach, he addresses the implicit, hidden causes of disorders and, like the behavioral approach, to maladaptive behavioral stereotypes. But the focus of this approach is not on the dynamics of the main mental forces and experiences and not on stimulus-reactive chains, but on thought patterns: any response to external circumstances is mediated by the internal organization of mental processes, thought patterns. The failure of these patterns triggers "negative cognitive circuits", which is fundamentally comparable to programming errors and virus distortions of computer programs.

Various schools within this approach emphasize the importance of individual cognitive styles, cognitive complexity, cognitive balance, cognitive dissonance, etc. The goals and objectives of psychotherapy are focused on "reprogramming" thinking and cognitive processes as a mechanism for the emergence of problems and the formation of symptoms. The range of methods is very wide - from rational psychotherapy according to P. Dubois to rational-emotive psychotherapy by A. Ellis. Like the behavioral approach, the cognitive approach is based on the directive position of the therapist.

Humanitarian (existential-humanistic) approach.

It originates in humanistic psychology and the works of its founders - K. Rogers, R. May, A. Maslow and others. The essential core of this approach is in understanding a person as an indivisible and fundamentally integral unity of the body, psyche and spirit, and, accordingly, in addressing integral experiences (happiness, grief, guilt, loss, etc.), and not to separate isolated aspects, processes and manifestations. The categorical apparatus of the humanitarian approach includes ideas about the "I", identity, authenticity, self-realization and self-actualization, personal growth, existence, the meaning of life, etc.

The methodological apparatus is associated with a humanistic-existential rethinking of life experience and the psychotherapeutic process. A wide range of methods is associated with this approach: non-directive client-centered psychotherapy (C. Rogers), psychological counseling (R. May), bioenergetics (W. Reich), sensory awareness (Sh. Silver, C. Brooks), structural integration (I Rolf), psychosynthesis (R. Assagioli), logotherapy (W. Frankl), existential analysis of R. May and J. Bugenthal, etc. Art therapy, poetic therapy, therapy creative expression(M. E. Burno), music therapy (P. Nordoff and K. Robbins), etc.

Systems approach.

It is determined not by an orientation towards theoretical models, but by a focus on partnerships, family, marriage, groups as independent organisms, integral systems with their own history, internal patterns and dynamics, stages of development, value orientations, etc. Therapy within this approach proceeds from the fact that a dysfunctional system of relations determines the disadaptation of its participants. The therapist takes the position of an included observer or playing coach. The systemic therapist is quite directive: he asks questions, observes and controls, structures the communication of participants, dramatizes relationships and models conflicts, gives homework, etc.

Integrative approach.

It is becoming an increasingly defining trend, within which methodological eclecticism, psychotherapeutic polypharmacy, and theoretical integration are distinguished. In practical terms, integration is guided by the principle of G. Paul (1967): which psychotherapy and by whom is most effective for this person with his specific problems in his circumstances and environment, or, in the words of M. Erickson (1975): each patient has his own psychotherapy. A mixture of different factors and integration styles creates a "wild psychotherapy" fraught, as A. Lazarus (1995) emphasizes, with unpredictable effects.

Classification of psychotherapy.

In relation to the subject of psychotherapy to the impact:

Autopsychotherapy;
- heteropsychotherapy.

By type of psycho-correctional influence:

Directive;
- non-directive.

By number of patients:

Individual;
- group.

By application technique:

suggestive;
- rational;
- reconstructive-personal;
- analytical;
- behavioral;
- cognitive;
- existential.

Mechanisms for the implementation of psychotherapy.

The goal of psychotherapy is the elimination of pathological symptoms. It has the following hierarchical levels: mental; neurological; vegetative; somatosystemic; somatoorganic.

The complex structure of clinical syndromes, which, as a rule, includes symptoms of all levels, is due to the presence of a single integrative system of psycho-neuro-vegeto-tropho-somatic regulation carried out by the nervous system.

The discovery of new classes of neurotransmitters, endorphins and others, filled in the missing links in the chain of subordination of the previously considered relatively autonomous humoral and endocrine systems.

The choice of forms and methods of psychotherapy is determined by the following factors:

Nosological affiliation of pathology for the choice of etiopathogenetic impact;
- determination of the personal characteristics of the patient;
- the relative predominance of any of the levels of symptoms;
- personal auto-identification of a psychotherapist;
- the conceptual and methodological basis of the psychotherapeutic direction, which determines the nature of the corrective effect.

Impact on the mental level.

The main one is the informational impact, i.e., the transfer of new information to the patient or a change in the meaning of an existing one. The emotional impact is very important, since if the cognitive and emotional perception of information does not coincide, it can be blocked or distorted. ultimate goal effects on the mental level can be both a leveling of monosymptoms and a change in the integrative characteristics of a personal response.

Impact on the psychophysiological level.

The main one is the combined psycho-physiological influence, as a rule, at the analyzer level, including the use of the feedback principle. The therapeutic effect is realized through reflex, physiological, behavioral mechanisms described by I. P. Pavlov, Ch. S. Sherrington, B. F. Skinner.

Impact on the neurovegetative-somatic level.

The main one is the reflex-somatogenic effect, as a rule, with emotional reinforcement, which is of a training nature. It uses physical impact on the reflex points, zones, body parts, systems (muscular, respiratory, cardiovascular, etc.).

The structure of psychotherapy.

Structure is a set of formal characteristics that describe psychotherapy:

1. The approach used (modality): psychodynamic, behavioral, cognitive, existential-humanistic, systemic. Within each of them there are many varieties. There are also approaches focused on a holistic psychotherapeutic process (integral, holistic, eclectic).

2. Situation: outpatient appointment, day hospital, hospital, etc.

3. Format: individual, couple, family, group.

4. Duration of the session: usually 45-60 minutes. Depending on the age of the child and the type of psychotherapy used, the duration of the sessions may fluctuate and be shorter. Given the involvement of parents, sessions should not be shorter than 30 minutes.

5. Frequency of sessions: depends on the approach used, the situation, the condition, the severity of the symptoms/problems, the ability of the therapist and ranges from 4-5 per week to one per month.

6. Duration: depends on the approach used, goals, situation, individual dynamics, in private practice, also on the financial possibilities of the family. The range of fluctuations is from short-term (several sessions) therapy to an open end date.

In child and adolescent psychotherapy, these moments should be clear to the family and, to the extent of psychological and intellectual maturity, to the child. As necessary, they can be changed already in the course of psychotherapy, but their ambiguity puts the family and the child in a position of uncertainty, which reduces the sense of security and increases dependence on the therapist. Such uncertainty deprives the therapist himself of the strongholds necessary for controlling his work and transfers him into an authoritarian position.

Stages of psychotherapy.

There are 4 stages:

1. Contact. Acquaintance, clarification of problems, establishment of initial contact.
2. Contract. The development by the therapist and the client of mutually acceptable goals and objectives of psychotherapy, determining the structure, ensuring confidentiality and determining the boundaries of responsibility, in private practice - determining the amount and method of payment.
3. Actually psychotherapy.
4. Completion and ending. It is determined by the achievement of the set goals and is a conscious and systematic process of fixing the results, summing up and changing the boundaries of the responsibility of the client and the therapist. In some cases, the stage of maintenance therapy with shorter sessions and a shift in emphasis from psychotherapy to psychological counseling is appropriate.

child's situation.

The situation of the child in psychotherapy was first clearly defined by A. Freud (1927) in relation to psychoanalysis: "The decision to analyze never comes from little patient, it always comes from his parents or from those around him. The child is not asked for his consent<...>The analyst is a stranger to him, and analysis is something unknown. But the most difficult thing is that only the people around him suffer from the symptoms of the child’s illness or his bad behavior, while for the child himself even the disease is not a disease at all. Often he does not even feel any violations. Thus, in the situation of the child, everything that seems necessary in the situation of an adult is missing: the consciousness of the disease, the voluntary decision and the will to recover.

Continuing this description, it can be noted that the situation is actually often even more complicated. Since the symptom is often a "message" addressed to adults, or a means of fighting with them or for one's place, the initiative of adults can be perceived as a manifestation of misunderstanding or a threat to vital interests. The image of the therapist thus created appears to the child as a continuation or double of the adults who have made an alliance with him against the child. At the same time, the child can be induced by adults' fears of this or that type of help. Add to this that behind the problem presented by adults as the problem of the child, there are often adults' own problems, so that the situation of the child becomes even more ambiguous and split.

The same applies to the role of the therapist, who is forced to solve interrelated, but multidirectional problems of the child and adults. An alliance with a child against adults, or with adults against a child, always proves to be best case ineffective, at worst - iatrogenic. Difficulties of this kind are exacerbated by the fact that being in the focus of conflicting problems and interests, the therapist is exposed to an increased risk of countertransference reactions.

Different researchers offer different ways and means of resolving these problems that complicate psychotherapy and establishing therapeutic contact. A psychotherapist working with children is always, albeit to varying degrees, a systemic (family or group) therapist.

Psychotherapist preparation.

It includes theoretical courses in basic and related disciplines, a course in individual therapy, psychological training, practice under supervision and supervisory counseling during the first years of independent work. Such training requires 3-5 years and gives rise to certification and licensing, which are repeated every 5 years and require completion of a set amount of hours of improvement in order to be admitted. The training of a child and adolescent psychotherapist involves the modification and expansion of the program.

Methods of psychotherapy.

Art therapy.

As an independent type of psychotherapy, it developed in the United States about half a century ago and is represented by a variety of approaches, combined with an understanding of visual activity and images as a way of communication and message, work with which forms the unique fabric of this type of psychotherapy. Art therapy, which grew out of psychoanalysis, quickly overcame its limits. It is used by representatives of almost all approaches as a method of psychotherapy, psychological training and medical / social pedagogy. The theoretical and artistic orientations of the art therapist and the tasks that he sets for himself affect the technical side of art therapy and the interpretation of the work.

The obvious advantages of art therapy are that it helps to establish and deepen therapeutic contact; serves both as a therapeutic and dynamic-diagnostic method; applicable in any situations and formats of psychotherapy; allows you to widely diversify the means - from drawing with a stick on the sand and with a simple pencil to painting and sculpture; has no contraindications and is applicable for a wide range of disorders. It creates and deepens (in children especially) a sense of security, allowing you to be open without feeling open and speak out without fear and social censorship.

The therapeutic effect is provided by a fusion of catharsis, insight, desensitization, suggestion, symbolic response and coping, learning, therapeutic modeling and, as a result, relationship restructuring and personal growth. With a certain degree of conventionality, the effects of art therapy can be divided into those associated with:

1. The actual process of creativity.
2. Image as externalized and thus open to internal dialogue experiences, an aspect of a personal situation, a subpersonal structure, etc.
3. Influences of an art therapist - from guidance in choosing a topic to facilitation and interpretation. In a group (studio) implementation, art therapy acts as a safe language and channel of communication.

In the strict sense of the word, art therapy does not imply the obligatory active intervention of the therapist. But in children's practice and in Russia (where art therapy is not an independent specialty, but rather an area of ​​preference for a psychotherapist), his role is more active.

When using art therapy in a psychotherapeutic complex, it is important to take into account the position of the disorder in the continuum "disease - fixed symptom - personal problem" and the goals of therapy - symptomatic, pathogenetic, supportive. When working, for example, with fear as a fixed symptom, it is enough to depict the object of fear. But in the case of fear as a reflection of an unresolved internal conflict, it is more successful for the child to portray himself. With symptomatic art therapy, a pattern that directly reflects the symptom may be sufficient. Such, for example, is the "symbolic destruction of obsessions" (V. I. Garbuzov, 1972) - the image of an obsessive representation with the subsequent destruction of the drawing.

In pathogenetic art therapy aimed at resolving an internal conflict, a metaphorical drawing is more successful. So, in the structure of the method of "dynamic synthetic drawing" (VE Kagan, 1993), the internal problem is expressed in the image of a tree with the subsequent destruction or change in the image of the tree in the imagination; the procedure can be one-time and be included in the structure of the course of therapy, options are possible with the introduction of suggestion after the first drawing and after it - a repeated image.

When using methods of this kind, it is necessary to assess the integration of the symptom into the "I" system. Thus, in the symbolic destruction of obsessive ideas or fear-producing objects, the drawing is usually effective, and in thumb-sucking, the image of oneself sucking the thumb and the subsequent destruction of the drawing cause resistance. During the course work, it is necessary to provide for the storage of drawings in a separate folder and their transfer to the therapist, who also has a special place for their storage. On the symbolic-suggestive level, the alienation of the symptom, the liberation from it and its imprisonment "in the fortress" are played out here. In working with young children, this procedure is especially effective and can be emphasized by the therapist: "Your fear (habit, violation) remains here."

In working with adolescents, spontaneous graffiti (drawings and graffiti on the walls - usually with sexual content) can be used to help understand the dominant experiences and the needs and problems behind them. A special place is occupied by art therapy in working with psychotic disorders - childhood and adolescent schizophrenia, childhood autism, depression. The free expression of spontaneous experiences in a wide, not limited by speech, semiotic field opens additional features for work in line with dynamic psychiatry.

Autogenic training.

It was proposed by J. Schultz in 1932 and goes back to the Buddhist traditions of self-regulation. It is most effective in functional and psychosomatic disorders. Patients with hysterical neurosis and a pronounced hysterical radical can receive additional skills of rental symptom formation in it, and those prone to anxious-suspicious pedantic fixation on their condition are at risk of strengthening and fixing symptoms. Due to its structural complexity, reliance on volitional potential and self-concentration, appeals to the ability to design the future - autogenic training is applicable not earlier than adolescence and requires special training of the therapist and his own experience of self-regulation.

Bibliotherapy.

The use of literary works as a tool of psychotherapy. It can be applied in the structure of almost all approaches to psychotherapy, in any situations and formats. A. E. Alekseychik (1985) divides it into non-specific (focused on the reactions of calm, pleasure, confidence, activity, etc. without nosological or personal individualization) and specific (aimed at specific processes of conflict resolution, control, emotional processing, etc. and using individualized bibliorecepts). In child psychotherapy, bibliotherapy can be used from the age of active reading and if the child has a tendency to read. Its implementation requires from the therapist himself a good knowledge of, at a minimum, the literature used and the ability / inclination to discuss what has been read. In young children, it is used in the form of various modifications of fairy tale therapy.

A. Lowen's bioenergetics, I. Rolf's structural integration (rolfing), F. Alexander's technique, M. Feldenkrais's method, bodily dynamics (bo-dynamic) and other methods are quite independent therapeutic systems related to neo-Reichianism and based on basic ideas and Reich technique. As holistic and independent methods in Russia, they are practically not used, but certain techniques - breathing, direct relaxation, relaxation through tension, massage, etc. are introduced into the structure of psychotherapy, including in children and adolescents.

Explosion technique.

Behavioral psychotherapy option. Imaginary or real events are used (see below for flooding and systematic desensitization), much stronger than usual, in order to desensitize the latter and reduce/eliminate learned responses. It is rarely used in children's practice (with the exception of some group work), but in adolescents it can be effective.

Suggestion (suggestion).

One way or another, suggestion is present in any psychotherapy, prompting the therapist to realize and evaluate their suggestive abilities and the suggestibility of patients, to control suggestive influences in the process of psychotherapy. Already by the time of the appeal, a certain - positive or negative - suggestive field is created, depending on the awareness of the child and the family about psychotherapy and the therapist, the severity and awareness of the need for help, the recording procedure and the expectation environment, etc. The sign of this suggestive field in the child and initiators the treatment of adults is often different.

Moreover, suggestibility may work in some directions and not work in others; this depends on many factors, including the alignment of the therapist's image and actions with the expectations of the child and family - this may open up additional opportunities or create a risk of iatrogenic, the emergence and strengthening of resistance. The assessment of these moments and the creation of a working suggestive background occur at the stages of contact and contract. For a better understanding of their suggestive potential and handwriting, it is useful for a novice therapist to refer to audio and video recordings of their sessions.

Suggestion in reality. It is divided into direct and indirect. Direct waking suggestion is made in an imperative, undoubted, emotionally saturated tone in the form of short phrases understandable to the patient with the repetition of key words and expressions, reinforced and reinforced by non-verbal signals. Suggestion can be imperative and motivated. Motivation is included in the text of the suggestion in the form of elements of clarification and persuasion or precedes the suggestion.

In young children, the mechanism of imprinting (imprinting) can be used: when the child is busy playing, drawing, or other absorbing activity, the therapist from time to time, without specifically addressing him, utters short - from a few words - inspiring phrases that can cause short orienting reactions , but do not interrupt classes. This technique can be used by family members trained by the therapist.

Shock suggestion in reality can be used for fixed neurotic reactions in adolescents. In such cases, after explanatory and persuasive conversations that combine the methods of rational psychotherapy with elements of indirect and motivated suggestion, the appointment of a time for the suggestion session and waiting for it for 1 to 4 weeks follows; the session is carried out in a group including already cured patients, parents, medical personnel in a special suggestive setting and ends with a short forced and precise suggestion. It is this method that underlies the so-called coding.

It is important to choose the optimal rhythm of waking suggestion sessions. If the intervals are too short, the suggestion does not have time to be included in the behavior, that is, to be not only formally implemented, but also integrated into the "I" system - this can cause protective counter-suggestive blocks. If the intervals are too long, the suggestion is not reinforced in the next session and is blurred, reducing suggestibility. On average, the intervals between sessions are for children 4-6 years old - 3 days, 6-10 years old - 4-5 days, after 10 years - 7-10 days. For each patient, one has to choose the rhythm of sessions that is optimal for him and vary it depending on the therapeutic dynamics. In children who are affectively tense and fearful of treatment, direct suggestion can be used in a state of relaxation and/or in the presence of the mother. With a sufficient depth of relaxation, suggestion can be imperative, with a superficial one, motivated B is preferable.

Direct suggestion in a dream is used in different options. For the suggestion procedure, the optimal phase superficial sleep falling asleep - in deep sleep, the suggestion is not perceived, in the phase of dreams it can enter into unpredictable combinations with the content of dreams. Parents trained by the therapist can use parental suggestion or recorded texts, including against the background of music that has the value of both music therapy and a suggestive password. Direct suggestion is more effective at the initial stages of neurosis, with neurotic reactions, short-term functional disorders, fixed psychosomatic and behavioral symptoms. Its effectiveness is lower at the stage of developed neuroses, in the presence of personality changes, in disinhibited children.

Indirect suggestion uses workarounds that reduce the patient's resistance. As a suggestive mediator, parents, games and game situations, dolls, regime moments, healing procedures, medicines. Parental indirect suggestion uses the effects of peripheral hearing - children usually perceive information that is not specifically addressed to them much better than direct appeal.

After an interview with a therapist, parents in a conversation with each other, but being in the field of hearing of the child, use suggestive formulas preferably positive value("I know that he/she can... I believe that...") or say things that are informative and persuasive (a story about someone who has overcome something similar to what is happening to a child, supportive child's reviews of other people about him, etc.). An effective source Such suggestion is usually made by those family members with whom the child is more closely connected emotionally and whose opinion he trusts more.

One commonly used indirect suggestion is the placebo. The actual placebo effect is achieved by prescribing an indifferent substance with information about the expected effect; it is advisable to use an enhancing placebo effect to achieve the maximum effect from the minimum dose of the drug;
the directing placebo effect consists in expanding the spectrum of action of a real drug (for example, setting a tranquilizer at the same time as a hypnotic or, conversely, an activating agent). The placebo effect is also provided by the color, shape, dose size of the drug, its mode of administration, etc.

When working with children, it is necessary to take into account the parental placebo effect described by I.P. Lapin (1975): the effect of the drug on the child depends on the attitude of the parents, it is especially important in working with young children who cannot yet be given direct instructions. The use of the parental placebo effect implies familiarity with their attitude to the treatment method used, the presence and nature of experience with its use and the effects obtained.

A number of special experiments with double-blind control established the presence of a medical placebo effect (positive iatrogenic). Thus, even in the treatment of delusional psychoses with antipsychotics, their effectiveness differs significantly depending on the doctor's attitude to the drug used.

Self-hypnosis.

It goes back to prayer and meditation, using many of their technical aspects, and in the history of psychotherapy - to the experience of E. Coue and P. Levy in France, V. M. Bekhterev and Ya. A. Botkin in Russia. Self-hypnosis procedures are very variable, but their use in psychotherapy is subject to a general pattern. The self-hypnosis itself is preceded by an explanation/persuasion with elements of direct and indirect suggestion, then a clear and precise instruction on the self-hypnosis procedure is given (in these two steps, responsibility is also delegated to the patient and criteria for the real acceptance of this responsibility are formulated), then the execution stage follows with reinforcements from the therapist and the therapeutically expedient development of self-hypnosis formulas.

Upon reaching the therapeutic effect, the meetings become less frequent, the therapist does not give instructions on how to stop the procedure, but does not turn to their implementation either - there is a spontaneous, at a pace individualized by the client, the extinction of the procedure with the possibility of temporary relapses to independently return to them.

When constructing self-hypnosis formulas, one should address not the problem, but the potentialities and resources of the client - any attention to undesirable behavior reinforces it, and many symptoms are compensatory in nature and, thus, integrated into the personality, due to which direct struggle with them can be subconsciously perceived as a struggle against oneself and provoke resistance.

S. is possible, starting from the age of 7-8, in children who are psychomotorally stable enough and motivated to cure. Unlike direct suggestion, self-hypnosis is well received by children with an anxious radical and obsessional disorders.

Suggestion in hypnosis. See below for hypnosis.

Gestalt therapy.

The founder of Gestalt therapy, F. Perls, applied the Gestalt theory, previously used in the study of perception and motivation, to the personality as a unity of mental and bodily experiences and to its functioning. Synthesizing the basic ideas of psychoanalysis, Gestalt psychology, psychodrama
J. Moreno, philosophy of existentialism, body psychology W. Reich and others, F. Perls created an integral and independent system of psychotherapy.

The therapist works simultaneously with verbal material and bodily manifestations, considered as messages about unconscious events, helping the patient to realize them as a whole. The process of awareness is built in such a way as to help organize feelings, behavior and bodily sensations and restore the integral organismic activity disturbed in the dynamics of the life cycle.

The main role of the therapist is to help each member of the group get involved in the process of awareness and remain in this process, which involves the participant taking responsibility for the dynamics of the process and its results. Gestalt therapy does not refer to the search for traumatic events in the past experience, but unfolds in the present (the "here-and-now" principle) - past experience is relevant in so far as and how it is presented in the present; its re-experiencing and playing, the completion of the gestalt leads to awareness and reorganization.

Gestalt therapy is carried out mainly in a group format with a focus not on group relations and dynamics, but on each participant. The group creates a safe environment, serves as a kind of "mirror" and a model of social relations. Indications include a wide range of neurotic and personality disorders. It is widely used in work with teachers and representatives of helping professions, in work with children and adolescents.

Hypnosis.

Systematically used and studied, starting with the works of F. Mesmer (70s of the XVIII century); the term was proposed in 1843 by the English surgeon J. Braid. The nature of hypnosis remains insufficiently clear and is interpreted in a wide field of theoretical models - from the neurophysiology of sleep to psychoanalysis and mysticism. The empirical and pragmatic aspects of its use are much better studied. It is useful to distinguish between hypnosis proper (as a technique used for research, suggestion, catharsis, etc.) and hypnotherapy.

The stages of hypnosis are described by A. Forel:

1. drowsiness (drowsiness) with a feeling of relaxation and light drowsiness;
2. hypotaxia - deep muscle relaxation with unwillingness to leave this state, periodic "withdrawals" to the next stage, the possibility of causing catalepsy;
3. somnambulism - extraneous stimuli (except for the voice of the therapist) are ignored or not perceived, easy induction of catalepsy, the ability to inspire dreams and hallucinatory experiences, anesthesia, actualization of latent abilities, changes in identity parameters (age, gender), etc.; post-hypnotic suggestions are possible.

Hypnotherapy.

The use of the hypnotic state as a proper remedy. In this case, no further special actions follow the entry into hypnosis, which leaves the patient free to fill the hypnotic state with its content and/or perceive it as a "miracle". Hypnotherapy is decisively connected with awareness of hypnosis and its therapeutic effect, the severity of the attitude towards treatment and the internal picture of the expected effect.

Much more often, hypnosis is used as a technique that significantly expands the possibilities of suggestion and increases the possibilities of therapeutic communication with repressed, sublimated, rejected experiences, deep experience, and the subconscious. As a technique hypnosis can be used in almost all approaches and models. The effects of hypnotherapy range from symptomatic to pathogenetic, depending on the goals set and the nature of the work carried out in the hypnotic state.

Suggestion in hypnosis is one of the most commonly used techniques. It allows you to bypass resistances and barriers that are relevant in the waking state. The methods and formulas of suggestion vary from therapist to therapist, so that what is effective in the practice of one may not necessarily be effective in another. One of the methods of suggestion in hypnosis is suggested dreams, using material and symbolic images previously received from the patient.

The duration of the session depends on the patient's condition and the goals of therapy. In case of enuresis with profundosomnia (- an excessively deep sleep that proceeds practically without dreams; it is difficult to wake the sleeper; with profundosomnia in children there is urinary and fecal incontinence), short (15-20 minutes) sessions are advisable, with asthenic neurosis and psychosomatic disorders - from half an hour to hours. The frequency of sessions varies from one to two per week, but sometimes (treatment in a hospital or sanatorium, other time limits for treatment), daily sessions are possible.

The duration of hypnotherapy ranges from one session to dozens and even hundreds. In child and adolescent practice, this is usually 10 sessions, after which this type of therapy is either stopped or the course is repeated after a pause filled with other types of psychotherapy.

Complications of hypnotherapy are less common the younger the child. Among them: hysterical hypnoid - the transition of somnambulism into pronounced hysterical psychotic pictures with loss of rapport - more often this happens when the therapist "clicks" on an unknown trigger; spontaneous trances can develop in response to random actions associated with the hypnotization procedure (someone's point-blank gaze, a decisive voice, the word "sleep", etc.), and sometimes when remembering the therapist and the session - in such cases during the next session, a special suggestion is made that the hypnotic state will develop only during sessions, and if this measure is ineffective, hypnotherapy is terminated; transference reactions to a therapist of the opposite (rarely one's own) sex - it is difficult to foresee them and one has to take care of the environment of the institution and the conduct of sessions that reduces the difficulties of this kind; seizures can occur in patients with epilepsy and organic epileptiform disorders, so they are either not given hypnotherapy or are carried out according to special methods; psychotic complications in the form of provoking an acute psychotic attack or weaving hypnosis into painful experiences.

Contraindications:

1. Complications of hypnosis that cannot be prevented or stopped.
2. Active psychotic symptoms.
3. Decompensation of psychopathy, psychopathy with antisocial attitudes.
4. Prepsychotic states.
5. Pronounced somatic distress.
6. Reluctance or fear of the patient.
7. Acute, special, emotionally intense interest of the patient in hypnosis or the active interest of the child's parents in it.

Hypnotherapist Requirements. A consciously and responsibly using hypnosis therapist should receive a comprehensive training in psychology and psychotherapy, be familiar with the principles of somatic medicine and psychiatry. The seductive ease of profanity in this area and the resulting feeling of power over people are incompatible with psychotherapy, but attract many untrained people to hypnotherapy and create the risk of manipulating the patient in the interests of the therapist himself. One of the indicators of such tendencies, including in quite gifted people, is the tendency to demonstrate their "gift" outside the therapeutic situation and mass hypnotic show. The control and regulation of these aspects of the use of hypnosis is a matter of the therapist's internal responsibility and a problem of the professional community to which he belongs.

Individual and group hypnotherapy. In symptomatic psychotherapy, hypnosis can be used in a group; in pathogenetic therapy, it is preferable to use an individual. When choosing, it is necessary to take into account the potentiating effect of the group and the patient's attitude. Individual suggestions in a group setting are possible.

Maternal Hypnotherapy. The mother trained by the therapist conducts the hypnotization procedure and jointly developed suggestions during the period of falling asleep of the child. It is usually used in work with children 4-6 years old, and especially in the presence of tension in a medical institution, the impossibility of fairly frequent visits to a therapist.

Narcopsychotherapy (narcosuggestion)(M. E. Teleshevskaya, 1985). An altered state of consciousness, against which the suggestion is realized, is achieved by the introduction of psychotropic pharmacological drugs: barbamyl, hexenal, sodium thiopental, nitrous oxide in medium therapeutic doses.

Emotional stress therapy (imperative suggestion). Overcoming the barriers of psychological defense and therapeutic implementation of suggestion is carried out due to a one-time change in the psychophysiological state of the central nervous system. At the same time, the suggestion is carried out against the background of the influence of stimuli that are limitless in strength on the analyzers of various modalities (M. I. Astvatsaturov, 1939; A. M. Svyadosh, 1982).

Materially mediated suggestion("armed" (J. Charcot), "extra-objective" (V. M. Bekhterev) suggestion, placebotherapy). The suggestion is realized when a therapeutic action is attributed to a real, but not having such an action, object or phenomenon. The range of such is practically unlimited - from diagnostic procedures, indifferent medicines(placebo), to fantastic fictitious material objects - "charged water", treatment "from a photograph", etc.

Hypnocatharsis. The method was proposed by J. Breuer in late XIX in. In his opinion, hypnosis itself is capable of providing "emergence" of amnesic experiences and circumstances associated with trauma. The healing effect is associated with the re-experiencing of psychotrauma in hypnosis and the resulting reduction in mental stress. After immersion in deep hypnosis, the patient is asked to recall and speak in detail everything related to the trauma.

Hypnotization. Hypnosis techniques are extremely diverse. The most commonly used are fascination (hypnotization with a look), verbal techniques, sound rhythms, fixing the gaze on an object, passes and tactile influences, non-verbal chains of the therapist's actions (measured walking with approach-removal, manipulations with a neurological hammer or a shiny ball, etc.). Fascination is preferable in boys, verbal hypnotization in girls, but this depends not only on the passport sex, but also on the individual characteristics of masculinity / femininity. When choosing methods and formulas of hypnotization, it is necessary to take into account the presence and nature of previous experience of hypnotherapy in order not to repeat actions that are ineffective or cause negative reactions.

Ericksonian hypnosis. The method was developed by M. Erickson (1901-1980) and consists in a special technique of non-directive hypnotization that uses the language of images in a system of a wide range of linguistic, non-verbal and directing techniques. The very concept of hypnosis as the transmission of images and a widespread phenomenon in everyday life is fundamentally different from the classical concepts of hypnosis. M. Erickson and his followers used this method in the widest range of indications and age. Recently, this method is becoming more and more widespread in Russia. Ericksonian hypnosis is one of the few methods of truly integral psychotherapy that uses all theoretical approaches and combines medical and psychological models. Erickson's experience served as one of the main bases for the development of Neuro-Linguistic Programming (see Neuro-Linguistic Programming later in this article).

Debriefing(from English debrief - meeting report).

The method of responding to crisis events proposed by J. Mitchell in the 1960s. The debriefing procedure is carried out in the first two days after a crisis event (catastrophe, natural disaster, physical or sexual aggression, fire and rescue operations, hostage, military or similar situations, etc.) and is aimed at returning the victims to the pre-traumatic level of functioning and deactivation of suicidal intentions.

Being essentially a preventive method, debriefing provides opportunities for ventilating emotions and managing crisis experiences, drawing up an adequate picture of what happened, normalizing reactions, reducing additional stresses, identifying and referring high-risk individuals for help.

Conducted by a team led by a psychologist or a specially trained volunteer. In cases of individual trauma, the debriefing procedure is conducted with the survivor; in cases of group trauma - with a group of people who survived this event. The work of the group lasts at least 2-3 hours without breaks.

Debriefing phases:

1. Introduction: motivating participants and establishing rules of work aimed at ensuring confidentiality and security (expressing only their own experiences, the inability to criticize others, the impossibility of any form of recording, the exclusion of media representatives, the prohibition of discussing what is happening in the group outside of it, etc.) .

2. Work with facts: all participants in their statements answer the questions: "Who am I? What was my place and role in the event? What did I see?" This makes it possible to restore a more objective and broad picture of the event, to work out a common ground for further discussion.

3. Reflection: This phase is devoted to discussing the first thought that arose in the trauma/crisis situation.

4. Dealing with reactions: the discussion focuses on the questions: "What do I think about this?" and "What do I feel about this?"

5. Dealing with symptoms: Participants' existing behavioral, emotional, physical, and intellectual distress is discussed.

6. Training: in the center of work - techniques for coping with stress, general issues experiences of stress, stressful problems of family and social/professional communication.

7. Revisit: This is a comment and question phase that may raise new, yet undiscussed, crisis response issues. In such cases, a new discussion is conducted starting from phase 4.

Game psychotherapy.

It is based on the main functions of children's play and is used, first of all, in the psychotherapy of a wide range of mental disorders, behavioral disorders and social adaptation in children. The most famous definition of a game belongs to E. Erickson (1950): "A game is a function of the Ego, an attempt to synchronize bodily and social processes with one's Self."

From the point of view of the influence on the development of the function of children's play, they are divided into:

1. Biological. From infancy, play promotes coordination of hand, body and eye movements, provides the child with kinesthetic stimulation and the opportunity to expend energy and relax.

2. Intrapersonal. The game contributes to the development of the ability to master situations, explore the environment, comprehend the structure and capabilities of the body, mind and world. In this sense, the game certainly stimulates and shapes cognitive development. In addition - and this function of the game, perhaps, is most of all used in game psychotherapy - the game allows the child, through symbolization and the mechanism of fantasy "fulfillment of desires", to respond and resolve intrapersonal conflicts. Traumatic experiences are reproduced in play; however, being the "master" of the game, the child can, as it were, subjugate a situation in which in reality he feels powerless;

3. Interpersonal. First of all, the game is one of the main means of achieving separation / individuation from the mother or the person replacing her. Games like "coo-coo, where am I?" or hide-and-seek - imitations of temporary separation in a comfortable situation, as if preparing the child for the possibility and correctness of real temporary separation from his mother or other loved one. In children with emotional disorders, the topic of separation is one of the most painful and is constantly reproduced in therapy sessions. Moreover, each session has a beginning and an end, and the child has to learn how to make contact first and then leave. In addition, at a later stage in the development of the child, the game serves as a testing ground for mastering a huge number of social skills - from how to share toys to how to share ideas. This function of the game is especially widely used in group or family play therapy.

4. Sociocultural. In every society, at every historical stage, there are both games that give children the opportunity to try on the desired adult roles, gradually expanding their repertoire, and games that reduce the fear of death. In this kind of play, children learn the ideas, behaviors, and values ​​associated in society with these roles. In play psychotherapy, this process continues when the child plays roles. various people evoking different emotions. For the first time, the game began to be included in the psychotherapeutic work with children by Hug-Helmut in 1919. Later, A. Freud and M. Klein described the systematic use of the game as a tool for the psychotherapy of children; while the game was a means of adapting the goals and techniques of psychoanalysis to work with children.

In 1928, A. Freud began to use the game as a way to involve the child in analytical work. From a psychoanalytic point of view, this was motivated by the need to create a therapeutic alliance with the patient, which in the case where the patient is a child is a particular difficulty. Children, as a rule, do not turn to a psychotherapist voluntarily, they are brought by their parents. Often it is the parents, and not the child himself, who see the problem and want to change something. In this case, a therapeutic alliance is possible with parents who are motivated to change, rather than with the child himself. In addition, the therapeutic techniques of dream analysis and free association are alien to the child and at first cause bewilderment and rejection.

In order to maximize the child's ability to form a therapeutic alliance, A. Freud began to use a form of establishing relationships that is familiar and pleasant for the child - a game. Only after reaching a relatively strong positive contact with the child, the main focus of attention on therapy session began to shift to verbal interaction and gradually - since children usually cannot use the method of free association - to the analysis of dreams and fantasies.

The representative of the British branch of psychoanalysis, M. Klein, unlike Anna Freud, believed that the game serves not only as a way to establish contact with the child, but also, even in the first place, direct material for interpretations. In 1932, M. Klein suggested using children's play in a therapeutic situation as a substitute for verbalizations that children are not yet capable of, while play expresses complex affects and ideas.

Kleinian therapy does not have an introductory phase; the child's play behavior is interpreted from the very first meeting. This approach allowed M. Klein to significantly expand the range of application of child psychoanalysis: if A. Freud believed that positive results are achieved in psychoanalysis mainly of neurotic children, then the patients of the Kleinian analyst can be children with very severe mental functioning disorders.

Currently, four main approaches to play psychotherapy can be distinguished: psychoanalytic, humanistic, behavioral and approach from the point of view of developmental theory.

Within the framework of the psychoanalytic model, the psychotherapist serves as an interpreter. His task is to interpret what the child brings to the therapy session, giving meaning to the child's behavior and communicating to him the results of his interpretations in a form the child can understand. The goal in this case is to achieve, the child's awareness of the unconscious motives of his own actions and internal conflicts. At the same time, the game is considered both as a way to establish contact with the child, and as a diagnostic tool, and as material for working out the child's problems.

The humanistic approach emphasizes the role of the "toxicity" of the environment in blocking the innate ability of a person to self-actualization (K. Rogers). Play sessions are therefore aimed at creating an environment conducive to the child's self-actualization. This goal is achieved through empathic listening, setting boundaries for acceptable behavior, providing the child with personal information about the therapist, maintaining constant interaction with the child, verbal and playful. The game is used both as a means of building warm friendly relations with the therapist, and as a source of information, and as a tool for development.

Behavioral theory views psychopathology primarily as the result of positive and negative conditioning of certain types of behavior and emotional responses. The goal of play psychotherapy is therefore, first of all, the discovery of pathological patterns and the nature of their conditioning. Then, by changing the system of reinforcements, you can change yourself pathological reactions. The game is used as material for the introduction of a new reinforcement system, the game itself is not seen as having its own healing properties.

Game psychotherapy within the framework of developmental theory involves the use of the game by the therapist as the main tool for development. At the same time, the therapist actually imitates the role of the main caring figures for the child, structuring the child's activity, forcing him to act in the "zone of proximal development", intervening and organizing interaction in which the child receives a feeling of warmth and trust.

The theories, however, emphasize and shade certain functional aspects of the game that are useful from the point of view of the psychotherapist. Play, on the other hand, remains an integral, special, and intrinsically valuable activity for the child, with its own "secret." The therapist's respect for this "secret" and awareness of one's own abilities, attitudes, preferences, styles, etc. in the game creates the necessary base, without which the therapeutic use of the game degenerates into manipulation.

Actually, play psychotherapy was one of the first to be used by A. Freud for the psychotherapy of children who survived the bombing of London during the Second World War. After the war, play psychotherapy began to be developed by various psychotherapeutic schools. Play therapy is used in individual, family and group formats; in outpatient, hospital and school work situations. It is effective in children and adolescents with almost all disorders, except for severe forms of childhood autism and profound autism in schizophrenia.

Play psychotherapy is non-directive. Introduced by V. Exline (1947): "Play experience is therapeutic, since play creates a safe relationship between a child and an adult, due to which the child is free to assert himself in the way he knows how, in full accordance with what he is at the moment, in my own way and at my own pace."

Game psychotherapy of response. Introduced in the 1930s. D. Levy. Recreating a traumatic situation in play, acting it out and acting it out, the child restructures his experience and moves from a passive-passive to an active-creative position. The task of the therapist is a reflection, pronunciation of the feelings expressed by the child.

Game psychotherapy of building relationships. Introduced by J. Taft and F. Allen in the early 1930s. and focuses on the child-therapist relationship here and now, rather than on the developmental history of the child and his unconscious.

Containerization of anxiety. Therapeutic technique developed by L. Di Cagno, M. Gandione and P. Massaglia in the 1970s and 1980s. to work with parents of children with severe organic and life-threatening diseases (pronounced congenital disorders, various forms of profound mental underdevelopment, tumors, leukemia, etc.). The intervention is based on psychoanalytic premises and is aimed at the allocation of adult roles of the individual by parents and the transition to them from the regressive children's roles to which they were thrown by the child's illness. Reception is focused on working with parents of young children.

Music therapy.

Goes back to experience ancient medicine, Atarvedam in India, the works of Avicenna, Maimonides and others. Empirical experience and many studies of the influence of music on the body and psyche justify the selection of sedative and tonic music, the development of special musical recipes for various diseases and emotional states. They are used in individual and group psychotherapy, as a background accompaniment of hypnosis and suggestion, as part of emotional stress psychotherapy according to V. E. Rozhnov and M. E. Burno, etc.

In children, it is often used in combination with plastic, rhythmic, dance classes. In older adolescents, it can be used as an independent type of psychotherapy. At the same time, many researchers notice that the individuality of perception and experience of music, its integration into psychobiography are very individual and dictate individual variations of common musical recipes.

Music therapy by Nordoff and C. Robbins. Within the framework of this approach, the foundations of which were laid in the 1950s and 1960s, music is used not as a directed influence with a predictable result, but as a language of dialogue between the therapist and the patient. The main role is played not by listening to "musical recipes", but by pre-music and pre-music - the vocalizations of the therapist and the patient, the exchange of the simplest musical signals - the rhythm of the drum, bells, piano sounds. Involvement in such a musical dialogue models communication and becomes the basis for transferring this communicative experience to other areas of life. The method is used in work with children who are practically inaccessible to either contact or other forms of psychotherapy - childhood autism, early childhood schizophrenia, severe mental underdevelopment, gross violations speech development, pronounced degrees of deprivation developmental delay, etc., and at an age when other forms of psychotherapy are still inapplicable - starting from 2.5-3 years. Classes lasting from half an hour to an hour are held individually and in small groups. As a rule, in the structure of classes there are elements that were later identified as paraverbal psychotherapy.

Flood technique.

One of the methods of cognitive psychotherapy, which includes a strong behavioral component of the "wedge-clip" type. The patient is immersed in a real fear-inducing situation for a sufficiently long time - at least an hour. This is supposed to stimulate creativity and displace fear-avoidance behavior. At the beginning of treatment, the therapist next to the patient plays a supportive and helping role, and then gradually "steps aside", preparing the patient (or in group work, the group) to independently perform such exercises. The method is quite time-consuming and can be performed from the age of 12-13.

Neuro-Linguistic Programming (NLP).

A new model of human behavior and communication, formulated in the 1970s. R. Bandler, J. Grinder and the most intensively developed L. Cameron-Bandler and J. DeLozier. The model is formulated on the basis of careful observation and analysis of the work of such leading psychotherapists as Milton Erickson, Virginia Satir, Fritz Perls and others. The model is based on practically developed ideas about sensory modalities, representational systems and meta-models of language that are not addressed to the content of experience, but to the mechanisms of its formation and consolidation. Formally, NLP can be classified as a cognitive approach, but unlike it, it relies on epistemology.

Many psychotherapists view NLP as extremely manipulative and therefore "dangerous" technique. In fact, NLP is not a technique, but a new methodology that is effective in building any type of psychotherapy. Strictly speaking, it concentrates those instrumental moments that are present in any psychotherapy, usually remaining hidden from the therapist, but determining the effectiveness or inefficiency of his work. NLP is as applicable to child psychotherapy as it is to working with adults.

operant conditioning.

A cognitive-behavioral method that uses the capabilities of the environment to change unwanted behavior. To stimulate and reinforce the desired behavior, a reward system (money, sweets, toys, permissions) is used.

The technique is often used in working with children. However, in such direct form it often degenerates into a system of mutual manipulation, especially when used in the family. Help to avoid this:

1. Optimization of expectations and requirements in relation to the child - awareness of the boundaries of a possible change in his behavior, the actual requests and needs of the child, the picture of his desired behavior.

2. Creation of situations of search activity for the child - unimposed awareness of the connection between the quality of life and their own behavior.

In practice, this means that the therapist, together with the parents, analyzes the behavioral problems of the child and possible ways reinforce the desired behavior. After that, the parents stop condemning the unwanted behavior (those of its forms that, together with the therapist, are chosen as the object of work), replacing them with feedback in the style of "I-messages" - "I'm very sorry about this ... I was very scared for you ... ", etc. This gives the child an idea of ​​the real impact of his behavior on the feelings of others, instead of protection from criticism and censure. At the same time, a system of rewards for desirable behavior is introduced, which is not discussed with the child - at the end of "good" days or periods of time, they simply allow him to watch TV longer or read at night, or they can play his favorite game with him, or they can simply stay with him longer (important so that it is included in the child's value system) without announcements - for what it is and without deprivation of encouragement "for something".

It takes time for the child himself to catch the connection between "good" behavior and the rewards he receives and begin not to "extort" these rewards with behavior, but to become interested in his own behavior. This modification of operant conditioning for use in the family makes it possible to overcome many disorders that had previously seemed inaccessible to the influence of the disorder.

When referring to operant conditioning, the therapist also has to take into account the points noted, taking into account the cultural differences between the Western culture in which the technique was developed and the Russian culture. It seems important to build a reward system based, first of all, on personal and emotional values. This does not cancel the possibility of materialized rewards, but gives them the character of a symbol. It is equally important to make sure that the therapist's encouragement does not cause negative reactions in parents, who can create a "double trap" for the child - to do badly and not to do badly.

Operant conditioning is indicated primarily for behavioral problems proper, and is less effective where behavioral problems arise as a result of disturbed relationships and emotional imbalances in the family or other group.

Paraverbal psychotherapy. (E. Heimlich, 1972). A method in which the therapist builds communication with the patient through sensorimotor channels. Sensorimotor communication does not replace verbal communication, but goes hand in hand with it. Primary contact with the child is established through sound, movement and touch - the latter plays a decisive role. Visual stimuli and minimal verbal contact act as an accompaniment. The techniques used are organized into a structure. Any means can be used - non-verbal vocalizations, rhyming, familiar melodies, facial expressions, dramatization and different materials- paints for drawing with fingers, a device for blowing soap bubbles, an elastic cable, water, simple percussion and string instruments. Although the materials are the same as in many other methods of psychotherapy, the goals are different. The emphasis is on communication and the reduction of communication disruptive elements - especially when they are reinforced by verbal psychotherapy. The material is not used for directed development and assessment of skills - it is impossible to make a mistake if the child is asked to beat the drum or ring the bell with the therapist: he can quickly feel competent and enjoy.

The therapist supports the game situation and regulates the structure of the sessions in various ways. His facial expressions, body movements, voice inflections provide structure to the session, acting both as a stimulus and a role model. Changes in the volume, stress, or tempo of the rhythmic sounds also adjust the structure of the session. Sounds and movements are intertwined, forming a single whole. Touches, touches, and later - verbal comments join them. Sessions usually start with drums - they are familiar to the child and easy to play. An atmosphere of pleasure and acceptance is needed. Therefore, the therapist carefully monitors the child's reactions, tries to prevent the weakening of interest and boredom, and flexibly changes the manner of his behavior. The method is used in preschoolers with communication disabilities of various origins and usually requires at least 10-20 sessions. (See also in this article about music therapy - P. Nordoff and K. Robbins and Theraplay).

positive psychotherapy.

Proposed by N. Pezeshkian in the 1970s. It comes from the fact that the disease contains not only negative, but also positive aspects. Violations are seen as a manifestation of one-sided forms of processing conflicts that have developed in the dynamics of family experience and cultural influences. Positive psychotherapy methodologically synthesizes psychodynamic, behavioral and cognitive approaches. It is effective in a wide range of disorders, primarily in psychosomatic ones. Successfully combines the advantages of medical and psychological models of psychotherapy. Can be used from adolescence and in family work.

Poetry Therapy.

The use of poetry for psychotherapeutic purposes. One of the ways of its application is bibliotherapeutic; the effects are enhanced by poetic conciseness, meaningful capacity, rhythm and music of poetry. Other paths in one way or another merge with expressive and creative forms of psychotherapy that assign the patient an active role. Such work can begin with pra-poetry - its own sound and verbal rhythms and continue in the field of poetic creativity, where it is not the quality of the poem and its compliance with the standards or ideals of poetry that matters, but the degree of expressiveness, reflexivity, insight, catharsis in the creative process.

The range of methodological techniques is very wide - from "babble" poetry to conscious creativity, from poetic suggestion to complex psychodynamic processes. Poetic therapy can be used at almost any age (sometimes as early as 3-4 years), without nosological and syndromic restrictions, in any situations and formats of psychotherapy, no matter what theoretical approach it adheres to.

Psychoanalytic therapy.

It is carried out in many different modifications depending on the orientation of the therapist/analyst. Even within the framework of orthodox psychoanalysis, methods can be extremely different - as, for example, in the work of A. Freud and M. Klein.

Psychodrama.

Proposed by J. Moreno at the beginning of the 20th century. method of group psychotherapy, which is based on therapeutic dramatization of personality and emotional problems and conflicts. The group includes the protagonist (the patient who chooses the situation reflected in the dramatization), additional egos (other members of the group representing someone or something in the patient's experiences), observers and the director (the professional leading the group). Among the techniques, the main place is occupied by a monologue, role reversal, double, multiple double, mirror, etc. Psychodrama can focus on various situations and problems, including hallucinations and delusions. In expanded form, psychodrama can be used from adolescence; before that, elements of psychodrama are used.

Psychotherapy with creative self-expression.

According to M. E. Burno, it is one of the systems of creative-expressive psychotherapy that uses creative activities (diaries, literature, photography, drawing, amateur theater, etc.) to strengthen self-confidence, optimize communication attitudes and capabilities, and personal growth. Applicable from adolescence - especially for defensive, reflective patients.

Problem resolution(problem solving).

Method of cognitive psychotherapy. It is used in the structure of therapeutic relationships and is aimed at developing patterns of productive behavior in various situations. First, the patient is taught to define his problems in terms of specific behavior, then to identify alternative ways of solving problems and behavior, and, finally, to choose the best way for him to behave. These steps are carried out under the guidance of a therapist who teaches how to apply behavioral strategies to increasingly complex problems. The method is effective when working with children and adolescents with behavioral problems, but due to age-related psychophysiological immaturity of behavior planning mechanisms, it is used when working with children more for tactical than for strategic purposes.

Rational psychotherapy(explaining psychotherapy, persuasion psychotherapy). Proposed by P. Dubois as an alternative to faith-based suggestion therapy. According to the provisions underlying it, it can be attributed to the cognitive approach, being one of its forerunners. Dubois believed that misconceptions were the cause of neuroses, and the tasks of psychotherapy were "to develop and strengthen the mind of the patient, to teach him to look at things correctly, to pacify his feelings, changing the mental representations that caused them." Believing that suggestion is a deception that enhances suggestibility - this "harmful mental weakness", Du Bois focused on the logical side of behavior and experience, interpreting his psychotherapy in terms of evidence, advice, persuasion and persuasion, clarification, Socratic dialogue.

However, the testimonies of contemporaries emphasize the passion of his convictions, which makes one think that the emotional impact and suggestion were by no means alien to his work; at the end of his life, P. Dubois himself seemed to agree that he often “inspired” his logic to the patients.

The effectiveness of rational psychotherapy significantly depends not on the severity of arguments and evidence, but on the personality of the therapist, the meaning invested in it and the possession of a wide range of psychotherapeutic techniques. Diluted to provide the patient with some knowledge and instructive advice, especially with the therapist's references to a personal example, it is not only ineffective, but often iatrogenic. But rational psychotherapy, addressed to this person with his problems and built as a dialogue "I-Thou", continues to be an effective method.

In working with children under 10, only elements of rational psychotherapy are usually used - short and accessible explanations. It is better to do this when absolutely necessary and prudently, because due to the difference between adult and child logic and role relationships, it is very easy to lose contact with the child or find yourself in the field of pedagogical, rather than therapeutic, dialogue.

After 10 years, the possibilities expand. However, one should be prepared for the "trap of puberty" that, in extreme manifestations, is called adolescent philosophical intoxication, together with the reaction of emancipation, can translate the therapeutic dialogue into a dispute or duel. For patients with a strong rational-analytical radical and alexithymia, rational psychotherapy is often the method of choice.

In children's practice, rational psychotherapy is an integral part of working with families. As a rule, the family is too involved in what is happening with the child and biased to see what is happening from a therapeutic distance. Rational psychotherapy helps to remove many ambiguities, build cognitive maps of what is happening with the child, which help parents find their place in therapeutic process and child care system.

Rational-emotive psychotherapy by A. Ellis.

One of the methods of cognitive psychotherapy. Considering a person as a cognitive-emotional-behavioral unity, Ellis refers to "thinking about thinking" as the semantic center of psychotherapy. Empirically developed techniques of emotional focusing, direct confrontation, etc. are used to resolve problems, realize one's own responsibility for their occurrence, and find ways to resolve conflicts productively.

Talk therapy.

The task of the therapist is to help the patient verbalize emotional experiences to eliminate pathological symptoms.

Self-instruction.

The method of cognitive psychotherapy proposed by D. Meichenbaum. The task of the therapist is to teach the patient, based on the analysis of problems, to set behavioral tasks for himself that can be an incentive to direct and guide his behavior. Such training requires the therapist to have a sufficiently clear and precise understanding of the cognitive aspect of the behavior in each particular case. It is used in work with those suffering from schizophrenia, delinquent adolescents, disinhibited children.

Family psychotherapy.

It arose in the 1950s, although the ideas of a therapeutic effect on the family were expressed in the last century, and earlier they were part of many traditional healing systems. The emergence of family psychotherapy is associated with the names of A. Maidlfort (1957) and N. Ackerman (1958). Currently, family psychotherapy is carried out within the framework of various theoretical approaches(dynamic, behavioral, cognitive, existential-humanitarian, systemic), methodically moving more and more towards an integral approach (positive family psychotherapy by N. Pezeshkian can serve as an example). It is based on the idea of ​​the determining role of family relations and dynamics in the state of its members. In relation to childhood, a number of target settings of family psychotherapy can be conditionally distinguished:

1. Therapeutic correction of the family as an etiopathogenetic factor in the occurrence of disorders in a child.

2. Resolution of family conflicts and traumas related to the child's problem state/behavior.
3. Systemic family psychotherapy, focused on the family as a social organism and the relationships existing in it as an object of intervention.

The methodological apparatus of family psychotherapy includes various techniques:

1. Directives - instructions to do something, to do something in a different way, not to do something. Directives can be direct - their implementation and control are carried out mainly in line with the behavioral approach, and paradoxical - calculated on the fact that the prohibition of one or another form of actual behavior removes the fear of it and contributes to its implementation.

2. Family discussion - discussion by family members of the problems of family life, ways to resolve family problems and conflicts. The therapist acts as a mediator and involved observer using active listening, repetition, paraphrasing, confrontation, silence, etc.

3. Conditional/Conditional Communication - A new element is introduced into the family discussion and/or relationship (color signaling, note exchange, communication rules) that slows down the processes of family dynamics and makes them easier to detect.

4. Role playing.

5. Playing each other's roles.

6. Sculpture of the family, according to V. Satir, when family members from each other create "frozen figures" that express one or another aspect of relationships that are relevant to the family.

The choice of style - directive or non-directive, issues of working with part of the family or the whole family, the frequency of sessions and course duration management of psychotherapy alone or with a co-therapist, orientation towards therapy regimens or family dynamics, etc., are decided by the therapist himself. Methods of organizing and conducting family psychotherapy should not be determined by the theoretical orientations of the therapist, his characterological features and be limited in any one way.

In children's and adolescent practice, it is often necessary to resort to individual work with several or all family members, helping each of them to solve their problems in the context of general family problems and thus optimize family communication. Keeping in mind that people often know WHAT to do, but do not know HOW, family therapy should be distinguished from mere information about appropriate behaviors.

Systematic desensitization (desensitization).

As a method, it was proposed by J. Wolpe and consists in the displacement of learned reactions. Pre-mastered simple technique relaxation - for example, deep muscle relaxation. The therapist, together with the patient, makes a list of situations that provoke unwanted emotions - from the most frequent and strong to the rarest and weakest, as well as a list of calming situations. The subsequent desensitization session lasts about half an hour.

The patient, in a state of relaxation with his eyes closed, imagines the situation causing the weakest fear as brightly as possible, and after its 30-40-second exposure - one of the calming situations. The cycle consists of 7-8 repetitions per session. If it is possible to achieve the disappearance of fear, the patient signals this to the therapist (for example, by raising a finger), and then the therapist allows him to move on to the next fear-producing situation. If the fear persists, the therapist, at the patient's signal about this (raised finger of the other hand), stops the session and, together with the patient, looks for the cause of the failure and more "working" details and shades of situations, after which the session resumes.
The therapy can be supplemented with a behavioral component - extinction of fear in specific situations. The method is effective starting from 10-12 years of age.

Hidden sensitization.

As a kind of opposite of desensitization, aimed at weakening / eliminating certain types of behavior through imagining them in disgusting form. So, in the psychotherapy of obesity, a plentiful and tasty table is imagined, at which the patient begins to absorb food, and then convulsive uncontrolled vomiting is imagined; similarly, the patient may imaginatively restrain undesirable behavior and be rewarded for it. It is used in the psychotherapy of phobias, overeating, alcoholism, smoking, homosexual attraction, communicative anxiety.

Latent conditioning.

As a method of cognitive psychotherapy, it was proposed by J. Kautela in the late 1960s. In it, the sequences of encouragement and censure act as independent behavioral events. They can be applied to imaginary events in the same way as in operant conditioning, and then transferred to real behavior. J. Kautela proposed special techniques for implementing the method.

Body Oriented Psychotherapy.

W. Reich believed that the individual character is expressed in characteristic patterns of muscle rigidity, which blocks the main biological excitations (anxiety, anger, sexuality) and reflects the functioning of a specific biological energy - an organ. According to W. Reich, the muscular armor as a bodily expression of psychological blocks is organized into seven main protective segments (eyes, mouth, neck, chest, diaphragm, abdomen and pelvis). Reich's therapy consists in weakening and eliminating the muscular shell in each segment using special techniques (breathing, contact methods, expression of emotions, etc.).

reality therapy.

The method of cognitive psychotherapy developed by W. Glasser in the 1950s. The purpose of the method is to improve the practical understanding of reality, to stimulate its concrete awareness and planning, which should lead to better adaptation, that is, to "lower down" the existing problems. The method is based on the assumption that the source of personal identity and self-acceptance is "doing": the development of responsibility and initiative leads to the experience of success and efficiency. The therapist focuses not on feelings, but on behavior - analyzing specific steps in specific situations, the patient's ideas about successful behavior, planning such behavior. The responsibility of the patient involves the implementation of the plans developed together with the therapist, detailed reports on the implementation with a joint analysis of success / failure and further planning.

One of important points building reality therapy consists in gradualness, step by step, making it possible both for "learning scales" successful behavior and for integrating the experience of successful behavior into a system of individual meanings. The method is effective in patients from 11-12 years of age with perceived behavioral problems and the desire to resolve them. It can be used in work with parents who need to develop effective ways of interacting with a problem child - mental underdevelopment, childhood autism, hyperactivity, etc.

Theraplay (therapeutic game).

A form of psychotherapy (E. Gernberg, 1979) that reproduces the relationship between parent and infant. The therapist in communication with the baby, like a mother, structures behavior, provokes, invades, educates, and, like a mother, does all this in a very personal, bodily, pleasant manner. The method proceeds from the fact that many problems of children and adolescents are preverbal. The therapist - he works with a 6-month-old baby or teenager - has two main tasks:

1. Determine at what stage of development, in what area of ​​the "mother-child" relationship and from which side (mother or child) the disorder manifested itself for the first time.

2. Fill in the resulting void in a way addressed to the child at the identified (see 1) stage, but without over-stimulation or over-forgiveness.

The best way to bring out this emptiness is to observe mother and child together. The therapy is built in such a way as to restore the "correct" course of previously broken or interrupted connections and attachments. Normal parenting contains at least four dimensions, which individually or together at any time can become the focus of psychotherapy. The mother's activity is structuring, laying down rules, following routines, holding firmly, defining the baby's bodily boundaries. In her efforts to expand the horizons of the child, she calls him to desire, reach out and achieve. She invades by blowing on his eyelids, holding him close, jumping with him, playing hide-and-seek, etc. Finally, there are many ways to nurture during feeding, calming, comforting.

These 4 dimensions are the main ones in the therapeutic game, which is different from the usual child psychotherapy. The ways in which the therapist approximates his behavior to that of the ideal mother are:

1. Focusing solely on the child.
2. Offensive and demonstration without apology and obtaining his permission.
3. The relationship is physical and concrete more than verbal and abstract.
4. Action is here-and-now rather than directed by the past.
5. Appeal mainly to reality, not fantasy.
6. Cheerfulness and optimism, not depression and pessimism.
7. Using your body and the body of the child, and not designers, dolls, etc.
8. Responding not to tasks well/correctly performed by the child, but to his uniqueness, vitality, beauty, love.
9. Immediate response to physical damage and problems.
10. Desire to support eye contact regardless of the consent/disagreement of the child.

It can be held in individual, family and group formats. Given the characteristics of the therapeutic game, it is advisable to create special groups for its implementation and keep in mind that it creates more high risk countertransference than conventional psychotherapy. Responses to intervention vary depending on the nature of the problem. Children with an obsessional radical—always overly supported and driven—respond better to a combination of intrusion and nurturing. At first, they can cause resistance because of their unusualness and physicality. But this resistance soon fades away. Similarly, you can start working with autistic children.

Disinhibited, hyperactive children, children with schizophrenic agitation need structuring, while intrusion and education can only exacerbate problems. Not all children perceive this type of therapy and it is not used in work with recent physical or mental trauma, sociopathic personalities.

Holding therapy.

Developed by M. Welsh in the 1970s. and proceeds from the understanding of early childhood emotional disorders as a result of disturbed emotional ties "mother-child". Initially, the method was intended to work with autistic children, but later the scope of its use expanded to behavioral and phobic disorders, as well as to the introduction of healthy children upbringing.

Holding therapy is carried out daily at times chosen by the mother depending on the condition of the child. The child is not given time for avoidant manipulation, but is warned of what is to come. For example - "Now I will hold you for a long, long time - until you feel that you are well." The child is held by the mother in such a position that during the whole session with him it was possible to maintain direct visual and close bodily contact, to control attempts to protest, dodge and struggle. If possible, other family members are included in the procedure. It is better for younger children not to be in order to avoid reactions of jealousy on their part.

The session goes through stages of confrontation, resistance and resolution. The session should not be interrupted and continues until the child reaches a state of complete relaxation. If you have to interrupt it, then therapy is suspended for several days. Sessions are usually held at home. The initial stages of the course require the presence of a therapist who conducts the necessary diagnostics, instructs the family, corrects the behavior of the parents and supports them. Later, he participates in therapy one to two times a month. Upon completion of holding therapy, depending on the condition of the child, a transition to other forms of psychotherapy is possible.
All professionals who use holding therapy also emphasize its positive effect on the mother and the mother-child relationship. Cases of ineffectiveness of holding therapy in autism are usually associated with its broad diagnosis.

With anxiety neuroses, holding therapy is carried out in a milder form, usually at bedtime, and brings relief in the first days. Unlike autism, there are practically no stages of confrontation and resistance. The course lasts approximately 68 weeks. and ends most often at the decision of the child himself. It is believed that during soft holding, the child regains a sense of security encoded in the early stages of development.