Psychotherapy doesn't help. Find a way out of the "psychic refuge", greater mental freedom. Depression: signs, types and methods of treatment

Who can benefit from psychotherapy? October 11th, 2013

AT recent times I am often told: “Here, they say, you criticize psychotherapy, but it helps many people.” I want to say clearly: let's be more precise. Whom does it help? What helps? How can you objectively prove the effectiveness of psychotherapy?

In trying to determine the effectiveness of psychotherapy, it is very important to formulate criteria for this effectiveness.

First, what do we consider to be accomplished psychotherapeutic help? Disappearance of symptoms? Raising the standard of living? Improved social status (wages increased, social circle expanded, got married, had a child, etc.)? A subjective feeling of the absence of problems, a decrease in the intensity of negative experiences? In any case, it is desirable to consider the effect of psychotherapy in a longitudinal mode: will the patient, a year after the supposedly successful completion of psychotherapy, slide into even worse problems?

Secondly, if we have clearly defined the criteria, they are unambiguous, measurable, then we need to show statistical data. In what percentage of cases is the usefulness of psychotherapy? Does this percentage differ significantly from the percentage of positive effects in the absence of psychotherapy? Does this percentage differ significantly from the positive effects in case of adopting a religion, visiting a shaman, psychic, sorcerer?

In reality, it often turns out that a psychotherapist's patient simply replaces a socially unacceptable neurosis (constant washing of hands) with a socially acceptable neurosis, for example, a constant visit to a psychoanalyst. In other words, earlier man when communicating with friends, he constantly ran to wash his hands, and now he constantly talks about sexual desire in children and anal fixation.

There are also situations when the positive effect of psychotherapy is purely subjective in type: before I was just a loser, but now I am a believing loser and can justify my sad situation by the importance of asceticism, the sinfulness of wealth, the need to suffer internally in the name of salvation, etc. The same effect is possible and in the case of psychotherapy, when a person, for example, gives up his motives according to the “green grapes!” scheme, and my motives are bad, due to childhood traumas and repressed memories.

In general, psychotherapy personally reminds me more of a cult practice: a person regularly visits the temple of psychotherapy, confesses, listens to sermons, receives instructions, etc. This does not give a verifiable effect, but it takes time, diverts attention from real problems, allows not solving real problems, but reconciling with them, reinterpreting them. In this regard, let's recall one of the basic principles of psychotherapy: it is useless to try to solve internal problems in the external world. But what are internal problems? After all, very often they are generated by a real disorder, inconsistency in modern society. And these moments, in turn, are generated by the specifics of the economy of a single country (a small number of independent industries, i.e. low level diversification), high level corruption, etc. For example, a person cannot get a job normal work or enter a normal university because of the situation in a country in which corruption, servility, patronage, nepotism and suzerainty flourish (“I give you a feud, and you give me homage”), and the psychotherapist will look for the root of these problems in childhood traumas and repressed memories …

In this case, the adoption of the psychotherapeutic dogma that everything must be decided within oneself is, in the classical (Marxist) sense, an opium for the people, a means of distracting people from real problems. And accordingly, psychotherapy helps not society and not patients, but people interested in maintaining and maintaining the status quo in the country. Just don't think that I'm calling for a revolution - by no means!

These are my thoughts on who is helped by psychotherapy.

Help, “fixing” a situation, healing from trauma, experiencing difficult feelings, identifying repetitive patterns and changing them are just a few examples of potential client requests.

However, even before you step into this world called "psychotherapy", it is important to understand how it helps a person, and whether psychotherapy will help in your particular case.

Key Ideas for Assistance in Psychotherapy

It is important to understand that today there are two areas of psychotherapy: medical (clinical) and non-medical (non-clinical). In the first case, the person who comes to the reception - a patient, in the second client.

Let's take a look at Wikipedia:

... the order of the Ministry of Health defines the specialty "physician-psychotherapist". This is a person with a higher medical education in the specialty "General Medicine", who received training in the specialty "Psychiatry". For brevity, they are often referred to simply as "therapist".

At the same time, the word "psychotherapist" is used to refer to persons who have received education in the field of one of the methods of psychotherapeutic practice. These are people with a higher psychological (but not medical) education, which is similar to some European countries, where “psychotherapists” are a humanitarian education that is not tied to medical education.

1. If no appointment is required medicines, then the most common choice is the second option.

Another point: how will a psychotherapist help? If you prefer clear problem-solving patterns, if you need someone to “show the right way”, your choice is directive psychotherapy. If you are ready to take its quality, then it is non-directive.

2. Both options have the right to exist, but what will be the help - it's up to you.

The third nuance: a group or personal work? Each direction has its pros and cons. One-to-one with a psychotherapist, you can raise very personal, deep questions and topics. But in a group, you are spared the “one look” effect - that is, you can rely on several views at once.

3. If it is important for you that psychotherapy helps with “group” tasks (as I act in society, in a group), if a lot of feedback is important to you, it will be useful for you, but for solving personal problems -.

How does psychotherapy usually help?

1. Find a way out of the “psychic refuge”, greater mental freedom.

Unless we are talking about disorders, but simply about the “average person”, exhausted by deeds, experiences, then psychotherapy helps:

revise own (often too rigid, or irrelevant, or mutually conflicting) attitudes, beliefs, principles,
explore different experiences (in a group, based on the knowledge of a psychotherapist),
clarify What is hidden behind certain concepts

For example, friendship: should it always be “strong”? Maybe for you personally in some cases it will be enough and friendly relations? Love: what do you mean by that? Are you sure that you can really live with one person all your life? What are you willing to “put on the altar of love” that you can give up in life for the sake of an ephemeral concept? Do you distinguish between love and infatuation, vigilance and total control, close relationships and erotic tension?

understand to what extent you live your life, whether you make a choice, what is important for you in this life or not,
define Are you hiding in your Everyday life: in alcohol, in work, in reading, in reflection, in pursuit of achievements, in relationships (“build a family”, “save your husband / wife”) from real life.

2. Live the old.

Previous experience is often "frozen": then a person is faced with the same scenarios. A classic example is the anecdote “if the fifth husband hits you in the face.” And yes, it's not in the face, but in a need that has not yet been determined.

For example, "to be a good man”, “do it right”, “be patient for the sake of something”, “build a family like your parents”, “make sure that all men / women are…”

Finding the "false path" by which a person again and again enters the next round of "walking in a circle" is a worthy task for psychotherapy. Find, realize the (true) need behind this, live out the feelings, the situation, and…

3. Try something new!

How much could be done in life, if not ... when you could ... so that you would like and be able ...

Instead of again dreaming “again in Paris”, it is quite possible to try new experience in safe environment. Often this experience is:

residence of aggression(it turns out that you can say: I don’t like you, move away! I don’t want / I won’t! I want to understand you, finally! I get angry when you say this!)
acceptance experience(it turns out that I can be accepted the way I am, without the requirements “to become the way I want to see you!”)
experience of nonjudgmental judgments(step away from “you are good / bad”, “suitable / not suitable”, “this is good / this is bad”)
experience of true intimacy(not to be confused with sexual, in which such just may not be): it turns out that you are not indifferent to someone, someone is not indifferent to you, you can live together sad, joyful, interesting moments,
interest in achievement true instead of imaginary - if your parents wanted you to become an artist / lawyer / doctor / astronaut, it is sometimes difficult to get to one that feeds the true need to develop, be interested, do something and achieve important heights.

Psychotherapy is a cure mental illness psychological methods. Treat somatic diseases(those in which the normal functioning organism, its organs and tissues) by psychological methods is impossible. Medical methods the psychiatrist treats, however, no one prevents the psychiatrist from applying psychotherapy.

Psychotherapy proper, i.e. treatment mental disorders and diseases, psychological methods can only be legally dealt with by a psychotherapist - a person who has a diploma of higher medical education and the medical specialization "psychotherapist" (other examples of specializations are "otolaryngologist", "surgeon", etc.). In Russia, in general, only a doctor has the right to treat - an accredited specialist with relevant experience and qualifications (Article 69, paragraph 1 federal law“On the fundamentals of protecting the health of citizens in Russian Federation"No. 323-FZ dated November 21, 2011).

However, the reader should not succumb here, so to speak, to the hypnosis of a white coat. And the point is not only that even certified doctors can be amateurs, they can have delusions and make mistakes.

The problem is wider: in medicine there are a lot of scientifically unfounded methods that, after an objective check, turn out to be useless, and even harmful. Therefore, evidence-based medicine arose - a movement whose goal is to freeing healthcare from inefficient practices .

So, a psychotherapist and just a psychotherapist are not the same thing at all. Almost anyone can call themselves a psychotherapist. Very often today there is a situation where a woman was a chemist, physicist or engineer, and at the age of 30 she went to some psychotherapeutic courses and then began to call herself, say, a Gestalt therapist or an existential-humanistic therapist, made herself a website and started psychological counseling, coaching, trainings and webinars. A similar case - a former engineer, chemist, physicist, railway worker, or in general a person with some dubious specialty (such as "manager") declares himself the creator of his own method of psychotherapy and offers psychological counseling, coaching, group psychotherapy.

Therefore, the first thing you need to know about when deciding whether to turn to a psychotherapist - "psychotherapy" and "psychotherapist" are not legally protected concepts. This means that anyone can claim to be a psychotherapist. And given that psychological quackery is easier to implement than medical quackery (at least you don’t need to spend money on jars and liquids or on the creation of pills), and today there are a great many charlatans under the guise of psychotherapy.

What are we treating?

You may be surprised, but today psychotherapy is also recommended for people without any mental disorders and diseases. It is believed that even healthy man must analyze his past, try to reveal the contents of his subconscious or react to his emotions.

With this approach, psychological counseling comes down to psychotherapy, and instead of solving a specific problem, the psychologist begins to “cleanse” your childhood, “free” you from “clamps”, achieve from you “spontaneity”, “non-judgmental” and constant being “here-and- now".

Today, many do not understand the difference between psychotherapy and psychological counseling at all. However, this difference is fundamental.

How does a psychologist solve psychological problems of clients? First of all, by providing them with objective information obtained as a result of scientific psychological research (in fact, any counseling - legal, financial - is carried out according to a similar scheme). For example, a woman complains that her husband constantly lies about doing more around the house than she does. The psychologist explains to the woman that her husband is probably not lying, because we are all subject to a cognitive bias called self-serving bias and we all think that our contribution to the matter is greater, whether writing a collective monograph or doing household chores.

If simple informing does not help, the psychologist can arrange in his office a kind of confrontation between this woman and her spouse, so that they can, in a safe environment and without the risk of again sliding into a scandal (the psychologist acts as an arbitrator here), discuss each contribution to household chores. . In some cases, it may be necessary to make a number of decisions, in particular, to redistribute household duties, agree on the order of their implementation, introduce certain code words so that each spouse can, on the one hand, express dissatisfaction, but, on the other hand, not offend the spouse, not provoke a new scandal.

If the psychologist has noticed that the client lacks certain skills, such as communication skills or self-control, he can build these skills in the client through training. For example, in our case, the psychologist could notice that the spouses do not know how to listen to each other, and instead of dialogue, they slide into parallel monologues. The psychologist can report this and invite the spouses to attend a constructive home communication training.

As you can see, there are no searches for repressed traumas and “acting out” of negative emotions.

Who invented psychotherapy and how?

A history of psychotherapy, even an extremely brief one, would require at least a separate article, but we absolutely need to know something. Indeed, if one wants to create a truly effective method, he must approach its creation from an objective position, focus on facts, not opinions, and on objective data, and not on subjective impressions. How does this work in psychotherapy?

Let's see, for example, how one of the main authorities of the industry, Sigmund Freud, created his psychotherapy called "psychoanalysis".

Through the analysis of dreams and free association, Freud seemed to have gained information about the early childhood of his patients. And in this childhood, Freud always discovered all sorts of unpleasant phenomena like a girl's envy of her father's penis or a boy's desire to kill his father in order to possess his mother.

Did Freud test the memories of his clients objectively? No, I didn't check. And is it possible to check whether the child was really rigidly accustomed to the toilet or whether the mother was breastfeeding the baby incorrectly?

By the way, initially Freud did not create psychoanalysis, but the so-called theory of seduction. His patients recalled, for example, that as children, their father forced them to do fellatio or something worse. And Freud concluded that the basis of any neurosis is the seduction of the child by one of the parents. Science community this theory was rejected, and Freud transformed it into a more harmless psychoanalysis. Now the patient's recollection that his father forced him to perform fellatio was interpreted only as the patient's fantasies. Well, really, what else can a three-year-old girl fantasize about, if not about owning her father's penis?

Remember everything

Over time, Freud's mishap with his theory of seduction was forgotten, and in the 1980s and 1990s, a massive "satanic panic" arose in the United States. Many patients of psychotherapists began to recall that in childhood their parents forced them to participate in disgusting orgies and bloody rituals. Lawsuits poured in, proceedings began.

And then it was scientifically proven that it is simply impossible to accurately restore memories with the help of hypnosis, psychoanalysis, regression therapy and other things. a huge role in the discovery of this amazing fact played by American psychologist Elizabeth Loftus.

It turned out that human memory is reconstructive, and remembering an event is not reading a record about it from some subcortex, but reconstructing this event taking into account new data and fresh information.

It became clear that even the testimony of witnesses to recently committed crimes must be filtered very seriously, to say nothing of memories of early childhood...

Therefore, if a therapist tells you that all your problems are rooted in childhood, that you will need to restore the memories that you have repressed received in childhood psychological trauma Feel free to leave this office.

Don't keep it to yourself!

By the way, not only the possibility of recovering memories, but also the popular concept of repression has also not received scientific confirmation. We do not forget about psychologically and/or physically traumatizing events. On the contrary, we cannot stop remembering these realities. For example, a soldier who has lost his comrades in the war cannot but recall bloody battles, explosions and mangled bodies. So, if during a psychotherapy session you suddenly remembered something painful that you never remembered before, then most likely, under the influence of psychotherapy, you acquired a false memory.

The concept of catharsis, on which many types of psychotherapy are based, has also not received scientific confirmation.

According to this concept, in order to get rid of negative emotion, you need to experience it again and again, for example, you should remember the event that traumatized you, and in a family conflict, anger does not need to be contained, it needs to be expressed, however, not with the help of insults, but with the help of, for example, the so-called I-messages (for example, you should not say to your husband “oh, you bastard!”, you should say “dear husband, because you began to dance with that girl in front of me and gently put your hands below her waist, I feel pain, resentment, fear, anger and desire to scratch your face").

Scientific studies (like this one) have shown that expressing an emotion only makes it worse. So the Stoics were right - if you want to get rid of a feeling, do not feed it and do not express it. Among modern psychotherapists, by the way, the recommendation not to express emotions will be perceived with anger: “not to express means to repress, it means to create a neurosis!”

All problems come from childhood?

What about childhood trauma? Do the traumas we experienced in childhood have no effect on us?

Looks like no. The fact is that the child's psyche, as, indeed, children's body, very lively. Therefore, for example, post-traumatic stress disorder, an example of which is the mentioned situation of a soldier who never ceases to remember the war, occurs much less frequently in children. This is true even in the case of sexual abuse. And it is very sad that the researcher who established this fact - Bruce Reind - is often accused of legitimizing pedophilia ...

And in general, this emphasis on childhood, which is inherent in many currents of psychotherapy, is completely unfounded. Of course, if a person did not learn to speak in childhood, then he is unlikely to master native language to a degree sufficient not to seem like an imbecile, but otherwise, perhaps, there is no such age when reality would cease to influence us, and we would cease to change under these influences.

So, if the therapist is trying to find the roots of your problems in childhood instead of analyzing your current situation, it is better to look for another specialist.

And it helped me!

Advanced people can ask the following question here: “How so?! After all, the effectiveness of psychotherapy is confirmed by scientific research!

Who would argue!

Indeed, there are such studies. And they are, first of all, because there are currents of psychotherapy that are not built on the concepts of repression, childhood trauma and catharsis. We are talking about behavioral and cognitive-behavioral psychotherapy and rational-emotive psychotherapy by Albert Ellis. Here is a fairly extensive review of research on the effectiveness of cognitive behavioral therapy.

In addition, one must understand that when trying to evaluate psychotherapy objectively - within the framework of scientific research - mistakes can be made. It should not be forgotten, in particular, that a double-blind method in the study of psychotherapy is impossible (the patient knows that he is receiving psychotherapy, and the psychotherapist knows that he is using psychotherapy). In addition, it is difficult to organize a placebo control in the study of psychotherapy: the standard placebo - dummy pills - is hardly suitable, you need to use what can conditionally be called a process placebo (instead of psychotherapy, arrange, for example, shamanic dances).

In addition, the famous American psychologist Scott Lilienfeld identified as many as 26 factors that create the illusion of the effectiveness of psychotherapy precisely in scientific research. By the way, he is one of the main participants in the movement of evidence-based practices - an analogue evidence-based medicine in psychology.

One of these factors is the so-called selective dropout: clients who leave the psychotherapist are simply not counted in the study, when they should be counted among clients who did not help psychotherapy.

Another reason for the apparent effectiveness of psychotherapy is the distortion of complaisance: it is not psychotherapy that helps the client, but another factor - obedience, conscientiousness, which made the person turn to a psychotherapist, as well as take other actions to overcome his problem and improve the situation.

And, of course, among the reasons for the apparent effectiveness of psychotherapy, one cannot fail to mention the so-called justification of efforts: a client who has spent a lot of money and time on psychotherapy is simply forced to demonstrate improvement in order to maintain his bright image in his own eyes and in the eyes of others. Justifying effort, by the way, is associated with a cognitive bias called the sunk cost fallacy.

Train on cats!

I know from experience that neither psychotherapists nor fans of these psychotherapists are convinced by all these arguments. They may even recognize that psychotherapy is a field with scientific point doubtful view, to declare that “we are only at the beginning of the path”, that “psychotherapy is an art”, etc. So be it, but I think everyone is able to decide for himself whether to become guinea pig and whether to spend your money and time on the attempts of psychotherapists to create really effective methods solutions psychological problems. Especially since most psychotherapists still rely on subjective and inaccurate approaches in an attempt to test the effectiveness of their work.

Or maybe I should see a psychiatrist?

If you have objective problems, you need to contact a psychologist. For example, you can’t find a job in any way, you are too worried at an interview, and when you find a job, you quickly slide into conflict with the management and again find yourself looking for a suitable job? Go to a psychologist. A psychologist can detect a lack of communication and self-regulation skills, he can teach you, train you, and everything will work out. On the other hand, the psychologist may find that you have inadequate levels of self-love and aggression. In this case, he may recommend that you see a psychiatrist to rule out a mental illness.

If there are no obvious problems, you are doing well, you have a family, friends, housing, a stable job, the opportunity to regularly relax, have fun, but you still feel bad, it is better to start with a visit to a psychiatrist. Perhaps a course of antidepressants will quickly bring you back to normal.

With phobias compulsive actions and obsessive thoughts It's also best to see a psychiatrist first. By the way, perhaps he will not treat you with drugs, but will conduct psychotherapy with you or refer you to a psychotherapist. However, having received a diagnosis of “neurosis” or “phobia” from a psychiatrist, you yourself, taking a medical card with you, can find a psychotherapist and make an appointment with him.

There is no need to be afraid to go to a psychiatrist: it is unlikely that you will be immediately registered with a psychiatric dispensary, and no one has canceled the secret of the diagnosis. In addition, in any case, it is better to get on a psychiatric record (by the way, it is not eternal, but temporary) than to jump out of the window because the psychologist tried to do something with your depression by purely psychological methods.

- Are you a psychologist?

-Yes.

- And what are you doing?

- In terms of?

- Any procedures, injections?

- Not.

- Are you just talking?

-Yes.

- Well, do you at least prescribe pills?

- No, I'm not a doctor, I'm a psychologist.

Telephone conversation with a failed client

Currently, there is a certain demand for psychological assistance. This is due, firstly, (culturologically and socially) to an increase in the situation of uncertainty and the need for choice in modern world, and as a result of this - anxiety in modern man, secondly (psychologically) - by raising the level of the psychological culture of the population.

Of particular interest is the second factor - psychological, since social and cultural factors that determine the need for psychological assistance have existed at all times. However, it is the appearance in the mind of a modern person of psychological culture - knowledge about psychology and problems of a psychological plan - that forms the need for psychological help in the latter. For this reason, the first clients of a psychologist / psychotherapist after the appearance of these specialists were graduates of psychological faculties.

Psychological therapy "works" through a word that affects the mind of the client, in contrast to medicine, which "works" at the physiological level and does not involve the patient's involvement in healing process. Psychotherapy appeals to the mind of the client and involves a certain degree of activity, awareness, reflexivity, that is, his involvement in therapeutic process. Medical preparations act against the will of a person, regardless of whether he believes or not in their action. The impact of psychotherapy is largely based on the client's faith in it. With some degree of conditionality, we can say that "Therapy is magic that works if you believe in it!".

Consequently, the client of a psychologist / psychotherapist has different requirements than a patient of a doctor. If the patient needs to obediently and carefully follow the doctor's prescriptions for a successful cure, then there are more such requirements for the client of a psychologist / psychotherapist.

Defining a client as a person who has a problem is incomplete. Not every person who has any difficulties can be classified as a client. Even if we admit the fact that everyone has problems, then, perhaps, not all of them are problems. psychological level. In turn, not every person who has precisely psychological difficulties is aware of them as such.

We can consider such people as conditional or potential clients. This does not mean that they will rush to your appointment. And even if such a person ends up in your office, it is not a fact that he will automatically become your client. There are a number of conditions, the presence of which will allow you to identify a person who is in your office as a client. Let's try to highlight these conditions. In my opinion they are the following:

3. Recognition of their problems as psychological problems;

4. Recognition of the fact that psychotherapy helps (the presence of elements of the psychological picture of the world);

5. Recognition of a psychologist/psychotherapist as a professional.

Only the presence of all of the above conditions gives us reason to define a person who is at the reception of a psychologist / psychotherapist as a client. How the therapeutic contact develops in the future depends to a greater extent on the skill of the psychologist/therapist.

Consider examples of insufficiency (deficiency) of conditions:

1. Involuntary application for psychological help. Situation: Someone else brings (sends) a person to a psychologist (parents - child; spouse - spouse; teacher - student, etc.). Message - "Something is wrong with him ... Do something with him)";

3. Non-recognition of their problems as psychological problems. Situation: A person voluntarily comes to a specialist, but believes that the problem he has is caused by non-psychological reasons. Message - "Give me advice, a recipe ...";

4. Not recognizing the fact that therapy helps. Situation: A person does not seek psychological help. Message - "I know your therapy..."

5. Non-recognition of the psychotherapist as a professional. Situation: A person turns to a specialist for competitive reasons. Message: "I know better..."

And one more thing, in our opinion, important condition: the client must pay for himself... Experience shows that if the client does not pay for himself, then he does not take responsibility for the therapy. Payment is known to create additional motivation for work, and also gives the client a sense of autonomy from the psychologist/therapist.

Let's now try to give a working definition of the client.

A client is a person who voluntarily seeks psychological help from a specialist, identifies his problems as psychological problems, acknowledges his contributions to their occurrence, and also recognizes the psychologist/therapist as a specialist who can help solve them.

Thus, a psychologist / psychotherapist will not help you if you:

Do you think that there are no psychological problems;

Do not believe in psychology/psychotherapy;

You think that Other people, circumstances, etc. are to blame for your problems;

Are not ready to be actively involved in the process of solving their problems;

Waiting for a psychologist/psychotherapist ready-made advice, decisions, prescriptions, recipes.

For non-residents, consultation and supervision via Skype is possible.

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